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2.
Med Clin North Am ; 104(3): 391-403, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32312405

RESUMEN

Prognostication is a vital aspect of decision making because it provides patients and families with information to establish realistic and achievable goals of care, is used in determining eligibility for certain benefits, and helps in targeting interventions to those likely to benefit. Prognostication consists of 3 components: clinicians use their clinical judgment or other tools to estimate the probability of an individual developing a particular outcome over a specific period of time; this prognostic estimate is communicated in accordance with the patient's information preferences; the prognostic estimate is interpreted by the patient or surrogate and used in clinical decision making.


Asunto(s)
Competencia Clínica/normas , Enfermedad Crítica/terapia , Planificación de Atención al Paciente/normas , Atención Dirigida al Paciente/métodos , Anciano , Anciano de 80 o más Años , Toma de Decisiones Clínicas/ética , Comunicación , Enfermedad Crítica/epidemiología , Demencia/mortalidad , Demencia/terapia , Femenino , Insuficiencia Cardíaca/mortalidad , Insuficiencia Cardíaca/terapia , Humanos , Esperanza de Vida/tendencias , Masculino , Neoplasias/mortalidad , Neoplasias/terapia , Cuidados Paliativos/normas , Percepción , Pronóstico , Cuidado Terminal/normas
3.
Fortschr Neurol Psychiatr ; 88(4): 266-284, 2020 Apr.
Artículo en Alemán | MEDLINE | ID: mdl-32325519

RESUMEN

According to the German S3 guideline dementia every patient with a dementia disorder should have a MRI. The goal is not only to uncover treatable conditions but also to detect region-specific atrophy pattern which are characteristic of primary dementia disorders such as Alzheimer's disease, fronto-temporal lobar degeneration and others. Diagnostic accuracy can be improved by Voxel- and Region-based volumetric analysis of the individual brain compared to age-matched controls.


Asunto(s)
Demencia/diagnóstico por imagen , Enfermedad de Alzheimer/diagnóstico por imagen , Encéfalo/diagnóstico por imagen , Demencia/patología , Demencia/terapia , Degeneración Lobar Frontotemporal/diagnóstico por imagen , Alemania , Humanos , Imagen por Resonancia Magnética , Guías de Práctica Clínica como Asunto
4.
Hu Li Za Zhi ; 67(1): 75-83, 2020 Feb.
Artículo en Chino | MEDLINE | ID: mdl-32281085

RESUMEN

BACKGROUND: Face (self-esteem) is an issue that involves socially endowed status, identity roles, and self-image management and maintenance. People with dementia and their family members often experience social isolation due to diminished self-image, which affects disease progression. Better understanding the factors that influence the self-image of people with dementia may promote the ability of caregivers to maintain self-image and promote public understanding and empathy toward people with dementia. PURPOSE: The aim of this study was to explore the factors influencing self-image in people with dementia using a systematic review of the literature. METHODS: A systematic review was used. Articles were retrieved from electronic databases including PubMed, CINAHL, Airiti Library, and Cochrane Library. The following keywords and MeSH terms were used to search for articles on dementia, face, self-esteem, respect, and self-concept. A total of 3,050 articles published prior to September 2018 that matched the search criteria were extracted. After screening the topics, deleting repetitions, and doing critical appraisals, eight articles were selected for analysis. Research quality was appraised using the Joanna Briggs Institute and the Melnyk and Fineout-Overholt for Evidence-Based Medicine Level of Evidence. RESULTS: Two themes related to the factors influencing self-image in people with dementia were extracted from the selected articles. The first theme was "loss of self-identity". As people with dementia gradually lose their cognitive function and memory ability, they are increasingly incapable of handling and managing their current role tasks. The second theme was "negative public perception". The public believes that people with dementia are at risk to others and that their behaviors are unpredictable, resulting in the deprivation of the rights to which people with dementia are entitled. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: Because of disease progression, people with dementia gradually lose their self-identity and become unable to perform their life-role tasks. This is accompanied by negative perceptions of the disease among the public, which, in turn, damages the self-image of people with dementia and their families. The results of this review may provide a reference for caregivers planning future person-centered care approaches for people with dementia. In addition, these results may help facilitate the establishment of a more friendly environment for people with dementia in both public and private spaces.


Asunto(s)
Demencia/psicología , Autoimagen , Cuidadores/psicología , Demencia/terapia , Empatía , Humanos
6.
HNO ; 68(3): 143-149, 2020 Mar.
Artículo en Alemán | MEDLINE | ID: mdl-32030453

RESUMEN

The aging of society observed during the past century in industrialized countries has not only led to a longer life expectancy, but also an increased frequency of age-related diseases and multimorbidity. In addition to dysphagia and vertigo, sensory deficits such as olfaction and hearing disorders are common in elderly persons and have a significant influence on quality of life. Alzheimer's disease is the most common form of dementia. Epidemiological studies have recently shown that disorders of olfaction and hearing are not only associated with dementia, but also represent specific risk factors for development and progression of the disease. Recognition and adequate treatment, e.g., of hearing loss, by otorhinolaryngologists is thus assuming an increasingly important role, not only to preserve patients' quality of life, but also to reduce the risk of developing dementia in the future.


Asunto(s)
Demencia , Pérdida Auditiva , Anciano , Demencia/complicaciones , Demencia/terapia , Progresión de la Enfermedad , Trastornos de la Audición , Pérdida Auditiva/etiología , Pérdida Auditiva/terapia , Humanos , Calidad de Vida
7.
Z Gerontol Geriatr ; 53(2): 138-144, 2020 Mar.
Artículo en Alemán | MEDLINE | ID: mdl-32048012

RESUMEN

BACKGROUND: The majority of acute care hospitals are not prepared for people with dementia with acute diseases in need of treatment. This results in an increased likelihood of the personnel being overtaxed. Dementia is the most frequent reason that hospital personnel administer sedating medication and use restraining measures. OBJECTIVE: The aim of this study was to investigate factors that influence the (inappropriate) use of sedating medication and physical restraints for patients with dementia in acute care hospitals. METHODS: A non-randomized case control study, including two internal medicine wards was conducted in Hamburg, Germany. In the intervention group a special care concept was implemented focussing on patients with dementia, while the control group received regular care without a special dementia care concept. Logistic regression models were conducted to investigate associations between factors, such as age, severity of dementia, conspicuous behavior, Barthel index and type of treatment and the use of sedating medication and physical restraint measures. RESULTS: Challenging behavior (odds ratio, OR = 1.32) and treatment in the control group (OR=1.94) were significantly associated with the use of sedating medication. A low Barthel index, longer periods of hospitalization and treatment in the control group were significantly associated with a higher probability of the implementation of physical restraining measures. DISCUSSION: The use of sedating medication as well as physical restraining measures varied greatly between the intervention and control groups. This is in line with other studies that came to similar results and suggests that multiple components of special care concepts can explain these differences. These include architectonic design and spatial aspects as well as dementia-specific training of employees and an appropriate personnel complement. Such interventions can also reduce agitation and behavioral problems of patients. The avoidance of sedation and restraining measures is also positively associated with an increase in the quality of life of patients with dementia.


Asunto(s)
Demencia/terapia , Hipnóticos y Sedantes/uso terapéutico , Restricción Física , Estudios de Casos y Controles , Demencia/complicaciones , Alemania , Humanos , Prescripción Inadecuada , Calidad de la Atención de Salud , Calidad de Vida
8.
JAMA ; 323(8): 757-763, 2020 02 25.
Artículo en Inglés | MEDLINE | ID: mdl-32096858

RESUMEN

Importance: Dementia (also known as major neurocognitive disorder) is defined by a significant decline in 1 or more cognitive domains that interferes with a person's independence in daily activities. Dementia affects an estimated 2.4 to 5.5 million individuals in the United States, and its prevalence increases with age. Objective: To update its 2014 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a review of the evidence on screening for cognitive impairment, including mild cognitive impairment and mild to moderate dementia, in community-dwelling adults, including those 65 years or older residing in independent living facilities. Population: This recommendation applies to community-dwelling older adults 65 years or older, without recognized signs or symptoms of cognitive impairment. Evidence Assessment: The USPSTF concludes that the evidence is lacking, and the balance of benefits and harms of screening for cognitive impairment cannot be determined. Recommendation: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for cognitive impairment in older adults. (I statement).


Asunto(s)
Disfunción Cognitiva/diagnóstico , Demencia/diagnóstico , Tamizaje Masivo , Anciano , Disfunción Cognitiva/terapia , Demencia/terapia , Diagnóstico Precoz , Humanos , Vida Independiente , Tamizaje Masivo/efectos adversos , Pruebas Neuropsicológicas , Sensibilidad y Especificidad
11.
Artículo en Alemán | MEDLINE | ID: mdl-31915864

RESUMEN

In March 2019 the Ethics Conference of the German Center for Neurodegenerative Diseases (DZNE) was held for the fifth time. It was organized by the DZNE Rostock/Greifswald site and chaired by Prof. Wolfgang Hoffmann. The conference provided scientists, physicians, representatives of the German Alzheimer Society, (informal) caregivers of people with dementia (PwD), and other interested people with the opportunity to talk about the opportunities and limitations of research on and for PwD.Nationally and internationally recognized experts on healthcare services research, clinical research, nursing research, (geriatric) psychiatry, interdisciplinary ageing research, economic law, and psychotherapy discussed the pros and cons of a multitude of topics like self-determination, research participant decree, informed consent, and participation of PwD in research. The aim of the event was to reconcile the view of practice pleading for an ethically correct, human treatment of PwD and respecting their autonomy with participation in (clinical) studies. Experts controversially discussed and consolidated different points of view of practice and research.


Asunto(s)
Demencia , Enfermedades Neurodegenerativas , Autonomía Personal , Anciano , Cuidadores , Demencia/psicología , Demencia/terapia , Alemania , Humanos , Enfermedades Neurodegenerativas/psicología , Enfermedades Neurodegenerativas/terapia
12.
Z Gerontol Geriatr ; 53(2): 123-128, 2020 Mar.
Artículo en Alemán | MEDLINE | ID: mdl-31965285

RESUMEN

BACKGROUND AND OBJECTIVE: The aim of the study was to evaluate a specific treatment concept for patients suffering from dementia in a geriatric day clinic with respect to improvement of dementia-related behavioral abnormalities and effects on distress of the caring relatives. MATERIAL AND METHODS: Designed as a naturalistic study with a sample of 34 dementia patients (average age 83 years, 62% female, 82% mild dementia, 18% moderate dementia) surveyed at three time points, the dementia-related behavioral symptoms and the relatives' distress were measured using the neuropsychiatric inventory. A waiting time before treatment was implemented as a control condition. RESULTS: Compared with waiting time, a significant improvement of dementia-related behavioral abnormalities was found after treatment, especially in patients suffering from moderate dementia. The distress of caring relatives was clearly reduced. CONCLUSION: The interprofessional treatment of patients with dementia using a specific program in a geriatric day clinic leads to a clear improvement in behavioral symptoms and positively influences the distress of caring relatives.


Asunto(s)
Síntomas Conductuales/complicaciones , Cuidadores/psicología , Demencia/terapia , Servicios de Salud para Ancianos/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Síntomas Conductuales/terapia , Demencia/diagnóstico , Demencia/psicología , Femenino , Humanos , Masculino , Resultado del Tratamiento
13.
Psychol Aging ; 35(1): 41-54, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31985248

RESUMEN

Caregiver distress is a complex, multicausal phenomenon. Most of the available interventions for caregivers are protocolized or manualized. A case formulation approach may be more appropriate, as it provides the opportunity for assessing and treating specific dysfunctional mechanisms explaining each caregiver's needs and causes of distress, through the design of an individualized modular intervention. In the present study, a randomized controlled study has been done in which a functional analysis-guided modular intervention (FAMI) was developed. The FAMI was compared with two manualized intervention (cognitive-behavioral therapy and acceptance and commitment therapy) which have received preliminary support, and a control group (waiting list). Mixed-effect models and clinical significance analyses were performed. Results suggest that all the interventions were effective in reducing depressive and anxious symptomatology at postintervention assessment, with large effect sizes, and with reductions in depression being maintained at follow-up. Regarding anxiety, long-term effects have been found only for the FAMI intervention. Results also suggest positive effects associated with the FAMI intervention in the long term with regards to comorbidity between depressive and anxious symptomatology. FAMI presents great potential for reducing dementia caregivers' levels of distress, being especially effective in maintaining therapeutic effects in the long term. (PsycINFO Database Record (c) 2020 APA, all rights reserved).


Asunto(s)
Ansiedad/psicología , Cuidadores/psicología , Demencia/terapia , Depresión/psicología , Demencia/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad
14.
Psychol Aging ; 35(1): 55-77, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31985249

RESUMEN

This systematic review and meta-analysis compared the effects of 131 randomized controlled trials, published between 2006 and mid-2018, for dementia caregivers with community-dwelling care-recipients. A new classification of interventions was proposed to enable a more detailed examination of the effectiveness of psychological interventions; 350 postintervention effect sizes in 128 studies and 155 follow-up effect sizes in 55 studies were computed. Postintervention effects were significant for all outcomes when all interventions are pooled together. Follow-up effects were found for all outcomes, except physical health and positive aspects of caregiving. Educational programs with psychotherapeutic components, counseling/psychotherapy, and mindfulness-based interventions had the strongest effects on reducing depressive symptoms. Multicomponent and miscellaneous interventions had the largest effects on reduction of burden/stress. Multicomponent and mindfulness-based interventions had the largest effects on enhancing subjective well-being. It should be noted that mindfulness and counseling/psychotherapy studies generally had small samples, and studies with smaller sample sizes tended to report larger effects. Metaregression analyses revealed that, overall, younger caregivers benefited more from the interventions. Although the majority of studies were from North America and Europe, there were a growing number from Asia and other parts of the world. Recommendations were made, including developing new theoretical models that address caregivers' changing needs over time; development of interventions that can be flexibly administered and individually "tailored," and assessing positive as well as negative aspects of caregiving to encourage development of greater resilience. We conclude with observations on the global health significance of improving the impact of psychosocial interventions on caregivers' lives. (PsycINFO Database Record (c) 2020 APA, all rights reserved).


Asunto(s)
Cuidadores/psicología , Demencia/terapia , Demencia/psicología , Humanos , Persona de Mediana Edad
15.
Gesundheitswesen ; 82(1): 40-49, 2020 Jan.
Artículo en Alemán | MEDLINE | ID: mdl-31863444

RESUMEN

BACKGROUND: The increasing prevalence of dementia raises challenges concerning the care of people with dementia (pwd). The care of pwd is mainly conducted by informal caregivers who are faced with several burdens; however, use of care services is generally low. The aim of this study was to identify predictors of the use of outpatient care services. METHODS: The Bavarian Dementia Survey (BayDem) is a multi-centre, longitudinal study that was conducted at 3 different sites in Bavaria, Germany. Participants were people with dementia (pwd) (according to ICD-10) and their informal caregivers. Data were collected by standardised face-to-face interviews using well-designed instruments in cooperation with local partners. Logistic regression analysis was carried out in order to identify predictors of the use of outpatient care services. RESULTS: In total, 364 pwd and 339 informal caregivers were included at the beginning of the study BayDem. The use of supportive care services was generally low. One-third of all participants used outpatient care services. In the logistic regression analysis, the following significant predictors for the use of outpatient care services 6 months after baseline were identified: severity of cognitive impairment of the pwd; use of outpatient care at the beginning of the study. CONCLUSION: The low use of outpatient care services is a well-known paradoxical phenomenon. Such services can help give relief to informal caregivers. In order to enhance the use of supportive outpatient care services, there should be more focus on innovative health service delivery models with a low access threshold barrier. Besides more public campaigns, more guidance for existing offers is needed.


Asunto(s)
Atención Ambulatoria , Cuidadores , Demencia , Atención Ambulatoria/normas , Demencia/enfermería , Demencia/terapia , Alemania , Humanos , Estudios Longitudinales , Encuestas y Cuestionarios
16.
Gesundheitswesen ; 82(1): 50-58, 2020 Jan.
Artículo en Alemán | MEDLINE | ID: mdl-31863445

RESUMEN

BACKGROUND: Dementia is usually a life-limiting disease. However, evidence-based guidelines for palliative care for people with dementia (PwD) are currently lacking. One reason for this is the dearth of reliable empirical data on PwD at the end of life. The aim of this study is to describe the symptom burden, causes of death, places of death and the use of various health services for PwD at the end of life. METHODS: The Bavarian Dementia Survey (BayDem) was a multi-center, longitudinal study at 3 different sites in Bavaria, Germany (Dachau, Kronach, Erlangen). Participants were PwD defined by ICD-10 and their informal caregivers. Data were collected in standardized face-to-face interviews in cooperation with local actors. In order to obtain comparable groups, deceased and non-deceased PwD were matched using 1:1 propensity score matching. For the statistical analyses, McNemar tests as well as paired t-tests were used. RESULTS: In this analysis, 58 deceased and 58 non-deceased PwD were studied (n=116). In most cases, PwD died at home (36.2%), in hospital (25.9%) or in a nursing home (19.0%), but no one in palliative care. The most common causes of death were respiratory (13.8%) and cardiovascular complications (12.1%) as well as stroke (12.1%). PwD at the end of life showed more pronounced physical comorbidities than the other PwD (Charlson-Index: M=2.75 vs. M=1.80; p=0.030, Cohen's d=0.425) and were therefore admitted to hospital (46.6 vs. 12.1%, p<0.001, OR=6.250) or emergency departments (22.4 vs. 3.4%, p=0.007, OR=6.500) more frequently. Behavioral and psychological symptoms were very pronounced (NPI Score: M=31.67 vs. M=24.77, p=0.118, Cohen's d=0.303). Nevertheless, the utilization of outpatient health services was low. CONCLUSION: The results underline the need to develop evidence-based guidelines to provide palliative care specifically adapted to the needs of PwD at the end of life. In this context, the high incidence of behavioral and psychological symptoms should be taken into account, as should the high incidence of physical comorbidities. Considering the frequent hospital admissions, special attention should also be paid to the development of recommendations for the inpatient sector (acute hospital and palliative care unit).


Asunto(s)
Causas de Muerte , Demencia , Utilización de Instalaciones y Servicios , Cuidado Terminal , Cuidadores , Costo de Enfermedad , Demencia/mortalidad , Demencia/terapia , Alemania/epidemiología , Humanos , Estudios Longitudinales , Calidad de Vida , Encuestas y Cuestionarios
18.
Arch Gerontol Geriatr ; 86: 103955, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31561064

RESUMEN

BACKGROUND: Increased awareness of the clinical course of nursing home residents with advanced dementia and advance care planning (ACP) has become the cornerstone of good palliative care. OBJECTIVE: The aim of our study is to describe changes in ACP in the form of physician treatment orders (PTOs), symptom prevalence and possible burdensome interventions among nursing home (NH) residents who died between 2004-2009 and 2010-2013 METHODS: Retrospective study RESULTS: The number of PTOs regarding forgoing antibiotics or parenteral antibiotics, forgoing artificial nutrition or hydration or forgoing hospitalisation doubled between 2004-2009 and 2010-2013 (38.1% vs. 64.9%, p < 0.001; 40.0% vs. 81.7%, p < 0.001; 28.1% vs. 69.5%, p < 0.001, respectively). PTOs were also done significantly earlier in 2010-2013 than in 2004-2009. The prevalence of distressing symptoms and possible burdensome interventions remained unchanged, although the prevalence of consistency with the PTOs was high. CONCLUSION: Despite the increased number of PTOs, this had little effect on symptom prevalence and possible burdensome interventions experienced by NH residents in the last days of life.


Asunto(s)
Planificación Anticipada de Atención/tendencias , Directivas Anticipadas/estadística & datos numéricos , Demencia/terapia , Casas de Salud/estadística & datos numéricos , Cuidados Paliativos/estadística & datos numéricos , Cuidado Terminal/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Muerte , Demencia/mortalidad , Demencia/psicología , Femenino , Finlandia/epidemiología , Hogares para Ancianos/estadística & datos numéricos , Hospitalización , Humanos , Masculino , Prevalencia , Estudios Retrospectivos
19.
Hu Li Za Zhi ; 66(6): 54-65, 2019 Dec.
Artículo en Chino | MEDLINE | ID: mdl-31802455

RESUMEN

BACKGROUND: Day care centers provide supportive services to older individuals with disability and dementia. Those who suffer from cognitive impairment typically also suffer from depression. PURPOSE: To explore whether TimeSlips, a reminiscence creative storytelling approach, improves depressive symptoms and quality of life (QoL) in older individuals of day care centers who have mild to moderate cognitive impairment. METHODS: A randomized non-blind controlled trial design was conducted. A total of 20 older individuals who met the inclusion criteria were recruited and randomly assigned to the experimental group and control group using the Internet randomization system, with 10 subjects in each group. The experimental group participated in the one-hour TimeSlips intervention once a week for six consecutive weeks, while the control group maintained their normal daily activities. We used the Cornell Scale for Depression in Dementia (CSDD) to measure depressive symptoms and used EQ-5D (EuroQol-5 dimensions) VAS (visual analogue scale) and utility values to measure QoL. RESULTS: (1) With the exception of age, there were no significant differences in the demographic data between two groups. (2) Under ANCOVA, when age was used as the covariate and the change in CSDD before and after the intervention was used as the dependent variable, the score of the experimental group was significant lower than that of the control group (p < .05). The interaction between group and age was also a significant difference in the change of CSDD before and after the intervention (p < .05). In terms of QoL, the EQ-5D VAS and EQ-5D utility value both decreased after the intervention in the experimental group. ANCOVA was performed separately using the change of EQ-5D VAS and the ranked change of EQ-5D utility values as dependent variables, with no significant differences found between the groups (p = .37 and p = .20, respectively). CONCLUSIONS: The results indicate that using TimeSlips may significantly improve depressive symptoms in mild to moderate cognitively impaired older individuals of day care centers. However, no evidence was found to support an effect of TimeSlips on QoL. Our findings provide information to help day care centers staffs design related activities.


Asunto(s)
Demencia/psicología , Demencia/terapia , Depresión/psicología , Narración , Calidad de Vida , Anciano , Centros de Día , Humanos , Resultado del Tratamiento
20.
Biomed Res Int ; 2019: 2308475, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31886182

RESUMEN

Exercise programs have been introduced to improve cognitive function, whereas studies showed inconsistent results regarding the effectiveness of exercise programs on patients with dementia. This study aimed to summarize randomized controlled trials (RCTs) to assess the effect of exercise programs on cognition, activities of daily living (ADL), and depression in elderly with dementia. We systematically screened PubMed, Embase, and the Cochrane library for relevant studies throughout November 21, 2018. The pooled standardized mean differences (SMDs) with 95% confidence intervals (CIs) were employed to calculate cognition, ADL, and depression by using random-effects model. A total of 20 RCTs with 2,051 dementia patients were included in final quantitative meta-analysis. There were no significant differences between exercise programs and control regarding cognition (SMD: 0.44; 95% CI: -0.21-1.09; P=0.183), ADL (SMD: 0.50; 95% CI: -0.03-1.02; P=0.066), and depression (SMD: -0.43; 95% CI: -0.90-0.05; P=0.077). Sensitivity analysis results indicated that exercise programs might play an important role in cognition and ADL, whereas the depression level was unaltered by the exclusion of any particular study. Subgroup analyses indicated that exercise programs were associated with increased cognitive levels if the mean age of patients was <80.0 years when compared with usual care and studies with low quality. Moreover, the ADL level was significantly increased in patients receiving exercise programs versus usual care. These results suggested that exercise programs might play an important role in cognition and ADL in patients with dementia. These results required further verification by large-scale RCTs, especially for depression outcomes.


Asunto(s)
Demencia/terapia , Terapia por Ejercicio , Actividades Cotidianas , Anciano , Anciano de 80 o más Años , Cognición/fisiología , Femenino , Humanos , Masculino , Ensayos Clínicos Controlados Aleatorios como Asunto
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