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When dementia and delirium come together
Abstract: Delirium is a multifactorial syndrome that, when superimposed on dementia, can lead to twice the risk of being admitted to acute care than for a person who is cognitively intact. Early detection of delirium can be a challenge, especially when there is an existing diagnosis of dementia. Despite the wealth of literature, there continues to be a widespread lack of knowledge about delirium, and under-detection in all types of health and social care settings.
This lack of recognition may lead to poor health outcomes and increased mortality. There is a need for effective training for staff working in community settings, and effective communication between health and social care staff and families who are affected by delirium. Furthermore, delirium superimposed on dementia is common, and may cause distress for patients, caregivers and staff. This article will explore some of the common factors when delirium is comorbid with dementia.
Source: Moore, A. British Journal of Healthcare Assistants, Feb 2020; 14(2): 57-102
Dementia and delirium: recognising common factors
Abstract: Delirium is a multifactorial syndrome that, when superimposed on dementia, can lead to twice the risk of being admitted to acute care than for a person who is cognitively intact. Early detection of delirium can be a challenge, especially when there is an existing diagnosis of dementia. Despite the wealth of literature, there continues to be a widespread lack of knowledge about delirium, and under-detection in all types of health and social care settings. This lack of recognition may lead to poor health outcomes and increased mortality. There is a need for effective training for staff working in community settings, and effective communication between health and social care staff and families who are affected by delirium. Furthermore, delirium superimposed on dementia is common, and may cause distress for patients, caregivers and staff. This article will explore some of the common factors when delirium is comorbid with dementia.
Source: Harrison Dening, K. Nursing and Residential Care, Jan 2023; 25(1): 1-9
The management of delirium in the older adult in advanced nursing practice
Abstract: Delirium is a term used to describe an array of symptoms that indicate a disruption in cerebral metabolism, a condition that is often under-recognised, leading to delayed interventions. The condition is a common cause of older adults presenting in hospital, with significant morbidity and mortality associated with increased length of stay. A case study is used to illustrate the use of a diagnostic algorithm for older adults presenting with delirium to an advanced nurse practitioner (ANP)-led service. The clinical decision pathway provides four differential diagnoses, using the case study to put the decision-making process in context. The article demonstrates the ability of the ANP to practise at a high level of expertise as an autonomous practitioner and shows how the pathway supports the nurse to reach an accurate diagnosis. It shows that prompt and accurate diagnosis of delirium in older adults is crucial to avoiding the complications and cognitive decline associated with the condition.
Source: Carey, E. British Journal of Nursing, Jan 2022; 31(2): 63-S28
Delirium in adult patients in intensive care: nursing interventions
Abstract: Background: Delirium is a neuropsychiatric syndrome of high incidence in the critically ill patient. It is characterised by changes in acute attention and cognition, has a multifactorial aetiology and has a negative impact on the patient's clinical situation and future quality of life. Prevention of delirium and early identification can reduce associated morbidity and mortality. Consequently, it is vital that intensive care unit (ICU) nurses perform targeted patient monitoring to identify acute cognitive changes.
Objective: To identify nursing interventions directed at the prevention and management of delirium in adult patients in ICU.
Method: A scoping review was undertaken based on the principles recommended by the Joanna Briggs Institute.
Results: Seven studies were selected for inclusion. Non-pharmacological and pharmacological nursing interventions were identified.
Conclusion: The interventions identified were predominantly aimed at the prevention of delirium. The training of nurses and wider clinical team in preventing and identifying this syndrome is crucial.
Source: Bento, A F G. British Journal of Nursing, May 2021; 30(9): 509-S30
Recognising pain in dementia: what has changed?
Abstract: Pain is common among older people due to the increased prevalence of age-related conditions. However, this might be misidentified and poorly managed in those with dementia. Karen Harrison Dening presents effective diagnostic and treatment strategies.
Source: Harrison Dening, K. British Journal of Neuroscience Nursing, Jun 2020; 16(3): 1-3
Recognition and assessment of dementia in primary care
Abstract: The majority of patients are diagnosed in a memory assessment service or a neurology clinic. However, early detection of a possible dementia is often done in a primary care setting. Dementia diagnosis has been seen by some as a ‘tick-box exercise’ but there are significant benefits to patients and their families when screening or testing for dementia is carried out early, especially in supporting the patients management of other comorbid or long-term conditions. Nurses working in primary care have a key role in identifying patients who may have the signs and symptoms of dementia by enabling them to access a timely diagnosis.
Source: Harrison Dening, K. Practice Nursing, Sept 2019; 30(9): 361-406
Dementia: recognition and cognitive testing in community and primary care settings
Abstract: Dementia is an umbrella term used to describe a group of symptoms characterised by behavioural changes, as well as loss of cognitive and social functioning brought about by progressive neurological disorders. There are approximately 944 000 people living with dementia in the UK and estimates indicate this will increase to over 2 million by 2051. Dementia, if left undiagnosed, can have an insidious and harmful impact on the people and their families who are affected by it. A timely diagnosis can be made when a person with a possible dementia comes to the attention of clinicians due to concerns about changes in their cognition, behaviour, or functioning. Community nurses are well-placed to observe changes in their older patients, which may be indicative of early dementia. This paper uses a case study to illustrate possible early signs of dementia and discusses the recognition and initial cognitive tests that can be used in a primary care setting.
Source: Harrison Dening, Karen. British Journal of Community Nursing, Jun 2023; 28(7): 317-362
Admiral Nursing: supporting families affected by dementia within a holistic intermediate care team
Abstract: There are increasing pressures on the health and social care system, particularly within acute hospital care. This has led to significant changes being implemented throughout the NHS England Long Term Plan (2019), such as moving services closer to home and improving ‘out of hospital’ care. Intermediate care services are being developed to improve timely discharge from hospital and prevent unnecessary hospital admissions and premature transfer to residential care. An innovative intermediate care model, inclusive of Admiral Nursing, has been developed within Olympus Care Services to support families living with dementia, implementing an intensive 8-week intervention model. It is essential that intermediate services are accessible for people with dementia, inclusive of the needs of the family, and that they work within the context of integrated and collaborative models of care across traditional organisational boundaries. The aim is not only to improve resilience and quality of life, but also to offer opportunities to promote the narrative of living well with dementia. This service model illustrates how this can be achieved with inclusion of Admiral Nursing working within reablement services.
Source: Aldridge, Z. British Journal of Neuroscience Nursing, Oct 2019; 15(5): 211-252
Enhanced healthcare in care homes for people with dementia: the Admiral nursing offer
Abstract: Background: The UK older population is higher than the global average. Over the next 20 years, England will see an increase in the number of older people who have higher levels of dependency, dementia and comorbidity, many of whom will require 24-hour residential care. It is estimated that 70% of residents in nursing and residential care homes either have dementia on admission or develop it while residing in the care home, many of who will have complex needs with high levels of multimorbidity. However, there is a lack of consistency in the provision of primary care and specialist services to this population and a known gap in knowledge and skills of dementia care in care home staff and primary care teams.
Methods: This article considers the current health policy drivers to enhance integrated health and social care provision to care homes and proposes a model of care that would support the aims of the NHS Long Term Plan for care to be delivered closer to home and improve out of hospital care which includes people who live in care homes by introducing Enhanced Health in Care Homes. It is crucial that such a model includes the correct skill mix to meet the needs of the care home population.
Conclusions: There are currently gaps in service provision to many care homes. Admiral nurse case managers and specialists in dementia care, are well placed to support the delivery of Enhanced Health in Care Homes and improve access to specialist support to care home residents, their families, care home staff and the wider health and social care system.
Source: Harrison Dening, K. Nursing and Residential Care, Jul 2021; 23(7): 1-3
Resistance to care in people with dementia: challenges, responsibilities and unmet need
Abstract: Resistance to care is common in people with dementia and can involve active resistance, such as shouting, or passive resistance, such as stiffening of muscles or refusing to open the mouth. Resistance occurs within a complex legal and ethical backdrop, where care staff must consider issues of consent, mental capacity, best interests and duty of care. Resistance also sits within powerful cultures of care, where care staff must resist task-orientated, dehumanising care that fails to acknowledge the personhood of people with dementia. Rather than accepting resistance as an expected part of dementia, care staff must look closer and with curiosity for underlying causes and unmet need. A biopsychosocial approach can be useful in uncovering these needs, and in allowing the structuring of a person-centred response.
Source: Pritchard, J. Nursing and Residential Care, Feb 2022; 24(2): 1-4
Overprescribing medication in patients with dementia
Abstract: Overprescribing is a common problem among all age groups in modern Western society. However, it is particularly dangerous in older people, especially in those with cognitive problems who cannot voice the effects they are experiencing. A person living with dementia may rely on strong behavioural or emotional expression to indicate their physical symptoms or they may display symptoms of delirium. A multitude of symptoms can be evoked by a toxic cocktail of medications, and it can be difficult to get the attention of care professionals if the person experiencing this has no cognitive awareness of what is happening. This is why staff are so important when it comes to understanding patient behaviour, as well as prescribers who are integral in knowing how to rethink their prescription for someone experiencing more harm than good from their medications.
Source: Mendes, A. Nursing and Residential Care, Dec 2022; 24(11): 1-3
Psychosocial support for people with dementia with Lewy bodies
Abstract: Background: Lewy body dementia is the second most common form of age-related neurodegenerative dementia. It has two forms: dementia with Lewy bodies and Parkinson's disease dementia.
Methods: There are specific core symptoms associated with dementia with Lewy bodies. Optimum care requires awareness of the features associated with these, as well as appropriate support and management strategies, which are provided in this article.
Results: The core features of dementia with Lewy bodies are visual hallucinations, cognitive fluctuations, Parkinsonism and rapid eye movement sleep behaviour disorder. Appropriate psychosocial strategies includes psychoeducation, social support and environmental modification. Adoption of these approaches can reduce adverse outcomes.
Conclusions: The core features of dementia with Lewy bodies can significantly impair quality of life. Nursing and residential care staff are ideally placed to address this through the implementation of psychosocial strategies both directly, and through the provision of psychoeducation for family caregivers.
Source: Killen, A. Nursing and Residential Care, Jun 2021; 23(5): 1-3
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
Vascular dementia: diagnosis, treatment and medical management
Abstract: In the UK, an estimated 954 000 people have dementia. Vascular dementia (VaD) is the second most common type of dementia and affects around 257 607 people (Prince et al, 2014:16—Table 4). This article explains about the pathophysiology and clinical features of VaD, how it can be prevented, how it is diagnosed and the medication used to treat VaD.
Source: Nazarko, L. British Journal of Neuroscience Nursing, Oct 2019; 15(5): 211-252
Lewy body dementia: diagnosis, treatment and medical management
Abstract: In the UK, an estimated 954 000 people have dementia. Lewy body dementia (LBD) can be difficult to diagnose and estimates of its prevalence in the UK range from 38 000–100 000. This article explains about the pathophysiology and clinical features of LBD, how it is diagnosed, treated and managed.
Source: Nazarko, L. British Journal of Neuroscience Nursing, Dec 2019; 15(6): 259-303
Dementia and the risk of poor outcomes as a result of the COVID-19 pandemic
Abstract: People with dementia belong to some of the most vulnerable groups of people, and their vulnerability has been augmented by the Covid-19 pandemic. This article critically appraises and evaluates a systematic review that investigated the relationship between dementia and COVID-19 related outcomes.
Source: Hill, James E. British Journal of Neuroscience Nursing, Oct 2022; 18(5): 207-245
Assessment of pain in people living with dementia at the end of life: a systematic review
Abstract: Background: People with dementia may not receive the same quality of palliative care as those with other life-limiting conditions, particularly at end of life (EoL).
Aims: To understand the best way to examine pain in people with dementia.
Methods: A systematic review of tools to assess pain in patients with dementia near the end of life; PubMed, Medline, Embase, EBSCO Host, CINAHL Plus, Web of Science, Psycinfo, PsycArticles and Scopus were searched.
Findings: A total of 15 articles were identified, which were qualitatively synthesised.
Conclusion: There are a range of pain assessment tools that are appropriate for use in people with dementia, but all 15 studies used a formal tool. A more robust approach is needed to improve the quality of research for measurement and management of pain in this population.
Source: McAnee, G. International Journal of Palliative Nursing; Apr 2021; 27(2): 71-118
Preventing delirium
Abstract: Delirium is a common and serious illness that affects many people, particularly those who are older. The condition can be extremely distressing for the person, their family members and the health professionals providing care (Mitchell, 2019).
Source: Mitchell, G. Nursing and Residential Care, Aug 2019; 21(9): 485-537
How the COVID-19 pandemic has affected people with dementia
Abstract: Linda Nazarko explains how the pandemic is having a disproportionate impact on those with dementia.
Source: Nazarko, L. Independent Nurse, Dec 2020; 2020(12): 12-22
Nonpharmacological nursing interventions for behavioural and psychological symptoms of dementia in acute and subacute settings: A systematic review
Abstract: Background: Behavioural and psychological symptoms of dementia are a group of non-cognitive symptoms such as agitation, physical aggression, depression, sexual disinhibition and psychosis. Therapeutic approaches vary because of the multifactorial and complex symptomology. The researchers of this study aimed to systematically review the nonpharmacological interventions for BPSD used by nurses in acute and subacute hospital settings.
Design: The PRISMA guidelines guided this systematic review. The review was registered with PROSPERO (CRD42020184015).
Method: The databases Cumulative Index of Nursing and Allied Health Literature (CINAHL) complete, Medline complete, Excerpta Medica (Embase®) and PsycINFO published by the American Psychological Association (APA) were searched for studies published in English to October 2021. Quality appraisal was performed independently by three reviewers using the Critical Appraisal Skills Program tools. Data were synthesized using a narrative approach.
Results: Two studies were identified that focused on interventions used by nurses; findings were positive for the use of nonpharmacological interventions to manage BPSD.
Conclusion: Current evidence suggests that nonpharmacological interventions are the best practices to manage BPSD. However, limited, and low-quality evidence suggests that further investigation is required to understand the factors contributing to the lack of use of nonpharmacological interventions by nurses in acute and subacute hospital settings.
Source: Jesto, S. International Journal of Nursing Practice, Oct 2023; Early View
Predicting sojourn times across dementia disease stages, institutionalization, and mortality
Abstract: INTRODUCTION: Inferring the timeline from mild cognitive impairment (MCI) to severe dementia is pivotal for patients, clinicians, and researchers. Literature is sparse and often contains few patients. We aim to determine the time spent in MCI, mild-, moderate-, severe dementia, and institutionalization until death.
METHODS: Multistate modeling with Cox regression was used to obtain the sojourn time. Covariates were age at baseline, sex, amyloid status, and Alzheimer's disease (AD) or other dementia diagnosis. The sample included a register (SveDem) and memory clinics (Amsterdam Dementia Cohort and Memento).
RESULTS: Using 80,543 patients, the sojourn time from clinically identified MCI to death across all patient groups ranged from 6.20 (95% confidence interval [CI]: 5.57–6.98) to 10.08 (8.94–12.18) years.
DISCUSSION: Generally, sojourn time was inversely associated with older age at baseline, males, and AD diagnosis. The results provide key estimates for researchers and clinicians to estimate prognosis.
Source: Tate, A E. Alzheimer’s & Dementia, Oct 2023; Early View
Exploring specialist dementia nursing models and their impact on people living with dementia and their family: A systematic review
Abstract: Background: Evidence that brings together the attributes, specialist knowledge, skills, and competencies required by specialist dementia nurses to fulfil their role is currently lacking, making it difficult to assess the effectiveness of specialist nurse-led interventions. We systematically reviewed the evidence for specialist dementia nursing to determine how it is defined in terms of key skills, models of delivery, and the impact on families and people living with dementia
Method: We searched for papers using three databases (MEDLINE, CINAHL, PsycINFO), grey literature (EThOS), and the National Institute for Health and Care Excellence (NICE) evidence search. Search terms related to ‘specialist nursing’ and ‘dementia’ were used. We screened titles and abstracts of identified articles and conducted forward searches for additional relevant studies. Two authors independently rated study quality. Findings were synthesised narratively.
Result: 31 studies were included in the review; 26 were conducted in the UK or USA using a range of methodologies. Role titles varied to include “Admiral Nurses”, “Nurse Practitioners” and “Clinical Nurse Specialists”. We found limited evidence comparing the knowledge, skills, and competencies required by specialist nurses except Admiral Nursing where these were described in three studies. In RCTs (n = 2), specialist nursing did not improve donepezil adherence; and personalised emails to family carers from a nurse specialist did not increase carer self-efficacy when compared to less intensive interventions. In non-randomised studies, a USA Nurse Dementia Care Manager service was associated with fewer emergency room and hospital admissions; there were no differences in clinical or cost outcomes in an Admiral Nursing service; and training inpatient specialist nurses in a behavioural intervention increased use of pain- relief medication and reduced patient length of stay. Of the 31 studies, 4 reported high carer satisfaction with specialist nursing.
Conclusion: We identified only one framework defining specialist dementia nursing competencies, and limited evidence for effectiveness of specialist nursing dementia services on families affected by dementia, despite care received being highly valued. No RCT has measured the impact of specialist nursing on family carer and client outcomes relative to less specialist care.
Source: Brown, P C. Alzheimer’s & Dementia, Dec 2023; 19(S19)
Applications of artificial intelligence in dementia
Abstract: The recent evolution of artificial intelligence (AI) can be considered life-changing. In particular, there is great interest in emerging hot topics in AI such as image classification and natural language processing. Our world has been revolutionized by convolutional neural networks and transformer for image classification and natural language processing, respectively. Moreover, these techniques can be used in the field of dementia. We introduce some applications of AI systems for treating and diagnosing dementia, including image-classification AI for recognizing facial features associated with dementia, image-classification AI for classifying leukoaraiosis in MRI images, object-detection AI for detecting microbleeding in MRI images, object-detection AI for support care, natural language-processing AI for detecting dementia within conversations, and natural language-processing AI for chatbots. Such AI technologies can significantly transform the future of dementia diagnosis and treatment.
Source: Kameyama, M. Geriatrics & Gerontology International, Nov 2023; Early View
Walking the talk for dementia: A unique immersive, embodied, and multi-experiential initiative
Abstract: Coping with dementia requires an integrated approach encompassing personal, health, research, and community domains. Here we describe “Walking the Talk for Dementia,” an immersive initiative aimed at empowering people with dementia, enhancing dementia understanding, and inspiring collaborations. This initiative involved 300 participants from 25 nationalities, including people with dementia, care partners, clinicians, policymakers, researchers, and advocates for a 4-day, 40 km walk through the Camino de Santiago de Compostela, Spain. A 2-day symposium after the journey provided novel transdisciplinary and horizontal structures, deconstructing traditional hierarchies. The innovation of this initiative lies in its ability to merge a physical experience with knowledge exchange for diversifying individuals' understanding of dementia. It showcases the transformative potential of an immersive, embodied, and multi-experiential approach to address the complexities of dementia collaboratively. The initiative offers a scalable model to enhance understanding, decrease stigma, and promote more comprehensive and empathetic dementia care and research.
Source: Peres, F A. Alzheimer’s & Dementia, Jan 2024; Early View
