Search

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]

The future welfare of older adults is a worldwide concern. By 2034, it is estimated that individuals 65 and older in the U.S. will be 77 million. Consequently, this reality will impact healthcare facilities and increase Medicare and Medicaid costs, resulting in higher incidents of homeless older adults, children caring for parents, the need for more caregivers, and an increased number of older individuals experiencing various forms of dementia. To address these concerns, the current trend for treating the onset of dementia and Alzheimer's disease has been moving toward nonpharmaceutical interventions. Even though researchers have tapped into the benefits of several nonpharmaceutical treatments, there appears to be a constant debate on establishing which method is most effective. Deciding on best practices and methods to slow down and/or halt the progression of dementia is the gap this research needs to fill. To provide clarity on the topic, an analysis of alternative interventions to treat the onset of dementia is what this paper strived to achieve. The analysis involved comparing and contrasting the benefits of each intervention as well as illustrating the implications of the findings. In this regard, a systematic review was conducted examining the benefits of five nonpharmaceutical strategies; mental training, music therapy, technology usage, physical activity, and social interaction. Although findings revealed some form of improvement in each of the nonpharmacological interventions examined, the overarching theme appeared to lean toward providing mental stimulation. It was also not conclusive that physical activity prevented cognitive decline. More research is recommended. [ABSTRACT FROM AUTHOR]

Background: Providing care for people with dementia incorporates a level of burden which can affect quality of life for both the caregiver and the recipient of care. This study measures the level of burden experienced by Jordanian caregivers for people with dementia and explore related predictors. Methods: Through a cross‐sectional survey, participants were invited through convenience sampling to participate in a structured interview. Results: A total of 406 participants completed the survey. According to Zarit Burden Interview, the mean burden score of the sample was 26.2 (SD = 16.2). This score falls under the mild to moderate burden level. Older age of the patient, severe dementia, lower number of caregivers, if the caregiving negatively affected family relations, and if the caregiving negatively affected jobs, were significant predictors of burden. Conclusion: Caregivers in the current study reported no burden to a minimum burden. This result does not mean that these caregivers have no or minimal stress or that they do not have psychological needs; on the contrary, these results call for more attention to providing extra psychological and emotional support to caregivers of patients with dementia in order to decrease the burden level and maintain their efforts in caregiving. Future studies are required to discern the shape and context of unmet caregiver needs, assessment, and support. [ABSTRACT FROM AUTHOR]

Background: Wandering behaviour affects a significant portion of dementia patients, ranging from 15% to 80%, presenting a serious safety concern and adding to caregivers' burden. Recent studies emphasise the effectiveness of non‐pharmacological interventions over pharmacological ones due to their minimal side effects. Consequently, in current literature there has been a surge of interest in exploring non‐pharmacological methods for managing wandering. Purpose: This integrative literature review aims to deepen comprehension of wandering behaviour, presents recent studies on non‐pharmacological approaches, and inspires further research in this field. Methods: Electronic data collection spanned from 2019 to 2024, sourcing 20 relevant articles from PubMed and Scopus databases using search terms such as 'dementia', 'Alzheimer's disease', 'wandering', and 'management'. A thematic analysis methodology was employed to identify non‐pharmacological treatment themes for managing wandering. This approach involves scrutinising and synthesising themes within the dataset. Qualitative data analysis focused on significant phrases and keywords, grouping them to derive relevant themes. Results: Recent literature extensively explores non‐pharmacological methods for managing wandering. These include understanding behaviours, identifying and targeting high‐risk groups, facilitating safe wandering, addressing environmental factors, promoting exercise and activity, and offering caregiver support. Conclusions: This study significantly advances understanding of wandering behaviour and highlights recent research on non‐pharmacological interventions. The findings suggest the potential for providing safe and effective treatment to wandering dementia patients, thereby alleviating stress for both patients and caregivers. [ABSTRACT FROM AUTHOR]

Background: This commentary offers a critical reflection on the current status of evidence‐based psychological treatments for psychological distress in dementia, with a particular emphasis on acceptance and commitment therapy (ACT). Purpose: The paper hypothesises several explanations, such as ethical dilemmas with recruitment and consent, and possible preconceptions surrounding the nature, scope and likelihood of therapeutic change in this population, for a lack of interventional research on people with dementia. Implications: We highlight some recent developments in psychological therapy with people with dementia that are raising more questions and generating new outcome research. [ABSTRACT FROM AUTHOR]

Introduction: The use of technology to deliver psychosocial interventions such as cognitive stimulation therapy (CST) to individuals with dementia may improve their cognition and quality of life. Objectives: This study aimed to investigate the participants' experiences with digital CST in Jordanian care homes, as well as the acceptability of the digital CST intervention in Jordanian care homes and recommendations for refinement. Methods: A qualitative study design and semistructured interviews were used to obtain data from 20 people with dementia and 12 care home staff who were purposefully selected. Data were analyzed thematically and comparatively to explore the experiences and outcomes of the participants. This study was conducted from February to April 2023. Results: Analysis of care home staff and residents' experiences revealed seven major themes: (a) personalized support and engagement, (b) positive impact on quality of life, (c) engagement and meaningful activities, (d) adaptable format and accessibility, (e) emotional connection and empowerment, (f) caregiver involvement and support, and (g) suggestions for improvement. The study's findings emphasize the necessity of tailored support, individualized difficulty levels, individualized material selection, emotional support, greater social connection, and caregiver participation in digital CST for people with dementia. Conclusion: Using digital touchscreen technology to deliver CST content has shown potential improvements, making interventions simpler for staff and more beneficial for individuals with dementia, thereby enhancing cognition and quality of life. [ABSTRACT FROM AUTHOR]

This study aimed to analyze the relationship between the caregiver burden, death obsessions, and somatic symptoms; and whether the death obsessions are playing a mediating role in the relationship between the caregiver burden and somatic symptoms. The study was done on the informal dementia caregivers residing in India. Three questionnaires in a google form were circulated. The correlational and mediation analysis revealed that there was a significant and positive correlation between the caregiver burden, death obsessions, and somatic symptoms. Further, the death obsessions significantly mediated the relationship between caregiver burden and somatic symptoms. [ABSTRACT FROM AUTHOR]

Objective: As populations age globally, there is an increasing prevalence of dementia, with an estimated 153 million living with dementia by 2050. Up to 70% of people with dementia experience dementia‐related psychosis (D‐RP). Antipsychotic medications are associated with many adverse effects in older people. This review aims to evaluate the evidence of non‐pharmacological interventions in managing D‐RP. Method: The search of Medline, EMBASE, Web of Science, CINAHL, PsycINFO, and Cochrane included randomised controlled trials that evaluated non‐pharmacological interventions. Data extraction and assessment of quality were assessed independently by two researchers. Heterogenous interventions were pooled using meta‐analysis. Results: A total of 18 articles (n = 2040 participants) were included and categorised into: sensory‐, activity‐, cognitive‐ and multi‐component‐orientated. Meta‐analyses showed no significant impact in reducing hallucinations or delusions but person‐centred care, cognitive rehabilitation, music therapy, and robot pets showed promise in single studies. Conclusions and Implications: Future interventions should be developed and evaluated with a specific focus on D‐RP as this was not the aim for many of the included articles. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To examine a 12-month dementia care management program's effect on health care cost, utilization, and overall return on investment in a Medicare managed care population. STUDY DESIGN: Pre-post analysis of participants (n = 121) enrolled in Ochsner's Care Ecosystem program from 2019 through 2021 compared with propensity-matched controls (n = 121). The primary outcome comparison was total cost of care. Secondary outcomes included components of total cost of care (eg, inpatient, outpatient, emergency department [ED] costs), health care utilization (eg, number of ED visits), and differences in Hierarchical Condition Category (HCC) risk scores. METHODS: Difference-in-differences analyses were conducted from baseline through 12 months comparing various financial metrics and utilization between groups. RESULTS: Care Ecosystem participants had significantly lower total cost of care at 12 months, mean savings of $475.80 per member per month compared with controls. Care Ecosystem participants had fewer ED, outpatient, and professional visits. HCC risk scores were also better relative to matched controls. CONCLUSIONS: A collaborative dementia care program demonstrated significant financial benefit in a managed Medicare population. [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.

The article presents insights on the U.S. Health Resources and Services Administration Geriatrics Workforce Enhancement Program (GWEP) special supplement. It stresses the need for all GWEP recipients to have at least three partner types, academia, primary care clinical sites, and community-based organization. It notes on the efforts of GWEP recipients continuously update their educational methods and develop new ways to educate primary care providers about older adults.

Background: The United States faces a growing challenge with over 6.5 million people living with dementia (PLwD). PLwD and their caregivers struggle with cognitive, functional, behavioral, and psychosocial issues. As dementia care shifts to home settings, caregivers receive inadequate support but bear increasing responsibilities, leading to higher healthcare costs. In response, the Centers for Medicare & Medicaid Services (CMS) introduced the Guiding an Improving Dementia Experience (GUIDE) Model. The study explores the real‐world implementation of the Cedars‐Sinai C.A.R.E.S. Program, a pragmatic dementia care model, detailing its recruitment process and initial outcomes. Methods: The Cedars‐Sinai C.A.R.E.S. Program was integrated into the Epic electronic health record system and focused on proactive patient identification, engagement, interdisciplinary collaboration, care transitions, and ongoing care management. Eligible patients with a dementia diagnosis were identified through electronic health record and invited to join the program. Nurse practitioners with specialized training in dementia care performed comprehensive assessments using the CEDARS‐6 tool, leading to personalized care plans developed in consultation with primary care providers. Patients benefited from a multidisciplinary team and support from care navigators. Results: Of the 781 eligible patients identified, 431 were enrolled in the C.A.R.E.S. Program. Enrollees were racially diverse, with lower caregiver strain and patient behavioral and psychological symptoms of dementia (BPSD) severity compared to other programs dementia care programs. Healthcare utilization, including hospitalizations, emergency department (ED) admissions, and urgent care visits showed a downward trend over time. Completion of advanced directives and Physician Order of Life‐Sustaining Treatment (POLST) increased after enrollment. Conclusion: The Cedars‐Sinai C.A.R.E.S. Program offers a promising approach to dementia care. Its real‐world implementation demonstrates the feasibility of enrolling a diverse population and achieving positive outcomes for PLwD and their caregivers, supporting the goals of national dementia care initiatives. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To recognise that being able to die well with dementia is of equal importance to living well with dementia • To consider why there may be a low uptake of advance care planning (ACP) in people with dementia • To learn about when to initiate an ACP discussion with a person with dementia. Recent policy focus in dementia care has been on living well with the condition; however, being able to die well with dementia is of equal importance. Advance care planning (ACP) enables people to consider, express and record their wishes and preferences for palliative and end of life care, however there is a low uptake of ACP in people with dementia. Although ACP discussions should be initiated as soon as possible after a diagnosis of dementia, there are other opportunities and transition points in the person’s care during which health and social care professionals could promote, engage in and support ACP discussions. This article considers the importance of ACP in dementia care and uses a case study to explore opportunities for initiating and engaging in ACP with people with dementia. [ABSTRACT FROM AUTHOR]

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]

The development and commercialization of digital therapeutics are increasing. The aim of this study was to determine the effects of digital technology interventions on cognitive function, thereby providing evidence for the development and practical application of interventions to manage cognitive function in patients with mild cognitive impairment and dementia. We conducted a systematic review and meta‐analysis of randomized controlled trials according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta‐Analysis) guidelines. Randomized controlled trials on digital technology interventions published until April 2023 were searched in PubMed, Embase, Cochrane Library, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases without a period limit. Articles that identified the effects of digital technology interventions on cognitive function improvement in dementia and mild cognitive impairment were integrated and analyzed. RevMan software 5.4 was used for quality assessment and meta‐analysis. Twelve out of 708 studies were included in the review and meta‐analysis. Digital technology interventions had significant effects on global cognitive function (standardized mean difference [SMD] = 0.31; 95% confidence interval [CI] = 0.04–0.57; p = 0.02; I² = 60%). In addition, these interventions had significant effects on neuropsychological characteristics, including attention (SMD = 1.17; 95% CI = 0.36–1.97; p = 0.004; I² = 84%), visuospatial perception (SMD = 0.68; 95% CI = 0.19–1.17; p = 0.006; I² = 57%), and memory (SMD = 0.45; 95% CI = 0.19–0.71; p = 0.0007; I² = 22%). The results suggest that digital technology interventions help improve cognitive function in patients with dementia and mild cognitive impairment. [ABSTRACT FROM AUTHOR]

This study aimed to understand which character strengths are most important for people living with dementia and therefore which strengths-based psychological interventions could be most meaningful and acceptable. A participatory design, utilising Delphi methodology, was incorporated into an iterative three stage framework: (1) literature reviewed for Positive Psychology (PP) interventions and patient public involvement to define the character strengths; (2) modified Delphi (N = 10) identified which character strengths are most important for living with dementia; (3) focus groups (N = 14) explored which PP interventions are most acceptable and meaningful. Qualitative data from the focus groups was analysed using thematic analysis. Love, kindness and humour were deemed the most important character strengths for living with dementia. Qualitative data from the focus groups was captured in three superordinate themes: (1) lack of opportunity not capacity; (2) key considerations of PP interventions for people living with dementia; and (3) potential benefits of PP interventions. Love, kindness and humour come naturally to people with dementia, but people may lack social opportunities to use these strengths. Therefore, a PP intervention promoting positive emotion, social relationships and connection to one's values appears most meaningful and acceptable as this may provide a social context to use and maintain these strengths. [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]

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]

While previous research studies have focused on either caregivers' or residents' perception and use of social robots, this article offers an empirical and theoretical examination of joint activities in triadic human–robot interaction. The symptomatology of dementia creates an asymmetrical relation wherein the impetus to employ a robot often originates from the caregiver. Drawing on field work and video recorded interactions in dementia care homes, the article investigates how caregivers draw on embodied resources to involve residents and robot animals in interaction. The analysis demonstrates how caregivers promote commitment and encounter resistance with residents. We draw on the theory of sociomaterial interactionism to study situated interaction between bodies in a meaning‐generating process. By re‐conceptualising the theoretical notions of manipulation and recruitment, the article offers an approach for studying orientations that distinguish between reciprocity of agential objects. We show that caregivers usually distinguish between interactions with people and machines by anticipating a specific response from the robots (manipulation), while they invite participation in a broader sense from residents (recruitment). Social friction arises, however, if caregivers act upon the residents as embodied objects in manipulative ways. [ABSTRACT FROM AUTHOR]

Research criteria for the diagnosis of prodromal dementia with Lewy bodies (DLB) include three clinical subtypes: mild cognitive impairment with Lewy bodies (MCI‐LB), delirium‐onset prodromal DLB, and psychiatric‐onset prodromal DLB. Late‐onset psychiatric manifestations are at a higher risk of developing dementia, but its relation to prodromal DLB remains unclear. In addition to the risk of severe antipsychotic hypersensitivity reactions, accurate discrimination from non‐DLB cases is important due to the potential differences in management and prognosis. This article aims to review a rapidly evolving psychiatric topic and outline clinical pictures of psychiatric‐onset prodromal DLB, including the proposed biomarker findings of MCI‐LB: polysomnography‐confirmed rapid eye movement sleep behaviour disorder, cardiac [123I]metaiodobenzylguanidine scintigraphy, and striatal dopamine transporter imaging. We first reviewed clinical pictures of patients with autopsy‐confirmed DLB. Regarding clinical reports, we focused on the patients who predominantly presented with psychiatric manifestations and subsequently developed DLB. Thereafter, we reviewed clinical studies regarding the diagnostic applications of the proposed biomarkers to patients with late‐onset psychiatric disorders. Clinical presentations were mainly late‐onset depression and psychosis; however, other clinical manifestations were also reported. Psychotropic medications before a DLB diagnosis may cause extrapyramidal signs, and potentially influences the proposed biomarker findings. These risks complicate clinical manifestation interpretation during the management of psychiatric symptoms. Longitudinal follow‐up studies with standardised evaluations until conversion to DLB are needed to investigate the temporal trajectories of core features and proposed biomarker findings. In patients with late‐onset psychiatric disorders, identification of patients with psychiatric‐onset prodromal DLB provides the opportunity to better understanding the distinct prognostic subgroup that is at great risk of incident dementia. Advances in the establishment of direct biomarkers for the detection of pathological α‐synuclein may encourage reorganising the phenotypic variability of prodromal DLB. [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]

Background Dementia encompasses neurodegenerative disorders that account for a global estimated healthcare expenditure of 1.3 trillion US dollars. In Australia, one in 12 people aged ≥65 has a diagnosis of dementia and it is the second leading cause of death. Paramedics play a crucial role in person-centred dementia care, particularly in the community. While consensus has been established on paramedicine's integration into interdisciplinary care teams, there remains a lack of clarity regarding the paramedic role in dementia care. Objective This study aimed to examine and report paramedic interactions with people living with dementia in the out-of-hospital setting. Design and Setting This was a scoping review study of paramedics and people living with dementia within the out-of-hospital setting. Methods This study was guided by the Joanna Briggs Institute (JBI) scoping review framework. Databases were searched without date limits, up to 4 April 2023. These encompassed OVID Medline, CINAHL, Scopus, APA PsycInfo and OVID Embase. Articles were included if they were primary, peer-reviewed studies in English and reporting on paramedic-specific interactions with people living with dementia in the out-of-hospital setting. Data extraction was performed based on study setting, design, population and key findings. Results Twenty-nine articles were included in the thematic analysis. Four themes emerged: need for training, patterns of attendances, patterns of documentation and the integrative potential of paramedicine. Paramedics reported feeling ill-equipped and unprepared in caring for patients living with dementia due to challenges in assessment and management of caregiver tensions. They were often called as a last resort due to poor service integration and a lack of alternative care pathways. Despite high conveyance rates, there was low incidence of paramedic interventions initiated. Underdocumentation of dementia and pain was found. Conclusion Emergency ambulance conveyance of people living with dementia is a surface reaction compounded by a lack of direction for paramedics in the provision of out-of-hospital care. There is a pressing need for establishment of research and educational priorities to improve paramedic training in dementia-specific skillsets. [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]

Many people living with dementia will also have multimorbidity comprising several other intercurrent, long-term and comorbid conditions. This article examines the relationship between such conditions in the context of dementia, giving an overview of the literature, including prevalence and some of the common conditions that can coexist with dementia. The theory and evidence-base will be tied together using a case study approach, to illustrate the complexity of managing comorbid conditions and multimorbidity alongside dementia, and explore some of the approaches that can be used by community nurses to support the overall health of people living with dementia that they work with. [ABSTRACT FROM AUTHOR]

Background and Objectives Transportation is an important component of dementia-friendly communities. People living with dementia have the right to access transportation services to keep their mobility in their community, which is essential for independence, well-being, and quality of life. This scoping review maps the literature on dementia-friendly transportation services and explores their characteristics to inform future development and research. Research Design and Methods Empirical quantitative and qualitative studies in English or French that informed on transportation services for people living with dementia in the community were searched in 15 databases. Two authors independently screened records and charted relevant characteristics from selected publications. Important findings were summarized with a narrative synthesis approach. Results Thirty-five studies informed on important dimensions of transportation services in urban and/or rural context: availability, accessibility, acceptability, adaptability, and affordability. Important insights were identified: the importance of staff training and attitude, and the challenges of availability of affordable services in the rural context. Emerging policy and program intervention areas include the need for access to quiet areas in transit hubs, training to use mass public transit and mobility management. Discussion and Implications The literature on dementia-friendly transportation services is important in the expansion and maintenance of mobility for people living with dementia in the community. The scope of the existing scientific literature remains limited. Although several studies indicated a clear need for better access to dementia-friendly transportation services, the best practices still need to be demonstrated in the scientific literature. [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]

Purpose: This paper aims to explore examine the therapeutic potential of head-mounted display (HMD)-based Virtual Reality Relaxation Therapy (VRRT) sessions for people individuals with dementia in Jordan. Design/methodology/approach: This cross-sectional survey recruited 75 dementia-diagnosed elderly individuals from three Jordanian care homes. A VRRT intervention comprising 10 tailored RT sessions held over the course of five weeks was administered to the participants. Apathy, cognitive performance, anxiety and depression were evaluated before and after the intervention to determine any changes. The Person-Environment Apathy Rating Scale's (PEARS) Arabic translation's validity and reliability were also evaluated. Findings: The VRRT intervention yielded noteworthy results in reducing apathy, as indicated by a substantial decrease in PEARS scores from 17.20 to 11.15. The findings of the study revealed that the participants demonstrated enhanced cognitive abilities, as evidenced by a significant rise in their Saint Louis University Mental Status ratings, which increased from 15.11 to 19.70. The levels of anxiety and depression exhibited a significant decrease subsequent to the implementation of VRRT, with anxiety levels decreasing from 13.66 to 8.23 and depression levels decreasing from 13.62 to 9.33. Furthermore, a notable 70% of participants demonstrated statistically significant decreases in indifference. Practical implications: This study makes a significant contribution to the advancement of innovative treatment approaches aimed at addressing the needs of the aging population, hence enhancing health outcomes and raising the quality of care in Jordan. Originality/value: The effectiveness of VRRT in reducing apathy among Jordanian senior citizens residing in nursing homes has not yet been fully investigated. Therefore, this paper seeks to assess the effectiveness of HMD-based VRRT by conducting pre- and post-intervention evaluations. This research aims to provide valuable insights into the applicability and significance of VRRT in the Jordanian context, contributing to the development of culturally appropriate and cutting-edge therapeutic interventions for older individuals in Jordan. Through this study, the authors aim to promote improved health and elevated standards of care for this population. [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]

Objectives: Speech-language pathologists (SLPs) have a crucial role in assisting individuals with dementia due to the communication and swallowing challenges associated with the disease. As the number of dementia cases rises in India at an increasing rate, investigating the level of dementia knowledge of SLP students can offer insight into the preparedness of the healthcare system to meet this emerging demand. Method: A cross-sectional survey was conducted on SLP students pursuing their final year undergraduate, postgraduate and doctoral degrees from four universities across India. Dementia knowledge was assessed using the Dementia Knowledge Assessment Scale (DKAS) and information about previous dementia exposure (both formal and informal) was collected. The collected data were analysed using quantitative methods. Results: A total of 220 students (64.70% response rate) completed the survey. Overall dementia knowledge was inadequate with an average score of 22.08 ± 10.06. Previous dementia exposure among the students was also found to be low and did not affect dementia knowledge scores. Discussion: Despite the fundamental role SLPs play in the care of individuals with dementia, the lack of knowledge in this area emphasizes the need for enhancing dementia training programs through educational curricula and clinical placements. [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]

Older adults with cognitive impairment have deficits in executive systems that affect their gait automaticity. The aim of the meta-analysis and systematic review was to examine the effects of interventions focus on only motor learning principles on gait performance and physical functions (e.g., dynamic balance). After inspections of 879 articles, 11 relevant studies were selected for systematic review and meta-analysis. The PEDro scale and Modified Downs and Black checklist were used to assess the quality of studies, and a random-effect model was used at a 95% confidence interval for calculating pooled effect sizes. The results of this systematic review and meta-analysis showed that motor learning interventions increased gait speed, cadence, stride length, and reduced gait cognitive cost but did not affect gait variability and physical function. In conclusion, practitioners should pay attention more to the potential benefits of motor learning interventions in rehabilitating older adults with cognitive impairment. [ABSTRACT FROM AUTHOR]

Introduction: Working with a person living with dementia over the years presents a significant challenge for the music therapist, particularly in determining the appropriate duration of intervention. This challenge is compounded by the evident deceleration process experienced by the person, necessitating a high degree of sensitivity and adaptability from the therapist. Method: This article draws on the author's extensive experience as a music therapist, spanning individual sessions lasting from 6 to 14 years with the same person. Insights gleaned from clinical moments over this duration highlight challenges inherent in long-term therapeutic interventions. Results: The therapeutic relationship developed over the years enables the music therapist to adjust the intervention progressively to the client's evolving needs and remain attuned despite challenges in interpreting the person's responses during severe dementia. Discussion: This reflection emphasizes the relevance of music therapy in providing continuous care for persons with severe dementia, acknowledging the inherent challenges of such interventions. [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]

Exergaming is a combination of exercise and gaming. Evidence shows an association between exercise and cognition in older people. However, previous studies showed inconsistent results on the cognitive benefits of exergaming in people with cognitive impairment. Therefore, this study aims to examine the effect of exergaming intervention on cognitive functions in people with MCI or dementia. A systematic literature search was conducted via OVID databases. Randomized controlled trials (RCTs) examined the effect of an exergaming intervention on cognitive functions in people with MCI or dementia were included. Subgroup analyses were conducted according to the type of intervention and training duration. Twenty RCTs with 1152 participants were identified, including 14 trials for MCI and 6 trials for dementia. In people with MCI, 13 studies used virtual-reality (VR)-based exergaming. Those who received VR-based exergaming showed significantly better global cognitive function [SMD (95%CI) = 0.67 (0.23–1.11)], learning and memory [immediate recall test: 0.79 (0.31–1.27); delayed recall test: 0.75 (0.20–1.31)], working memory [5.83 (2.27–9.39)], verbal fluency [0.58 (0.12–1.03)], and faster in executive function than the controls. For people with dementia, all studies used video-based exergaming intervention. Participants with exergaming intervention showed significantly better global cognitive function than the controls [0.38 (0.10–0.67)]. Subgroup analyses showed that longer training duration generated larger effects. The findings suggest that exergaming impacts cognitive functions in people with MCI and dementia. Cognitive benefits are demonstrated for those with a longer training duration. With technological advancement, VR-based exergaming attracts the attention of people with MCI and performs well in improving cognitive functions. [ABSTRACT FROM AUTHOR]

Objective: This study was conducted to comprehensively understand the context, barriers, and opportunities for improving dementia care, treatment, and support. The objective is to guide the development of a national dementia care plan. Methodology: This document review was conducted by analyzing literature available in the public domain, including scientific publications, project documents/reports, media reports, and hospital records. Additionally, annual reports published by the Department of Health Services, national census and demographic and health survey reports, Old Age Homes, and other relevant government reports were examined. Firsthand information was gathered from relevant stakeholders based on the World Health Organization's situational analysis framework for dementia plans. This framework encompasses four domains: Policy context (national ministries, legislation, policies, strategies, plans related to dementia, mental health, aging, and disability), service delivery assessment (health and social care workforces, services, support and treatment programmes, and promotion of awareness and understanding), and epidemiological indicators (prevalence and incidence rates of dementia, risk factors). Ethical clearance was obtained from the Institutional Review Committee (IRC) of B.P. Koirala Institute of Health Sciences (IRC no.2658/023). Results: Existing policies in Nepal inadequately address the needs of people with dementia and their caregivers. Concerning health services, the Government of Nepal provides financial subsidies to individuals diagnosed with dementia; however, numerous hurdles impede access to care. These obstacles include geographical and structural barriers, an inefficient public healthcare system, weak governance, financial constraints, low awareness levels, stigma, and inadequate workforce. Furthermore, the absence of robust nationally representative epidemiological studies on dementia in Nepal hampers the development of evidence‐based plans and policies. Similarly, there are no interventions targeted at caregivers of people with dementia, and no initiatives for dementia prevention are in place. Conclusions: This review underscores the urgent need to formulate a comprehensive national dementia care plan to address the growing challenges. Key priority action areas include the integration of dementia care into primary healthcare services, training workforce to provide the care, increasing awareness, mitigating stigma, developing caregiver support programs, and initiating high‐quality research to inform evidence‐based policymaking. Key points: Existing policies in Nepal fall short in addressing the specific needs of people with dementia and their caregivers.There is immense scarcity of trained health workforce to provide dementia care as well as access to merely available dementia care services is also hindered by a combination of geographical, structural, and systemic obstacles within the public healthcare system.The absence of robust local epidemiological studies limits the evidence base for effective policymaking.Key action areas include integrating dementia care into primary healthcare, enhancing health care workers training, raising awareness, combating stigma, implementing caregiver support programs, and initiating high‐quality research to inform evidence‐based policymaking. [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]

A large proportion of hospital inpatients are affected by cognitive impairment, posing challenges in the provision of their care in busy, fast-paced acute wards. Signs and symbols, known as visual identifiers, are employed in many U.K. hospitals with the intention of helping healthcare professionals identify and respond to the needs of these patients. Although widely considered useful, these tools are used inconsistently, have not been subject to full evaluation, and attract criticism for acting as a shorthand for a routinized response. In order for visual identifiers to be used effectively in acute care settings, thorough consideration must be given to the ethical and legal issues that are engaged in this context, and their potential benefits and harms must be weighed and balanced. This paper proposes a set of legal and ethical principles that can be used to guide the implementation of visual identifiers. Together, these principles provide a framework applicable in the design and implementation phases to systematically identify relevant considerations arising from the use of these tools. We outline some tensions that arise between principles and conclude that selecting a preferred moral framework could help to guide decision-making, as does clarity around the purpose and objectives of the identifier. [ABSTRACT FROM AUTHOR]

Background Dementia caregiving is a dynamic and multidimensional process. To gain a comprehensive understanding of informal caregiving for people living with dementia (PLWD), it is pivotal to assess the quality of life (QoL) of informal caregivers. Objective To evaluate whether the care–recipient relationship type predicts changes in the QoL of informal caregivers of PLWD over a two-year period. Methods This was a secondary analysis of longitudinal data. The data were drawn from two waves of linked data from the National Health and Aging Trends Study (NHATS) and the National Study of Caregiving (NSOC) (2015: NHATS R5 & NSOC II; 2017: NHATS R7 & NSOC III). Caregivers were categorized into spousal, adult–child, "other" caregiver and "multiple" caregivers. QoL was assessed through negative emotional burden (NEB), positive emotional benefits and social strain (SS). Generalized estimating equation modelling was used to examine changes in caregivers' QoL outcomes across types of relationship over time. Results About, 882 caregivers were included who linked to 601 PLWD. After adjusting caregivers' socio-demographics, "other" caregivers had lower risk of NEB and SS than spousal caregivers (OR = 0.34, P  = 0.003, 95%CI [0.17, 0.70]; OR = 0.37, P  = 0.019, 95%CI 0.16, 0.85], respectively), and PLWD's dementia status would not change these significance (OR = 0.33, P  = 0.003, 95%CI [0.16, 0.68]; OR = 0.31, P  = 0.005, 95%CI [0.14, 0.71], respectively). Conclusions The study demonstrates that spousal caregivers face a higher risk of NEB and SS over time, underscoring the pressing need to offer accessible and effective support for informal caregivers of PLWD, especially those caring for their spouses. [ABSTRACT FROM AUTHOR]