Welcome to the latest key papers and publications focussing mainly on all things sepsis in the nursing profession.
Please click on the links below and enter your OpenAthens username and password to download the full text or contact the library at esth.hirsonlibrary@nhs.net to request the full text.
Factors and outcomes associated with under- and overdiagnosis of sepsis in the first hour of emergency department care
Abstract: Background: Sepsis remains the leading cause of in-hospital death and one of the costliest inpatient conditions in the United States, while treatment delays worsen outcomes. We sought to determine factors and outcomes associated with a missed emergency physician (EP) diagnosis of sepsis.
Methods: We conducted a secondary analysis of a prospective single-center observational cohort of undifferentiated, critically ill medical patients (September 2020–May 2022). EP gestalt of suspicion for sepsis was measured using a visual analog scale (VAS; 0%–100%) at 15 and 60 min post–patient arrival. The primary outcome was an explicit hospital discharge diagnosis of sepsis that was present on arrival. We calculated test characteristics for clinically relevant subgroups and examined factors associated with initial and persistent missed diagnoses. Associations with process (antibiotics) and clinical (mortality) outcomes were assessed after adjusting for severity.
Results: Among 2484 eligible patients, 275 (11%) met the primary outcome. A VAS score of ≥50 (more likely than not of being septic) at 15 min demonstrated sensitivity 0.83 (95% confidence interval [CI] 0.78–0.87) and specificity 0.85 (95% CI 0.83–0.86). Older age, hypoxia, hypotension, renal insufficiency, leukocytosis, and both high and low temperature were significantly associated with lower accuracy due to reduced specificity, but maintained sensitivity. Of 48 (17%) and 23 (8%) missed cases at 15 and 60 min, elevated lactate, leukocytosis, bandemia, and positive urinalysis were more common in the missed sepsis compared to nonsepsis cases. Missed diagnoses were associated with median (interquartile range) delay of 48 (27–64) min in antibiotic administration but were not independently associated with inpatient mortality as risk ratios remained close to 1 across VAS scores.
Conclusions: This prospective single–academic center study identified patient subgroups at risk of impaired diagnostic accuracy of sepsis, with clinicians often overdiagnosing rather than underdiagnosing these groups. Prompt abnormal laboratory test results can “rescue” initial missed diagnoses, serving as potential clinician- and systems-level intervention points to reduce missed diagnoses. Missed diagnoses delayed antibiotics, but not mortality after controlling for severity of illness.
Source: Pandy Shivansh R. Academic Emergency Medicine, 2024 Dec; 32(3):
Development and validation of a prediction model for in-hospital mortality in patients with sepsis
Abstract: Background: Sepsis, a life-threatening condition marked by organ dysfunction due to a dysregulated host response to infection, involves complex physiological and biochemical abnormalities.
Aim: To develop a multivariate model to predict 4-, 6-, and 8-week mortality risks in intensive care units (ICUs).
Study Design: A retrospective cohort of 2389 sepsis patients was analysed using data captured by a clinical decision support system. Patients were randomly allocated into training (n = 1673) and validation (n = 716) sets at a 7:3 ratio. Least Absolute Shrinkage and Selection Operator (LASSO) regression identified variables incorporated into a multivariate Cox proportional hazards regression model to construct a prognostic nomogram. The area under the receiver operating characteristic curve (AUROC) assessed model accuracy, while performance was evaluated for discrimination, calibration and clinical utility.
Results: A risk score was developed based on 11 independent predictors from 35 initial factors. Key predictors included minimum Acute Physiology and Chronic Health Evaluation II (APACHE II) score as having the greatest impact on prognosis, followed by days of mechanical ventilation, number of vasopressors, maximum and minimum Sequential Organ Failure Assessment (SOFA) scores, infection sources, Gram-positive or Gram-negative bacteria and malignancy. The nomogram demonstrated superior discriminative ability, with AUROC values of 0.882 (95% confidence interval [CI], 0.855–0.909) and 0.851 (95% CI, 0.804–0.899) at 4 weeks; 0.836 (95% CI, 0.798–0.874) and 0.820 (95% CI, 0.761–0.878) at 6 weeks; and 0.843 (95% CI, 0.800–0.887) and 0.794 (95% CI, 0.720–0.867) at 8 weeks for training and validation sets, respectively.
Conclusion: A validated nomogram and web-based calculator were developed to predict in-hospital mortality in ICU sepsis patients. Targeting identified risk factors may improve outcomes for critically ill patients.
Relevance to Clinical Practice: The developed prediction model and nomogram offer a tool for assessing in-hospital mortality risk in ICU patients with sepsis, potentially aiding in nursing decisions and resource allocation.
Source: Shi W. Nursing in Critical Care, 2025 Apr; 30(3):
Investigating key factors of feeding intolerance in sepsis: A scoping review
Abstract: Background: At present, domestic and international research on the current status of feeding intolerance in septicemia patients only stops at the study of influencing factors; however, due to the specificity of the disease, the influencing factors are numerous and controversial.
Aims: To systematically analyse the studies related to the occurrence of feeding intolerance in patients with sepsis, to find out the influencing factors of feeding intolerance in these patients and to provide a reference for nursing staff to develop relevant interventions.
Study Design: The study employed Arksey and O'Malley's methodology to carry out a scoping review. We conducted a systematic search, using the scoping review as a framework, for relevant Chinese and English literature on factors influencing feeding intolerance in patients with sepsis in China Knowledge Network, Wanfang, CINAHL, Pubmed, Web of Science and Google Scholar, covering a time frame from construction to 1 September 2024. We identified research questions, completed literature screening and quality assessment, extracted data and summarized and analysed the data.
Results: The review included a total of 13 papers. Factors influencing feeding intolerance in septicemia patients included patient factors, disease factors, biochemical indicators, feeding determinants, clinical treatment and drug effects.
Conclusions: Factors affecting feeding intolerance in patients with sepsis are multifaceted. We should develop individualized care plans based on relevant risk factors to improve feeding tolerance and shorten hospital stays in patients with sepsis.
Relevance to Clinical Practice: In order to improve the ability of ICU nurses to identify the risk factors of feeding intolerance in patients with sepsis, it is recommended to conduct systematic training on the pathophysiology of sepsis, influencing factors of feeding intolerance and intervention measures and assist nurses to implement appropriate intervention measures.
Source: Ling Y. Nursing in Critical Care, 2025 Apr; 30(3):
The triglyceride glucose index and delirium risk in sepsis patients: A causal inference study
Abstract: Background: Sepsis, a grave systemic infection, presents substantial health challenges. While insulin resistance frequently occurs in sepsis conditions, its relationship with sepsis-associated delirium remains insufficiently explored.
Aim: This study aimed to explore the causal effect between the triglyceride glucose (TyG) index and its risk of delirium in patients with sepsis through the use of causal inference.
Study Design: A cohort of 5461 sepsis patients admitted to the intensive care unit (ICU) was selected from the Medical Information Mart for Intensive Care IV database. Patients were grouped into high TyG (≥9.48) and low TyG (<9.48) categories. Propensity score matching was applied to control for confounders, and the average treatment effect on the treated was calculated.
Results: Of the 5461 patients, 59.6% experienced delirium. The incidence of delirium was higher in the high TyG group (1751 patients; 66.6%) than in the low TyG group (56.3%) (p < .001). The results of the logistic regression analysis indicated that the risk of delirium was significantly higher in the high TyG group (adjusted odds ratio 1.34, 95% confidence interval: 1.16–1.53). Following matching, the delirium risk increased by 6.9% in the high TyG group (T = 3.29), a finding that was confirmed by a Rosenbaum sensitivity analysis.
Conclusions: The TyG index represents a straightforward and efficacious instrument for nursing staff to ascertain the likelihood of delirium in patients with sepsis during the routine monitoring of their condition. The ability to make causal inferences in observational studies provides a novel approach to research.
Relevance to Clinical Practice: The TyG index represents a readily applicable instrument for ICU nurses to identify the risk of delirium in sepsis patients. This enables the possibility of early intervention in high-risk individuals and the optimization of care outcomes.
Source: Li X. Nursing in Critical Care, 2025 Feb; 30(2):
Decreased racial disparities in sepsis mortality after an order set–driven initiative: An analysis of 8151 patients
Abstract: Background: Sepsis is a leading cause of hospital mortality and there is evidence that outcomes vary by patient demographics including race and gender. Our objectives were to determine whether the introduction of a standardized sepsis order set was associated with (1) changes in overall mortality or early antibiotic administration or (2) changes in outcome disparities based on race or gender.
Methods: Patients seen in the emergency department and admitted to the hospital with a diagnosis code of sepsis were identified and divided into a preintervention cohort seen during the 18 months prior to the initiation of a new sepsis order set and an intervention cohort seen during the 18 months after a quality initiative driven by introducing the order set. Associations between time period, race, gender, and mortality were assessed using univariate and multivariate logistic regression models. Other outcomes included early antibiotic administration (<3 h from arrival).
Results: Overall mortality was unchanged during the intervention period (7.8% vs. 7.2%) in both univariate (relative risk [RR] 1.08, 95% confidence interval [CI] 0.93–1.26) and multivariate logistic regression (RR 1.11, 95% CI 0.93–1.28) models. Although male gender tended to have higher mortality, there was no statistically significant association between gender and mortality in either cohort. In the multivariable model, Black race was associated with increased risk of death in the preintervention period (RR 1.41, 95% CI 1.02–1.94), but this association was not present in the intervention period. Patients of color also saw significantly more improvement in early antibiotic administration during the intervention period than White patients.
Conclusions: An order set–driven sepsis initiative was not associated with overall improved mortality but was associated with decreased racial disparities in sepsis mortality and early antibiotics.
Source: Fernandez Olivera Maria L. Academic Emergency Medicine, 2025 Jan; Early View
Diagnostic safety and quality optimization in sepsis study protocol
Abstract: Background: Sepsis ranks among the “Big Three" conditions most prone to harmful diagnostic errors. Despite its high prevalence and severity, health systems lack effective and contextually tailored strategies to optimize diagnostic accuracy for sepsis.
Objectives: The purpose of this study is to understand factors related to high sepsis diagnostic accuracy using principles and tools of safety and implementation science.
Methods: This is a multi-site study involving 20 hospitals across four states in the United States. The primary objectives are to (1) describe hospital-level variability and understand barriers and facilitators to sepsis diagnostic accuracy and (2) apply cross-case and coincidence analysis to determine minimally sufficient and necessary conditions for optimal sepsis diagnosis that minimizes under- and overtreatment. To identify barriers and facilitators of acute sepsis diagnosis, we will conduct electronic surveys and in-depth interviews with key informants from each hospital. We will use data from electronic health records (EHR) and data warehouses to operationalize sepsis diagnostic accuracy.
Results: We have enrolled 20 hospitals and begum data collection. The findings of this study will be used to develop a context-specific toolkit that guides the selection of feasible and important strategies to promote optimal sepsis diagnosis in diverse hospitals settings.
Conclusions: The study uses tools and principles from safety and implementation science to generate first-of-its-kind evidence to improve diagnostic excellence in sepsis.
Source: Shrestha Sachita. Journal of Hospital Medicine, 2025 Apr; Early View
Association between optimum blood glucose level and mortality in critically ill patients with septic shock: A real-world time-series data analysis
Abstract: Background: Sepsis remains a significant health challenge in ICU, with septic shock requiring meticulous glycaemic management due to metabolic dysregulation. Existing research highlights the detrimental effects of both hyperglycaemia and hypoglycaemia on septic patient outcomes, emphasizing the need for effective glycaemic control. Despite extensive studies, optimal glycaemic targets in septic shock patients remain contentious and unclear, necessitating further research.
Aim: Our study aims to identify optimal glycaemic targets for patients in septic shock by analysing time-series blood glucose data.
Study Design: This retrospective observational study utilized the MIMIC-IV database, encompassing ICU patients diagnosed with septic shock from 2008 to 2019. We extracted time-series blood glucose data and applied the Stineman interpolation to achieve a standardized resolution. The primary analysis involved calculating the time-weighted average blood glucose (TWA-BG) and examining its relationship with 28-day mortality using a restricted cubic spline model within a Cox regression framework. Sensitivity analyses with multiple models and subgroup analyses were used to reveal the robustness of the results.
Results: From 34 677 identified septic patients, 11 375 met the inclusion criteria. The optimal TWA-BG range, associated with the lowest 28-day mortality risk, was determined to be 105 to 131 mg/dL. Patients within this range exhibited significantly lower mortality rates compared to those with higher or lower TWA-BG levels. Sensitivity analyses confirmed these findings, indicating robustness across various subgroups and analytical models.
Conclusions: Our findings suggest that maintaining TWA-BG levels between 105 and 131 mg/dL minimizes the risk of 28-day, ICU, and in-hospital mortality in patients with septic shock.
Relevance to Clinical Practice: The results provide evidence-based guidance for ICU nursing interventions, advocating for a precise TWA-BG range to be maintained for septic shock patients, thus potentially setting new benchmarks for glycaemic control in critical care settings.
Source: Muhetaer Gulizeba. Nursing in Critical Care, 2025 Mar; 30(2):
Critical care nurses’ knowledge, confidence, and clinical reasoning in sepsis management: a systematic review
Abstract: Background: Sepsis is a critical condition with high global mortality, accounting for 11 million deaths annually. Nurses are central to sepsis management, and their knowledge, confidence, and clinical reasoning significantly impact patient outcomes.
Aim: This systematic review evaluates critical care nurses’ knowledge, confidence, and clinical reasoning in sepsis management and examines factors influencing these competencies.
Methods: A comprehensive search of PubMed, CINAHL, MEDLINE, Scopus, EMBASE, and the Cochrane Library was conducted, covering studies published from 2014 to 2023. Studies were included if they assessed knowledge, confidence, or clinical reasoning in sepsis management among critical care nurses using quantitative, qualitative, or mixed-methods approaches in clinical settings. Only peer-reviewed studies were considered to ensure academic rigor. The risk of bias was assessed using the JBI Checklist for quantitative studies and the CASP tool for qualitative studies, with discrepancies resolved through discussion or a third reviewer. A total of 70 records were screened, with 25 studies (sample sizes ranging from 28 to 835 nurses) meeting the inclusion criteria. Data extraction focused on study design, tools used, and key outcomes related to knowledge, confidence, and clinical reasoning in sepsis management.
Results: Across 25 studies involving over 5,000 nurses globally, knowledge scores were moderate, with significant gaps in early sepsis recognition (e.g., only 52% of nurses could define sepsis). In three studies, confidence improved with sepsis-specific training, showing a 10–25% increase post-intervention. Clinical reasoning was influenced by organizational factors, experience, and the use of technology, with decision-support tools enhancing timely sepsis recognition and reducing mortality by up to 23%.
Conclusion: This review provides a global perspective on sepsis management among critical care nurses, strengthened by diverse study designs. However, limitations include variability in measurement tools, self-reporting bias, small sample sizes, and language-based selection bias. Continuous education, targeted training, and the integration of AI-driven decision tools are essential to improving sepsis outcomes. Addressing gaps in sepsis knowledge and promoting better clinical reasoning will enhance the overall quality of care in critical settings.
Source: Abdalhafith O. BMC Nursing, 2025 ; 24:
Sepsis and Septic Shock Management and Care: A Case Presentation
Abstract: Approximately 1.7 million adults in America develop sepsis annually (Centers for Disease Control and Prevention [CDC], 2024). [...]350,000 Americans were reported to have died of sepsis in hospital settings. An increased chance of capillary leakage results in hypotension followed by an immunosuppression phase of the immune system. Because of the deregulation of the immune system, the host fails to control the infection; this can cause organ failure and death. Understanding the pathophysiology of sepsis helps nurses provide safe care, improve patients' quality of life, and plan therapeutic interventions to improve patients' survival in hospital settings. Discussion Nurses from the medical-surgical unit need to perform a thorough physical assessment when caring for a patient with sepsis to aid in effective management and treatment. Because sepsis may have widespread effects, the nurse must assess the neurological, respiratory, cardiovascular, gastrointestinal, and genitourinary systems.
Source: Cadet Myriam J. Medsurg Nursing, 2024 Sep/Oct; 33(5):
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Association between comorbidities at ICU admission and post-Sepsis physical impairment: A retrospective cohort study
Abstract: Purpose: Few studies have measured the association between pre-existing comorbidities and post-sepsis physical impairment. The study aimed to estimate the risk of physical impairment at hospital discharge among sepsis patients, adjusting for pre-existing physical impairment prior to ICU admission and in-hospital mortality.
Materials and methods: We analyzed all consecutive adult patients admitted to an ICU in a tertiary community hospital, Kameda Medical Center, with sepsis diagnosis from September 2014 to October 2020. Inverse probability attrition weighting using machine learning was employed to estimate the risk of physical impairment at hospital discharge for sepsis patients with and without pre-existing comorbidities at ICU admission. This estimation was adjusted for baseline covariates, pre-ICU physical impairment, and in-hospital mortality.
Results: Of 889 sepsis patients analyzed, 668 [75.1%] had at least one comorbidity and 221 [24.9%] had no comorbidities at ICU admission. Upon adjusting for baseline covariates, pre-ICU physical impairment, and in-hospital mortality, pre-existing comorbidities were not associated with an elevated risk of physical impairment at hospital discharge (RR: 1.02, 95% CI: 0.92, 1.14).
Conclusions: Pre-existing comorbidities prior to ICU admission were not associated with an increased risk of physical impairment at hospital discharge among sepsis patients after adjusting for baseline covariates and in-hospital mortality.
Source: Gildea A. BMJ, 2024 June; 385: q1173
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Improving Early Identification of Sepsis with a Modified Early Warning Score Review Tool
Abstract: Use of a sepsis screening tool led to a significant decrease in mortality and hospital length of stay, as well as earlier identification of sepsis and timelier treatment. Implementation of the Change in Practice During the unfreezing phase of the change (Lewin, 1951), hospital leaders identified sepsis as an underlying problem in recent morbidity and mortality cases on inpatient units. Hospital leaders, including quality management, and chief nursing and chief medical officers, were briefed on the extent of the problem by the project team (clinical nurse specialist [CNS], CNS student). [...]this project served as a temporary measure until information on the new EHR and its embedded screening tools were released.
Source: Lorenz Megan E. Medsurg Nursing, 2024 Nov/Dec; 33(6): 287-292
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Modified frailty index effectively predicts adverse outcomes in sepsis patients in the intensive care unit
Abstract: Background: Frailty and sepsis have a significant impact on patient prognosis. However, research into the relationship between frailty and sepsis in the general adult population remains inadequate. This paper aims to investigate the association between frailty and adverse outcomes in this population.
Method: This retrospective analysis investigated sepsis patients who were initially admitted to the intensive care unit (ICU). The Modified Frailty Index (MFI) was derived by tracking patients’ International Classification of Diseases (ICD) codes during their hospitalization. Patients were classified into two groups based on their MFI scores: a frail group (MFI ≥ 3) and a non-frail group (MFI = 0–2). The key outcomes were mortality rates at 90 and 180 days, with secondary outcomes including the incidence of delirium and pressure injury.
Result: Of the 21,338 patients who were recruited for this study (median age about 68 years, 41.8 % female), 5,507 were classified as frail and 15,831 were classified as non-frail. Frail patients were significantly more likely to have delirium (48.9 % vs. 36.1 %, p < 0.001) and pressure injury (60.5 % vs. 51.4 %, p < 0.001). After controlling for confounding variables, the multifactorial Cox proportional hazard regression analyses revealed a significantly elevated mortality rate at 90 days (adjusted HR: 1.58, 95 % CI: 1.24–2.02, p < 0.001) and 180 days (adjusted HR: 1.47, 95 % CI: 1.18, 1.83, p < 0.001) in the frail group compared to their non-frail counterparts.
Conclusions: Frailty independently predisposes adult sepsis patients in the ICU to adverse outcomes. Future investigations should concentrate on evaluating frailty and developing targeted interventions to improve patient prognosis.
Implication for clinical practice: The MFI provides a simple clinical assessment tool that can be integrated into electronic medical records for immediate calculation. This simplifies the assessment process and plays a key role in predicting patient outcomes.
Source: Li X. Intensive & Critical Care Nursing, 2024 Oct; 84:
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Early sepsis recognition: Is hypothermia the most neglected symptom?
Abstract: Sepsis is a heterogenous syndrome characterized by a life-threatening organ dysfunction due to a dysregulated host response to infection. Despite all efforts in infection prevention and control and advances in modern medicine, sepsis even nowadays remains an important cause of morbidity and mortality. As early aggressive treatment has been proven to improve survival, sepsis can be considered a time-sensitive emergency: early sepsis recognition results in timely intervention and therefore in better patient outcomes.
Source: Papathanakos G. Intensive & Critical Care Nursing, 2024 Oct; 84:
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Sepsis: the latest guidance on identification and management
Abstract: Sepsis is a life-threatening condition caused by the body's response to an infection. This article explores the role of assessment tools in sepsis identification, as well as the Sepsis Six strategy, which is used to treat the condition. One Sepsis Six intervention is the use of antibiotics; when used unnecessarily, these can contribute to antimicrobial resistance, so considering antimicrobial stewardship is an important aspect of sepsis management.
Source: Ahmed F. Nursing Times, 2024 Oct; 120(10): 36-39
Thursday, May 22, 2025
Friday, April 25, 2025
Continence Champions: April 2025
Welcome to the latest key papers and publications focussing mainly on continence issues in the nursing profession.
Please click on the links below and enter your OpenAthens username and password to download the full text or contact the library at esth.hirsonlibrary@nhs.net to request the full text.
Experiences of Urinary Incontinence in Women Who Are Post-Menopausal: A Systematic Review
Abstract: To synthesise the qualitative knowledge of urinary incontinence in post-menopausal women to better understand the experiences and impact of urinary incontinence on quality of life. Urinary incontinence can be an unpleasant and stressful experience as many women assume it is a part of the natural ageing process. The experiences of urinary incontinence can impact many women in different ways as some are reluctant to discuss or report the incidences with health professionals. There were 85 studies identified in the review, and 61 were screened for eligibility. Only four were included in the review. Common themes were identified in the studies that included psychological, physical, informational/education, social, practical needs, intimacy and sexual aspects. The psychological and physical aspects were noted in all the included studies. Many of the studies identified the difficulties post-menopausal women endure in managing episodes of urinary incontinence, as many expressed shame and embarrassment when urinary incontinence occurred. The physical aspects included concerns about maintaining good hygiene and managing irritation on their skin from constant washing. The physical aspect also included exhaustion and tiredness from managing urinary incontinence episodes. Many women in the studies expressed a desire to have ongoing education about managing urinary incontinence and the need to discuss the topic more openly. The social impact of urinary incontinence was also captured in the review, as many women expressed the desire to be social with family and friends but felt reluctant due to the fear of urinary incontinence occurring in front of other people. The practical burden of managing urinary incontinence was illustrated in this review, as some women faced many challenges in managing soiled clothing, constant washing of clothing and the skin and the need to visit the bathroom regularly. The intimacy and sexual components of their lives have been disrupted by episodes of urinary incontinence and replaced with excuses for intimate activities. Post-menopausal women living with urinary incontinence experience a range of different burdens across many different areas in trying to manage their condition. Healthcare professionals need to acknowledge that post-menopausal women are reluctant to seek treatment due to shame and feelings that urinary incontinence is a normal part of aging. To ensure quality of life for post-menopausal women living with urinary incontinence, healthcare professionals need to tailor treatment strategies to provide better care.
Source: McKie, Amanda L. International Journal of Urological Nursing, Mar 2025; 19(1):
Adherence and uncertainty during rehabilitation for urinary incontinence: Validation of a scale
Abstract: We sought to create an Italian version of Mishel's Uncertainty in Illness Scale, dedicated to people undergoing conservative rehabilitation for urinary incontinence, for studying uncertainty as a determinant of therapeutic adherence. Urinary incontinence has a high prevalence worldwide, ranging from 25% to 45%. Incontinence is often treatable with conservative interventions but demands a long and intensive commitment from the patient. Results are not immediate, and relapses are possible. These patients can experience uncertainty and difficulty complying with rehabilitation programs, hence the importance of the therapeutic relationship with a healthcare professional. Mishel's theory of uncertainty can be used to measure uncertainty and the effects of such a relationship, but no instrument currently exists for this purpose. Prospective observational study enrolling all male and female adult patients admitted to a nurse-led outpatient pelvic clinic for non-neurogenic urinary incontinence, excluding puerpera. A scale named MUIS-PF (pelvic floor) was created, based on previous versions of Mishel's scale, and administered during the first consultation and at the end of the rehabilitation program. Internal consistency was assessed, and exploratory factor analysis was conducted. A total of 109 patients enrolled (54 M, 55 F) aged 64 ± 5 years, medial initial leakage 245 grams/day, IQR [90; 370]. Seventy-nine percent obtained continence; there were no dropouts during the study. Internal consistency of the MUIS-PF was high (93%), and structure analysis yielded a clear separation of the factors. Patient uncertainty decreased significantly at the end of the program compared to the first consultation (p < 0.001). The MUIS-PF is valid and reliable. Utilizing the correct approach, the nurse could significantly reduce the uncertainty of persons with incontinence by listening, giving clear information and searching for the best solution for their continence issues.
Source: Terzoni, S. International Journal of Urological Nursing, Oct 2024; 18(3):
Short-Term Urinary Incontinence After Radical Prostatectomy Is Still Based on Patients' Age, Nerve-Sparing Approach, and Surgical-Experience, Despite the Higher-Use of Robotic Surgery in 2022 Compared to 2016 Real-World Results of a Large Rehabilitation Center in Germany
Abstract: Background:
Despite constant improvements, incontinence is one of the most relevant and quality-of-life-reducing side effects of radical prostatectomy (RP) and, in addition to patient-specific factors such as age, the experience of the surgeon/center and the surgical technique used play an important role.
Aims:
To present current real-world data on short-term incontinence after RP from one of the largest German rehabilitation centers in 2022 and to compare it to the results from the same institution in 2016.
Methods and Results:
Retrospective, unicentric, univariate analysis of data from 1394 men after RP in 2022 on admission and discharge from the rehabilitation clinic. Incontinence defined as ≥ 1 pad/day was evaluated by quantitative measuring all day incontinence under a defined graduation and compared to the results of 2016. Totally, 1393 men were available for analysis in 2022 compared to 1390 in 2016. Median age for both cohorts was 66 years with minor differences in preoperative PSA levels. Despite different surgical approaches, no significant change in short-term incontinence rates in 2016 and 2022 were noted at discharge (76.9% vs. 77.9%, p = 0.56). A notable increase in patients with ISUP grade Group 2 and a shift towards robotic surgery were observed in 2022 (45.5%–71%). While nerve sparing led to a significant improvement in continence (p < 0.01), lymphadenectomy and T-stage were not related to any significant increase in short-term incontinence rates. Comparing age groups within the cohort, patients > 69 years exhibited the highest risk of short-term incontinence and least likelihood of regaining continence during rehabilitation (p < 0.01). Men treated at a certified prostate cancer center had significantly (p < 0.01) lower short-term incontinence rates.
Conclusion:
Our study shows little improvement in short-term postoperative incontinence rates after RP in Germany in the last 6 years and known risk factors for postoperative incontinence like age, nerve-sparing surgery, and level of experience were reproduced in our analyses. We conclude not only to carefully select but also to counsel patients before being treated for prostate cancer and to strongly advice treatment at certified centers.
Source: Püllen, L. Cancer Reports, Dec 2024; 7(12):
Adults with Intellectual Disabilities and Incontinence: Assessment and Toileting Issues
Abstract: Background:
Urinary and bowel incontinence are more common in adults with intellectual disability (ID), compared to the general population. Little is known about their incontinence experiences and toileting issues. The aim was to learn about their experiences and toileting issues.
Method:
Incontinence and toileting issues assessment was conducted with a community-based sample of 22 adults with ID and urinary incontinence, with or without bowel incontinence. Assessment included the IPSS, ICIQ-UI, and POTI checklists; bladder scans; and urine sample screening for presence of a urinary tract infection.
Results:
The majority (19 adults, 86%) developed urinary incontinence during adulthood. Seven adults (32%) also experienced bowel incontinence, and constipation was the most commonly reported health condition (13 adults, 59%), other than urinary incontinence. Fifty per cent (11 adults) had been treated for a urinary tract infection within the previous 12 months.
Conclusion:
There is an urgent need to develop accessible and reliable incontinence assessment materials with and for adults with ID and their supporters. These assessments should pay close attention to health conditions that can cause incontinence in this group and factors associated with incontinence which are more commonly experienced by adults with ID. These factors are potentially modifiable.
Source: Finlayson, J. Journal of Intellectual Disability Research, Nov 2024; 69(2):
Smart Personalized Continence Care for People with Profound Intellectual and Multiple Disabilities: A Theory and Practice- Based Implementation Guideline for a Digital Innovation
Abstract: Introducing smart technologies can personalize and improve continence care for people with profound intellectual and multiple disabilities within residential care facilities. Currently, continence care is provided according to fixed schedules. This can lead to oversaturated incontinence materials, leading to leakages and an increased chance of incontinence-associated dermatitis or unnecessary changes. Both result in an unneeded burden for individuals with profound intellectual and multiple disabilities and their caregivers. Smart technologies that notify caregivers when incontinence materials need to be changed can improve the quality of life for individuals experiencing incontinence and lead to a more efficient care process for their caregivers. Yet, implementation is challenging. We present a Guideline for Smart Continence Care (SCC) Implementation in Residential Disability Care. The guideline is systematically and iteratively developed by combining implementation literature and daily practice. Lessons learned from applying a draft version at six residential care facilities are integrated. Eight steps are identified and detailed to guide the SCC implementation process: (1) analyze and determine goals for each target group, (2) analyze the innovation, (3) analyze the context, (4) arrange preconditions, (5) formulate implementation strategy, (6) carry out and monitor the implementation, (7) evaluate and adapt implementation strategy, and (8) continued use and upscaling. The guideline is illustrated by examples from actual SCC implementation practice. This guideline is not only useful for those who lead the implementation of SCC in residential care, but may offer guidance for other care technology implementations in various care settings as well.
Source: Van Cooten, V. Journal of Policy and Practice in Intellectual Disabilities, Mar 2025; 22(1):
Urinary incontinence: implications for nursing practice
Abstract: Urinary incontinence, encompassing stress, urge, and overflow types, significantly impacts patients' physical, psychological, and social wellbeing. This article provides an overview of each type, exploring their pathophysiology, risk factors, and clinical presentations. It emphasises the crucial role of nursing and discusses evidence-based management strategies, including behavioural therapies, pharmacological treatments and patient education. The article also addresses the impact of incontinence on quality of life and future directions for research and practice, advocating a multidisciplinary approach to improve patient outcomes.
Source: Horta Reis da Silva, T. British Journal of Nursing, Dec 2024; 33(22):
Urinary incontinence in older adult women: fighting a rising tide
Abstract: The world's population is rapidly ageing, with conditions such as urinary incontinence, which are especially prevalent among older adults, expected to rise in prevalence as a result. Urinary incontinence is particularly common in older women; however, despite its profound impact on every aspect of women's health and wellbeing, it is often minimised by both individual patients and the wider healthcare system. Francesca Ramadan delves into the prevalence of and psychosocial effects and patient-related factors related to urinary incontinence in older women.
Source: Ramadan, F. British Journal of Community Nursing, Dec 2024; 30(1):
The invisible disability: how to manage urinary incontinence in a neurological patient
Abstract: Urinary incontinence is a significant challenge in patients with neurological conditions, requiring a multifaceted approach to management from a broad range of healthcare professionals. It not only affects quality of life, but also is a leading cause of emergency NHS admissions. The considerable increasing cost of emergency bladder and bowel admissions has highlighted the urgent need for education in uro-neurology across the multidisciplinary team. In response, the Uro-neurology Academy was established in 2023 and hosted an initial webinar in the summer of 2023, which explored a basic approach to managing urinary incontinence in a neurological patient from a medical, nursing and allied health perspective. The webinar also provided an update on the NHS England and NHS improvement neuroscience transformation programme which outlined future commissioning models for neurology, with implications for multiple sclerosis, bladder and urology services. This article will summarise the practical guidance and key points presented by the speakers and chair.
Source: Stross, R. British Journal of Neuroscience Nursing, April 2025; 21(2):
Revolutionising treatment for urinary incontinence and enhancing intimate wellness with EMSELLA
Abstract: Older people are at an increased risk of developing skin damage related to incontinence, including pressure ulceration and incontinence-associated dermatitis (IAD). Factors exacerbating risk in older people include: a higher rate of faecal and urinary incontinence, reduced mobility, long-term conditions and changes to skin barrier function, as a result of the ageing process. Nurses have a key role to play in the assessment of continence, IAD prevention and management. This article explores nursing knowledge in relation to continence care on six inpatient wards for older people, and describes the implementation of improvement strategies, in order to reduce voidable harm.
Source: Attewell, D. Journal of Aesthetic Nursing, Apr 2025; 14(2):
The impact of urinary and bowel incontinence: psychological and physical effects and interventions
Abstract: This clinical review explores the multifaceted impact of urinary and bowel incontinence on the physical and psychological wellbeing of individuals, particularly older adults. The psychological effects, which often include anxiety, depression and social isolation, are addressed through interventions such as cognitive behavioural therapy and peer support groups, which are crucial for alleviating the emotional burden. The review also examines conservative management strategies, such as pelvic floor muscle training, bladder retraining and dietary changes, as well as discussing pharmacological treatments and surgical options for more severe cases. A key emphasis is placed on the importance of a multidisciplinary approach and incorporating the expertise of continence nurses, physiotherapists, occupational therapists and psychologists to comprehensively address patient needs.
Source: Alsararatee, Hasan H. Gastrointestinal Nursing, Nov 2024; 22 (suppl 9):
The impact of incontinence on mental health
Abstract: Bladder and bowel issues, particularly those related to continence, can significantly impact an individual's mental health. These challenges often lead to isolation, anxiety, stress, depression and social anxiety, all of which can profoundly affect a person's quality of life. Healthcare professionals are uniquely positioned to recognise these concerns and incorporate them into assessments for bladder and bowel health. By actively listening, offering empathy and guiding patients toward further support—alongside providing practical treatment and management strategies—clinicians can play a vital role in delivering comprehensive care. This article explores common bladder and bowel issues, the psychological and social challenges they present, and the difficulties both patients and healthcare professionals face in addressing and managing them.
Source: Robson, M. British Journal of Community Nursing, Apr 2025; 30(suppl 4a):
To pad or not to pad? The use of containment products in healthcare
Abstract: Containment products, commonly known as incontinence pads, are medically used in healthcare for patients with bladder and bowel symptoms. However, using them without a clinical need or selecting the wrong style or absorbency can lead to avoidable patient harm. In some cases, product formularies are developed with a greater focus on cost than clinical need, restricting access to certain styles and limiting the number of products prescribed per day. While registered healthcare professionals are accountable for assessing and prescribing containment products for patients under their care, they may not always be aware of this responsibility. Providing pads prematurely can cause unintended physical harm, and foster psychological dependence and reluctance to pursue curative treatment.
Source: Evans, T. British Journal of Community Nursing, Apr 2025; 30(suppl 4a):
A review of the role for pelvic floor physiotherapy in postmenopausal women with urinary incontinence
Abstract: Urinary incontinence is a prevalent condition affecting women. Pelvic floor physiotherapy is a specialized field of physiotherapy dedicated to assessing and treating pelvic floor muscles. This therapy has demonstrated benefits in addressing stress urinary incontinence in premenopausal women, with numerous studies supporting its efficacy in this population. However, pelvic floor physiotherapy in the treatment of postmenopausal women is less well-established, and furthermore, the types of urinary incontinence in postmenopausal women are much broader. We provide a comprehensive review of recent literature investigating the effectiveness of pelvic floor physiotherapy therapy for various conditions in postmenopausal women, including urinary incontinence, urgency urinary incontinence, pelvic organ prolapse, genitourinary syndrome of menopause, sexual dysfunction, and urinary incontinence in the context of obesity, frailty, mobility, and dementia. After evaluating the current literature, it is evident that there is insufficient data to definitively endorse or dismiss the utilization of Pelvic floor physiotherapy for treating urinary incontinence in postmenopausal women. Nevertheless, considering the low associated risks of pelvic floor physiotherapy, we advocate for the initiation of comprehensive, large-scale randomized studies aimed at evaluating its effectiveness in addressing urinary incontinence in postmenopausal women with special attention to vulnerable subgroups, including individuals who are obese, frail or experiencing cognitive impairment.
Source: Walgren, Lauren A. Post Reproductive Health, Dec 2024; 30(4): 239-245
Contact the library for a copy of this article
Key in Lock Syndrome: A Case Report of Situational Urge Incontinence
Abstract: Urgency urinary incontinence, a subtype of overactive bladder, is a common complaint in primary care. One type of urgency urinary incontinence is key in lock or latchkey syndrome, which causes patients to release urine uncontrollably because of a situational environmental trigger or triggers. This incontinence often occurs when patients visualize the door of their house or hear running water. This article presents the case of an older adult woman experiencing recurrent genitourinary infections in the setting of worsening key in lock syndrome.
Source: White, Krista A. The Journal of Nurse Practitioners, Sep 2024; 20(8):
Contact the library for a copy of this article
Reproductive history of parous women and urinary incontinence in midlife: A National Birth Cohort follow‐up study
Abstract:
Objective:
To investigate how reproductive history was associated with urinary incontinence in midlife.
Design:
A follow‐up study.
Setting:
Denmark.
Population:
A total of 39 977 mothers who participated in the Maternal Follow up (2013–2014) in the Danish National Birth Cohort. National registries provided their reproductive history.
Methods:
How parity, mode of birth and obstetric tears associated with urinary incontinence were estimated with adjusted odds ratios (OR) and 95% CI using logistic regression.
Main outcome measures:
Self‐reported urinary incontinence including subtypes stress, urge and mixed urinary incontinence.
Results:
At an average age of 44 years, the prevalence of any urinary incontinence was 32% (21% stress, 2% urge, and 8% mixed urinary incontinence). Women with two births more often had urinary incontinence than women with one birth (OR 1.20, 95% CI 1.10–1.31). Compared with women with only spontaneous births, a history of only caesarean sections was associated with much lower odds of urinary incontinence (OR 0.39, 95% CI 0.35–0.42) and a history of instrumental births with slightly lower odds (OR 0.92, 95% CI 0.86–0.98). Compared with no tear/first‐degree tear as the largest tear, episiotomy was associated with less urinary incontinence (OR 0.91, 95% CI 0.86–0.97) whereas third/fourth‐degree tears were associated with more (OR 1.14, 95% CI 1.04–1.25). Findings were mainly explained by similar associations with stress and mixed urinary incontinence.
Conclusions:
Vaginal birth was associated with a higher risk of long‐term urinary incontinence, but our results indicate that this risk may be reduced by shortening the second stage of birth.
Source: Kjeldsen, Anne C. BJOG: An International Journal of Obstetrics and Gynaecology, Oct 2024; 131(11): 1495-1505
A study to untangle the puzzle of urinary incontinence and frailty co‐occurrence among older adults: The roles of depression and activity engagement
Abstract: Aims:
To explore the co‐occurrence of urinary incontinence and frailty by testing the roles of depression and activity engagement guided by the mechanisms of common cause and interaction pathways.
Design:
A secondary analysis of a 1‐year three‐wave panel data collected from older nursing home residents in China.
Methods:
Changes in depression and activity engagement were regressed on urinary incontinence and frailty incidence underpinned by the common cause mechanism of chronic conditions co‐occurrence, and these changes were also taken as mediators linking from frailty to urinary incontinence incidence supported by the interaction pathways' mechanism.
Results:
A total of 348 older adults were included in this study, and 55.7% were women. The co‐occurrence of urinary incontinence and frailty was found in 16.7% of the participants at baseline. Older adults with sole frailty at baseline had almost twice the rate of incident urinary incontinence (32.7%) compared with those without (16.7%) over a 1‐year period. The subsample analyses showed that changes in depression and activity engagement failed to significantly predict the incidence of urinary incontinence and frailty. The mediating roles of these changes linking frailty to urinary incontinence incidence were also not statistically significant.
Conclusion:
The co‐occurrence of urinary incontinence and frailty is prevalent in older nursing home residents. Older adults with frailty at baseline are more likely to develop urinary incontinence a year later. The common cause and interaction pathways mechanisms for the co‐occurrence of urinary incontinence and frailty were not verified with changes in depression and activity engagement.
Source: Wang, C. Journal of Advanced Nursing, Nov 2024; 80(11): 4584-4592
Care Needs of Older Adults with Urinary Incontinence: A Cross-Sectional Study
Abstract: Purpose:
To explore care requirements of older adults with urinary incontinence (UI) and contributing factors.
Method:
This cross-sectional study used the Older Adults Urinary Incontinence Care Needs Inventory to survey participants with UI in three large-scale tertiary hospitals located in Guangzhou City, China, from January 2023 to November 2023. Statistical analyses, including analysis of variance, t tests, correlation analyses, and linear regression models, were conducted to assess factors influencing participants' care needs.
Results:
A total of 530 older adults with UI participated in the survey and mean standardized score for overall care needs was 78.65 (SD = 5.01), with mean scores for each dimension ranging from 70.88 (SD = 10.55) for social participation needs to 82.45 (SD = 7.11) for health education needs. Factors that were found to influence incontinence care needs in older adults included age, literacy level, number of leaks, and type of disease (F = 37.07, adjusted R2 = 0.290, p < 0.001).
Conclusion:
Comprehensive care for older adults with UI, encompassing physiological, psychological, and social aspects, is crucial. It is essential to tailor care to individual needs and characteristics, taking into account factors, such as age and education, to ensure effective care. [Journal of Gerontological Nursing, 50(5), 43–49.]
Source: Xiang, Su Y. Journal of Gerontological Nursing, May 2024; 50(5): 43-49
Managing female stress urinary incontinence in a post mesh era: What to do and when to refer
Abstract: SUI is defined by the International Continence Society as 'the complaint of any involuntary loss of urine on effort or physical exertion (eg sporting activities), or on sneezing or coughing'.2 SUI affects many domains of a person's life, and a large proportion of SUI can be improved or cured, but SUI is often under-reported secondary to incontinence-related stigma.3 Primary care providers are therefore essential in the assessment and management of SUI. Pathophysiology and assessment of SUI is related to weakness of the pelvic floor and urethral sphincter, resulting in leakage of urine with increased intra-abdominal pressure, such as that experienced during exercise, coughing and laughing. Proactive management of constipation, as well and encouraging reduced intake of alcohol and caffeine, are suggested.9 Both body mass index and waist circumference are positively associated with SUI,10 and weight reduction has been shown to lessen SUI symptoms, as well as improve postoperative outcomes in patients undergoing surgical intervention for SUI.11 The literature demonstrates that women with chronic respiratory conditions were twice as likely to develop urinary incontinence compared to the general population, so management of respiratory comorbidities is essential.12 Smoking cessation should also be recommended to relevant patients.9 Pelvic floor muscle training (PFMT) is highly effective in managing SUI and has a strong body of evidence (particularly in mild-moderate severity SUI cohorts).13-15 PFMT aims to strengthen the pelvic floor and sphincter complex and should be recommended as a first-line therapy to all patients with SUI13'14 (Table 4). PVS were performed in increasing numbers following the concerns about the use of mesh for prolapse surgery27 and have comparable clinical outcomes to synthetic slings, without mesh-specific complications (Table 5).28 Systematic reviews quote success rates between 46.9 and 90%.22,29 Burch colposuspension Burch colposuspension is a mesh-free treatment for primary SUI and involves placing sutures between the anterior vaginal wall (either side of the urethra) and Cooper's ligaments, thereby elevating the urethra and providing a support mechanism against rises in intra-abdominal pressure.
Source: McDonald, J. Australian Journal of General Practice, May 2024: 53(5): 283-288
The impact of male urinary incontinence on quality of life and sexual health
Abstract: Men with urinary incontinence problems may have a fear of urinary incontinence during sexual intercourse, which may negatively affect their sexual lives. This study aimed to determine the effect of urinary incontinence on quality of life and erectile dysfunction in men. A total of 203 men with urinary incontinence who presented to a urology outpatient clinic were assessed using a patient information form, the International Consultation on Incontinence Questionnaire‐Urinary Incontinence Short Form (ICIQ‐SF), and the International Index of Erectile Function (IIEF). The mean age was 63.48 ± 8.80 years, the mean ICIQ‐SF score was 13.45 ± 3.14 (moderate), and the IIEF erectile dysfunction score was 18.52 ± 6.48 (mild/moderate). Patient age correlated positively with the ICIQ‐SF total score (r = 0.309, p < 0.001) and negatively with the IIEF total score (r = −0.452, p < 0.001). The ICIQ‐SF score was negatively correlated with erectile function, orgasmic function, sexual desire, intercourse satisfaction and overall satisfaction scores (p < 0.001, p = 0.015, p = 0.037, p = 0.006 and p = 0.001, respectively). More severe urinary incontinence in men was associated with lower quality of life and greater erectile dysfunction. Further studies are needed to raise men's awareness of urinary incontinence.
Source: Gezginci, E. International Journal of Urological Nursing, Nov 2024; 18(3):
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Experiences of Urinary Incontinence in Women Who Are Post-Menopausal: A Systematic Review
Abstract: To synthesise the qualitative knowledge of urinary incontinence in post-menopausal women to better understand the experiences and impact of urinary incontinence on quality of life. Urinary incontinence can be an unpleasant and stressful experience as many women assume it is a part of the natural ageing process. The experiences of urinary incontinence can impact many women in different ways as some are reluctant to discuss or report the incidences with health professionals. There were 85 studies identified in the review, and 61 were screened for eligibility. Only four were included in the review. Common themes were identified in the studies that included psychological, physical, informational/education, social, practical needs, intimacy and sexual aspects. The psychological and physical aspects were noted in all the included studies. Many of the studies identified the difficulties post-menopausal women endure in managing episodes of urinary incontinence, as many expressed shame and embarrassment when urinary incontinence occurred. The physical aspects included concerns about maintaining good hygiene and managing irritation on their skin from constant washing. The physical aspect also included exhaustion and tiredness from managing urinary incontinence episodes. Many women in the studies expressed a desire to have ongoing education about managing urinary incontinence and the need to discuss the topic more openly. The social impact of urinary incontinence was also captured in the review, as many women expressed the desire to be social with family and friends but felt reluctant due to the fear of urinary incontinence occurring in front of other people. The practical burden of managing urinary incontinence was illustrated in this review, as some women faced many challenges in managing soiled clothing, constant washing of clothing and the skin and the need to visit the bathroom regularly. The intimacy and sexual components of their lives have been disrupted by episodes of urinary incontinence and replaced with excuses for intimate activities. Post-menopausal women living with urinary incontinence experience a range of different burdens across many different areas in trying to manage their condition. Healthcare professionals need to acknowledge that post-menopausal women are reluctant to seek treatment due to shame and feelings that urinary incontinence is a normal part of aging. To ensure quality of life for post-menopausal women living with urinary incontinence, healthcare professionals need to tailor treatment strategies to provide better care.
Source: McKie, Amanda L. International Journal of Urological Nursing, Mar 2025; 19(1):
Adherence and uncertainty during rehabilitation for urinary incontinence: Validation of a scale
Abstract: We sought to create an Italian version of Mishel's Uncertainty in Illness Scale, dedicated to people undergoing conservative rehabilitation for urinary incontinence, for studying uncertainty as a determinant of therapeutic adherence. Urinary incontinence has a high prevalence worldwide, ranging from 25% to 45%. Incontinence is often treatable with conservative interventions but demands a long and intensive commitment from the patient. Results are not immediate, and relapses are possible. These patients can experience uncertainty and difficulty complying with rehabilitation programs, hence the importance of the therapeutic relationship with a healthcare professional. Mishel's theory of uncertainty can be used to measure uncertainty and the effects of such a relationship, but no instrument currently exists for this purpose. Prospective observational study enrolling all male and female adult patients admitted to a nurse-led outpatient pelvic clinic for non-neurogenic urinary incontinence, excluding puerpera. A scale named MUIS-PF (pelvic floor) was created, based on previous versions of Mishel's scale, and administered during the first consultation and at the end of the rehabilitation program. Internal consistency was assessed, and exploratory factor analysis was conducted. A total of 109 patients enrolled (54 M, 55 F) aged 64 ± 5 years, medial initial leakage 245 grams/day, IQR [90; 370]. Seventy-nine percent obtained continence; there were no dropouts during the study. Internal consistency of the MUIS-PF was high (93%), and structure analysis yielded a clear separation of the factors. Patient uncertainty decreased significantly at the end of the program compared to the first consultation (p < 0.001). The MUIS-PF is valid and reliable. Utilizing the correct approach, the nurse could significantly reduce the uncertainty of persons with incontinence by listening, giving clear information and searching for the best solution for their continence issues.
Source: Terzoni, S. International Journal of Urological Nursing, Oct 2024; 18(3):
Short-Term Urinary Incontinence After Radical Prostatectomy Is Still Based on Patients' Age, Nerve-Sparing Approach, and Surgical-Experience, Despite the Higher-Use of Robotic Surgery in 2022 Compared to 2016 Real-World Results of a Large Rehabilitation Center in Germany
Abstract: Background:
Despite constant improvements, incontinence is one of the most relevant and quality-of-life-reducing side effects of radical prostatectomy (RP) and, in addition to patient-specific factors such as age, the experience of the surgeon/center and the surgical technique used play an important role.
Aims:
To present current real-world data on short-term incontinence after RP from one of the largest German rehabilitation centers in 2022 and to compare it to the results from the same institution in 2016.
Methods and Results:
Retrospective, unicentric, univariate analysis of data from 1394 men after RP in 2022 on admission and discharge from the rehabilitation clinic. Incontinence defined as ≥ 1 pad/day was evaluated by quantitative measuring all day incontinence under a defined graduation and compared to the results of 2016. Totally, 1393 men were available for analysis in 2022 compared to 1390 in 2016. Median age for both cohorts was 66 years with minor differences in preoperative PSA levels. Despite different surgical approaches, no significant change in short-term incontinence rates in 2016 and 2022 were noted at discharge (76.9% vs. 77.9%, p = 0.56). A notable increase in patients with ISUP grade Group 2 and a shift towards robotic surgery were observed in 2022 (45.5%–71%). While nerve sparing led to a significant improvement in continence (p < 0.01), lymphadenectomy and T-stage were not related to any significant increase in short-term incontinence rates. Comparing age groups within the cohort, patients > 69 years exhibited the highest risk of short-term incontinence and least likelihood of regaining continence during rehabilitation (p < 0.01). Men treated at a certified prostate cancer center had significantly (p < 0.01) lower short-term incontinence rates.
Conclusion:
Our study shows little improvement in short-term postoperative incontinence rates after RP in Germany in the last 6 years and known risk factors for postoperative incontinence like age, nerve-sparing surgery, and level of experience were reproduced in our analyses. We conclude not only to carefully select but also to counsel patients before being treated for prostate cancer and to strongly advice treatment at certified centers.
Source: Püllen, L. Cancer Reports, Dec 2024; 7(12):
Adults with Intellectual Disabilities and Incontinence: Assessment and Toileting Issues
Abstract: Background:
Urinary and bowel incontinence are more common in adults with intellectual disability (ID), compared to the general population. Little is known about their incontinence experiences and toileting issues. The aim was to learn about their experiences and toileting issues.
Method:
Incontinence and toileting issues assessment was conducted with a community-based sample of 22 adults with ID and urinary incontinence, with or without bowel incontinence. Assessment included the IPSS, ICIQ-UI, and POTI checklists; bladder scans; and urine sample screening for presence of a urinary tract infection.
Results:
The majority (19 adults, 86%) developed urinary incontinence during adulthood. Seven adults (32%) also experienced bowel incontinence, and constipation was the most commonly reported health condition (13 adults, 59%), other than urinary incontinence. Fifty per cent (11 adults) had been treated for a urinary tract infection within the previous 12 months.
Conclusion:
There is an urgent need to develop accessible and reliable incontinence assessment materials with and for adults with ID and their supporters. These assessments should pay close attention to health conditions that can cause incontinence in this group and factors associated with incontinence which are more commonly experienced by adults with ID. These factors are potentially modifiable.
Source: Finlayson, J. Journal of Intellectual Disability Research, Nov 2024; 69(2):
Smart Personalized Continence Care for People with Profound Intellectual and Multiple Disabilities: A Theory and Practice- Based Implementation Guideline for a Digital Innovation
Abstract: Introducing smart technologies can personalize and improve continence care for people with profound intellectual and multiple disabilities within residential care facilities. Currently, continence care is provided according to fixed schedules. This can lead to oversaturated incontinence materials, leading to leakages and an increased chance of incontinence-associated dermatitis or unnecessary changes. Both result in an unneeded burden for individuals with profound intellectual and multiple disabilities and their caregivers. Smart technologies that notify caregivers when incontinence materials need to be changed can improve the quality of life for individuals experiencing incontinence and lead to a more efficient care process for their caregivers. Yet, implementation is challenging. We present a Guideline for Smart Continence Care (SCC) Implementation in Residential Disability Care. The guideline is systematically and iteratively developed by combining implementation literature and daily practice. Lessons learned from applying a draft version at six residential care facilities are integrated. Eight steps are identified and detailed to guide the SCC implementation process: (1) analyze and determine goals for each target group, (2) analyze the innovation, (3) analyze the context, (4) arrange preconditions, (5) formulate implementation strategy, (6) carry out and monitor the implementation, (7) evaluate and adapt implementation strategy, and (8) continued use and upscaling. The guideline is illustrated by examples from actual SCC implementation practice. This guideline is not only useful for those who lead the implementation of SCC in residential care, but may offer guidance for other care technology implementations in various care settings as well.
Source: Van Cooten, V. Journal of Policy and Practice in Intellectual Disabilities, Mar 2025; 22(1):
Urinary incontinence: implications for nursing practice
Abstract: Urinary incontinence, encompassing stress, urge, and overflow types, significantly impacts patients' physical, psychological, and social wellbeing. This article provides an overview of each type, exploring their pathophysiology, risk factors, and clinical presentations. It emphasises the crucial role of nursing and discusses evidence-based management strategies, including behavioural therapies, pharmacological treatments and patient education. The article also addresses the impact of incontinence on quality of life and future directions for research and practice, advocating a multidisciplinary approach to improve patient outcomes.
Source: Horta Reis da Silva, T. British Journal of Nursing, Dec 2024; 33(22):
Urinary incontinence in older adult women: fighting a rising tide
Abstract: The world's population is rapidly ageing, with conditions such as urinary incontinence, which are especially prevalent among older adults, expected to rise in prevalence as a result. Urinary incontinence is particularly common in older women; however, despite its profound impact on every aspect of women's health and wellbeing, it is often minimised by both individual patients and the wider healthcare system. Francesca Ramadan delves into the prevalence of and psychosocial effects and patient-related factors related to urinary incontinence in older women.
Source: Ramadan, F. British Journal of Community Nursing, Dec 2024; 30(1):
The invisible disability: how to manage urinary incontinence in a neurological patient
Abstract: Urinary incontinence is a significant challenge in patients with neurological conditions, requiring a multifaceted approach to management from a broad range of healthcare professionals. It not only affects quality of life, but also is a leading cause of emergency NHS admissions. The considerable increasing cost of emergency bladder and bowel admissions has highlighted the urgent need for education in uro-neurology across the multidisciplinary team. In response, the Uro-neurology Academy was established in 2023 and hosted an initial webinar in the summer of 2023, which explored a basic approach to managing urinary incontinence in a neurological patient from a medical, nursing and allied health perspective. The webinar also provided an update on the NHS England and NHS improvement neuroscience transformation programme which outlined future commissioning models for neurology, with implications for multiple sclerosis, bladder and urology services. This article will summarise the practical guidance and key points presented by the speakers and chair.
Source: Stross, R. British Journal of Neuroscience Nursing, April 2025; 21(2):
Revolutionising treatment for urinary incontinence and enhancing intimate wellness with EMSELLA
Abstract: Older people are at an increased risk of developing skin damage related to incontinence, including pressure ulceration and incontinence-associated dermatitis (IAD). Factors exacerbating risk in older people include: a higher rate of faecal and urinary incontinence, reduced mobility, long-term conditions and changes to skin barrier function, as a result of the ageing process. Nurses have a key role to play in the assessment of continence, IAD prevention and management. This article explores nursing knowledge in relation to continence care on six inpatient wards for older people, and describes the implementation of improvement strategies, in order to reduce voidable harm.
Source: Attewell, D. Journal of Aesthetic Nursing, Apr 2025; 14(2):
The impact of urinary and bowel incontinence: psychological and physical effects and interventions
Abstract: This clinical review explores the multifaceted impact of urinary and bowel incontinence on the physical and psychological wellbeing of individuals, particularly older adults. The psychological effects, which often include anxiety, depression and social isolation, are addressed through interventions such as cognitive behavioural therapy and peer support groups, which are crucial for alleviating the emotional burden. The review also examines conservative management strategies, such as pelvic floor muscle training, bladder retraining and dietary changes, as well as discussing pharmacological treatments and surgical options for more severe cases. A key emphasis is placed on the importance of a multidisciplinary approach and incorporating the expertise of continence nurses, physiotherapists, occupational therapists and psychologists to comprehensively address patient needs.
Source: Alsararatee, Hasan H. Gastrointestinal Nursing, Nov 2024; 22 (suppl 9):
The impact of incontinence on mental health
Abstract: Bladder and bowel issues, particularly those related to continence, can significantly impact an individual's mental health. These challenges often lead to isolation, anxiety, stress, depression and social anxiety, all of which can profoundly affect a person's quality of life. Healthcare professionals are uniquely positioned to recognise these concerns and incorporate them into assessments for bladder and bowel health. By actively listening, offering empathy and guiding patients toward further support—alongside providing practical treatment and management strategies—clinicians can play a vital role in delivering comprehensive care. This article explores common bladder and bowel issues, the psychological and social challenges they present, and the difficulties both patients and healthcare professionals face in addressing and managing them.
Source: Robson, M. British Journal of Community Nursing, Apr 2025; 30(suppl 4a):
To pad or not to pad? The use of containment products in healthcare
Abstract: Containment products, commonly known as incontinence pads, are medically used in healthcare for patients with bladder and bowel symptoms. However, using them without a clinical need or selecting the wrong style or absorbency can lead to avoidable patient harm. In some cases, product formularies are developed with a greater focus on cost than clinical need, restricting access to certain styles and limiting the number of products prescribed per day. While registered healthcare professionals are accountable for assessing and prescribing containment products for patients under their care, they may not always be aware of this responsibility. Providing pads prematurely can cause unintended physical harm, and foster psychological dependence and reluctance to pursue curative treatment.
Source: Evans, T. British Journal of Community Nursing, Apr 2025; 30(suppl 4a):
A review of the role for pelvic floor physiotherapy in postmenopausal women with urinary incontinence
Abstract: Urinary incontinence is a prevalent condition affecting women. Pelvic floor physiotherapy is a specialized field of physiotherapy dedicated to assessing and treating pelvic floor muscles. This therapy has demonstrated benefits in addressing stress urinary incontinence in premenopausal women, with numerous studies supporting its efficacy in this population. However, pelvic floor physiotherapy in the treatment of postmenopausal women is less well-established, and furthermore, the types of urinary incontinence in postmenopausal women are much broader. We provide a comprehensive review of recent literature investigating the effectiveness of pelvic floor physiotherapy therapy for various conditions in postmenopausal women, including urinary incontinence, urgency urinary incontinence, pelvic organ prolapse, genitourinary syndrome of menopause, sexual dysfunction, and urinary incontinence in the context of obesity, frailty, mobility, and dementia. After evaluating the current literature, it is evident that there is insufficient data to definitively endorse or dismiss the utilization of Pelvic floor physiotherapy for treating urinary incontinence in postmenopausal women. Nevertheless, considering the low associated risks of pelvic floor physiotherapy, we advocate for the initiation of comprehensive, large-scale randomized studies aimed at evaluating its effectiveness in addressing urinary incontinence in postmenopausal women with special attention to vulnerable subgroups, including individuals who are obese, frail or experiencing cognitive impairment.
Source: Walgren, Lauren A. Post Reproductive Health, Dec 2024; 30(4): 239-245
Contact the library for a copy of this article
Key in Lock Syndrome: A Case Report of Situational Urge Incontinence
Abstract: Urgency urinary incontinence, a subtype of overactive bladder, is a common complaint in primary care. One type of urgency urinary incontinence is key in lock or latchkey syndrome, which causes patients to release urine uncontrollably because of a situational environmental trigger or triggers. This incontinence often occurs when patients visualize the door of their house or hear running water. This article presents the case of an older adult woman experiencing recurrent genitourinary infections in the setting of worsening key in lock syndrome.
Source: White, Krista A. The Journal of Nurse Practitioners, Sep 2024; 20(8):
Contact the library for a copy of this article
Reproductive history of parous women and urinary incontinence in midlife: A National Birth Cohort follow‐up study
Abstract:
Objective:
To investigate how reproductive history was associated with urinary incontinence in midlife.
Design:
A follow‐up study.
Setting:
Denmark.
Population:
A total of 39 977 mothers who participated in the Maternal Follow up (2013–2014) in the Danish National Birth Cohort. National registries provided their reproductive history.
Methods:
How parity, mode of birth and obstetric tears associated with urinary incontinence were estimated with adjusted odds ratios (OR) and 95% CI using logistic regression.
Main outcome measures:
Self‐reported urinary incontinence including subtypes stress, urge and mixed urinary incontinence.
Results:
At an average age of 44 years, the prevalence of any urinary incontinence was 32% (21% stress, 2% urge, and 8% mixed urinary incontinence). Women with two births more often had urinary incontinence than women with one birth (OR 1.20, 95% CI 1.10–1.31). Compared with women with only spontaneous births, a history of only caesarean sections was associated with much lower odds of urinary incontinence (OR 0.39, 95% CI 0.35–0.42) and a history of instrumental births with slightly lower odds (OR 0.92, 95% CI 0.86–0.98). Compared with no tear/first‐degree tear as the largest tear, episiotomy was associated with less urinary incontinence (OR 0.91, 95% CI 0.86–0.97) whereas third/fourth‐degree tears were associated with more (OR 1.14, 95% CI 1.04–1.25). Findings were mainly explained by similar associations with stress and mixed urinary incontinence.
Conclusions:
Vaginal birth was associated with a higher risk of long‐term urinary incontinence, but our results indicate that this risk may be reduced by shortening the second stage of birth.
Source: Kjeldsen, Anne C. BJOG: An International Journal of Obstetrics and Gynaecology, Oct 2024; 131(11): 1495-1505
A study to untangle the puzzle of urinary incontinence and frailty co‐occurrence among older adults: The roles of depression and activity engagement
Abstract: Aims:
To explore the co‐occurrence of urinary incontinence and frailty by testing the roles of depression and activity engagement guided by the mechanisms of common cause and interaction pathways.
Design:
A secondary analysis of a 1‐year three‐wave panel data collected from older nursing home residents in China.
Methods:
Changes in depression and activity engagement were regressed on urinary incontinence and frailty incidence underpinned by the common cause mechanism of chronic conditions co‐occurrence, and these changes were also taken as mediators linking from frailty to urinary incontinence incidence supported by the interaction pathways' mechanism.
Results:
A total of 348 older adults were included in this study, and 55.7% were women. The co‐occurrence of urinary incontinence and frailty was found in 16.7% of the participants at baseline. Older adults with sole frailty at baseline had almost twice the rate of incident urinary incontinence (32.7%) compared with those without (16.7%) over a 1‐year period. The subsample analyses showed that changes in depression and activity engagement failed to significantly predict the incidence of urinary incontinence and frailty. The mediating roles of these changes linking frailty to urinary incontinence incidence were also not statistically significant.
Conclusion:
The co‐occurrence of urinary incontinence and frailty is prevalent in older nursing home residents. Older adults with frailty at baseline are more likely to develop urinary incontinence a year later. The common cause and interaction pathways mechanisms for the co‐occurrence of urinary incontinence and frailty were not verified with changes in depression and activity engagement.
Source: Wang, C. Journal of Advanced Nursing, Nov 2024; 80(11): 4584-4592
Care Needs of Older Adults with Urinary Incontinence: A Cross-Sectional Study
Abstract: Purpose:
To explore care requirements of older adults with urinary incontinence (UI) and contributing factors.
Method:
This cross-sectional study used the Older Adults Urinary Incontinence Care Needs Inventory to survey participants with UI in three large-scale tertiary hospitals located in Guangzhou City, China, from January 2023 to November 2023. Statistical analyses, including analysis of variance, t tests, correlation analyses, and linear regression models, were conducted to assess factors influencing participants' care needs.
Results:
A total of 530 older adults with UI participated in the survey and mean standardized score for overall care needs was 78.65 (SD = 5.01), with mean scores for each dimension ranging from 70.88 (SD = 10.55) for social participation needs to 82.45 (SD = 7.11) for health education needs. Factors that were found to influence incontinence care needs in older adults included age, literacy level, number of leaks, and type of disease (F = 37.07, adjusted R2 = 0.290, p < 0.001).
Conclusion:
Comprehensive care for older adults with UI, encompassing physiological, psychological, and social aspects, is crucial. It is essential to tailor care to individual needs and characteristics, taking into account factors, such as age and education, to ensure effective care. [Journal of Gerontological Nursing, 50(5), 43–49.]
Source: Xiang, Su Y. Journal of Gerontological Nursing, May 2024; 50(5): 43-49
Managing female stress urinary incontinence in a post mesh era: What to do and when to refer
Abstract: SUI is defined by the International Continence Society as 'the complaint of any involuntary loss of urine on effort or physical exertion (eg sporting activities), or on sneezing or coughing'.2 SUI affects many domains of a person's life, and a large proportion of SUI can be improved or cured, but SUI is often under-reported secondary to incontinence-related stigma.3 Primary care providers are therefore essential in the assessment and management of SUI. Pathophysiology and assessment of SUI is related to weakness of the pelvic floor and urethral sphincter, resulting in leakage of urine with increased intra-abdominal pressure, such as that experienced during exercise, coughing and laughing. Proactive management of constipation, as well and encouraging reduced intake of alcohol and caffeine, are suggested.9 Both body mass index and waist circumference are positively associated with SUI,10 and weight reduction has been shown to lessen SUI symptoms, as well as improve postoperative outcomes in patients undergoing surgical intervention for SUI.11 The literature demonstrates that women with chronic respiratory conditions were twice as likely to develop urinary incontinence compared to the general population, so management of respiratory comorbidities is essential.12 Smoking cessation should also be recommended to relevant patients.9 Pelvic floor muscle training (PFMT) is highly effective in managing SUI and has a strong body of evidence (particularly in mild-moderate severity SUI cohorts).13-15 PFMT aims to strengthen the pelvic floor and sphincter complex and should be recommended as a first-line therapy to all patients with SUI13'14 (Table 4). PVS were performed in increasing numbers following the concerns about the use of mesh for prolapse surgery27 and have comparable clinical outcomes to synthetic slings, without mesh-specific complications (Table 5).28 Systematic reviews quote success rates between 46.9 and 90%.22,29 Burch colposuspension Burch colposuspension is a mesh-free treatment for primary SUI and involves placing sutures between the anterior vaginal wall (either side of the urethra) and Cooper's ligaments, thereby elevating the urethra and providing a support mechanism against rises in intra-abdominal pressure.
Source: McDonald, J. Australian Journal of General Practice, May 2024: 53(5): 283-288
The impact of male urinary incontinence on quality of life and sexual health
Abstract: Men with urinary incontinence problems may have a fear of urinary incontinence during sexual intercourse, which may negatively affect their sexual lives. This study aimed to determine the effect of urinary incontinence on quality of life and erectile dysfunction in men. A total of 203 men with urinary incontinence who presented to a urology outpatient clinic were assessed using a patient information form, the International Consultation on Incontinence Questionnaire‐Urinary Incontinence Short Form (ICIQ‐SF), and the International Index of Erectile Function (IIEF). The mean age was 63.48 ± 8.80 years, the mean ICIQ‐SF score was 13.45 ± 3.14 (moderate), and the IIEF erectile dysfunction score was 18.52 ± 6.48 (mild/moderate). Patient age correlated positively with the ICIQ‐SF total score (r = 0.309, p < 0.001) and negatively with the IIEF total score (r = −0.452, p < 0.001). The ICIQ‐SF score was negatively correlated with erectile function, orgasmic function, sexual desire, intercourse satisfaction and overall satisfaction scores (p < 0.001, p = 0.015, p = 0.037, p = 0.006 and p = 0.001, respectively). More severe urinary incontinence in men was associated with lower quality of life and greater erectile dysfunction. Further studies are needed to raise men's awareness of urinary incontinence.
Source: Gezginci, E. International Journal of Urological Nursing, Nov 2024; 18(3):
Monday, March 17, 2025
Dementia Champions: March 2025
Welcome to the latest key papers and publications focussing mainly on all things dementia, delirium and ageing in the nursing profession.
Please click on the links below and enter your OpenAthens username and password to download the full text or contact the library at esth.hirsonlibrary@nhs.net to request the full text.Keeping well with dementia: supporting the person with dementia to function to capacity
Abstract: Nearly a million people are living with dementia in the UK, and less than 65% of them have been formally diagnosed according to the Alzheimer's Society. Dementia exists on a continuum and people can have mild, moderate or severe symptoms. People with dementia are more likely to experience health problems than people of the same age who do not have dementia. Dementia affects the ability to understand and relate to the world and to manage health conditions. This article discusses how to a person with dementia can be helped to maintain health and enjoy the best possible quality of life.
Source: Nazarko L. British Journal of Community Nursing, Feb 2025; 30(3): 101-144
The care certificate: awareness of mental health, dementia and learning disability
Abstract: This article, the ninth in the series about the care certificate, will explore the meaning of the standard ‘awareness of mental health, dementia and learning disability’ and consider what this requires of the healthcare assistant.
Source: Ellis P. British Journal of Healthcare Assistants, Feb 2025; 19(2): 029-045
Managing dementia and diabetes in primary care settings
Abstract: This article looks at the links between diabetes and dementia and the prevalence of dual co-morbidity.
Source: Morris D. Independent Nurse, Feb 2025; 2025(2): 3-30
Dementia, assisted dying, euthanasia
Abstract: This article discusses assisted suicide and euthanasia in relation to dementia. It presents some broad arguments against any form of ‘assisted dying’. But then focuses on advance euthanasia directives as used in the Netherlands and the case of ‘coffee euthanasia’. Decision-making capacity and the possibility of coercion are briefly discussed. Lord Walton's robust support of the prohibition of intentional killing concludes the article.
Source: Hughes Julian C, British Journal of Neuroscience Nursing, Dec 2024; 20(6): 239-288
Immune-mediated diseases, inflammation and the increased risk of developing dementia
Abstract: Sarah Jane Palmer discusses the links between the immune system, inflammation and the increased risk of developing dementia.
Source: Palmer Sarah J. Nursing and Residential Care, Feb 2025; 27(1): 1-2
A Nurse-Initiated Protocol for Interprofessional Management of Changed Behaviours in Hospital Patients with Dementia and/or Delirium: A Modified e-Delphi Study
Abstract:
Aim: To develop a nurse-initiated protocol for early ward-based interprofessional coordination and formulation of person-centred care plans to assist in point-of-care management of behaviour in older patients on general hospital wards.
Design: A modified e-Delphi method was employed to establish expert consensus.
Method: Multidisciplinary acute-care experts experienced in hospital care of patients with dementia and/or delirium in Australia were recruited by email from 35 professional networks. Three online survey rounds were planned. The first sought free-text comments on point-of-care practices. The following rounds sought expert ratings for subsequently developed protocol components. The study occurred between January and June 2023.
Results: Fifty-three experts participated (eight completed all rounds). Existing practices, opportunities and barriers were established in round one (n = 32), informing development of three multicomponent stages: (1) a bundle of bedside care comprising generic person-centred approaches, (2) a stepped-care workflow redirecting multidisciplinary teams to adopt an interprofessional approach to formulating individualised behavioural-care and (3) a one-page Behaviour Support Plan template. Content Validity Index scores for all items in round two (n = 29) were 0.89–0.96, meeting a priori consensus criteria, and negating the need for a third round.
Conclusion: To improve outcomes for older hospital patients with changed behaviours, a multicomponent protocol for timely interprofessional formulation of point-of-care Behaviour Support Plans was established through expert panel consensus.
Impact: Management of patient behaviours has resided almost solely with nursing, ignoring the potential inherent in ward-based multidisciplinary teams. A pragmatic procedure for initiating early interprofessional support to nurses' management of behaviours may potentially improve care, safety and outcomes for patients and staff alike. Ready for feasibility testing in hospitals, the protocol capitalises on existing multidisciplinary resources.
Reporting Method: The study is reported in accordance with the Guidance on Conducting and Reporting Delphi Studies (CREDES) recommendations.
Patient or Public Contribution: No patient or public contribution.
Source: Graham Frederick A. Journal of Advanced Nursing, Jan 2025; Early View
Intensive Care Unit Admissions among Persons with Dementia: Overuse or Underuse?
Abstract: Decision-making when providing critical care to persons with dementia (PWD) should include clinical, ethical, and human rights considerations. Risks exist for both overuse and underuse of critical care among PWD since allocating resources appropriately while respecting people's wishes is challenging.
Source: Cetin-Sahin D. Journal of the American Geriatrics Society, Jan 2025; 28(7): Early View
Deprescribing considerations for central nervous system-active polypharmacy in patients with dementia
Abstract: Older adults with dementia are much more likely than those without dementia to experience polypharmacy, defined as taking at least five medications. Approximately 72% of older adults with dementia, versus only 44% of those without dementia, experience polypharmacy. Although multiple medications may be prescribed to treat multiple chronic conditions, polypharmacy in older adults is associated with increased risks of adverse drug events, cognitive and physical impairment, frailty, falls, and mortality. For older adults with dementia, the most common contributors to polypharmacy include cardiovascular medications and medications acting on the central nervous system. An estimated 73% of adults aged 65 and over with dementia use at least one cardiovascular medication, and an estimated 85% use at least one medication acting on the central nervous system. Yet another risk beyond polypharmacy alone is the concomitant use of three or more medications all acting on the central nervous system, termed central nervous system-active polypharmacy. These medications typically include: antiepileptics, antidepressants, antipsychotics, benzodiazepines, nonbenzodiazepine benzodiazepine receptor agonist hypnotics (i.e., z-drugs), opioids, and skeletal muscle relaxants. The concomitant use of these medications is associated with increased risks of falls, cognitive decline, emergency room visits, and hospitalizations. The 2023 Beers Criteria recommend against central nervous system-active polypharmacy.
Source: Hung A. Journal of the American Geriatrics Society, Nov 2024; 73(2): 343-346
Privileges, and Permissions: Theorising Intersectionality and Cultures of Control in the Care of People Living With Dementia in Acute Hospital Settings
Abstract: A longstanding body of public enquiries and research identifies people living with dementia experience systemic inequalities within hospital settings, concluding a focus on improving care cultures is required. Drawing on a 3-year multi-sited hospital ethnography, this paper examines everyday cultures of care in NHS acute hospital wards to interrogate how ethnicity, gender and social class intersects to shape the care of people living with dementia. Drawing on Collins' concept of intersectionality and the relational nature of power, the analysis reveals that while cared for by diverse teams of healthcare professionals, a patients' age, ethnicity, gender and social class, as interconnected categories, influences the tightening of ward rules for some people living with dementia and the granting of significant privileges for others. Focussing on walking within the ward, with a large number of people living with dementia classified as ‘wandering’, we explore ways in which intersectional identities informed who was granted privileges to leave the bedside and ‘wander’ the ward, and who experienced further control. The paper concludes that institutional racism and attitudes to gender, social class and ageing permeate the routine organisation and delivery of care within NHS acute hospital wards to significantly impact people living with dementia, and in turn, increases the consideration of care pathways that emphasise their discharge to institutional settings.
Source: Mwale S. Sociology of Health and Illness, Jan 2025; 47(1): e13869
Midlife is good for more than a crisis: Exercise for dementia prevention
Abstract: Alzheimer's disease (AD) will have touched the lives of many readers, as nearly 7 million older Americans currently live with the disease. While there has been recent progress toward disease-modifying treatment, these medications have limited efficacy, carry known risks (e.g., brain bleeding and brain swelling), and are expensive. Given the current Alzheimer's landscape, identifying effective ways to prevent dementia is of paramount importance. Engaging in physical activity, or exercise, is a widely accepted strategy for dementia prevention. However, questions about the causal nature of the relationship remain. While epidemiological and cohort studies have consistently shown benefits of exercise for reducing dementia risk, evidence from randomized controlled trials (RCTs), the gold standard for assessing causality, is a mixed bag. Indeed, trials provide inconsistent results on the benefits of exercise, possibly due to difference in exercise duration, modality, and intensity, in addition to trial design and participant characteristics.
Source: Fenton L. Journal of the American Geriatrics Society, Oct 2024; 72(12): 3627-3630
Dementia Diagnosis Before and After Hip Fracture in Medicare Patients
Abstract: Dementia is a risk factor for hip fracture. Persons with both hip fracture and dementia are medically complex and have heightened risk for post-operative complications, hospital readmission, functional impairment, and death. Despite implications for healthcare quality and post-acute care reimbursement reform, little is known about the prevalence and trajectory of dementia diagnosis before and after hospitalization for hip fracture.
Source: Reider L. Journal of the American Geriatrics Society, Dec 2024; Early View
Clinician contributions to central nervous system-active polypharmacy among older adults with dementia in the United States
Abstract:
Background: Exposure to central nervous system (CNS)-active polypharmacy—overlapping exposure to three or more CNS-active medications—is potentially harmful yet common among persons living with dementia (PLWD). The extent to which these medications are prescribed to community-dwelling PLWD by individual clinicians versus distributed across multiple prescribers is unclear.
Methods: We identified community-dwelling Medicare beneficiaries with a dementia diagnosis and Medicare Parts A, B, and D coverage for at least one month in 2019. Using fill date and days' supply for prescriptions filled between January 1, 2019 and December 31, 2019, we identified beneficiaries exposed to CNS-active polypharmacy (i.e., >30 days of overlapping exposure to three or more antidepressant, antipsychotic, antiseizure, benzodiazepine, opioid, nonbenzodiazepine benzodiazepine receptor agonists, or skeletal muscle relaxant medications). We examined the number and type of clinicians who contributed to polypharmacy person-days among PLWD.
Results: The cohort included 955,074 PLWD who were primarily female (64.0%), were White (78.5%), and had a mean age of 83.4 years (standard deviation 8.0). Notably, 14.3% were exposed to CNS-active polypharmacy. At the person level, 24.6% of PLWD experienced polypharmacy prescribed by a single clinician. Considering total days of exposure, 45.3% of polypharmacy person-days were prescribed by a single clinician. Primary care physicians prescribed 63.0% of polypharmacy person-days and accounted for the plurality of days for all seven medication classes, followed by psychiatrists for antipsychotics and benzodiazepines and primary care advanced practice providers (APPs) for antidepressants and antiseizure medications.
Conclusion: In this cross-sectional analysis of Medicare claims data, primary care clinicians (both physicians and APPs) prescribed the majority of medications that contributed to CNS-active polypharmacy for PLWD. Future research is needed to identify strategies to support primary care clinicians in appropriate prescribing of CNS-active medications to PLWD.
Source: Vordenberg Sarah E. Journal of the American Geriatrics Society, Nov 2024; 73(2): 422-430
Faecal incontinence management in dementia patients
Abstract: Faecal incontinence is a complex issue faced by many older adults. This article will provide an overview of this condition and its causes. It will also provide policy and guidance on the subject, its general management, complications, the support available for carers, and the issue of faecal incontinence in someone who has dementia.
Source: Palmer, S J. British Journal of Community Nursing, Nov 2022; 27(11): 521-566
Colder Climates and Dementia: An Ecological Analysis of Climate-Patterned Temperature's Influence on Neurological Health
Abstract: Countries with lower climate-patterned temperatures (Tcp), typically colder, have not been consistently correlated with higher dementia risk in population studies. This study explores Tcp's influence on global and regional dementia rates. Country-specific Tcp data was analyzed alongside dementia incidence using bivariate analysis, partial correlation, and multiple linear regression. Factors like life expectancy (Life e(0)), economic affluence, genetic predisposition (Biological State Index), and urbanization were considered. Both Pearson's r and nonparametric tests revealed a significant inverse correlation between Tcp and dementia incidence, holding true even after adjusting for life expectancy, affluence, genetic predisposition, and urbanization. Multiple linear regression identified Tcp as a key predictor of dementia incidence, ranking second after life expectancy. Affluence, genetic predisposition, and urbanization did not significantly predict dementia rates. Tcp's predictive power was consistent across different country groups, with minor correlation variations between developing versus developed countries and LMICs versus high-income nations. Countries with colder climate (lower Tcp) may experience higher dementia rates, a correlation robust across major risk factors. Including Tcp in dementia studies is crucial for understanding its public health implications.
Source: You W. Nursing and Health Sciences, Dec 2024; 26(4): e70012
Dementia-Friendly Hospital—the Perspective of Professional Dementia Experts
Abstract:
Aim: To investigate the professional dementia experts' understanding of a dementia-friendly hospital to identify its characteristics.
Design: We used a qualitative design embedded in a case study. A total of 16 semi-structured expert interviews were conducted with 17 professional dementia experts. Using inductive content analysis, the interviews were analysed in a participatory manner involving a group of researchers and dementia experts.
Results: We identified six characteristics of dementia-friendly hospitals: Proud to be dementia-friendly—That's what we want; Seeing the human being
—Taking care of everyone; Having everyone on board—It's a collective task; Being professional
—It takes more than being nice and kind; Rethinking the ‘running’ system
—We have to change, not them; and Being part of the community
—Thinking beyond the hospital.
Conclusion: The concept of a dementia-friendly hospital seems complex and requires a rethinking of the traditional hospital. For a conceptualisation, the involvement of people with dementia and their relatives is important to gain a comprehensive understanding.
Implications for the Profession and Patient Care: A dementia-friendly hospital is characterised by professional care that comprises a safe, familiar and supportive environment, is prepared but also flexible, has everyone on board, and sees the human being. To become dementia-friendly, individual interventions such as training courses can be a starting point. However, an overall concept is required that also includes components that contribute to successful implementation and a welcoming culture of people with dementia.
Impact: Our findings on the perspective of professional dementia experts contribute to the conceptualisation of dementia-friendly hospitals.
Reporting Method: We reported our study according to the COREQ checklist.
Patient and Public Contribution: The investigation of the perspective of professional dementia experts is one part of a larger study. In this overall DEMfriendlyHospital study, we interviewed professional dementia experts, people with dementia and their relatives and also involved them in a participatory manner in various stages of the research process.
Source: Manietta C. Journal of Clinical Nursing, Sep 2024; Early View
An innovative model of behavioral healthcare for older adults with serious mental illness, substance use disorders, and dementia
Abstract:
Introduction: Older adults with serious mental illness (SMI) experience higher rates of medical comorbidities, mortality, hospital readmissions, and total healthcare spending when compared with Medicare beneficiaries without SMI. Although telehealth provides an opportunity to overcome barriers to behavioral healthcare access, older adults face unique challenges when accessing and utilizing telehealth services. We present Author Health's care model, which integrates virtual-first behavioral health care with an interdisciplinary approach to health-related social needs (HRSN) screening and intervention in older adults.
Methods: We launched an innovative behavioral healthcare delivery model in collaboration with primary care for Medicare Advantage recipients with SMI, substance use disorders (SUD), and dementia. All patients completed an intake with an MD/NP and were offered screening for HRSN at entry using the Accountable Health Communities HRSN tool. Primary diagnosis was assigned and categorized into SMI/SUD/dementia and non-SMI. Logistic regression was used to quantify the odds of food, housing, and transportation insecurity explained by SMI/SUD/dementia versus non-SMI behavioral health conditions.
Results: A total of 2301 patients completed an intake from January 2023 to March 2024. Moderate/severe depression (40%) was the most common primary target condition at intake, followed by dementia/Alzheimer's disease (12%) and bipolar disorder (5%). The rates of housing insecurity, food insecurity, and transportation insecurity were 27%, 30%, and 21%, respectively. Within our sample of Medicare Advantage participants in Florida, patients with SMI/SUD/dementia were 1.42 times (p < 0.05) and 1.58 times (p < 0.01) more likely to report housing insecurity and food insecurity, respectively, when compared with those with mild/moderate behavioral health conditions.
Conclusion: Author Health provides a blueprint for behavioral health services that remove barriers and provide tenacious, consistent, and whole-person virtual-first behavioral health care tailored to the unique needs of older adults. Our sample of Medicare Advantage participants in Florida suggests SMI/SUD/dementia may be a predictor for HRSN independent of socioeconomic status and race/ethnicity.
Source: Chukrun T. Journal of the American Geriatrics Society, Dec 2024; Early View
Organizational factors associated with less use of restraints in older adults with dementia in acute care hospitals: A scoping review
Abstract:
Objective: Dementia affects more than 55 million people worldwide. Use of restraints for hospitalized older adults with dementia is a social issue that should be addressed systematically and should not depend on the characteristics of nurses. This study reviewed the literature on organizational factors associated with reducing use of restraints in older adults with dementia admitted to acute care hospitals.
Methods: A scoping review was performed. Three databases were searched for papers that met our eligibility criteria. Factors related to restraint reduction were extracted, and results were deduced. Through inductive analysis, subthemes were categorized according to similarities and differences, which were then integrated into broader themes.
Results: Sixteen studies were eligible for inclusion. The prevalence of restraints ranged from 5.1% to 80.0% depending on how the meaning of restraint was interpreted. The most common indications for restraints were history of falls and fall risk. Interdisciplinary screening for restraints was associated with reduced prevalence of restraints, with a 0.18-fold (confidence interval [CI]: 0.12–0.24) reduction through use of a restraint decision flowchart and a 0.76-fold (CI: 0.63–0.92) reduction through consultation with a psychiatrist. Interdisciplinary members included nurses, physicians, clinical psychologists, pharmacists, respiratory therapists, and therapists.
Conclusions: Research is needed to introduce and develop an interdisciplinary restraint decision-making system and to test its effectiveness. Important factors in implementing alternatives to restraints are the harmful effects of restraints, expertise in dementia, regular education on alternative methods, an inpatient environment that ensures patient safety, and the development of human resources.
Source: Makino M. Japan Journal of Nursing Science, Sep 2024; 21(4): e12620
Supportive Interventions Involving Family Carers of Patients with Delirium Superimposed on Dementia in Hospital: A Scoping Review
Abstract:
Background: People with dementia admitted to hospital are at risk of developing delirium. Patients with delirium superimposed on dementia (DSD) have higher mortality rates, longer hospital stays and further cognitive loss. The role of family is often recommended as a resource to inform and support how patients with dementia's needs are understood. This review focuses on ward-based interventions that enable family carers and health care professionals to work together to improve patient experience and outcomes.
Aim: To review evidence on ward-based approaches involving family (or their proxies) and staff working together to prevent and manage delirium for patients living with dementia.
Methods: We undertook a scoping review including all types of research. Six electronic databases were searched (CINAHL, MEDLINE (run twice), EMBASE, Cochrane, PsycINFO and PubMed). The search was limited to papers written in English and published from 2009 to 2019. The search was updated in 2023. Papers were independently read by two researchers. Findings were presented through narrative synthesis (Prospero CRD42019130369).
Results: Fifteen papers were included. Studies focused on educational and system change to improve the care of people with DSD. Family involvement ranged from enabling baseline assessment of delirium, commenting on different resources and measures designed to support their involvement in care or simulate their presence. The evidence of effectiveness was varied. Interventions to support personalised care and give family carers and staff confidence were positively evaluated in some studies but not all included both family carers and staff. Benefits to patients over time were less clearly demonstrated.
Conclusion: This review identified the potential of family to mitigate the risk of delirium and improve patient outcomes. Further research is needed to understand how system and practitioner changes to enable family involvement in the support of people with DSD benefit patients in the short and long term.
Relevance to Clinical Practice: The review findings provide evidence for clinical practice when selecting existing interventions and approaches involving family in supporting patients with DSD.
Patient or Public Contribution: Not required as this was a review, not an original piece of research.
Source: Ashton-Gough C. International Journal of Older People Nursing, Feb 2025; 20(2): e70016
Role of a Dementia Virtual Reality App in Developing Situated Empathy, Attitude and Person-Centred Care—A Qualitative Approach
Abstract:
Background: The demands of any health education programme including nurse education would benefit from innovative ways to support students learning in an effective and efficient manner. Such approaches resonate particularly when caring for older people living with dementia, due to multifactorial manifestations of the condition, patients' difficulty in articulating their needs and the potential for negative care outcomes. Empathy is an important part of understanding dementia and is also recognised as a complex and multidimensional concept.
Objective: This study investigated the impact of undergraduate nursing students' 15-min use of the Experience Dementia in Singapore (EDIS) virtual reality app in their tutorial lesson for developing their empathy, changing their attitude and increasing their sensitivity for person-centred care of people with dementia.
Method: We carried out content and thematic analysis of data anonymously collected via the in-class learning activities at the start and at the end of the lesson.
Results: All participating students (n = 89, 89% response rate) achieved their learning goal to experience a first-person perspective and gain insights into needs and care for persons living with dementia. The results showed students transitioned from having mainly knowledge foremost in their mind, to more empathetic and care related thoughts when delivering care to persons living with dementia. The experience made more students aware of how they could communicate care, make environmental modifications to support and develop an attitude of person-centred care for persons living with dementia and their families. The analysis resulted in four themes: (1) immersive learning—walking in the shoes of the person living with dementia (2) feelings evoked from the first-person perspective (3) little things, big impact; little things, positive impact; and (4) communicating care.
Conclusion: The EDIS virtual reality app was an efficient and effective way for students to develop essential elements, especially empathy, as well as positive attitudes and sensitivity towards person-centred care for those living with dementia.
Implications for Practice: The first-hand experience the VR app offers allows students to challenge pre-conceived perceptions about older people and those living with dementia. As such, it is a versatile tool that can be incorporated into a variety of study and training programmes for students, professionals and caregivers who provide care or care solutions for persons living with dementia and their families.
Source: Tan Chin P. International Journal of Older People Nursing, Feb 2025; 20(2): e70012
Cardiovascular health, measured using Life's Essential 8, is associated with reduced dementia risk among older men and women
Abstract:
Background: Dementia poses considerable challenges to healthy aging. Prevention and management of dementia are essential given the lack of effective treatments for this condition.
Methods: A secondary data analysis was conducted using data from 928 InCHIANTI study participants (55% female) aged 65 years and older without dementia at baseline. Cardiovascular health (CVH) was assessed by the “Life's Essential 8” (LE8) metric that included health behaviors (diet, physical activity, smoking status, sleep duration) and health factors (body mass index, blood lipid, blood glucose, blood pressure). This new LE8 metric scores from 0 to 100, with categorization including “low LE8” (0–49), indicating low CVH, “moderate LE8 (50-79)”, indicating moderate CVH, and “high LE8 (80-100)”, indicating high CVH. Dementia was ascertained by a combination of neuropsychological testing and clinical assessment at each follow-up visit. Cox proportional hazards models were used to examine associations between CVH at baseline and risk of incident dementia after a median follow-up of 14 years.
Results: Better CVH (moderate/high LE8 vs. low LE8) was inversely associated with the risk of incident dementia (hazard ratio [HR]: 0.61, 95% confidence interval [CI]: 0.46–0.83, p = 0.001). Compared with health factors, higher scores of the health behaviors (per 1 standard deviation [SD]), specifically weekly moderate-to-vigorous physical activity time (per 1 SD), were significantly associated with a lower risk of incident dementia (health behaviors: HR: 0.84, CI: 0.73–0.96, p = 0.01; physical activity: HR: 0.62, CI: 0.53–0.72, p < 0.001).
Conclusion: While longitudinal studies with repeated measures of CVH are needed to confirm these findings, improving CVH, measured by the LE8 metric, may be a promising dementia prevention strategy.
Source: Li X. Journal of the American Geriatrics Society, Sep 2024; 72(12): 3695-3704
The Experience of Hospitalisation for People Living With Dementia: A Qualitative Exploration of How Context Shapes Experiences
Abstract:
Introduction: Dementia has become an increasingly pressing issue in healthcare systems, and acute care settings such as hospitals have been shown to be particularly problematic for people living with dementia. People living with dementia are hospitalised at higher rates than those without and often have poor experiences and outcomes of hospitalisation. To support the evolution of hospital systems to better meet the needs of people living with dementia, it is important to consider the relationship between the context of the hospital and the experiences of people living with dementia and their caregivers. The term context refers to the environment and conditions that shape experiences and includes elements such as policies, procedures, design and social norms. A greater understanding of the relationship between the hospital context and the experiences of people living with dementia will support the future development of interventions to modify contextual elements to improve the experiences of people living with dementia. Our aim was to explore the relationship between the experiences of people living with dementia and their caregivers in hospital, and the contextual elements of the hospital.
Methods: In this interpretive descriptive study, we conducted interviews with people living with dementia and caregivers of people living with dementia about their experiences in hospital. Interviews were conducted with people living with dementia (n = 3), caregivers of people living with dementia (n = 8) and one dyad of a person living with dementia and their caregiver (n = 1) about the hospitalisation of the person living with dementia. Using inductive and deductive methods of analysis, we describe contextual factors that shape their experiences.
Results: Our findings demonstrate how the hospital context shaped the experiences of people living with dementia and their caregivers while the person living with dementia was hospitalised. The themes reflect elements of the hospital context: communication systems, the value of caregivers, the focus on acute physical needs, staff capacity, the physical environment and normalised practices. The findings suggest that there are aspects of the hospital context that can be modified to influence the experiences of people living with dementia and their caregivers.
Conclusion: This study demonstrates how the context of hospital shapes the experiences of people living with dementia and their caregivers and points to aspects of the context that health system leaders could explore to begin to improve the capacity of hospitals to support people living with dementia.
Implications for Practice: The study provides evidence of the need for health system leaders and practitioner to explore how the hospital context shapes the experiences of people with dementia and their caregivers, and begins to explore ways that contextual changes can improve their experiences.
Source: Moody E. International Journal of Older People Nursing, Sept 2024; 19(6): e12651
Navigating Dementia and Delirium: Balancing Identity and Interests in Advance Directives
Abstract: The moral authority of advance directives (ADs) in the context of persons living with dementia (PLWD) has sparked a multifaceted debate, encompassing concerns such as authenticity and the appropriate involvement of caregivers. Dresser critiques ADs based on Parfit's account of numeric personal identity, using the often-discussed case of a PLWD called Margo. She claims that dementia leads to a new manifestation of Margo emerging, which then contracts pneumonia. Dworkin proposes that critical interests, concerning one's higher moral values, trump experiential interests (things or activities one enjoys because they are pleasurable). Dresser argues that Margo's current experiential interests override her self's critical ones, as they contribute significantly to her quality of life (QoL). To render the argument more realistic, I introduce a variation in which Margo develops delirium, a common and severe comorbidity in PLWD. I argue that delirium could precipitate a sudden decline in experiential interests and, consequently, a deterioration in QoL. Given the uncertain trajectory of Margo's illness, I contend that her competent self's critical interests, as reflected in her AD, along with her right to self-ownership, should take precedence over current experiential interests. Thus, the AD possesses moral authority. However, it is imperative for healthcare professionals to offer consultations for PLWD, facilitating an understanding of ADs and enabling a shared decision-making process. Such consultations are essential for honouring the autonomy and dignity of PLWD, ensuring that their values and preferences guide ethical decision-making amidst the complexities of dementia care.
Source: Rutenkröger M. Nursing Philosophy, Jan 2025; 26(1): e70016
The Effects of Exergaming on the Depressive Symptoms of People with Dementia: A Systematic Review and Meta-Analysis
Abstract:
Background: Depressive symptoms are common among people with dementia (PWD). Exergaming consisting of combined cognitive and physical training in gaming is increasingly used to alleviate their depressive symptoms in research. With its potential synergistic neurobiological and psychosocial effects on reducing depressive symptoms among PWD, this review aimed to understand its effectiveness and contents.
Methods: This is a systematic review of the effectiveness of exergames on depressive symptoms among older adults with dementia. A search was conducted on 7 May 2024 of the online databases CINAHL, Embase, PsycINFO, PubMed and the China Academic Journal Network Publishing Database (CNKI). The methodological quality of randomised controlled trials (RCT) and quasi-experimental studies was assessed with RoB2 and ROBINS-I, respectively. A meta-analysis of the included RCTs was conducted.
Results: Six studies consisting of four RCTs and two quasi-experimental studies involving 235 participants with various stages of dementia were included. The meta-analysis showed a significant overall improvement in depression with a large effect size (SMD = 1.46, 95% CI = −2.50, −0.43; p = 0.006). Despite high heterogeneity (I2 = 91%), all studies demonstrated a trend of improvement in depression after the intervention. The exergames adopted in the included trials had the following elements: simultaneous motor-cognitive training, a scoring mechanism and a social play. The dose of exergames ranged from 15 to 60 min per session for at least 8 weeks, with a minimum of two sessions weekly. However, the included studies had a moderate-to-serious risk of bias. The certainty of the evidence was very low.
Conclusion: Exergames could be effective at improving the depressive symptoms of older adults with dementia. Yet, a moderate-to-severe risk of bias shows a rigorous study should be conducted in the future.
Implications for Patient Care: This study provides evidence for healthcare professionals and informal caregivers to use exergames to address depressive symptoms in PWD.
Review Registration: The review was registered on PROSPERO with the reference CRD42022372762.
Source: Cheung Daphne S K. Journal of Clinical Nursing, Jan 2025; Early View
A meta-analysis of person-centered care interventions for improving health outcomes in persons living with dementia
Abstract:
Background: Person-centered care emphasizes the importance of valuing and supporting the humanness of a person living with dementia as compared to focusing heavily on disease symptom management and treatment. The state of the evidence and outcomes from person-centered care is unclear and is an important knowledge gap to address informed evidence-based care for persons living with dementia.
Aims: To synthesize the evidence on the efficacy of person-centered care in improving health outcomes in people living with dementia.
Methods: Our search using the following databases: Academic Search Complete, CINAHL, COCHRANE library, EMBASE, MEDLINE, PubMed, and Google Scholar. The methodology quality of the included studies was assessed using a revised Cochrane risk-of-bias tool for randomized trials. Meta-analyses were performed using the DerSimonian and Laird random effects model to investigate the effectiveness of person-centered care on improving health outcomes in persons living with dementia.
Results: Seventeen trials were included in this systematic review and meta-analysis. Person-centered care implementation was found to improve cognitive function (pooled SMD: 0.22; 9CRD420223808975% CI [0.04, 0.41], p = .02) in persons living with dementia, although outcomes including the impact of the care model on activities of daily living, agitation, depression, and quality of life remain inconclusive.
Linking Evidence to Action: Person-centered care improves the cognitive function of persons living with dementia, which is clinically meaningful and should not be ignored or overlooked in delivering evidence-based care to this population. The findings of this study emphasize the importance of person-centered care implementation among people living with dementia as an approach in improving health outcomes particularly on cognitive function improvement. Person-centered care emphasizes the personhood of individuals living with dementia while respecting their needs, values, and beliefs and is identified as a preferred model of delivering dementia care in all settings as a non-pharmacological approach.
Source: Saragih Ita D. Worldviews on Evidence-Based Nursing, Sep 2024; 22(1): e12746
Towards Establishing Quality Standards on Human Rights for Services in Dementia Care
Abstract:
Background: People with dementia often experience violations of fundamental human rights and impeded access to healthcare. This study aims to investigate the views of experts regarding the use of the United Nations Convention on the Rights of People with Disabilities (CRPD) principles as quality standards for human rights–based care.
Methods: A single-round Delphi e-consultation with 15 dementia experts was designed to evaluate each CRPD principle and collect feedback on their views about the application of the CRPD principles in dementia care.
Results: The CRPD principles were fully endorsed as quality standards; however, several experts commented on the complexities of the use of CRPD principles in relation to information disclosure, capacity assessment, stakeholders' involvement in decision-making, respecting needs and preferences, holistic approaches in care practice, and protection against abuse, neglect and discrimination.
Conclusions: These findings indicate the CRPD quality standards were fully applicable for people with dementia although some clarification around interpretation could assist in their use. Future research should elaborate on further points of support and guidance for dementia care providing examples of good practice from across the globe, and develop a concordant, human rights–based scheme for the implementation and evaluation of dementia services.
Implications for Practice: This study suggests that the CRPD can serve as a benchmark for human rights-based practices in dementia services globally that could enhance nursing care practice. Nursing staff are encouraged to consider human rights in relation to the complexities associated with people with dementia, their caregivers, and other services involved in their care.
Source: Panagiotidou N. Sep 2024, International Journal of Older People Nursing; 19(5): e12643
Effectiveness of Horticultural Therapy in Older Patients with Dementia: A Meta-Analysis Systemic Review
Abstract:
Aim: Our study aims to assess the effectiveness of horticultural therapy in improving outcomes in older patients with dementia.
Design: A systematic review and meta-analysis.
Methods: The included studies comprised randomised controlled trials (RCTs) that aimed to assess the effectiveness of horticultural therapy on cognitive function in older patients with dementia. The study design and data extraction were independently conducted by two investigators, who also evaluated the risk of bias using RoB 2.0. The meta-analysis was carried out using Stata 15.1 software.
Data Sources: On November 2023, we searched relevant English and Chinese publications in PubMed, Web of Science, Cochrane Library, Embase, CNKI and Wanfang databases.
Results: The meta-analysis included a total of 9 RCTs, involving 655 older patients diagnosed with dementia. The findings from these studies demonstrated that horticultural therapy had a significant positive impact on various aspects of the patients' well-being when compared to conventional care. Specifically, it was found to improve cognitive function scores, alleviate symptoms of depression, enhance daily activities and enhance overall quality of life. When conducting a subgroup analysis, it was observed that horticultural therapy had a statistically significant effect on cognitive function in older patients with dementia when the intervention frequency was at least two times per week. Furthermore, interventions with a duration of less than 6 months were found to be more effective than those lasting 6 months or longer. Additionally, outdoor horticultural therapy was found to be superior to indoor interventions. Moreover, structured interventions were observed to yield better outcomes compared to non-structured interventions.
Conclusion: More high-quality studies are needed to further corroborate these findings due to the low quality of the included studies. Horticultural therapy has been found to have a significantly positive impact on the cognitive function, depression status, ADL, and quality of life of older patients with dementia.
Implications for the Profession and/or Patient Care: We provide references for non-pharmacologic treatment of older patients with dementia.
What Problem Did the Study Address? This study aimed to measure the efficacy of horticultural therapy in older patients with dementia across four dimensions: cognitive function, depression levels, daily living activities and overall quality of life.
What Were the Main Findings? In older patients with dementia, horticultural therapy has been proven to have a significant positive impact on cognitive function, depressive status, activities of daily living and quality of life.
Where and on Whom Will the Research Have an Impact? This study will inform non-pharmacological interventions for older patients with dementia worldwide.
Patient or Public Contribution: No Patient or Public Contribution.
Source: Wang M. Journal of Clinical Nursing, Sep 2024; 33(12): 4543-4553
Effect of Massage and Touch on Agitation in Dementia: A Meta-Analysis
Abstract:
Aims and Objectives: To systematically assess the effects of massage and touch on agitation in patients with dementia and to determine the optimal intervention design.
Background: Agitated behaviour is the most common behavioural symptom in patients with dementia and can seriously affect the health status and quality of life of individuals with dementia and their caregivers. Massage and touch have been widely used as a non-pharmacological intervention to address the behavioural issues of dementia. However, current research findings on the effects of massage and touch on agitation in people with dementia are inconsistent.
Design: A meta-analysis of randomised controlled trials.
Methods: This meta-analysis complied with PRISMA guidelines, and relevant literature up to January 2024 was systematically retrieved from PubMed, Embase, Web of Science, the Clinical Trials Registry, Cochrane Library and four Chinese databases. Statistical evaluations were performed utilising Review Manager 5.4, and the included studies' bias risks were assessed with the Cochrane Collaboration tool.
Results: Seventeen randomised controlled trials involving 980 patients with dementia were included. The results of the meta-analysis showed that massage and touch could ameliorate agitation and behaviour problems in dementia. Subgroup analyses based on massage type showed that hand, head and foot massage significantly improved agitation. Massage and touch for ≤ 4 weeks were more effective in reducing agitated behaviour than those for > 4 weeks. Furthermore, subgroup analysis revealed that massages and touch were more effective for individuals with less severe dementia.
Conclusions: Massage and touch in the short term can effectively improve agitation in dementia patients, while hand, head and foot massage can effectively reduce agitation. Thus, clinical nursing staff and caregivers of individuals should be actively helped to apply massage and touch to their patients. However, more studies are needed to validate our results before we can give a more definitive recommendation.
Relevance to Clinical Practice: This study suggests that massage and touch can be used as complementary treatments for agitation in people with dementia and encourages nursing staff and caregivers to apply massage and touch to better cope with the agitated behaviour of older adults with dementia.
Patient or Public Contribution: No patient or public contribution.
Trial Registration: PROSPERO registration number: CRD42024507133
Source: Lui X. Journal of Clinical Nursing, Feb 2025; Early View
Perspectives on the Dementia Public Health Exposome
Abstract: Dementia is a public health concern in the aging population with an estimated 55 million people impacted globally. Public health initiatives that focus on minimizing dementia risk factors may support efforts to reduce the incidence of dementia in at-risk populations. Exposomics considers both modifiable and non-modifiable risk factors for disease, including genetic changes with age and lifetime exposures to environmental, social, and behavioral risk factors. Dementia precursors may remain undetected for up to 20 years. An understanding and application of the dementia exposome may promote healthy brain interventions, screening, and risk mitigation. The proposed dementia public health exposome (DPHE) provides a framework for understanding and addressing the complex interactions between genetics, health behavior, and environment (natural, built, and social) linked to modifiable and non-modifiable risk factors for dementia. The DPHE may be used to inform public health strategies and advancements in healthy brain initiatives.
Source: Flaherty Christine N. Nursing and Health Policy Perspective, Oct 2024; 42(1): 215-220
Capacity assessment for euthanasia in dementia: A qualitative study of 60 Dutch cases
Abstract:
Background: The number of patients with dementia who are granted euthanasia or assisted suicide (EAS) increases yearly in the Netherlands. By law, patients need to be decisionally competent or have an advance directive. Assessment of decisional capacity is challenging as dementia progressively affects cognitive performance. We aimed to assess qualitatively which factors, and how, influence the judgment of decisional capacity in EAS cases with dementia.
Methods: We performed a qualitative study of 60 dementia EAS case summaries published by the Dutch regional euthanasia review committees between 2012 and 2021. Included reports were evaluated using the grounded theory approach. All quotes related to decisional capacity were coded independently by two researchers and compared in an iterative process to formulate an overarching framework on the assessment of decisional capacity. We selected 20 patients who had an advance directive and were judged to be decisionally compromised, as well as a selection of 40 EAS cases judged to be decisionally competent, half of which also had an advance directive (purposive sampling).
Results: Decisional capacity was present in every case report. Predefined, external criteria were rarely described explicitly, but physicians indirectly referred to the (cognitive) criteria set by Appelbaum and Grisso. Whether the thresholds for these dimensional criteria were met was influenced by six supporting factors (level of communication, psychiatric comorbidity, personality, presence of an advance directive, consistency of the request, and, finally, the patient–physician relationship) that also directly contributed to the judgment of capacity. The involved physicians and executed investigations were the two contextual factors providing a background.
Conclusions: Decisional capacity regarding euthanasia is a multidimensional construct, often implicitly assessed and influenced by supporting and contextual factors. The subjectivity of the final judgment poses ethical and legal issues and argues for continuous quality improvement processes.
Source: Van den Bosch A. Journal of the American Geriatrics Society, Oct 2024; 73(1): 112-122
Dexmedetomidine for agitation in dementia: Current data and future direction
Abstract:
Background: The incidence and prevalence of dementia, and thus dementia-related behavioral and psychological symptoms, are increasing significantly. Currently, there are limited safe and efficacious options for treating these symptoms. Dexmedetomidine has been used for agitation related to delirium and showed significant benefit in prior studies. This raises the question whether dexmedetomidine could also provide a safe and effective treatment for BPSD, including agitation related to dementia.
Methods: Our team searched PubMed, Cochrane Database, and Ovid with the terms dexmedetomidine and dementia. Only studies published in English language journals, or with official English language translations, and human studies were included. All reports of dexmedetomidine for dementia were included regardless of study type.
Results: No completed studies on dexmedetomidine for agitation in dementia were identified. The TRANQUILITY study is in progress, although results are yet to be published.
Conclusion: Dexmedetomidine has shown benefit for hospital delirium and for agitation in schizophrenia and bipolar disorder. However, there are no completed studies published on dexmedetomidine for agitation in dementia. Controlled studies with larger sample sizes are needed to assess the efficacy, safety, and the best route of administration for this drug in managing BPSD including agitation.
Source: Murphy Kayla S. Journal of the American Geriatrics Society, Sep 2024; 73(2): 552-557
Neuropsychiatric presentations of common dementia syndromes: A concise review for primary care team members
Abstract: Dementia is a syndrome characterized by cognitive changes which interfere with daily functioning. Neuropsychiatric symptoms (NPS) are also pervasive and may even occur prior to any noticeable cognitive decline. Still, NPS are less associated with the early stages of the disease course, despite mounting research evidence that NPS present early and often in several dementia syndromes, even in the absence of cognitive decline (i.e., mild behavioral impairment [MBI]). Primary care teams are at the forefront of dementia care, yet they frequently report insufficient training in dementia diagnosis and management. This poses a serious problem considering that timely diagnosis of dementia is critical for optimal outcomes and maximum efficacy of intervention. We provide a concise narrative review of four dementia syndromes (Alzheimer's disease, vascular dementia, dementia with Lewy bodies, and behavioral variant frontotemporal dementia) and their associated neuropsychiatric presentations, as well as at-a-glance clinical guides, to help primary care team members recognize possible prodromal neurodegenerative disease and to prompt further workup. We also review next steps in the management of dementia and symptoms of MBI for primary care team members. As evidenced by the NPS profiles of these dementia syndromes, subacute new onset of psychiatric symptoms in an older adult should prompt consideration of an emerging dementia process and possible further workup of such, even in the absence of cognitive decline.
Source: Bell Z. Journal of the American Geriatrics Society, Oct 2024; 73(2): 349-357
Conclusion: The concept of a dementia-friendly hospital seems complex and requires a rethinking of the traditional hospital. For a conceptualisation, the involvement of people with dementia and their relatives is important to gain a comprehensive understanding.
Implications for the Profession and Patient Care: A dementia-friendly hospital is characterised by professional care that comprises a safe, familiar and supportive environment, is prepared but also flexible, has everyone on board, and sees the human being. To become dementia-friendly, individual interventions such as training courses can be a starting point. However, an overall concept is required that also includes components that contribute to successful implementation and a welcoming culture of people with dementia.
Impact: Our findings on the perspective of professional dementia experts contribute to the conceptualisation of dementia-friendly hospitals.
Reporting Method: We reported our study according to the COREQ checklist.
Patient and Public Contribution: The investigation of the perspective of professional dementia experts is one part of a larger study. In this overall DEMfriendlyHospital study, we interviewed professional dementia experts, people with dementia and their relatives and also involved them in a participatory manner in various stages of the research process.
Source: Manietta C. Journal of Clinical Nursing, Sep 2024; Early View
An innovative model of behavioral healthcare for older adults with serious mental illness, substance use disorders, and dementia
Abstract:
Introduction: Older adults with serious mental illness (SMI) experience higher rates of medical comorbidities, mortality, hospital readmissions, and total healthcare spending when compared with Medicare beneficiaries without SMI. Although telehealth provides an opportunity to overcome barriers to behavioral healthcare access, older adults face unique challenges when accessing and utilizing telehealth services. We present Author Health's care model, which integrates virtual-first behavioral health care with an interdisciplinary approach to health-related social needs (HRSN) screening and intervention in older adults.
Methods: We launched an innovative behavioral healthcare delivery model in collaboration with primary care for Medicare Advantage recipients with SMI, substance use disorders (SUD), and dementia. All patients completed an intake with an MD/NP and were offered screening for HRSN at entry using the Accountable Health Communities HRSN tool. Primary diagnosis was assigned and categorized into SMI/SUD/dementia and non-SMI. Logistic regression was used to quantify the odds of food, housing, and transportation insecurity explained by SMI/SUD/dementia versus non-SMI behavioral health conditions.
Results: A total of 2301 patients completed an intake from January 2023 to March 2024. Moderate/severe depression (40%) was the most common primary target condition at intake, followed by dementia/Alzheimer's disease (12%) and bipolar disorder (5%). The rates of housing insecurity, food insecurity, and transportation insecurity were 27%, 30%, and 21%, respectively. Within our sample of Medicare Advantage participants in Florida, patients with SMI/SUD/dementia were 1.42 times (p < 0.05) and 1.58 times (p < 0.01) more likely to report housing insecurity and food insecurity, respectively, when compared with those with mild/moderate behavioral health conditions.
Conclusion: Author Health provides a blueprint for behavioral health services that remove barriers and provide tenacious, consistent, and whole-person virtual-first behavioral health care tailored to the unique needs of older adults. Our sample of Medicare Advantage participants in Florida suggests SMI/SUD/dementia may be a predictor for HRSN independent of socioeconomic status and race/ethnicity.
Source: Chukrun T. Journal of the American Geriatrics Society, Dec 2024; Early View
Organizational factors associated with less use of restraints in older adults with dementia in acute care hospitals: A scoping review
Abstract:
Objective: Dementia affects more than 55 million people worldwide. Use of restraints for hospitalized older adults with dementia is a social issue that should be addressed systematically and should not depend on the characteristics of nurses. This study reviewed the literature on organizational factors associated with reducing use of restraints in older adults with dementia admitted to acute care hospitals.
Methods: A scoping review was performed. Three databases were searched for papers that met our eligibility criteria. Factors related to restraint reduction were extracted, and results were deduced. Through inductive analysis, subthemes were categorized according to similarities and differences, which were then integrated into broader themes.
Results: Sixteen studies were eligible for inclusion. The prevalence of restraints ranged from 5.1% to 80.0% depending on how the meaning of restraint was interpreted. The most common indications for restraints were history of falls and fall risk. Interdisciplinary screening for restraints was associated with reduced prevalence of restraints, with a 0.18-fold (confidence interval [CI]: 0.12–0.24) reduction through use of a restraint decision flowchart and a 0.76-fold (CI: 0.63–0.92) reduction through consultation with a psychiatrist. Interdisciplinary members included nurses, physicians, clinical psychologists, pharmacists, respiratory therapists, and therapists.
Conclusions: Research is needed to introduce and develop an interdisciplinary restraint decision-making system and to test its effectiveness. Important factors in implementing alternatives to restraints are the harmful effects of restraints, expertise in dementia, regular education on alternative methods, an inpatient environment that ensures patient safety, and the development of human resources.
Source: Makino M. Japan Journal of Nursing Science, Sep 2024; 21(4): e12620
Supportive Interventions Involving Family Carers of Patients with Delirium Superimposed on Dementia in Hospital: A Scoping Review
Abstract:
Background: People with dementia admitted to hospital are at risk of developing delirium. Patients with delirium superimposed on dementia (DSD) have higher mortality rates, longer hospital stays and further cognitive loss. The role of family is often recommended as a resource to inform and support how patients with dementia's needs are understood. This review focuses on ward-based interventions that enable family carers and health care professionals to work together to improve patient experience and outcomes.
Aim: To review evidence on ward-based approaches involving family (or their proxies) and staff working together to prevent and manage delirium for patients living with dementia.
Methods: We undertook a scoping review including all types of research. Six electronic databases were searched (CINAHL, MEDLINE (run twice), EMBASE, Cochrane, PsycINFO and PubMed). The search was limited to papers written in English and published from 2009 to 2019. The search was updated in 2023. Papers were independently read by two researchers. Findings were presented through narrative synthesis (Prospero CRD42019130369).
Results: Fifteen papers were included. Studies focused on educational and system change to improve the care of people with DSD. Family involvement ranged from enabling baseline assessment of delirium, commenting on different resources and measures designed to support their involvement in care or simulate their presence. The evidence of effectiveness was varied. Interventions to support personalised care and give family carers and staff confidence were positively evaluated in some studies but not all included both family carers and staff. Benefits to patients over time were less clearly demonstrated.
Conclusion: This review identified the potential of family to mitigate the risk of delirium and improve patient outcomes. Further research is needed to understand how system and practitioner changes to enable family involvement in the support of people with DSD benefit patients in the short and long term.
Relevance to Clinical Practice: The review findings provide evidence for clinical practice when selecting existing interventions and approaches involving family in supporting patients with DSD.
Patient or Public Contribution: Not required as this was a review, not an original piece of research.
Source: Ashton-Gough C. International Journal of Older People Nursing, Feb 2025; 20(2): e70016
Role of a Dementia Virtual Reality App in Developing Situated Empathy, Attitude and Person-Centred Care—A Qualitative Approach
Abstract:
Background: The demands of any health education programme including nurse education would benefit from innovative ways to support students learning in an effective and efficient manner. Such approaches resonate particularly when caring for older people living with dementia, due to multifactorial manifestations of the condition, patients' difficulty in articulating their needs and the potential for negative care outcomes. Empathy is an important part of understanding dementia and is also recognised as a complex and multidimensional concept.
Objective: This study investigated the impact of undergraduate nursing students' 15-min use of the Experience Dementia in Singapore (EDIS) virtual reality app in their tutorial lesson for developing their empathy, changing their attitude and increasing their sensitivity for person-centred care of people with dementia.
Method: We carried out content and thematic analysis of data anonymously collected via the in-class learning activities at the start and at the end of the lesson.
Results: All participating students (n = 89, 89% response rate) achieved their learning goal to experience a first-person perspective and gain insights into needs and care for persons living with dementia. The results showed students transitioned from having mainly knowledge foremost in their mind, to more empathetic and care related thoughts when delivering care to persons living with dementia. The experience made more students aware of how they could communicate care, make environmental modifications to support and develop an attitude of person-centred care for persons living with dementia and their families. The analysis resulted in four themes: (1) immersive learning—walking in the shoes of the person living with dementia (2) feelings evoked from the first-person perspective (3) little things, big impact; little things, positive impact; and (4) communicating care.
Conclusion: The EDIS virtual reality app was an efficient and effective way for students to develop essential elements, especially empathy, as well as positive attitudes and sensitivity towards person-centred care for those living with dementia.
Implications for Practice: The first-hand experience the VR app offers allows students to challenge pre-conceived perceptions about older people and those living with dementia. As such, it is a versatile tool that can be incorporated into a variety of study and training programmes for students, professionals and caregivers who provide care or care solutions for persons living with dementia and their families.
Source: Tan Chin P. International Journal of Older People Nursing, Feb 2025; 20(2): e70012
Cardiovascular health, measured using Life's Essential 8, is associated with reduced dementia risk among older men and women
Abstract:
Background: Dementia poses considerable challenges to healthy aging. Prevention and management of dementia are essential given the lack of effective treatments for this condition.
Methods: A secondary data analysis was conducted using data from 928 InCHIANTI study participants (55% female) aged 65 years and older without dementia at baseline. Cardiovascular health (CVH) was assessed by the “Life's Essential 8” (LE8) metric that included health behaviors (diet, physical activity, smoking status, sleep duration) and health factors (body mass index, blood lipid, blood glucose, blood pressure). This new LE8 metric scores from 0 to 100, with categorization including “low LE8” (0–49), indicating low CVH, “moderate LE8 (50-79)”, indicating moderate CVH, and “high LE8 (80-100)”, indicating high CVH. Dementia was ascertained by a combination of neuropsychological testing and clinical assessment at each follow-up visit. Cox proportional hazards models were used to examine associations between CVH at baseline and risk of incident dementia after a median follow-up of 14 years.
Results: Better CVH (moderate/high LE8 vs. low LE8) was inversely associated with the risk of incident dementia (hazard ratio [HR]: 0.61, 95% confidence interval [CI]: 0.46–0.83, p = 0.001). Compared with health factors, higher scores of the health behaviors (per 1 standard deviation [SD]), specifically weekly moderate-to-vigorous physical activity time (per 1 SD), were significantly associated with a lower risk of incident dementia (health behaviors: HR: 0.84, CI: 0.73–0.96, p = 0.01; physical activity: HR: 0.62, CI: 0.53–0.72, p < 0.001).
Conclusion: While longitudinal studies with repeated measures of CVH are needed to confirm these findings, improving CVH, measured by the LE8 metric, may be a promising dementia prevention strategy.
Source: Li X. Journal of the American Geriatrics Society, Sep 2024; 72(12): 3695-3704
The Experience of Hospitalisation for People Living With Dementia: A Qualitative Exploration of How Context Shapes Experiences
Abstract:
Introduction: Dementia has become an increasingly pressing issue in healthcare systems, and acute care settings such as hospitals have been shown to be particularly problematic for people living with dementia. People living with dementia are hospitalised at higher rates than those without and often have poor experiences and outcomes of hospitalisation. To support the evolution of hospital systems to better meet the needs of people living with dementia, it is important to consider the relationship between the context of the hospital and the experiences of people living with dementia and their caregivers. The term context refers to the environment and conditions that shape experiences and includes elements such as policies, procedures, design and social norms. A greater understanding of the relationship between the hospital context and the experiences of people living with dementia will support the future development of interventions to modify contextual elements to improve the experiences of people living with dementia. Our aim was to explore the relationship between the experiences of people living with dementia and their caregivers in hospital, and the contextual elements of the hospital.
Methods: In this interpretive descriptive study, we conducted interviews with people living with dementia and caregivers of people living with dementia about their experiences in hospital. Interviews were conducted with people living with dementia (n = 3), caregivers of people living with dementia (n = 8) and one dyad of a person living with dementia and their caregiver (n = 1) about the hospitalisation of the person living with dementia. Using inductive and deductive methods of analysis, we describe contextual factors that shape their experiences.
Results: Our findings demonstrate how the hospital context shaped the experiences of people living with dementia and their caregivers while the person living with dementia was hospitalised. The themes reflect elements of the hospital context: communication systems, the value of caregivers, the focus on acute physical needs, staff capacity, the physical environment and normalised practices. The findings suggest that there are aspects of the hospital context that can be modified to influence the experiences of people living with dementia and their caregivers.
Conclusion: This study demonstrates how the context of hospital shapes the experiences of people living with dementia and their caregivers and points to aspects of the context that health system leaders could explore to begin to improve the capacity of hospitals to support people living with dementia.
Implications for Practice: The study provides evidence of the need for health system leaders and practitioner to explore how the hospital context shapes the experiences of people with dementia and their caregivers, and begins to explore ways that contextual changes can improve their experiences.
Source: Moody E. International Journal of Older People Nursing, Sept 2024; 19(6): e12651
Navigating Dementia and Delirium: Balancing Identity and Interests in Advance Directives
Abstract: The moral authority of advance directives (ADs) in the context of persons living with dementia (PLWD) has sparked a multifaceted debate, encompassing concerns such as authenticity and the appropriate involvement of caregivers. Dresser critiques ADs based on Parfit's account of numeric personal identity, using the often-discussed case of a PLWD called Margo. She claims that dementia leads to a new manifestation of Margo emerging, which then contracts pneumonia. Dworkin proposes that critical interests, concerning one's higher moral values, trump experiential interests (things or activities one enjoys because they are pleasurable). Dresser argues that Margo's current experiential interests override her self's critical ones, as they contribute significantly to her quality of life (QoL). To render the argument more realistic, I introduce a variation in which Margo develops delirium, a common and severe comorbidity in PLWD. I argue that delirium could precipitate a sudden decline in experiential interests and, consequently, a deterioration in QoL. Given the uncertain trajectory of Margo's illness, I contend that her competent self's critical interests, as reflected in her AD, along with her right to self-ownership, should take precedence over current experiential interests. Thus, the AD possesses moral authority. However, it is imperative for healthcare professionals to offer consultations for PLWD, facilitating an understanding of ADs and enabling a shared decision-making process. Such consultations are essential for honouring the autonomy and dignity of PLWD, ensuring that their values and preferences guide ethical decision-making amidst the complexities of dementia care.
Source: Rutenkröger M. Nursing Philosophy, Jan 2025; 26(1): e70016
The Effects of Exergaming on the Depressive Symptoms of People with Dementia: A Systematic Review and Meta-Analysis
Abstract:
Background: Depressive symptoms are common among people with dementia (PWD). Exergaming consisting of combined cognitive and physical training in gaming is increasingly used to alleviate their depressive symptoms in research. With its potential synergistic neurobiological and psychosocial effects on reducing depressive symptoms among PWD, this review aimed to understand its effectiveness and contents.
Methods: This is a systematic review of the effectiveness of exergames on depressive symptoms among older adults with dementia. A search was conducted on 7 May 2024 of the online databases CINAHL, Embase, PsycINFO, PubMed and the China Academic Journal Network Publishing Database (CNKI). The methodological quality of randomised controlled trials (RCT) and quasi-experimental studies was assessed with RoB2 and ROBINS-I, respectively. A meta-analysis of the included RCTs was conducted.
Results: Six studies consisting of four RCTs and two quasi-experimental studies involving 235 participants with various stages of dementia were included. The meta-analysis showed a significant overall improvement in depression with a large effect size (SMD = 1.46, 95% CI = −2.50, −0.43; p = 0.006). Despite high heterogeneity (I2 = 91%), all studies demonstrated a trend of improvement in depression after the intervention. The exergames adopted in the included trials had the following elements: simultaneous motor-cognitive training, a scoring mechanism and a social play. The dose of exergames ranged from 15 to 60 min per session for at least 8 weeks, with a minimum of two sessions weekly. However, the included studies had a moderate-to-serious risk of bias. The certainty of the evidence was very low.
Conclusion: Exergames could be effective at improving the depressive symptoms of older adults with dementia. Yet, a moderate-to-severe risk of bias shows a rigorous study should be conducted in the future.
Implications for Patient Care: This study provides evidence for healthcare professionals and informal caregivers to use exergames to address depressive symptoms in PWD.
Review Registration: The review was registered on PROSPERO with the reference CRD42022372762.
Source: Cheung Daphne S K. Journal of Clinical Nursing, Jan 2025; Early View
A meta-analysis of person-centered care interventions for improving health outcomes in persons living with dementia
Abstract:
Background: Person-centered care emphasizes the importance of valuing and supporting the humanness of a person living with dementia as compared to focusing heavily on disease symptom management and treatment. The state of the evidence and outcomes from person-centered care is unclear and is an important knowledge gap to address informed evidence-based care for persons living with dementia.
Aims: To synthesize the evidence on the efficacy of person-centered care in improving health outcomes in people living with dementia.
Methods: Our search using the following databases: Academic Search Complete, CINAHL, COCHRANE library, EMBASE, MEDLINE, PubMed, and Google Scholar. The methodology quality of the included studies was assessed using a revised Cochrane risk-of-bias tool for randomized trials. Meta-analyses were performed using the DerSimonian and Laird random effects model to investigate the effectiveness of person-centered care on improving health outcomes in persons living with dementia.
Results: Seventeen trials were included in this systematic review and meta-analysis. Person-centered care implementation was found to improve cognitive function (pooled SMD: 0.22; 9CRD420223808975% CI [0.04, 0.41], p = .02) in persons living with dementia, although outcomes including the impact of the care model on activities of daily living, agitation, depression, and quality of life remain inconclusive.
Linking Evidence to Action: Person-centered care improves the cognitive function of persons living with dementia, which is clinically meaningful and should not be ignored or overlooked in delivering evidence-based care to this population. The findings of this study emphasize the importance of person-centered care implementation among people living with dementia as an approach in improving health outcomes particularly on cognitive function improvement. Person-centered care emphasizes the personhood of individuals living with dementia while respecting their needs, values, and beliefs and is identified as a preferred model of delivering dementia care in all settings as a non-pharmacological approach.
Source: Saragih Ita D. Worldviews on Evidence-Based Nursing, Sep 2024; 22(1): e12746
Towards Establishing Quality Standards on Human Rights for Services in Dementia Care
Abstract:
Background: People with dementia often experience violations of fundamental human rights and impeded access to healthcare. This study aims to investigate the views of experts regarding the use of the United Nations Convention on the Rights of People with Disabilities (CRPD) principles as quality standards for human rights–based care.
Methods: A single-round Delphi e-consultation with 15 dementia experts was designed to evaluate each CRPD principle and collect feedback on their views about the application of the CRPD principles in dementia care.
Results: The CRPD principles were fully endorsed as quality standards; however, several experts commented on the complexities of the use of CRPD principles in relation to information disclosure, capacity assessment, stakeholders' involvement in decision-making, respecting needs and preferences, holistic approaches in care practice, and protection against abuse, neglect and discrimination.
Conclusions: These findings indicate the CRPD quality standards were fully applicable for people with dementia although some clarification around interpretation could assist in their use. Future research should elaborate on further points of support and guidance for dementia care providing examples of good practice from across the globe, and develop a concordant, human rights–based scheme for the implementation and evaluation of dementia services.
Implications for Practice: This study suggests that the CRPD can serve as a benchmark for human rights-based practices in dementia services globally that could enhance nursing care practice. Nursing staff are encouraged to consider human rights in relation to the complexities associated with people with dementia, their caregivers, and other services involved in their care.
Source: Panagiotidou N. Sep 2024, International Journal of Older People Nursing; 19(5): e12643
Effectiveness of Horticultural Therapy in Older Patients with Dementia: A Meta-Analysis Systemic Review
Abstract:
Aim: Our study aims to assess the effectiveness of horticultural therapy in improving outcomes in older patients with dementia.
Design: A systematic review and meta-analysis.
Methods: The included studies comprised randomised controlled trials (RCTs) that aimed to assess the effectiveness of horticultural therapy on cognitive function in older patients with dementia. The study design and data extraction were independently conducted by two investigators, who also evaluated the risk of bias using RoB 2.0. The meta-analysis was carried out using Stata 15.1 software.
Data Sources: On November 2023, we searched relevant English and Chinese publications in PubMed, Web of Science, Cochrane Library, Embase, CNKI and Wanfang databases.
Results: The meta-analysis included a total of 9 RCTs, involving 655 older patients diagnosed with dementia. The findings from these studies demonstrated that horticultural therapy had a significant positive impact on various aspects of the patients' well-being when compared to conventional care. Specifically, it was found to improve cognitive function scores, alleviate symptoms of depression, enhance daily activities and enhance overall quality of life. When conducting a subgroup analysis, it was observed that horticultural therapy had a statistically significant effect on cognitive function in older patients with dementia when the intervention frequency was at least two times per week. Furthermore, interventions with a duration of less than 6 months were found to be more effective than those lasting 6 months or longer. Additionally, outdoor horticultural therapy was found to be superior to indoor interventions. Moreover, structured interventions were observed to yield better outcomes compared to non-structured interventions.
Conclusion: More high-quality studies are needed to further corroborate these findings due to the low quality of the included studies. Horticultural therapy has been found to have a significantly positive impact on the cognitive function, depression status, ADL, and quality of life of older patients with dementia.
Implications for the Profession and/or Patient Care: We provide references for non-pharmacologic treatment of older patients with dementia.
What Problem Did the Study Address? This study aimed to measure the efficacy of horticultural therapy in older patients with dementia across four dimensions: cognitive function, depression levels, daily living activities and overall quality of life.
What Were the Main Findings? In older patients with dementia, horticultural therapy has been proven to have a significant positive impact on cognitive function, depressive status, activities of daily living and quality of life.
Where and on Whom Will the Research Have an Impact? This study will inform non-pharmacological interventions for older patients with dementia worldwide.
Patient or Public Contribution: No Patient or Public Contribution.
Source: Wang M. Journal of Clinical Nursing, Sep 2024; 33(12): 4543-4553
Effect of Massage and Touch on Agitation in Dementia: A Meta-Analysis
Abstract:
Aims and Objectives: To systematically assess the effects of massage and touch on agitation in patients with dementia and to determine the optimal intervention design.
Background: Agitated behaviour is the most common behavioural symptom in patients with dementia and can seriously affect the health status and quality of life of individuals with dementia and their caregivers. Massage and touch have been widely used as a non-pharmacological intervention to address the behavioural issues of dementia. However, current research findings on the effects of massage and touch on agitation in people with dementia are inconsistent.
Design: A meta-analysis of randomised controlled trials.
Methods: This meta-analysis complied with PRISMA guidelines, and relevant literature up to January 2024 was systematically retrieved from PubMed, Embase, Web of Science, the Clinical Trials Registry, Cochrane Library and four Chinese databases. Statistical evaluations were performed utilising Review Manager 5.4, and the included studies' bias risks were assessed with the Cochrane Collaboration tool.
Results: Seventeen randomised controlled trials involving 980 patients with dementia were included. The results of the meta-analysis showed that massage and touch could ameliorate agitation and behaviour problems in dementia. Subgroup analyses based on massage type showed that hand, head and foot massage significantly improved agitation. Massage and touch for ≤ 4 weeks were more effective in reducing agitated behaviour than those for > 4 weeks. Furthermore, subgroup analysis revealed that massages and touch were more effective for individuals with less severe dementia.
Conclusions: Massage and touch in the short term can effectively improve agitation in dementia patients, while hand, head and foot massage can effectively reduce agitation. Thus, clinical nursing staff and caregivers of individuals should be actively helped to apply massage and touch to their patients. However, more studies are needed to validate our results before we can give a more definitive recommendation.
Relevance to Clinical Practice: This study suggests that massage and touch can be used as complementary treatments for agitation in people with dementia and encourages nursing staff and caregivers to apply massage and touch to better cope with the agitated behaviour of older adults with dementia.
Patient or Public Contribution: No patient or public contribution.
Trial Registration: PROSPERO registration number: CRD42024507133
Source: Lui X. Journal of Clinical Nursing, Feb 2025; Early View
Perspectives on the Dementia Public Health Exposome
Abstract: Dementia is a public health concern in the aging population with an estimated 55 million people impacted globally. Public health initiatives that focus on minimizing dementia risk factors may support efforts to reduce the incidence of dementia in at-risk populations. Exposomics considers both modifiable and non-modifiable risk factors for disease, including genetic changes with age and lifetime exposures to environmental, social, and behavioral risk factors. Dementia precursors may remain undetected for up to 20 years. An understanding and application of the dementia exposome may promote healthy brain interventions, screening, and risk mitigation. The proposed dementia public health exposome (DPHE) provides a framework for understanding and addressing the complex interactions between genetics, health behavior, and environment (natural, built, and social) linked to modifiable and non-modifiable risk factors for dementia. The DPHE may be used to inform public health strategies and advancements in healthy brain initiatives.
Source: Flaherty Christine N. Nursing and Health Policy Perspective, Oct 2024; 42(1): 215-220
Capacity assessment for euthanasia in dementia: A qualitative study of 60 Dutch cases
Abstract:
Background: The number of patients with dementia who are granted euthanasia or assisted suicide (EAS) increases yearly in the Netherlands. By law, patients need to be decisionally competent or have an advance directive. Assessment of decisional capacity is challenging as dementia progressively affects cognitive performance. We aimed to assess qualitatively which factors, and how, influence the judgment of decisional capacity in EAS cases with dementia.
Methods: We performed a qualitative study of 60 dementia EAS case summaries published by the Dutch regional euthanasia review committees between 2012 and 2021. Included reports were evaluated using the grounded theory approach. All quotes related to decisional capacity were coded independently by two researchers and compared in an iterative process to formulate an overarching framework on the assessment of decisional capacity. We selected 20 patients who had an advance directive and were judged to be decisionally compromised, as well as a selection of 40 EAS cases judged to be decisionally competent, half of which also had an advance directive (purposive sampling).
Results: Decisional capacity was present in every case report. Predefined, external criteria were rarely described explicitly, but physicians indirectly referred to the (cognitive) criteria set by Appelbaum and Grisso. Whether the thresholds for these dimensional criteria were met was influenced by six supporting factors (level of communication, psychiatric comorbidity, personality, presence of an advance directive, consistency of the request, and, finally, the patient–physician relationship) that also directly contributed to the judgment of capacity. The involved physicians and executed investigations were the two contextual factors providing a background.
Conclusions: Decisional capacity regarding euthanasia is a multidimensional construct, often implicitly assessed and influenced by supporting and contextual factors. The subjectivity of the final judgment poses ethical and legal issues and argues for continuous quality improvement processes.
Source: Van den Bosch A. Journal of the American Geriatrics Society, Oct 2024; 73(1): 112-122
Dexmedetomidine for agitation in dementia: Current data and future direction
Abstract:
Background: The incidence and prevalence of dementia, and thus dementia-related behavioral and psychological symptoms, are increasing significantly. Currently, there are limited safe and efficacious options for treating these symptoms. Dexmedetomidine has been used for agitation related to delirium and showed significant benefit in prior studies. This raises the question whether dexmedetomidine could also provide a safe and effective treatment for BPSD, including agitation related to dementia.
Methods: Our team searched PubMed, Cochrane Database, and Ovid with the terms dexmedetomidine and dementia. Only studies published in English language journals, or with official English language translations, and human studies were included. All reports of dexmedetomidine for dementia were included regardless of study type.
Results: No completed studies on dexmedetomidine for agitation in dementia were identified. The TRANQUILITY study is in progress, although results are yet to be published.
Conclusion: Dexmedetomidine has shown benefit for hospital delirium and for agitation in schizophrenia and bipolar disorder. However, there are no completed studies published on dexmedetomidine for agitation in dementia. Controlled studies with larger sample sizes are needed to assess the efficacy, safety, and the best route of administration for this drug in managing BPSD including agitation.
Source: Murphy Kayla S. Journal of the American Geriatrics Society, Sep 2024; 73(2): 552-557
Neuropsychiatric presentations of common dementia syndromes: A concise review for primary care team members
Abstract: Dementia is a syndrome characterized by cognitive changes which interfere with daily functioning. Neuropsychiatric symptoms (NPS) are also pervasive and may even occur prior to any noticeable cognitive decline. Still, NPS are less associated with the early stages of the disease course, despite mounting research evidence that NPS present early and often in several dementia syndromes, even in the absence of cognitive decline (i.e., mild behavioral impairment [MBI]). Primary care teams are at the forefront of dementia care, yet they frequently report insufficient training in dementia diagnosis and management. This poses a serious problem considering that timely diagnosis of dementia is critical for optimal outcomes and maximum efficacy of intervention. We provide a concise narrative review of four dementia syndromes (Alzheimer's disease, vascular dementia, dementia with Lewy bodies, and behavioral variant frontotemporal dementia) and their associated neuropsychiatric presentations, as well as at-a-glance clinical guides, to help primary care team members recognize possible prodromal neurodegenerative disease and to prompt further workup. We also review next steps in the management of dementia and symptoms of MBI for primary care team members. As evidenced by the NPS profiles of these dementia syndromes, subacute new onset of psychiatric symptoms in an older adult should prompt consideration of an emerging dementia process and possible further workup of such, even in the absence of cognitive decline.
Source: Bell Z. Journal of the American Geriatrics Society, Oct 2024; 73(2): 349-357
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