Communication as Healing Art in Caring for Persons with Alzheimer's and Dementia.

ABSTRACT: Communication is an essential aspect of care for all patients but is especially important for individuals with Alzheimer's disease or other forms of dementia. Nurses who care for persons living with dementia (PwD), as well as family members and caregivers, need understanding of verbal and nonverbal communication techniques and approaches that are effective throughout the stages of dementia. Spiritual assessment and care also are critical. This article provides evidence-based and biblical examples for communication as a healing art in caring for PwD.

How does group music therapy help in combating the anxiety and depression of dementia patients? A quasi-experimental investigation.

This study looked at the effect of group music therapy on dementia patients' levels of feelings of depression and anxiety. Quasi-experiment was carried out (N = 121) in which patients were randomly divided into a control (N = 61) and an experimental group (N = 60). Following a six-weeks, twelve-sessions trial involving both passive and active music therapy, it was discovered that the music group therapy intervention decreased the anxiety and depression levels of dementia patients in the experimental group as compared to the control group, which did not receive any music therapy. It was also noted that after three months of follow-up, participants in the experimental group still maintained a low level of anxiety and depression, but the control group's level remained high, therefore, substantiating the effect of music in lowering anxiety and depression among older ones. We urge the nursing descipline, medical professionals, carers, and care homes to include music therapy in the care they provide for patients with dementia.

Changing the focus: Facilitating engagement in physical activity for people living with mild dementia in a local community-Protocol for a pre-post mixed methods feasibility study.

This study aims to address and improve the low physical activity levels among people with mild dementia by implementing a novel shared decision-making and motivational support program, named "Changing the Focus". It will utilise a pre-post mixed methods approach, aiming to recruit 60 community living older people with mild dementia and their care-partners. The shared decision-making process will involve the person living with dementia, their care-partner, and a research therapist, using a purpose-designed discussion tool including factors such as preferred physical activities, health status, local opportunities and program accessibility. This process aims to identify personalised local physical activity opportunities. Participants will be supported with the help of a research therapist to engage in targeted community-based physical activities for 12-months, to progress towards the recommended physical activity guidelines of 150 minutes per week. The intervention provided by the research therapist will include three home visits (baseline, 6- and 12-months) and seven motivational support phone calls (within the first six months). Research therapists may provide additional home visits and support calls as needed. Primary outcomes include program participation (participants living with dementia continuing with the program after 12-months), total physical activity time per week (measured using the Active Australia Survey at baseline, 6- and 12- months) and program acceptability (assessed through semi-structured interviews with participants, care-partners, referrers, and physical activity providers). Secondary outcomes include physical performance, mental health, wellbeing measures, and impact on care-partners (evaluated through physical tests or validated scales at baseline, 6- and 12-months). Other implementation aspects include reach, maintenance, safety (falls, other adverse events) and an economic evaluation. Results will inform feasibility, potential benefits, and challenges associated with this innovative shared decision-making and supported physical activity program for people living with mild dementia. Findings will guide future large-scale studies and contribute to enhancing physical activity opportunities for this population.

Effects of graphene far-infrared and social network interventions on depression, anxiety and dementia in older adults.

BACKGROUND: Five-guaranteed elderly individuals are a special group of the elderly Chinese population faced with unique challenges; these individuals lack any financial resources (including support by relatives), and are solely reliant on the government to provide food, clothing, medical care, and housing as well as burials. In this article, we aim to investigate mood problems (depression, anxiety) and cognitive functioning in Five-guaranteed elderly individuals, and to validate the effectiveness of two promising interventions, graphene far-infrared intervention (GFII; an exploratory and noninvasive technique) and social network intervention (SNI), for elderly people to lay the foundation for future social service work. METHODS: To address the emotional and cognitive difficulties experienced by this special group, we designed this study, which is the first to apply GFII in this population. We also administered SNI given the social isolation of these individuals, in addition to a corresponding control group. 108 elderly individuals in 3 elder care facilities were screened to evaluate eligibility to participate in the current study, including 44 from Facility A (allocated to the GFII group), 43 from Facility B (allocated to the SNI group), and 21 from Facility C (allocated to the control group). GFII lasts for four weeks, with professionally trained carers putting on and removing intervention caps for half an hour each day. SNI lasts for three weeks, three times a week, and consists of a total of nine themed activities. The length of an activity is 90 min. We also did pre- and post-test comparisons of depression, anxiety and cognition in each group of older adults. RESULTS: The results showed that GFII led to immediate improvements in anxiety and cognitive impairment in the five-guaranteed elderly individuals, and the improvement in cognitive function was sustained over time. Moreover, SNI group showed significant improvements in cognitive function after the intervention period. CONCLUSIONS: The GFII is a promising intervention that can be applied to intervene in cognitive and mood disorders in older adults. The GFII has short-term interventions for anxiety in older adults, but long-term effects for cognitive impairment. SNI also had an interventional effect on cognition.

[Kommunikation bei Demenz].

A scoping review investigated the effectiveness of different communicative interventions for patients with dementia. It demonstrated that communication between caregivers and dementia patients is improved by music, multisensory stimulation, and communication training. As a result agitation, mania, fear, anger and corrective touching are reduced, and fluency, spontaneous speech, eye contact, smiling and affective touching are enhanced. The recommendations, summarized in a fact sheet, also contribute to improved therapeutic decision making with bystanders and oral health of people with dementia.

Education Program for Enhancing Health Care Students' Attitudes Toward People Living With Dementia: Protocol for a Single-Arm Pre-Post Study.

BACKGROUND: Health care students are instrumental in shaping the future of dementia care. Cultivating a positive attitude and understanding toward people living with dementia is crucial for diminishing the stigma associated with the condition, providing effective and person-centered care, and enhancing the quality of life for people living with dementia. Educational programs about dementia are increasingly recognizing the potential of gaming tools. OBJECTIVE: This study aimed to evaluate the effectiveness of gaming-based dementia educational programs in improving attitudes toward people living with dementia among health care students. METHODS: This single-arm pre-post study will be conducted among health care students in Indonesian universities. This educational program based on gaming tools will consist of a lecture on dementia, the use of N-impro (gaming tool), and the enactment of short dramas depicting desirable and undesirable communication with people living with dementia behaviors. We will assess attitudes toward people living with dementia, intention to help people living with dementia, knowledge of dementia, and the stigma associated with people living with dementia. The gaming-based dementia education program will be integrated into the curriculum of the health care students. The program will be implemented once with a duration of 90 minutes. RESULTS: Data collection will occur from August 2023 to March 2024. Analysis of the data will be finalized by May 2024, and the outcome will be determined by July 2024. The impact of the gaming-based dementia educational program on improving attitudes toward people living with dementia will be reported. The study findings will be published in a peer-reviewed journal. CONCLUSIONS: The gaming education program demonstrates significant potential in enhancing attitudes toward people living with dementia across various countries, introducing an innovative method for the community-based support of people living with dementia. TRIAL REGISTRATION: ClinicalTrials.gov NCT06122623; https://clinicaltrials.gov/study/NCT06122623. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/62654.

Doing the Right Thing? General Practitioners' Considerations in Achieving a Timely Dementia Diagnosis.

OBJECTIVES: Timely detection and diagnosis of dementia are beneficial for providing appropriate, anticipatory care and preventing acute situations. However, initiating diagnostic testing is a complex and dynamic process that requires general practitioners (GPs) to balance competing priorities. Previously identified barriers, such as a lack of time, knowledge, and resources, may not fully represent the challenges involved in this process. Therefore, this study aimed to examine GPs' more implicit considerations on starting the diagnostic trajectory for dementia. METHODS: A qualitative study was conducted using semi-structured interviews with 14 Dutch GPs who were purposively selected through maximum variation sampling. The interview transcripts were inductively analyzed in multiple rounds by a multidisciplinary research team using thematic analysis. RESULTS: GPs' considerations on starting the diagnostic trajectory for dementia can be summarized in three main themes that are interconnected: (1) 'the presumed patient's willingness', that is, facing a dilemma of wanting to respect patient autonomy in cases of denial or an absence of a diagnostic request, while at the same time identifying a problem and feeling the urgency to act; (2) 'the GP's attempt not to harm', that is, balancing between not wanting to harm the patient and/or relatives with the burdensome label of dementia and with the possible negative consequences of a late diagnosis; and (3) 'time, trust, and interprofessional collaboration influence timeliness of diagnostic work-up', that is, time available for consultations, time as a diagnostic factor, GP's diagnostic confidence, and trustful physician-patient relationship. CONCLUSIONS: This study revealed that important ethical dilemmas regarding patient autonomy and the principle of doing no harm lie behind practical GP barriers to initiating diagnostic testing for dementia. Time, trust, and interprofessional collaboration were found to facilitate GPs in determining the right decision and timing with each individual patient and their relatives. Future research could explore the value of diagnostic decision aids that explicitly involve patients and their relatives in this balancing act.

Cognitive stimulation in activities of daily living for individuals with mild-to-moderate dementia (CS-ADL): Study protocol for a randomised controlled trial.

BACKGROUND: Multi-component CS programs incorporating practice of activities of daily living (ADL) into intervention have reported benefits for ADL outcomes in individuals living with mild-to-moderate dementia. A randomised controlled trial (RCT) within community occupational therapy services in Ireland, is planned to evaluate the effects of CS-ADL, an ADL-focused, multi-component CS program, on ADL outcomes for individuals living with mild-to-moderate dementia. METHOD: A single-blind RCT with a calculated sample size of 34 participants has been planned to compare the effects of CS-ADL versus treatment as usual on the outcomes of basic ADLs and instrumental ADLs. Cognition, mood, communication, and quality of life will also be evaluated as secondary outcomes. CS-ADL sessions will run once weekly for a total of seven weeks, lasting approximately two hours each. Outcome data will be collected at baseline, within sessions and post-intervention at week eight. Descriptive statistics will be used to analyse the data. This study has been registered at clinicaltrials.gov (NCT06147479). DISCUSSION: CS programs are commonly conducted by occupational therapists working with individuals living with mild-to-moderate dementia. This study aims to demonstrate the effectiveness of a multi-component CS program delivered through an occupational therapy lens, potentially influencing the approach to CS and ADL interventions undertaken by occupational therapists.

Medication management information priorities of people living with dementia and their carers: a scoping review.

BACKGROUND: People living with dementia and their carers often experience difficulties in effectively managing medications and have indicated they lack necessary support, information and guidance. Recognising the medication management information needs of this population is an important first step in addressing these issues. OBJECTIVES: To identify the priorities for information on medication management expressed by people living with dementia and their carers. METHODS: A scoping review with systematic search was conducted from inception to 12 May 2023 for any original studies that reported the information needs of people living with dementia and their carers (informal, i.e. unpaid or within an existing relationship) regarding medication management. Two authors independently screened the abstracts, full-texts and extracted data. Study characteristics were described descriptively, and themes of information need were extracted using an iterative approach. RESULTS: Of the 11 367 records screened, 35 full-texts were included. All studies (n = 35) involved carers, with 17 also including people living with dementia. Most studies (n = 30) were conducted in the community and used qualitative methods (n = 32). Five major themes of information need were identified: critical medication information; medication effects; medication indication(s); disease progression and impact on medications; and safe and appropriate administration of medications. People living with dementia and their carers indicated they need more medication management information generally and want it simple, tailored and relevant. CONCLUSIONS: This review highlights the key medication information priorities for people living with dementia and their carers and will help guide the provision of medication management guidance and development of new information resources.

Advice for dementia carers: A critique of the literature.

Although hundreds of advice manuals for dementia carers have been published, most have serious limitations. They emphasize the various problems family members experience without noting the social and political context within which caring unfolds. As a result, they eschew structural reforms in favor of individual solutions, including self-care. The manuals also encourage carers to detach emotionally from people with dementia by viewing them in terms of their disease. In addition, the books hew so closely to the medical model of dementia that they ignore newer perspectives. Narratives by people with dementia provide a critical corrective. Those works argue that the disproportionate attention directed toward carers has eclipsed the perspective of people with dementia, that people remain individuals despite a dementia diagnosis, that issues of stigma and discrimination shape the experience of living with dementia, that more emphasis should be placed on promoting the autonomy of people with dementia, that they are entitled to reasonable accommodations, and that they should have more opportunities for growth. I have reviewed the policies detailed in the guide and have no competing interests.

Effects of oral health interventions on cognition of people with dementia: a systematic review with meta-analysis.

BACKGROUND: Increasing studies have shown that poor oral health contributes to the progression of dementia. It is meaningful to find out the role of oral health interventions in maintaining people's cognition levels and delaying the progression of dementia. Thus, we conducted this review to summarize the present evidence on the effect of oral health interventions on the cognition change of people with dementia. METHODS: Literature search was conducted in the databases of PubMed, Embase, Web of Science, Cochrane library, and Dentistry and Oral Sciences by two independent reviewers from inception to 6 March 2024. Clinical studies such as randomized controlled trials reporting on the effect of oral health interventions on the cognition of people with dementia were included in this review. Mini-Mental State Examination (MMSE) scores were used to measure cognition level. The mean deviation (MD), generated by subtracting the baseline MMSE score from the MMSE score at follow-up was used to assess the change in cognition. Studies with oral hygiene practice as an oral health intervention were further conducted with a meta-analysis. RESULTS: A total of 6646 references were identified by the literature search, and 5 studies were eligible to be included in this review. Among the included studies, 4 studies reported the cognition change after having various oral hygiene practice as oral health intervention, while the other study adopted oral exercises as the intervention. Two studies presented positive MD values after intervention provided, indicating improved cognition level at follow-up (MD = 0.6, MD = 0.9, respectively). Another two studies reported less cognition deterioration with smaller absolute MD values in the intervention group, (intervention vs. control, -0.18 vs. -0.75, p < 0.05 and - 1.50 vs. -3.00, p < 0.05, respectively). The random-effect model was selected in the meta-analysis, and the weighted mean difference (WMD) was 1.08 (95% confidence interval, 0.44 to 1.71), favoring the intervention group. CONCLUSION: With limited evidence, oral hygiene care may play a positive role in maintaining the cognition level of people with dementia. However, further studies are needed to provide direct evidence on the effectiveness of oral health interventions on oral health conditions as well as cognition status and to disclose the rationale behind it.

Burden in caregivers of patients with schizophrenia, depression, dementia, and stroke in Japan: comparative analysis of quality of life, work productivity, and qualitative caregiving burden.

BACKGROUND: The main objective of this study was to examine the burden of schizophrenia, depression, Alzheimer's disease/dementia, and stroke on caregivers and non-caregivers in Japan. This study also aimed to provide a comparative landscape on the burden of caregiving for each disorder. METHODS: The Japan National Health and Wellness Survey database, 2016 and 2018 was used in this study. Health-related quality of life (HRQoL), work productivity, and health care utilization were assessed using a self-administered, Internet-based questionnaire. The burden of caregiving experienced by each group of caregivers was compared with background-matched non-caregivers (controls) as well as with caregivers of patients with each disorder. RESULTS: Caregivers of patients with schizophrenia, depression, Alzheimer's disease/dementia, or stroke had lower HRQoL, higher healthcare costs and work productivity impairment than non-caregivers. Furthermore, caregivers of patients with psychiatric disorders such as schizophrenia and depression had lower HRQoL and work productivity than caregivers of patients with Alzheimer's disease/dementia and stroke. In addition, according to the Caregiver Reaction Assessment (CRA), caregivers of patients with schizophrenia and depression were more inclined to perceive a loss in physical strength and financial burden to the same extent as their self-esteem. CONCLUSIONS: This study indicated a substantial caregiving burden among caregivers of patients with psychiatric and neurological diseases in Japan. The caregiver burden of psychiatric disorders (schizophrenia and depression) was greater than that of neurological disorders (Alzheimer's disease/dementia and stroke), suggesting a need to provide support to caregivers of patients with psychiatric disorders to be better able to care for their patients. TRIAL REGISTRATION: None.

Quality of Life and Relationships in Caregivers of People With Dementia. A Gender Perspective.

Home-dwelling people with dementia rely on their family members to be able to stay at home. This affects the family caregivers' quality of life (QoL). However, less is known about how male and female caregivers differ in their QoL. Our study aimed to investigate gender differences in caregivers' quality of life (QoL), whether emotional relationships influence QoL, and how their QoL changes over time. The study applied a cross-sectional and a longitudinal design to examine a total of 208 caregivers, 158 female and 50 male caregivers, and their family member with dementia. Regression analysis and t-tests were performed to identify what characteristics about caregivers and care receivers influence male and female QoL, and whether caregivers' QoL developed after one year. Both male and female caregivers' depression influenced their QoL. For females, their own social distress influenced their QoL, and for males, their experience of their care receivers' overemotional attitude influenced their QoL. From baseline to one-year follow-up their QoL decreased while their distress and experience of care receivers' emotional attitudes was stable. Significant gender-specific differences were found, indicating that gender must be considered when approving caregivers' needs and planning interventions for caregivers.

The lucidity in dementia experience: perspectives from family and professional caregivers.

BACKGROUND: Family and professional caregivers of individuals with dementia often witness care-receiver's lucidity events. OBJECTIVE: A qualitative data analysis was performed of documented family and professional caregivers' experiences and their respective appraisals of lucidity events. RESEARCH DESIGN AND METHODS: Using a reduction method of selection, data from 10 in-home family caregivers and 20 professional caregivers to long-term care residents was content-coded and analysed. Framed by a priori research questions, a summative approach to qualitative content analysis guided the interpretation of findings. RESULTS: Eight of 10 family- and 15 of 20 staff caregivers gave an example of what they believed was a witnessed lucid event; 88% of family- and 40% of staff caregivers' provided examples that appeared to fit the conceptual definition of lucidity. The emotional impact that the events had on both sets of caregivers was reported. Family caregivers' characterization of lucidity events reflected appraisals of a puzzling occurrence while staff caregivers depicted elements associated with dementia, and lucidity descriptors. The enhanced verbal communication followed by the brief, unexpected quality of lucidity, were the main elements highlighted by both sets of caregivers in their description of lucidity to others. The variability and complexity of the lucidity phenomenon and the potential challenges it poses for both sets of caregivers were characterized. Commonalities and divergences across responses were highlighted. DISCUSSION: Findings validated previous studies' results. The notions introduced by both types of caregivers were thought-provoking and borne practical, clinical, ethical, and assessment (measurement) applicability.

General practitioners' perspectives on lifestyle interventions for cognitive preservation in dementia prevention.

BACKGROUND: General practitioners (GPs) play a crucial role in identifying cognitive impairment and dementia and providing post-diagnostic care. This study investigates (1) how promising GP consider lifestyle changes to maintain cognitive performance in general, (2) GP beliefs about the power of modifiable health and lifestyle factors to maintain cognitive performance, and (3) whether those beliefs vary by GP age. METHODS: As part of the AgeWell.de trial, GPs (n = 72) completed a process evaluation questionnaire assessing their perspectives on lifestyle changes to preserve cognitive performance in elderly patients. In greater detail, their perceived efficacy of established risk and protective factors was investigated using a 5-point Likert scale. Descriptive statistical analyses were performed for research question (1) and (2). Spearman´s rank correlations and ordinal logistic regressions were used to answer research question (3). All results were interpreted exploratively. RESULTS: GPs rated the overall chance of lifestyle changes maintaining cognitive performance quite neutral with a median score of 3.0 (IQR = 2.0). They rated the efficacy of all the modifiable health and lifestyle factors high, with increase in physical and social activity ((Mdn = 5.0, IQR = 1.0) receiving the highest ratings with the narrowest range. Spearman's rank correlation indicated a significant positive relationship between age and the belief in "Optimization of nutrition" for preventing cognitive decline and dementia (ρ = .255, p = .041). However, ordinal logistic regressions showed no significant relationships between age and GP ratings of lifestyle change efficacy. CONCLUSION: These findings highlight the positive perception of GPs on the efficacy of modifiable health and lifestyle factors for preventing cognitive decline and dementia. TRIAL REGISTRATION: The AgeWell.de trial is registered in the German Clinical Trials Register (DRKS; trial identifier: DRKS00013555, Registration Date 07 December 2017).

Process evaluation of a New psychosocial goal-setting and manualised support intervention for Independence in Dementia (NIDUS-Family).

INTRODUCTION: We report a mixed-methods process evaluation embedded within a randomised controlled trial. We aimed to test and refine a theory of change model hypothesising key causal assumptions to understand how the New Interventions for Independence in Dementia Study (NIDUS)-Family (a manualised, multimodal psychosocial intervention), was effective relative to usual care, on the primary outcome of Goal Attainment Scaling (GAS) over 1 year. METHODS: In 2021-2022, intervention-arm dyads completed an acceptability questionnaire developed to test causal assumptions. We conducted qualitative interviews with dyads and intervention facilitators, purposively selected for diverse follow-up GAS scores. We collected observational data from intervention session recordings. We thematically analysed data, then integrated qualitative and quantitative data. RESULTS: 174/204 (85.3%) dyads allocated to NIDUS-Family, fully completed it, 18 partially completed, while 12 received no intervention. We interviewed 27/192 (14%) of dyads receiving any sessions, and 9/10 facilitators; and observed 12 sessions. 47/192 (24.5%) of carers completed the acceptability questionnaire. We identified four themes: (A) 'Someone to talk to helps dyads feel supported'; (B) 'NIDUS-Family helps carers change their perspective'; (C) 'Personalisation helps people living with dementia maintain their identity' and (D) 'Small steps help dyads move forward'. CONCLUSION: Key causal pathway mechanisms were: a respectful, trusting and impartial relationship with the facilitator: supporting the development of meaningful goals and support to find manageable solutions. Core implementation factors were delivery of the modules from a consistent facilitator across regular sessions. Core contextual factors influencing these mechanisms were dyadic participation and understanding of abilities.

Association between days spent at home and functional status and health among persons living with dementia.

BACKGROUND: Many persons living with dementias (PLWD) prefer to remain at home as long as possible, and days spent at home (DAH)-defined as the time an individual spends outside of healthcare facilities-has emerged as a person-centred outcome measure in this population. We examined the association between DAH and functional status and health among PLWD. METHODS: Utilizing a nationally representative cohort of individuals age 65 and older in the United States with dementia from the 2010-2018 Health and Retirement Study (HRS), we assessed the relationship between an ordinal categorical DAH variable and number of activities of daily living (ADLs) (range 0-10; 10 being independent), mobility (0-5; 5 being mobile), and self-rated health (SRH) (0-4; 4 being excellent), controlling for patient characteristics. DAH was defined as the number of self-reported days spent outside a hospital or nursing home in the time between survey waves, typically 730 days. RESULTS: We identified 3002 participants (4192 observations, average 1.4 observations per participant). The mean DAH was 704.4 days (SD 10.8 days) and 64.9% spent all days at home (i.e. 730 days). A 2-week decrease in DAH was associated with a lower ADL score by 0.32 points (95% confidence internal [CI]: 0.24-0.40, P-for-trend<0.001), a lower mobility score by 0.18 points (95% CI: 0.13-0.22, P-for-trend<0.001), and a lower SRH by 0.05 points (95% CI: 0.02-0.08, P-for-trend<0.001). CONCLUSION: We demonstrate that DAH is positively associated with important patient-reported outcomes among the dementia population, strengthening the argument for considering DAH as a meaningful outcome measure for PLWD.