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
