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Background: Monitoring technologies are used to collect a range of information, such as one's location out of the home or movement within the home, and transmit that information to caregivers to support aging in place. Their surveilling nature, however, poses ethical dilemmas and can be experienced as intrusive to people living with Alzheimer disease (AD) and AD-related dementias. These challenges are compounded when older adults are not engaged in decision-making about how they are monitored. Dissemination of these technologies is outpacing our understanding of how to communicate their functions, risks, and benefits to families and older adults. To date, there are no tools to help families understand the functions of monitoring technologies or guide them in balancing their perceived need for ongoing surveillance and the older adult's dignity and wishes. Objective: We designed, developed, and piloted a communication and education tool in the form of a web application called Let's Talk Tech to support family decision-making about diverse technologies used in dementia home care. The knowledge base about how to design online interventions for people living with mild dementia is still in development, and dyadic interventions used in dementia care remain rare. We describe the intervention's motivation and development process, and the feasibility of using this self-administered web application intervention in a pilot sample of people living with mild AD and their family care partners. Methods: We surveyed 29 mild AD dementia care dyads living together before and after they completed the web application intervention and interviewed each dyad about their experiences with it. We report postintervention measures of feasibility (recruitment, enrollment, and retention) and acceptability (satisfaction, quality, and usability). Descriptive statistics were calculated for survey items, and thematic analysis was used with interview transcripts to illuminate participants' experiences and recommendations to improve the intervention. Results: The study enrolled 33 people living with AD and their care partners, and 29 (88%) dyads completed the study (all but one were spousal dyads). Participants were asked to complete 4 technology modules, and all completed them. The majority of participants rated the tool as having the right length (>90%), having the right amount of information (>84%), being very clearly worded (>74%), and presenting information in a balanced way (>90%). Most felt the tool was easy to use and helpful, and would likely recommend it to others. Conclusions: This study demonstrated that our intervention to educate and facilitate conversation and documentation of preferences is preliminarily feasible and acceptable to mild AD care dyads. Effectively involving older adults in these decisions and informing care partners of their preferences could enable families to avoid conflicts or risks associated with uninformed or disempowered use and to personalize use so both members of the dyad can experience benefits. [ABSTRACT FROM AUTHOR]

The article informs that dementia counseling with a human challenge and a social responsibility as counseling can work in a domestic setting. Topics include personality changes and the potential for violence in the home Handling with mobile home nursing; and provide information about the illness and to discuss further care options with dementia care and employment.

Background and Objectives Antipsychotic medications have been widely used in nursing homes to manage behavioral and psychological symptoms of dementia, despite significantly increased mortality risk. Use grew rapidly during the 2000s, reaching 23.9% of residents by 2011. A national campaign for safer dementia care in U.S. nursing homes was launched in 2012, with public reporting of quality measures, increased regulatory scrutiny, and accompanying state and facility initiatives. By the second quarter of 2019, use had declined by 40.1% to 14.3%. We assessed the impact of state and facility initiatives during the Campaign aimed at encouraging more-judicious prescribing of antipsychotic medications. Research Design and Methods Our mixed-methods strategy integrated administrative and clinical data analyses with state and facility case studies. Results Results suggest that substantial change in prescribing is achievable through sustained, data-informed quality improvement initiatives integrating educational and regulatory interventions, supported by public quality reporting. Adequate staffing, particularly of registered nurses, is key to support individualized management of symptoms through nonpharmacological strategies. Case study results suggest that state and facility initiatives during the campaign achieved considerable buy-in for the goal of more conservative prescribing, through a social process of normalization. Reporting and reduction of antipsychotic use was not followed by increases in sedative-hypnotic medication use. Rather, sedative-hypnotic use declined in tandem with antipsychotic reduction, suggesting that increased attention to prescribing patterns led to more cautious use of other risky psychotropic medications. Discussion and Implications Quality improvement initiatives to change entrenched but problematic clinical practices face many barriers to success, including provider-level inertia; perceptions that alternatives are not available; and family and staff resistance. Nevertheless, systemic change is possible through concerted, collaborative efforts that touch prescribing practices at multiple points; integrate educational and regulatory influences; activate local and state champions for improvement; foster reputational influences through public reporting and benchmarking; and support a social process of normalization of preferred care processes as a best practice that is in the interest of patients. [ABSTRACT FROM AUTHOR]

OBJECTIVES Care for older adults with dementia during the final years of life is costly, and families shoulder much of this burden. We aimed to assess the financial burden of care for those with and without dementia, and to explore differences across residential settings. DESIGN Using the Health and Retirement Study (HRS) and linked claims, we examined total healthcare spending and proportion by payer—Medicare, Medicaid, out‐of‐pocket, and calculated costs of informal caregiving—over the last 7 years of life, comparing those with and without dementia and stratifying by residential setting. SETTING The HRS is a nationally representative longitudinal study of older adults in the United States. PARTICIPANTS We sampled HRS decedents from 2004 to 2015. To ensure complete data, we limited the sample to those 72 years or older at death who had continuous fee‐for‐service Medicare Parts A and B coverage during the 7‐year period (n = 2909). MEASUREMENTS We compared decedents with dementia at last HRS assessment with those without dementia across annual and cumulative 7‐year spending measures, and personal characteristics. We present annual and cumulative spending by payer, and the changing proportion of spending by payer over time, comparing those with and without dementia and stratifying results by residential setting. RESULTS: We found that, consistent with prior studies, people with dementia experience significantly higher costs, with a disproportionate share falling on patients and families. This pattern is most striking among community residents with dementia, whose families shoulder 64% of total expenditures (including $176,180 informal caregiving costs and $55,550 out‐of‐pocket costs), compared with 43% for people with dementia residing in nursing homes ($60,320 informal caregiving costs and $105,590 out‐of‐pocket costs). CONCLUSION: These findings demonstrate disparities in financial burden shouldered by families of those with dementia, particularly among those residing in the community. They highlight the importance of considering the residential setting in research, programs, and policies. J Am Geriatr Soc 68:1319–1324, 2020. [ABSTRACT FROM AUTHOR]

Digital labor platforms are gaining in popularity in our societies. Information systems and software engineering disciplines have focused on organizational and technological aspects of these platforms, favoring the views of platform owners. At the same time, extensive knowledge of how workers use these platforms, and how they are affected by them, is emerging within computer-supported collaborative work and human-computer interaction disciplines. These two strands of research, one favoring the views of the platform owners and the other advocating the views of the platform users, are mainly developed in parallel and without influencing each other much. In this paper, we describe a case study of designing a digital labor platform for person-centered dementia care in a small company. Dementia care illustrates an extreme case of a complex type of work. This complexity helps us debate some of the benefits and shortcoming of current platforms and platform governance models. We analyze our case using an adaptation of the platform boundary resources model. This model helps us illustrate the tensions between platform owners and workers. A focus on platform governance models and how we co-create such models can hopefully lead to better designs for both views. [ABSTRACT FROM AUTHOR]

This article explores the design and practice of laundries and laundry work in care home settings. This is an often-overlooked aspect of the care environment, yet one that shapes lived experiences and meanings of care. It draws on ethnographic and qualitative data from two UK-based Economic and Social Research Council–funded studies: Buildings in the Making, a study of architects designing care homes for later life, and Dementia and Dress, a project exploring the role of clothing in dementia care. Drawing together these studies, the article explores the temporality and spatiality of laundry work, contrasting designers' conceptions of laundry in terms of flows, movement, and efficiency with the lived bodily reality of laundry work, governed by the messiness of care and 'body time'. The article examines how laundry is embedded within the meanings and imaginaries of the care home as a 'home' or 'hotel', and exposes the limitations of these imaginaries. We explore the significance of laundry work for supporting identity, as part of wider assemblages of care. The article concludes by drawing out implications for architectural design and sociological conceptions of care. [ABSTRACT FROM AUTHOR]

Background: There is no common definition for the Dementia Care Network (DCN). They are heterogeneous and there is no general, longitudinal evidence for the effects of DCN.Objective: We describe changes in utilization of health services by people served by dementia care networks in Germany and factors associated with those changes over time.Methods: Primary data was assessed in 560 people with dementia (PwD) and their caregivers supported by DCN in Germany; sociodemographic and clinical variables, utilization of services; DCN were characterized according to governance. The design: observational study with face-to-face interviews at two time points over a period of one year. Data was assessed via semi-structured interviews at the participants' homes.Results: Utilization of health services in this study is consistently higher than reported for the general population and does not significantly change over time. The strongest predictor of utilization of any service after one year was the use of this service at baseline (OR from 3.23 to 44.16). Higher activities of daily functioning increased the chances to utilize specialist physicians (OR = 1.32; 95% -CI: 1.08-1.63) or occupational therapy (OR = 1.24; 95% -CI: 1.02-1.50) significantly. Being a female decreased chances to utilize specialist physicians (OR = 0.57; 95% -CI: 0.37-0.87) and increased the chances to utilize no services (OR = 2.08; 95% -CI: 1.29-3.33).Conclusion: While health care acknowledges the importance and benefits of dementia care networks (i.e., in Germany, the results were considered in new German legislation (SGB XI)), further research is needed to define this kind of service delivery to facilitate comparison as well as promote evidence-based implementation. [ABSTRACT FROM AUTHOR]

MRI features of cerebral small vessel disease (CSVD), i.e. white matter hyperintensities, lacunes, microbleeds, perivascular spaces, and cerebral atrophy, may be associated with clinical events, but the strength of these associations remains unclear. We conducted a systematic review and meta-analysis on the association between these features and incident ischaemic and haemorrhagic stroke, all-cause dementia and depression, and all-cause mortality. For the association with stroke, 36 studies were identified (number of individuals/events [n] = 38,432/4,136), for dementia 28 (n = 16,458/1,709), for depression nine (n = 9,538/1,746), and for mortality 28 (n = 23,031/2,558). Only two studies evaluated perivascular spaces; these results were not pooled. Pooled analyses showed that all other features were associated with all outcomes (hazard ratios ranged 1.22–2.72). Combinations of two features were more strongly associated with stroke than any individual feature. Individual features and combinations of CSVD features are strongly associated with incident ischaemic and haemorrhagic stroke, all-cause dementia and depression, and all-cause mortality. If these associations are causal, the strength of these associations suggests that a substantial burden of disease is attributable to CSVD. [ABSTRACT FROM AUTHOR]

Lack of sufficient exposure to high-intensity light during the morning can negatively affect the health and well-being of residents in dementia care facilities. The objective of this study was to evaluate the circadian stimulus potential of daylight provided by windows in dementia care facilities in southern California. A mobile spectrometer cart was used to measure eye-level light exposures in 9 daylit and 4 non-daylit spaces. A total of 579 spectrometer measurements, acquired over a period of 13 weeks, were analyzed in units of equivalent melanopic lux and compared to dose-response models and emerging threshold criteria for circadian lighting. Comparison between daylit and non-daylit spaces revealed significant benefits of daylit spaces in regard to circadian stimulus potential and circadian efficacy. This study is a first step in addressing the need to measure and evaluate light exposures in biologically-meaningful units to better support the care of people living with dementia in long-term care facilities. Outcomes of the study contribute to a body of evidence that can be used to inform clinically significant decisions related to the current use and future design of dementia care facilities. [ABSTRACT FROM AUTHOR]

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Objectives To determine the prognostic value of apathy for mortality in patients of somatic ( SC) and dementia special care ( DSC) nursing home ( NH) units. Design Longitudinal design, secondary analyses of a 2-year, cluster-randomized trial with six measurements, approximately 4 months in between. Setting SC and DSC-units of Dutch NHs. Participants NH-patients of seventeen SC-units (n = 342) and sixteen DCS-units (n = 371). Measurements Data were available for 713 NH-patients, 266 of whom died during the study. Apathy was assessed using the 10-item Apathy Evaluation Scale ( AES-10) and applied as categorical variable using known cut-off scores as well as dimensional variable. Additionally, depressive symptoms were assessed using the Cornell Scale for Depression in Dementia. Results Mixed effects cox models using the coxme package in R revealed a higher risk of mortality between two measurements, if apathy was present (hazard ratio ( HR) = 1.77; 95% confidence interval ( CI] = 1.35-2.31, P < .001). Results remained significant ( HR = 1.64; 95% CI = 1.23-2.19, P < .001) when controlled for depressive symptoms. DSC-units and SC-units did not differ ( P > .05) in the effect of apathy on mortality. Male gender ( HR = 1.67; 95% CI = 1.23-2.27, P < .001), and higher age in years ( HR = 1.06; 95% CI = 1.04-1.08, P < .001) were also predictors of mortality. Regarding apathy as a dimensional construct, one standard deviation increase of AES-10 scores was associated with a 62% increase of mortality risk ( HR = 1.62, 95% CI = 1.40-1.88, P < .001). Conclusions Apathy was associated with mortality over a 4-month period in NH patients, even when controlling for depression. These data suggest that screening and treatment strategies for apathy should be developed for this patient population. [ABSTRACT FROM AUTHOR]

There is limited knowledge on how people with younger onset dementia experience the transition to care facilities with people significantly older than themselves. The researchers asked those with younger onset dementia to give voice to their experiences when facing elder care. Through purposeful sampling, nine people with younger onset dementia were identified through medical records. Using an established qualitative investigation strategy, audio taped interviews were analyzed using Interpretive Phenomenological Analysis. This paper summarizes findings from the four participants with younger onset dementia who were still able to provide a narrative for analysis. The lived experience of those facing life in aged care may be one of distress and characterized by loss of belonging, loss of agency, and loss of vital activity. Difficulty in timely diagnosis, combined with a lack of access to age appropriate care and unfamiliar institutional environments, all compromise their quality of life. The study strengthens the -view that individuals with dementia are capable of reflecting on their lived experience and contributes to the growing body of evidence that people with younger onset dementia require specialized, age-appropriate services. [ABSTRACT FROM AUTHOR]

Background: Despite the finding that involvement in activities is one of the most important needs of residents with dementia living in care homes, care facilities struggle to fulfill this need. Over the years, various factors are suggested which may contribute to or disable activity provision in dementia care homes. These include limited financial resources, task oriented staff and disease-related characteristics of residents. This study aims to further clarify which of these factors predict higher activity involvement.Methods: Data were derived from the second measurement (2011) of the Living Arrangements for people with Dementia study. One thousand two hundred eighteen people residing in 139 dementia care homes were involved. Forty predictors of higher involvement were studied. Multilevel backward regression analyses were performed.Results: The most important predictors of higher involvement were: absence of agitation, less ADL dependency, and a higher cognitive status of the residents, higher staff educational level, lower experienced job demands by care staff and a smaller number of residents living in the dementia care wards of a facility. More social supervisor support as perceived by staff was found to predict less activity involvement.Conclusions: To increase the activity involvement of care home residents with dementia it seems vital to: 1) reduce staff's experienced job demands; 2) elevate their overall educational level; 3) train staff to provide suitable activities, taking account of the behavior and preserved capabilities of residents; and 4) foster transition towards small-scale care. In order to achieve these aims, care organizations might need to evaluate the use of their financial means. [ABSTRACT FROM AUTHOR]

Background: Many countries are introducing smaller, more home-like care facilities that represent a radically new approach to nursing home care for people with dementia. The green care farm is a new type of nursing home developed in the Netherlands. The goal of this study was to compare quality of care, quality of life and related outcomes in green care farms, regular small-scale living facilities and traditional nursing homes for people with dementia.Methods: A cross-sectional design was used. Three types of nursing homes were included: (1) green care farms; (2) regular small-scale living facilities; (3) traditional nursing homes. All participating nursing homes were non-profit, collectively funded nursing homes in the south of the Netherlands. One hundred and fifteen residents with a formal diagnosis of dementia were included in the study. Data on quality of care was gathered and consisted of outcome indicators (e.g. falling incidents, pressure ulcers), structure indicators (e.g. hours per resident per day), and process indicators (e.g. presence, accessibility and content of protocols on care delivery). Furthermore, questionnaires on cognition, dependence in activities of daily living, quality of life, social engagement, neuropsychiatric symptoms, agitation, and depression were used.Results: Data showed that quality of care was comparable across settings. No large differences were found on clinical outcome measures, hours per resident per day, or process indicators. Higher quality of life scores were reported for residents of green care farms in comparison with residents of traditional nursing homes. They scored significantly higher on the Quality of Life - Alzheimer's disease Scale (p < 0.05, ES = 0.8) indicating a better quality of life. In addition, residents of green care farms scored higher on three quality of life domains of the Qualidem: positive affect, social relations and having something to do (p < 0.05, ES > 0.7). No differences with regular small-scale living facilities were found.Conclusions: Green care farms seem to be a valuable alternative to existing nursing homes. This is important as people with dementia are a heterogeneous group with varying needs. In order to provide tailored care there also is a need for a variety of living environments. [ABSTRACT FROM AUTHOR]

Dementia is a worldwide health priority and much of the burden of care for people with dementia is placed on family members and informal systems of care in the community. The perspectives of 36 informal dementia carers on current and future community-based services for people with dementia in Tasmania, Australia, are reported using a mixed methods design. Qualitative data were collected, thematically analyzed, and double coded. Quantitative data were collected and analyzed to determine carers' level of satisfaction with services. Three main themes were identified: (a) quality support for carers and people with dementia; (b) adaptive, tailored, and flexible organizations; and (c) development of the workforce. Although most carers were highly satisfied with the current support services they received, they wanted organizational and workforce changes to meet their varied and complex needs. Results suggest a community-driven agenda for a coproduction approach for aged and dementia care reform in Australia. [ABSTRACT FROM AUTHOR]

Periodical exercise is important and essential for preventing dementia, for increasing treatment effect and for increasing quality of life. Exercise and health service platform for dementia prevention is the open platform that enables individuals to effectively manage and integrate individuals dementia-related health information that are scattered around at the hospitals, life log service companies, health check-up centers, public clinics, fitness centers and others based on the ICT to enable use of the information for the customized dementia prevention services. It is comprised of three delivery channels that are mutually connected; dementia perception improvement and education service, dementia risk factor management service, and dementia diagnosis structure service. Platform for the elderly dementia prevention and health service gathers together the information on dementia-related risk factors and on the exercise that was scattered around to enable supply of diverse services for dementia prevention. [ABSTRACT FROM AUTHOR]

Background: Dementia is one of the most challenging age-related illnesses for family caregivers, whose care-related burden is well known. Research indicates that day care centres (DCCs) can reduce the caregiver burden and help family caregivers to cope with demands; however, the current body of knowledge is still tentative and inconsistent, and more research is recommended. The aim of this study is to provide an extended understanding of the situation of family caregivers and to examine to what extent DCCs can meet their need for support and respite.Methods: This study has a qualitative descriptive design using in-depth interviews with 17 family caregivers of people with dementia attending DCCs. The data analysis was undertaken using systematic text condensation.Results: Caregivers experience a complex role, with added responsibilities, new tasks, and emotional and relational challenges that are expressed through distressing emotions and demands for interaction. Additionally, the caregiving role leads to positive experiences, such as acceptance and adaptation, support and help, and positive changes in the relationship. Day care relieves family caregivers by meeting the person with dementia's needs for social community, nutrition, physical activity, and structure and variety in everyday life. Using a DCC led to a higher quality of time spent together and easier cooperation, but it also produced some hard feelings and challenging situations. DCCs gave the caregivers a feeling of freedom and increased the time available to be spent on their own needs, to be social and to work or do practical tasks undisturbed.Conclusions: DCCs for people with dementia can give family caregivers support and relief and have a positive impact on the relationship between the family caregiver and the person with dementia. A more individualized program, in addition to flexible opening hours, would make DCCs even more effective as a respite service, positively influencing the family caregiver's motivation and ability to care and postponing the need for nursing home placement. [ABSTRACT FROM AUTHOR]

We present a user-centered development process for a GPS monitoring system to be used in dementia care to support care for persons withwandering behavior. The usage ofGPS systems in dementia care is still very low. The article takes a socio-technical stance on development and appropriation of GPS technology in dementia care and assesses the practical and ideological issues surrounding care to understand why. The results include (1) results from qualitative user studies from which design ideas, implications, and requirements for design and redesign were developed. (2) Description of the politics, negotiations, and challenges encountered in the project at hand. These processual matters had a powerful impact on the product that was finally envisaged. The design process was taken as a whole to illuminate the way in which design outcomes are arrived at and to foster discussion about how "best practice" might possibly be achieved. [ABSTRACT FROM AUTHOR]

Background: Use of antipsychotics in elderly patients with dementia has decreased in the past decade due to safety regulations; however use is still high. Geographical variation may indicate discrepancies in clinical practice and lack of adherence to evidence-based guidelines for the management of behavioral symptoms. Objective: To investigate potential geographical variances in use of antipsychotic drugs in dementia care. Methods: A registry-based cross-sectional study in the entire elderly population of Denmark (≥65 years) conducted in 2012. Data included place of residence, prescriptions filled, and hospital discharge diagnoses. Antipsychotic drug use among elderly with (n = 34,536) and without (n = 931,203) a dementia diagnosis was compared across the five regions and 98 municipalities in Denmark, adjusted for age and sex. Results: In 2012, the national prevalence of antipsychotic drug use was 20.7% for elderly patients with dementia, with a national incidence of 3.9%. The prevalence ranged from 17.0% to 23.3% in the five regions and from 7.5% to 33.1% in the 98 municipalities, demonstrating an over four-fold difference. Conclusion: The observed geographical variation was more pronounced at municipal level as compared to regional level, suggesting that the variation may be related to variances in clinical practice in primary care. This study highlights an urgent need for further educating professional carers and physicians to guide non-pharmacological as well as pharmacological management of neuropsychiatric symptoms in elderly patients with dementia. [ABSTRACT FROM AUTHOR]

The conventional wisdom about advance care planning holds that the normative force of my prior wishes is simply that they are mine. It is their connection to me that matters. This paper challenges conventional thinking. I propose that the normative force of prior wishes does not depend exclusively on personal identity. Instead, it sometimes depends on a special relationship that exists between a prior, capacitated person and a now incapacitated person. I consider what normative guidance governs persons who stand in a special relationship, and contrast these with the standard model of respect for autonomy. My conclusion is that advance care planning for individuals who have lost decision-making capacity should incorporate the virtues of prudence and integrity, even when one and the same person ceases to exist, and respect for personal autonomy is no longer relevant. [ABSTRACT FROM AUTHOR]

Background: As nursing homes become increasingly diverse, dementia care needs a wider range of culturally responsive strategies for individual and collective social interactions. While previous studies conclude that medical clowns have positive effects on verbal and non verbal social interactions, research is lacking from the perspective of residents' cultural background. The aim of this study was to identify interaction strategies employed by medical clowns in culturally diverse dementia care settings.Method: An ethnographic approach was used and data were collected through observation of interactions between medical clowns and residents with dementia in two nursing homes during a ten week period.Results: The observations showed that the medical clowns interacted with residents by being tuned in and attentive to the residents as individuals with a unique life-history, confirming each person´s sense of self. The clowns used sensory triggers, encouragement and confirmation in culturally responsive ways to bond socially with the residents in their personal spaces. The clowns involved objects in the daily environment that were meaningful for the residents, and paid attention to significant places and habits in the past. The clowns further contributed to joint interaction in the common spaces in the nursing homes, using music and drama.Conclusion: The strategies employed by medical clowns in activities with older people with dementia appear to support social interaction. The medical clowns used the social and material environment in culturally responsive ways to strengthen individuals' sense of self, while contributing to a sense of togetherness and interaction among residents in the common spaces. Findings suggest that both verbal and non-verbal cultural content affected social interaction. The non-demanding encouraging way the clowns tuned in to the residents as individuals could help nurses and staff members improve ways of communication in social activities inside the nursing home. [ABSTRACT FROM AUTHOR]

Using ethnographic data collected from nursing homes in England and Sweden, this article analyzes how a person-centered approach to dementia care has been interpreted in two different contexts. Based on typical elements of person-centered care identified in previous research, the analysis examines environmental changes and the way care is performed. A discourse of person-centered care is articulated at both nursing homes, which aim to create a good environment and care practice for people with dementia. Although we found similarities in how good care was understood at the two homes, we also found important differences. The results point by to two types of care atmospheres, such that cheerfulness and activity are underlined at the English home and calmness at the Swedish home. Differences in the environments and practices of a person-centered approach can be related to how ways of giving care in the two homes accentuate two different symptoms of dementia. In the English home, the problem of a shrinking world was stressed and the solution was stimulation. At the Swedish home, problems of agitation and anxiety were stressed and the solution was calm and quiet. These differences are discussed in the light of the role of national policy, resources and the organization of work, which can partly clarify why some aspects of what is good care for persons with dementia are underscored in a specific context and not in others. [ABSTRACT FROM AUTHOR]

Objective: To evaluate dementia care organisations' capacity to acquire, assess, adapt and apply dementia research.Methods: We used the Canadian Health Services Research Foundation's survey, 'Is research working for you?' by inviting the members of the New Zealand National Dementia Cooperative to participate in the online survey.Results: A total of 146 (32%) members responded and indicated that, although the workforce had the skills to engage in research and implement evidence into practice, there was limited organisational support in terms of the time, resources and access to external support.Conclusions: We propose a number of strategies to improve knowledge translation in dementia care. [ABSTRACT FROM AUTHOR]

Purpose: Care provided in the community for dementia patients on an individual basis may be very time consuming. Yet, little is known about the factors affecting caregiving time for community-dwelling dementia patients. Thus, we aimed to investigate the predictors of informal and formal caregiving time for these patients in a longitudinal approach.Method: Caregiving time for n = 126 community-dwelling dementia patients was assessed by proxy interviews in four assessments at 6-month intervals (1.5 years of longitudinal follow-up; AgeCoDe study). Measurement of informal caregiving time was based on a German adaptation of the Resource Utilization in Dementia questionnaire. Dementia severity was measured by the Clinical Dementia Rating (CDR). We used random effects models to estimate the effects of sociodemographic variables (age, gender, marital status and education), comorbidity and dementia severity on informal and formal caregiving time.Results: At the first assessment, mean age was 85.0 years (±3.2 years). The majority of patients was female (65.9 %), not married (divorced, single, widowed: 55.6 %) and had primary education (63.5 %). Furthermore, mean GDS was 4.4 (±0.8) and mean MMSE was 20.1 (±5.1). According to CDR, 43 individuals had very mild dementia, 55 individuals had mild dementia and 28 individuals had moderate/severe dementia. Moreover, mean total caregiving time was 3.4 h per day (±4.0). Thereof the main part represents informal caregiving time (2.3 h ± 3.4), whereas formal caregiving time was 1.2 h (±2.4). Dementia severity was associated with total caregiving time, mainly influenced by informal caregiving time. Age was positively associated with total caregiving time, driven by formal caregiving time, while being married was positively associated with total caregiving time, mainly affected by informal caregiving time. All need categories of informal caregiving time were strongly related to dementia severity, whereas none of the categories of formal caregiving time were related to dementia severity.Conclusions: Our findings extend previous studies that found an association between informal caregiving time and dementia severity. Moreover, our findings highlight the role of informal care for community-dwelling dementia patients in Germany. Informal caregiving time strongly increases with dementia severity. Consequently, as the number of patients suffering from dementia is expected to increase considerably in the next decades, there is a paramount need to strengthen the informal care system to meet patients' needs. [ABSTRACT FROM AUTHOR]

Specialized dementia care units (DCUs) house individuals whose behaviors cannot be managed in other settings. To ensure environmental fit, admission/discharge criteria are recommended for DCUs; however, there is no consensus about what criteria should be used. This study aimed to describe, in a random sample of DCUs, the current admission criteria, current/recommended discharge criteria, and services to support discharge. Usable surveys were returned by 23 of 30 facilities. Residents were most frequently admitted because they had a diagnosis of dementia and exhibited cognitive/behavioral problems. The four most common discharge criteria in place/recommended were resident ability to manage in a non-specialized long-term care environment, lack of socially inappropriate behaviors, dependency in activities of daily living, and inability to participate in dementia care activities. These findings suggest that discharge from DCUs is relatively ad hoc. The study lays the groundwork for future research to evaluate the use/appropriateness of these criteria. [ABSTRACT FROM AUTHOR]

This essay describes the first phase of a project in which life writing is used as a form of person-centred care for people who have, or appear to have, dementia. Section one of the essay considers the relationship between the academic field of life writing and the uses of life narrative in dementia care. Examples of published dementia life writing are cited; topics discussed include conventional cultural understandings of dementia; the distinction between illness and disease; dementia as a form of biographical interruption; depression and dementia; and the evolving part that narrative therapy of various kinds may play in an individual's dementia journey. Section two compares aspects of political critique in academic life writing studies and in theories of dementia care. With particular reference to the work of Kitwood we argue for a model of person-centred dementia care which includes critique of dehumanising aspects of the ‘medical model’, of insufficiently relational understandings of selfhood, and of negative ideological constructions of the condition. Section three outlines the conduct and preliminary outcomes of life writing workshops for individuals who appear to have dementia, run under the auspices of Baptcare. This section includes samples of participant writing, issues encountered, and discussions of plans for phase two of the project. [ABSTRACT FROM PUBLISHER]

The majority of Vietnamese Australians migrated to Australia as refugees to escape a war and this unique migration background may affect their ability to access and utilize healthcare services in Australia. Inability to utilize dementia services is associated with higher levels of caregiver burden, higher rates of morbidities and mortality and hospitalization. The aim of the study was to explore the perceived challenges of dementia care from Vietnamese family caregivers and Vietnamese care workers. Gadamer's philosophical hermeneutics was used to interpret and describe the experiences of the participants. Data were collected from in-depth interviews with six Vietnamese family caregivers and a focus group with Vietnamese care workers using purposive sampling. Participants were recruited from a Vietnamese community care organization in South Australia. Five themes were identified from the data analysis namely: (1) a need for culturally and linguistically appropriate dementia education programs; (2) a willingness and unwillingness to seek help; (3) poor knowledge of health care service availability related to dementia; (4) the effect of language barrier in accessing services; and (5) the main sources of services utilized. The study revealed that Vietnamese family caregivers and Vietnamese care workers held different views on the association of stigma with dementia. Findings also revealed factors that impacted accessing and utilizing dementia services. These findings facilitate a more comprehensive understanding of Vietnamese family caregivers' needs and have implications for developing individualized support for family caregivers and for consumer-directed dementia services in Australia. [ABSTRACT FROM AUTHOR]

Background: Mobility problems and cognitive deficits related to transferring or moving persons suffering from dementia are associated with dependency. Physical assistance provided by staff is an important component of residents' maintenance of mobility in dementia care facilities. Unfortunately, hands-on assistance during transfers is also a source of confusion in persons with dementia, as well as a source of strain in the caregiver. The bidirectional effect of actions in a dementia care dyad involved in transfer is complicated to evaluate. This study aimed to develop an assessment scale for measuring actions related to transferring persons with dementia by dementia care dyads. Methods: This study was performed in four phases and guided by the framework of the biopsychosocial model and the approach presented by Social Cognitive Theory. These frameworks provided a starting point for understanding reciprocal effects in dyadic interaction. The four phases were 1) a literature review identifying existing assessment scales; 2) analyses of video-recorded transfer of persons with dementia for further generation of items, 3) computing the item content validity index of the 93 proposed items by 15 experts; and 4) expert opinion on the response scale and feasibility testing of the new assessment scale by video observation of the transfer situations. Results: The development process resulted in a 17-item scale with a seven-point response scale. The scale consists of two sections. One section is related to transfer-related actions (e.g., capability of communication, motor skills performance, and cognitive functioning) of the person with dementia. The other section addresses the caregivers' facilitative actions (e.g., preparedness of transfer aids, interactional skills, and means of communication and interaction). The literature review and video recordings provided ideas for the item pool. Expert opinion decreased the number of items by relevance ratings and qualitative feedback. No further development of items was performed after feasibility testing of the scale. Conclusions: To enable assessment of transfer-related actions in dementia care dyads, our new scale shows potential for bridging the gap in this area. Results from this study could provide health care professionals working in dementia care facilities with a useful tool for assessing transfer-related actions. [ABSTRACT FROM AUTHOR]

This paper describes and discusses an action research collaboration between a multi-disciplinary team of practice educators, a practice development nurse and a university lecturer in order to explore, evaluate and improve a dementia care training package developed for a range of staff providing care for people with dementia. Whilst it is recognised that the findings of this small evaluation study are only of local interest, we believe the approach we took to be of general use for other teams of practice educators as a way of exploring and evaluating their own practice. This paper will therefore focus mostly on the philosophy, methodology and conduct of the study, including our own reflections and learning as novice action researchers. [ABSTRACT FROM AUTHOR]

The authors offer a fresh look at the debate about the use of assisted nutrition and hydration (ANH) in advanced dementia. The philosophical and ethical issues are presented. The importance of distinguishing basic care from medical acts is explained. A key question is addressed: Does ANH nourish and hydrate the patient with dementia? The ANH debate is placed in its cultural context and contrasted with the Catholic response. A clinical analysis of the evidence for benefit and harm of ANH in advanced dementia is given. The authors point out the lack of hard evidence against ANH, discuss questions that need further clinical research, and argue that there is sufficient evidence for a presumption, in principle, in favor of ANH in patients with advanced dementia. [ABSTRACT FROM AUTHOR]

The present case study demonstrates how the multilingual practices of a linguistically diverse workforce contribute to the functioning of a modern workplace. Based on ethnographic fieldwork and recordings in a residential home for elderly people with dementia in Sweden, the article explores how multilingual immigrant care workers creatively use their language skills to overcome linguistic boundaries and communicate with an elderly Kurdish resident. It is shown that despite the fact that the participants do not, or only to a limited extent, share a common language, the care workers manage to create multilingual encounters that allow them to perform care tasks in an activity context where empathy and efficiency are of great importance. Although the data in this study manifest the struggle of multilingual care workers to bridge language barriers, the study also highlights the complexity of providing adequate and well-functioning care in today's diverse society, where linguistic and cultural matching of clients and caregivers cannot always be obtained. These results are discussed in the light of new demands on Swedish (and more broadly Western) care systems to adapt to the increasing number of multilingual older people, who will become residents in care facilities. [ABSTRACT FROM AUTHOR]

Highlights: [•] The Homecare system improved the daily surveillance of the medical staff. [•] The ADL criteria with histogram visualization make the system user friendly. [•] The identification function enables monitoring of the subjects around the clock. [•] The localization function allows the location of subjects in the hospital. [•] The preliminary results of fall detection function are encouraging. [ABSTRACT FROM AUTHOR]

The article reviews existing literature on people with early onset dementia. The impact of early onset dementia on patients, caregivers and family members is examined. The needs of patients, their family and carers are discussed. Key issues identified include the ability to have a break from caring, access to age-appropriate day care services, and finding appropriate homes for permanent care.

Abstract: Objective: To compare a complex nondrug intervention including actively approaching counseling and caregiver support groups with differing intensity against usual care with respect to time to institutionalization in patients with dementia. Methods: Within this three-armed cluster-randomized controlled trial, 390 community-dwelling patients aged 65 years or older with physician-diagnosed mild to moderate dementia and their caregivers were enrolled via 129 general practitioners in Middle Franconia, Germany. The intervention included general practitioners'' training in dementia care and their recommendation of support groups and actively approaching caregiver counseling. Primary study end point was time to institutionalization over 2 years. In addition, long-term intervention effects were assessed over a time horizon of 4 years. Secondary end points included cognitive functioning, (instrumental) activities of daily living, burden of caregiving, and health-related quality of life after 2 years. Frailty models with strict intention-to-treat approach and mixed linear models were applied to account for cluster randomization. Health care costs were assessed from the societal perspective. Results: After 2 (4) years, 12% (24%) of the patients were institutionalized and another 21% (35%) died before institutionalization. No significant differences between study groups were observed with respect to time to institutionalization after 2 and 4 years (P 0.25 and 0.71, respectively). Secondary end points deteriorated, but differences were not significant between study groups. Almost 80% of the health care costs were due to informal care. Total annual costs amounted to more than €47,000 per patient and did not differ between study arms. Conclusion: The intervention showed no effects on time to institutionalization and secondary outcomes. [Copyright &y& Elsevier]

The author offers his opinions on how interior designers can make a difference in the lives of those living in memory care facilities designed for those with geriatric dementias and Alzheimer's disease (AD). Particular focus is given to the importance of building a flexible and affordable model of assisted care for the baby boomer generation. Insights on how design must meet the physical, societal and spiritual needs of patients are also included.

Background: Evidence on the importance of the physical environment for the well-being of people with dementia has been growing steadily. Objective: This article aims to (1) introduce an assessment tool for evaluating the physical care environment for people with dementia; (2) describe the method's initial results and the subsequent feedback provided to the 10 care units; and (3) describe the follow-up results 1 year later. The goal has been to provide care workers and managers with information that affects the well-being of people with dementia and to provide this information on the care environment in the context of their own work environment. Methods: The assessment was part of a randomized controlled intervention using nonpharmaceutical methods to decrease behavioral and psychological symptoms of people with dementia. During the half-day visits, photographs and lightfield notes were taken, and a final assessment was carried out via the Residential Care Environment Assessment (RCEA) tool developed at the beginning of the study and based on affordance theory. Follow-up data were gathered after 12 months. Results: There were several possibilities for improvements in the provision of residential care in a person-centered environment. Improvements were needed mostly in comfort and in providing opportunities for engagement, activity, and expression of identity. However, in practice, it was difficult to achieve the improvements even with an intensive intervention study. Conclusions: The authors conclude that the physical care environment involves a complex set of issues and stakeholders in which the impetus to fulfill responsibilities to carry out improvements can easily fall away [ABSTRACT FROM AUTHOR]

Objective: To determine to what extent the care home environment met the requirements of residents with dementia in the context of the views of managers, family carers and staff, and a standard environmental assessment. Methods: Sixty participants joined focus groups to give their views, and the managers of all five care homes were interviewed. An environmental assessment of each home was carried out using the Sheffield Care Environment Assessment Matrix (SCEAM). Results: The most common themes identified from the residents and carers groups were the need for activities and outings, staffing levels, and staff training, attitudes and commitment. Managers felt comfort and homeliness were most important features whilst staff rated health and safety highest. Care homes scored well on the SCEAM for health and safety, and comfort, however key aspects such as activities and staff factors were not covered by the tool. Conclusion: Care homes may be designed and organised according to the priorities of staff and managers rather than the needs of residents and family carers. Service planners need to be aware of this discrepancy and consider the views of residents. [ABSTRACT FROM AUTHOR]

Purpose - Through consultation with people living with dementia and carers, this paper aims to identify skills that patients and carers feel need to be developed in the workforce. This work is part of a project to develop competencies for the West Midlands dementia workforce.Design/methodology/approach - People living with a dementia and carers were contacted through cafés, a carers' group and memory group, and two people contributed interviews to the analysis. All materials were analysed qualitatively using thematic analysis.Findings - Feedback was received from 69 individuals. In total, six major themes were identified: knowledge about dementia, person centred care, communication, relationships, support and helping people engage in activities.Originality/value - It is argued that people living with dementia and carers bring unique and valuable perspectives to an analysis of the skills of the dementia workforce, which grounds the required skills in the relationship between the worker and the person and family they are working with. This different emphasis needs to be considered and addressed throughout dementia training and education. [ABSTRACT FROM AUTHOR]

Purpose - This article aims to describe the aims, role and impact of a specialist intermediate care service for people with dementia in Kent, entitled the Home Treatment Service (HTS). The authors reflect on two workshops about the service, delivered as part of the "Dementia Care: A Positive Future" conference held in May 2010.Design/methodology/approach - The 45 participants in the workshops included service providers, professionals and family carers. The aimsand nature of the servicewere outlined by members of the clinical team as: adopting a multi-professional approach, emphasising the value of a shared assessment process and having a commitment to flexible and intensive working within a person centred framework.Findings - Focusing on the HTS's work with care homes, presenters offered case illustrations to highlight its collaborative approach to working with service users, staff, managers and families to improve the quality of life for users presenting with "challenging behaviour" and preventing placement breakdown. Discussion with participants explored the obstacles and opportunities in working productively with care homes. The HTS's potential to reduce reliance on anti-psychotic medication was specifically highlighted. In addition to improving user and carer quality of life, outcomes of HTS intervention include a reduction in and quicker discharge from, mental health hospitals and maintaining the person in their existing setting.Originality/value - The importance of including all parties - the older person with dementia, relatives, care staff and professionals - in co-creating "solutions" was identified as one the HTS's keys to success. [ABSTRACT FROM AUTHOR]

Purpose - The purpose of this paper is to consider the experiences and perspectives of residents with dementia living in a care home.Design/methodology/approach - The paper reviews current sources of evidence about "the care home experience", including material drawn from: research instruments, interviews, observational methods and phenomenological research which aims to capture the lived experiences of residents.Findings - Research that is attempting to capture the lived experiences of residents further adds to the understanding of quality of life (QoL) and quality of care. Specifically, residents prioritise non-disease-related domains of QoL, which is somewhat different than those identified by relatives, care home staff and "objective" measures.Originality/value - Not only is it evident that residents are able to describe aspects of their situation but they appear to retain a sense of self and identity. There is a distinctive need for assessment of QoL amongst residents with dementia that places their subjective view of this concept at its core. [ABSTRACT FROM AUTHOR]

Purpose - This paper aims to discuss professionals working in partnership with family carers and the importance of learning from their experiences in designing and delivering support to themselves and people with dementia.Design/methodology/approach - Working in partnership with carers is a key goal of policy and practice. This paper demonstrates how this can work in practice.Findings - Key issues are synthesized, drawing on the stories of three carers who shared their stories as part of the original conference workshop on which the paper is based.Originality/value - Lessons for professionals about the nature of the dementia caring journey and dimensions of good practice are highlighted. [ABSTRACT FROM AUTHOR]