Ethical self-efficacy among healthcare professionals caring for people with dementia: a brief pre- and post-report on the CARE intervention.

BACKGROUND: Interventions targeting healthcare professionals' confidence in managing ethical issues in dementia care are limited despite documented positive effects of educational programs on staff knowledge and self-efficacy. However, inconsistencies in the literature regarding the impact of educational programs underscore the need for targeted interventions. The CARE intervention, specifically designed to enhance confidence in ethical decision-making, aims to address this gap. This study evaluates the effectiveness of the CARE intervention in enhancing the ethical self-efficacy of healthcare professionals caring for people with dementia, particularly those with initially low levels of self-efficacy. METHODS: Using a non-experimental pre-post evaluation design, the CARE intervention was administered to healthcare professionals (n = 86), measuring ethical self-efficacy pre-and post-intervention. We hypothesized significant differences in ethical self-efficacy mean scores pre- and post-intervention for all participants, particularly those with low pre-measurement scores, whom we expected to benefit most from the intervention. Statistical analysis included paired t-tests and Wilcoxon tests for the low pre-measurement subgroup analysis. RESULTS: While no significant change was observed in the entire sample, participants with low initial self-efficacy showed a statistically significant improvement post-intervention. CONCLUSIONS: The CARE intervention holds promise in improving ethical self-efficacy among healthcare professionals with initial low confidence levels. Targeted interventions are essential in addressing confidence gaps in managing ethical challenges in dementia care, with implications for professional well-being and quality of care. Further research should explore long-term effects and expand sample size to enhance generalizability and sustainability of findings.

Internet-Based Supportive Interventions for Family Caregivers of People With Dementia: Randomized Controlled Trial.

Background: As dementia progresses, patients exhibit various psychological and behavioral symptoms, imposing a significant burden on families and society, including behavioral and psychological symptoms of dementia. However, caregivers lack professional care knowledge and skills, making it difficult for them to effectively cope with the diverse challenges of caregiving. Therefore, it is necessary to provide caregivers with professional knowledge and skills guidance. Objective: This study aimed to analyze the impact of internet-based training on behavioral and psychological symptoms of dementia in patients, and explore how this training model affects the caregiving abilities and caregiving burden of the family caregivers of patients with dementia. Methods: Using a consecutive enrollment method, the Department of Geriatrics at Zhejiang Hospital (Zhejiang, China) recruited 72 informal caregivers of patients with dementia. These caregivers were randomly divided into an intervention group and a control group, with 36 participants in each group. The intervention group underwent caregiver skill training via a web-based platform, whereas the control group initially received face-to-face follow-up guidance and was subsequently offered web-based training after 6 months. To assess the effectiveness of the intervention program, we used the Neuropsychiatric Inventory Questionnaire (NPI-Q), the Chinese version of the Zarit Burden Interview (CZBI), and the Sense of Competence in Dementia Care Staff Scale (SCIDS) for evaluations conducted before the intervention, 3 months after the intervention, and 6 months after the intervention. Results: Between July 2019 and December 2020, a total of 66 patients successfully completed the intervention and follow-up. After 6 months of intervention, the NPI-Q score of the intervention group was 3.18 (SD 3.81), the CZBI score was 10.97 (SD 5.43), and the SCIDS score was 71.88 (SD 4.78). The NPI-Q score of the control group was 8.09 (SD 8.52), the CZBI score was 30.30 (SD 13.05), and the SCIDS score was 50.12 (SD 9.10). There were statistically significant differences in NPI-Q (P=.004), CZBI (P<.001), and SCIDS scores (P<.001) between the intervention group and the control group. Repeated measures analysis of variance showed that compared with before the intervention, there were statistically significant differences in CZBI (P<.001) and SCIDS (P<.001) scores 3 months after the intervention, while the difference in NPI-Q (P=.11) scores was not significant. The total scores of NPI-Q (P<.001), CZBI (P<.001), and SCIDS (P<.001) were significantly improved 6 months after the intervention. In addition, the results of the covariance analysis showed that after excluding the time effect, the web-based training intervention significantly reduced the NPI-Q score (-2.79, 95% CI -4.38 to -1.19; P<.001) of patients with dementia and the CZBI score (-13.52, 95% CI -15.87 to -11.16; P<.001) of caregivers, while increasing the SCIDS score (12.24, 95% CI 9.02-15.47; P<.001). Conclusions: Internet-based training could significantly reduce the level of behavioral symptoms in older patients with dementia and alleviate the burden on caregivers, enhancing their caregiving abilities. Our results confirmed the effectiveness and feasibility of web-based training, which was of great significance in providing caregiving knowledge training for informal caregivers of persons with dementia.

Post-diagnosis dementia care in the Western Pacific region: assessment of needs and pathways to optimal care.

The Western Pacific region is home to approximately 25% of the world's population. In the absence of cures for dementia, it is essential to focus on appropriate and accessible care pathways for people living with dementia and their families. This approach will ultimately result in timely diagnosis and improved care and support. Ensuring adequate dementia care and support pathways has been a longstanding issue in many developed countries and is becoming a more prominent issue in countries with rising dementia prevalence rates but comparatively limited health resources. This Viewpoint provides an overview of system-level post-diagnosis dementia care, from diagnosis to rehabilitation, across some of the region's lower (Laos, Solomon Islands, Philippines) and upper (China) middle income and high income (South Korea, Australia) countries. Gaps and challenges in post-diagnosis dementia care, as well as suggestions for optimal care, are discussed. This Viewpoint highlights highly variable system level post-diagnosis dementia care in the region.

Capitalizing on Dementia Care Mapping in an Evaluation of a Montessori-Based Intervention for Individuals Living with Dementia.

BACKGROUND AND OBJECTIVES: Montessori-based interventions (MBIs) promote quality of life among older adults living with dementia. We used Dementia Care Mapping (DCM) to evaluate the impact of a small-scale MBI. DCM is a systematic observation tool that records the behavior and mood/engagement of individuals living with dementia and can be used to improve quality of care and well-being. RESEARCH DESIGN AND METHODS: Pre- and post-intervention data from 15 care community residents compared: 1) residents' range and types of behaviors, 2) their mood/engagement and 3) staff behaviors that facilitated and impeded residents' personhood. In this mixed-methods study, deductive qualitative content analysis of DCM field notes further explored staff behaviors. RESULTS: Post-intervention, a significantly higher proportion of residents' behaviors had the potential to promote their well-being, although there was little change in mood/engagement while engaging in those behaviors. Post-intervention, there was also a significant increase in staff behaviors that facilitated, and a decrease in staff behaviors that impeded, residents' personhood. Further, post-intervention, staff interactions with residents were more open-ended and inclusive. Although some staff behaviors still excluded residents, the exclusion was more benign than pre-intervention. DISCUSSION AND IMPLICATIONS: DCM documented incremental changes toward person-centered care, and DCM field notes provided insight into missed opportunities for effective staff interactions with residents. Taken together, findings provide additional support for the use of MBIs and highlights the usefulness of DCM, especially its associated field notes, to help researchers and practitioners create environments that promote the personhood that individuals living with dementia deserve.

The COM-B model: a cross-sectional survey assessing capability, opportunities, and motivation to follow the MIND diet among informal female caregivers of people with Alzheimer's disease and related dementias.

Introduction: Caring for a person with Alzheimer's disease or dementia has been correlated with poor dietary patterns in caregivers. Dietary patterns like The Mediterranean-DASH diet intervention for neurodegenerative delay (MIND) diet have the potential to reduce the negative health outcomes associated with caregiving. Our objective was to assess capabilities, opportunities, and motivation of caregivers to follow the MIND diet using the COM-B model approach. Method: Female caregivers (n = 299, m age = 37.7 ± 13.7) participated in an online survey. Majority were White (72%) and cared for someone with Alzheimer's disease (42.6%). The survey included at least one question for each of the 6 COM-B subcomponents: psychological capability, physical capability, social opportunity, physical opportunity, reflective motivation, and automatic motivation. Results: Most caregivers were not consuming the MIND diet as only 8.4% reported normally eating the MIND diet items. Caregivers (36.5%) were slightly confident or not confident at all in cooking and eating the MIND diet. Participants (67.1%) reported that consuming the MIND diet would somewhat to very much be supported by friends and family. Budget, time, and transportation were selected as the main barriers. Budget, cooking skills, access to food and stores, and family support were the main facilitators. Discussion: Strategies to increase capability, opportunities, and motivation for the MIND diet are needed to improve caregivers' health. Future MIND diet interventions should improve budget planning and cooking skills of caregivers (capabilities), make MIND diet food items accessible to them (opportunity) and incorporate social support from family and friends (motivation).

Traditional healing and medicine in dementia care for Indigenous populations in North America, Australia, and New Zealand: Exploring culturally-safe dementia care policy from a global perspective.

INTRODUCTION: In 2018, the World Health Organization recognized traditional healers as community stakeholders in dementia care. This scoping review aimed to summarize the existing dementia care literature regarding strategies for the integration of traditional healing in dementia care and the roles of traditional healers. METHODS: A group of Indigenous Elders from Northern Ontario, Canada, guided, reviewed, and validated the research process and findings. The Joanna Briggs Institute approach was applied to a structured search strategy across the CINAHL, Embase, MEDLINE, and PsycINFO databases. A title and abstract screening were completed, followed by a full-text assessment of the identified manuscripts. RESULTS: A total of 143 full manuscripts were reviewed, of which two studies fully met the community-determined inclusion/exclusion criteria. DISCUSSION: The integration of traditional healing practices into dementia care offers a pathway to culturally-safe care for people with dementia. The findings identified policy advocacy as key to engage, educate, and empower traditional healers. Highlights: The WHO recognized traditional healers as community stakeholders in dementia care and prevention worldwide in 2018; however, traditional healers are underrepresented and marginalized in healthcare systems due to the lack of culturally-safe dementia care (CSDC) policies at community and national levels globally.Community-based CSDC models were critically reviewed and validated by local Indigenous community stakeholder consultations.The result is a call to action to assist the WHO and Alzheimer's Disease International in developing guidelines for CSDC policy improvements with the global Indigenous community for the engagement and empowerment of traditional healers to navigate dementia care and to implement the WHO Global Action Plan on the Public Health Response to Dementia (2017-2025).Integration of Western biomedical and Indigenous traditional healing and medicine in dementia care in the healthcare system can reduce health disparities and empower traditional healers on a global scale. Indigenous-led models that include traditional healers in dementia care are critical for improving equity gaps in dementia care for Indigenous Peoples.

Exploring Stakeholder Perspectives on the Implementation of WHO iSupport for Dementia Program: A Qualitative Study.

AIM: To explore the stakeholders' perspectives and develop a conceptual framework for promotion strategies to implement the iSupport-based intervention for family caregivers of people with dementia. DESIGN: A descriptive qualitative design was adopted. METHODS: Semi-structured interviews were conducted with 49 stakeholders of people with dementia from July to December 2023. The Consolidated Framework for Implementation Research was applied to guide the development of the interview guide, data collection and analysis. Directed content analysis was employed to identify facilitators and barriers, with data analysed based on the framework and the established its codebook. These findings were then summarised into a conceptual framework of critical components. RESULTS: The identified 16 barriers and 28 facilitators were distributed across all Consolidated Framework for Implementation Research domains. All facilitators and barriers were integrated into a conceptual framework guiding the implementation of iSupport. This four-tier, eight-component conceptual framework guides the global promotion of the web-based dementia care model, covering state, society, hospitals, individuals and strategies. The components included comprehensive and balanced national medical guidelines, a friendly social culture, adequate hospital collaboration, cooperative healthcare workers, responsible family caregivers, a comprehensive intervention system, appropriate learning content and digital health support. CONCLUSION: The 'iSupport for Dementia' program is seen positively for its potential to improve dementia care by providing mental and technical support to family caregivers. Successful implementation requires addressing barriers, enhancing facilitators and adapting to China's conditions and policies. Mobilising local healthcare resources and gaining stakeholder recognition is crucial. This approach may help develop a localised version of iSupport that suits the needs and habits of Chinese family caregivers, with the potential for broader dissemination. IMPACT: The 'iSupport for Dementia' program could greatly improve dementia care in China by addressing barriers and utilising facilitators. This study offers critical insights for future policy development and effective implementation strategies. REPORTING METHOD: Adherence to the COREQ guidelines for reporting qualitative research was maintained. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Horticultural therapy impact on people with dementia.

BACKGROUND: Dementia is a progressive disease, and as the disease progresses, many families seek help through activities and therapies. In contrast to some other therapies, horticultural therapy (HT) is widely accepted by most people with dementia (PWD) because it invites them to the natural world. OBJECTIVES: To explore whether HT emotional and communication measures (i.e. appropriate expression of emotions, ability to communicate with others) are higher than in other activities offered to PWD in adult day care centers (ADCC) and continuing care retirement community (CCRC), and whether there is a difference between the impact of HT on the number of "positive actions" (communication actions and actions that fit the guided activity) vs. the other activities. RESEARCH DESIGN AND METHODS: Fifty-one PWD attending ADCCs and living in one CCRC were recruited to a structured HT activity and other activities that took place in the ADCCs and CCRC. The activity took place over 10 weeks. The effects were assessed using Dementia Care Mapping (DCM) and questionnaires. RESULTS: Paired t-tests found that higher levels of mood and behavior were observed during HT activities compared to the other activities. Also, communication and function actions were higher in the HT activities as compared to the other activities. DISCUSSION AND IMPLICATIONS: This study adds to the growing evidence of the benefits of HT for PWD regardless of past experience in gardening/agriculture. HT seems to provide high therapeutic benefits and should be more prevalent in centers caring for PWD.

Validation of the Attitudes toward Lying to People with Dementia (ALPD) Questionnaire among Social Workers in Spain.

Gerontological interventions should address the various geriatric syndromes suffered by the elderly, such as neurodegenerative diseases. Therapeutic lying is an effective and humanizing strategy to deal with dementia, used by various disciplines in the social and healthcare fields. This intervention strategy is made up of all the different responses to reality that are given to a person with cognitive impairment. This study analyzes the validity of the Spanish adaptation of the Attitudes toward Lying to People with Dementia (ALPD) questionnaire, given to 253 social workers who directly and indirectly intervened with older people suffering from cognitive impairment in public and private centers in Spain during the year 2022. The results of the validity and reliability analyses support the psychometric quality of ALPD for use in Spanish social workers. The statistical results indicate a good fit of the bifactor model (person-focused and lie-focused) and show the questionnaire to be reliable, with adequate psychometric properties. The article concludes with a discussion of practical, formative, and ethical challenges for social work in the field of geriatric services.

Second Partnership and Dementia Care in a Blended Family: Case Study of a Wicked Problem.

Dementia care research has largely ignored the challenges that may emerge from couple and family dynamics, especially about second partnerships in blended families. This paper details the case of a 79-year-old man, Hannes, in his second partnership who tried to handle the complexities of his wife's dementia care as her children and healthcare providers discounted his role as husband and decision maker. He faced difficult communications with family members and challenges to his role as decision maker by healthcare providers and legal system professionals. This man's story is explored through multiple interviews and document analyses from 2020 to 2023. This case study uses the concept of the "wicked problem" to frame the potential complexities of dementia care when blended families are involved in decision making. This framework allows us to consider the many facets of family dementia care and how improvements could be made to facilitate role transitions and family decision making.

Healthcare Professionals' Perspectives on Dignity in Dementia: A Qualitative Analysis.

In dementia care, the concept of dignity has garnered substantial attention from both researchers and policymakers. However, the concept often remains vague and open to interpretation, potentially leading to misunderstandings and suboptimal care for people with dementia. As healthcare professionals occupy a critical role in upholding dignity, exploring their viewpoints on this complex concept is paramount. In this study, we explore Danish healthcare professionals' views on the dignity of people with dementia and discuss these perspectives against existing theoretical accounts. We employed thematic analysis of data collected during facilitated discussions with a total of 99 healthcare professionals, including nurses and healthcare workers, during which we posed the question, "What is dignity to you?" and documented their perspectives. Through a systematic process of data coding and interpretation, we identified recurring patterns in their responses. This approach allowed us to uncover the depth and complexity of their viewpoints, providing valuable insights into the multifaceted nature of dignity as perceived by healthcare professionals. Our findings revealed that healthcare professionals possessed a nuanced understanding of dignity, recognizing both a subjective element and a universal aspect applicable to all individuals, aligning with theoretical interpretations. However, conceptual ambiguity remained a challenge.

Understanding the role of agency in the navigation of regional dementia care and support service pathways.

INTRODUCTION: Reliable dementia care and support service pathways are essential for timely diagnoses and for reducing the delay in time from diagnosis to care and support. However, carers commonly experience difficulties in finding information about where to go and what to do before and following a dementia diagnosis. In rural and regional areas, accessing dementia care and support services can be especially challenging. This qualitative, narrative inquiry study explores the agency of carers, and people living with dementia, in their navigation of regional dementia care and support service pathways. METHODS: Semi-structured interviews were conducted with ten carers of people living with dementia from a regional location in Victoria, Australia. Data analysis was guided by the tripartite framework of Giddens' Theory of Structuration which considered the carers' intentionality, capacity and power to act in the navigation of their dementia care and support service pathways. FINDINGS: Carers had intentionality; however, they did not always have the capacity and power to act. Information played a critical role in facilitating agency. Health literacy was important - as knowledge about where to look for/find information, and knowledge gained through experience, education or learning from others. Where carers encountered barriers, they lacked capacity and power. This occurred where there was an absence of information or knowledge, incorrect information (e.g. misdiagnoses), and where government bodies impeded carers' efforts. CONCLUSIONS: Information and knowledge are critical to the progression of dementia care and support service pathways. Health literacy is a significant resource, and carers would benefit from dementia education/training. The agency of carers in navigating their dementia care and support service pathways relies on carers themselves finding information and seeking out knowledge and education. However, GPs, local health providers, and dementia organisations have an important role to play in helping carers to find information towards accessing dementia care and support services.

Promoting Independence Through Quality Dementia Care at Home (PITCH): An Australian Stepped-Wedge Cluster Randomised Controlled Trial Evaluating a Dementia Training Program for Home Care Workers.

OBJECTIVES: The primary aim of this pragmatic stepped-wedge cluster RCT was to determine the efficacy of a co-designed dementia specialist training program (the PITCH program) for home care workers (HCWs) to improve their confidence and knowledge when providing care for clients living with dementia. METHODS: HCWs who provided care to clients with dementia were recruited from seven home care service provider organisations in Australia between July 2019 and May 2022, and randomised into one of 18 clusters. The primary outcome was HCW's sense of self-competence in providing care services to people living with dementia at 6 months post PITCH training measured by the Sense of Competence in Dementia Care Staff (SCIDS) Scale. RESULTS: Two hundred and thirteen HCWS completed baseline assessment and almost half (48.4%) completed all three study assessments. HCWs in clusters that received PITCH training had significantly higher sense of competence (measured by SCIDS) than those who had not received PITCH training. Post hoc analysis revealed that face-to-face PITCH training consistently resulted in improvements in the HCWs sense of competence, dementia attitudes and knowledge when compared to online training and when compared to no training. PITCH training had no effect on the sense of strain HCWs felt in delivering dementia care. CONCLUSIONS: Given the majority of care for people living with dementia is provided at home by family carers supported by HCWs, it is essential that HCWs receive training that improves their skills in dementia care. This study is an important step towards better care at home for people living with dementia.

User Experience Testing of the Meta Quest 2 for Integration With the Virtual Reality Simulation for Dementia Coaching, Advocacy, Respite, Education, Relationship, and Simulation (VR-SIM CARERS) Program.

Caregivers (CGs) of persons with dementia (PWDs) face numerous challenges, including learning about the condition, managing behavioral symptoms, and prioritizing their own well-being. Virtual reality (VR) technology has emerged as a promising tool to adopt certain elements of existing CG psychoeducation programs, such as the Reitman Centre CARERS (coaching, advocacy, respite, education, relationship, and simulation) program, which has been shown effective in reducing CG burden and stress and building the required skills for caring for PWD. Recently, we have developed a VR prototype utilizing Meta Quest 2 (Meta, Menlo Park, CA, USA), which will be referred to as the (virtual reality simulation for dementia CARERS) VR-SIM CARERS program. This technical report aims to describe the early stages of intervention modeling by testing user experiences related to the hardware used. The Meta Quest 2 VR system is chosen for its accessibility and functionality, aiming to ensure widespread access. Through interviews and observational techniques, we explored CGs age-matched controls' attitudes, comfort, and proficiency with the Meta Quest 2 VR system, which are crucial for informing technological choices. Initial findings revealed mixed attitudes, comfort, and proficiency about the Meta Quest 2 VR system. Although further testing of the Meta Quest 2 VR system within the CG community is warranted, the interpretation of these preliminary results indicates that the VR-SIM CARERS program should have minimal technological skill requirements for user engagement or provide in-depth training resources for the CGs who choose to use the system.

Persisting gaps in dementia carer wellbeing and education: A qualitative exploration of dementia carer experiences.

AIMS: To explore the emotional wellbeing of dementia carers in the lead up to and during transition of a person living with dementia to a residential aged care facility. DESIGN: An interpretative qualitative study. METHODS: Semi-structured interviews were conducted with informal carers of person living with dementia between February and June 2023. Data were analysed using an inductive thematic approach and resulted in three themes. RESULTS: The majority of carers were adult children (n = 19) and six were wives. Carers lived across metropolitan (n = 20) and regional settings (n = 5) in the most populous state of Australia. Three themes were identified which were attributed to different aspects of the carer role: (1) Carer emotional journey as dementia progresses - impacted by knowledge and lack of support; (2) Questioning decision making-underpinned by knowledge and confidence; and (3) Challenges in re-establishing identity - impacted by ongoing concerns. CONCLUSION: As dementia progresses carers of person living with dementia consistently reported gaps in knowledge including how to access support. Specifically, this study identified the need for more to be done to help carers to develop the skills needed for their role, including participation in care planning and identifying care preferences for the future. Nurses can play a key role in promoting referral to services that support carers. Findings offer practical solutions to ameliorate carer stress and promote shared decision making. REPORTING METHOD: This research was guided by the Consolidated Criteria for Reporting Qualitative Research.

Relationship quality perceived by family caregivers of people with dementia in the context of a psychoeducational intervention: A qualitative exploration.

BACKGROUND: Caring for a person with dementia can be a challenging experience, often associated with chronic stress and a heavy burden on family caregivers. Dementia also impacts the relationship between the caregiver and the person with dementia. The quality of this relationship is, in turn, an important factor influencing the well-being of both dyad members. The psychoeducational intervention "Learning to feel better . . . and help better" has shown positive results regarding family caregivers' subjective burden, psychological distress, and self-efficacy. However, relationship quality has not been addressed in the context of this intervention. METHODS: A longitudinal constructivist grounded theory approach was used to explore relationship quality as perceived by caregivers, possible changes and intervention components facilitating or preventing such changes. Three qualitative, semi-structured interviews (before, during and after the intervention) were performed with 13 family caregivers from three different intervention groups. The resulting 39 interviews were analysed regarding individual caregiver trajectories, per time point for all caregivers and regarding specific caregiver subgroups. FINDINGS: A model focusing on sustaining relationship quality in dementia was developed. It shows strategies that family caregivers develop and apply to facilitate positive interactions and feelings of connectedness with their family members with dementia. It also indicates that mastering such strategies requires reflective skills based on specific knowledge of dementia and coping strategies, which can be enhanced through active skills training, in which caregivers are guided to work on their individual stressful situations. Factors hampering change included difficulties in accepting dementia-related changes. CONCLUSION: Findings suggest that psychoeducation, with active skills training based on caregivers' current daily life situations, providing systematic procedures to handle daily challenges and specific knowledge about the impact of the disease, could support them in developing and applying supportive strategies to sustain or improve their relationship to their family member with dementia.

Everyday Uses of Music Listening and Music Technologies by Caregivers and People With Dementia: Survey and Focus Group Study.

BACKGROUND: Music has long been identified as a nonpharmacological tool that can provide benefits for people with dementia, and there is considerable interest in designing technologies to support the use of music in dementia care. However, to ensure that music technologies are appropriately designed for supporting caregivers and people living with dementia, there remains a need to better understand how music is currently used in everyday dementia care at home. OBJECTIVE: This study aims to understand how people living with dementia and their caregivers use music and music technologies in everyday caring, as well as the challenges they experience using music and technology. METHODS: This study used a mixed methods design. First, a survey was administered to 13 people living with dementia and 64 caregivers to understand their use of music and technology. Subsequently, 18 survey respondents (family caregivers: n=12, 67%; people living with dementia: n=6, 33%) participated in focus groups regarding their experiences of using music and technology in care. Interview transcripts were analyzed using reflexive thematic analysis. RESULTS: Most of the survey respondents (people living with dementia: 9/13, 69%; family caregivers: 47/63, 75%) reported using music often or very often in their daily lives. Participants reported a range of technologies used for listening to music, such as CDs, radio, and streaming services. Focus groups highlighted the benefits and challenges of using music and music technologies in everyday care. Participants identified using music and music technologies to regulate mood, provide joy, facilitate social interaction and connection, encourage reminiscence, provide continuity of music use before and after the dementia diagnosis, and make caregiving easier. The challenges of using music technology in everyday caring included difficulties with staying up to date with evolving technology and low self-efficacy with technology for people living with dementia. CONCLUSIONS: This study shows that people with a dementia diagnosis and their caregivers already use music and music technologies to support their everyday care needs. The results suggest opportunities to design technologies that enable easier access to music and to support people living with dementia with recreational and therapeutic music listening as well as music-based activities.

Optimizing Technology-Based Prompts for Supporting People Living With Dementia in Completing Activities of Daily Living at Home: Experimental Approach to Prompt Modality, Task Breakdown, and Attentional Support.

BACKGROUND: Assistive technology is becoming increasingly accessible and affordable for supporting people with dementia and their care partners living at home, with strong potential for technology-based prompting to assist with initiation and tracking of complex, multistep activities of daily living. However, there is limited direct comparison of different prompt features to guide optimal technology design. OBJECTIVE: Across 3 experiments, we investigated the features of tablet-based prompts that best support people with dementia to complete activities of daily living at home, measuring prompt effectiveness and gaining feedback from people with dementia and their care partners about their experiences. METHODS: Across experiments, we developed a specialized iPad app to enable data collection with people with dementia at home over an extended experimental period. In experiment 1, we varied the prompts in a 3 (visual type: text instruction, iconic image, and photographic image) × 3 (audio type: no sound, symbolic sound, and verbal instruction) experimental design using repeated measures across multiple testing sessions involving single-step activities. In experiment 2, we tested the most effective prompt breakdown for complex multistep tasks comparing 3 conditions (1-prompt, 3-prompt, and 7-prompt conditions). In experiment 3, we compared initiation and maintenance alerts that involved either an auditory tone or an auditory tone combined with a verbal instruction. Throughout, we asked people with dementia and their care partners to reflect on the usefulness of prompting technology in their everyday lives and what could be developed to better meet their needs. RESULTS: First, our results showed that audible verbal instructions were more useful for task completion than either tone-based or visual prompts. Second, a more granular breakdown of tasks was generally more useful and increased independent use, but this varied across individuals. Third, while a voice or text maintenance alert enabled people with dementia to persist with a multistep task for longer when it was more frequent, task initiation still frequently required support from a care partner. CONCLUSIONS: These findings can help inform developers of assistive technology about the design features that promote the usefulness of home prompting systems for people with dementia as well as the preferences and insights of people with dementia and their care partners regarding assistive technology design.

A comparison of written case notes and the delivery of care in dementia specialist mental health wards.

Introduction: Stigmatising language concerning people living with dementia can cause potentially harmful and dehumanising consequences. Language used about people living with dementia in mental health wards may focus on medical perspectives and suggest custodial relationships with patients rather than person-centred accounts of individuals. This language could have a devastating impact on the provision of person-centred care. This study investigated the relationship between accounts of people living with dementia written in healthcare case notes and clinical practice at three dementia specialist wards in Wales, UK. Language guidance was provided to ward staff to assess whether stigmatising language could be reduced and whether this influenced the provision of person-centred care.Methodology: Dementia Care Mapping was adapted to analyse case note entries for enhancing and detracting accounts of people living with dementia at three data collection points. These were compared to the results of routine DCM observations of care across the three wards. The healthcare case notes of 117 people living with dementia, encompassing 4, 522 entries over ten months were analysed. DCM observations of 38 people living with dementia within the three wards were compared against the case note results. Person-centred language guidance was shared with care staff following each data collection point.Results: Following the provision of person-centered language guidance, the use of personally enhancing language was observed to increase across all three wards. Non-person-centred case note entries predominantly focussed on Labelling language, whilst language concerning Invalidation and Objectification also occurred frequently compared to other DCM domains. Person centred language typically concerned Acknowledgement. A relationship between case note entries and practice was evident in some domains although findings were inconsistent.Discussion and Implications: The findings highlight the importance of addressing stigmatising language in healthcare and suggest that further studies to support the anti-stigma agenda in dementia care are required.