Effectiveness of computer-based interventions for community-dwelling people with cognitive decline: a systematic review with meta-analyses.

BACKGROUND: Cognitive deficits arise with age and can increase the risk for subjective cognitive decline (SCD) and mild cognitive impairment (MCI), which may result in dementia, leading to health problems, care dependency and institutionalization. Computer-based cognitive interventions (CCIs) have the potential to act as important counteraction functions in preserving or improving cognition concomitant to available pharmacological treatment. The aim was to assess the effectiveness of CCIs performed individually with a personal or tablet computer, game console, virtual, augmented, or mixed reality application on cognition in community-dwelling people with SCD, MCI and dementia. METHODS: A systematic review with meta-analyses of randomized controlled trials (RCTs) was performed. The systematic literature search was conducted in MEDLINE, CINAHL, Embase, Cochrane CENTRAL, IEEE Xplore Digital Library, Web of Science, Scopus and PsycINFO. In addition, a search for gray literature and backward citation searching were carried out. To judge on the evidence, two reviewers independently used the Cochrane Risk of Bias Tool. The standardized mean difference (SDM) for pooling comparable studies using the random-effects model was applied. RESULTS: Twenty-four RCTs were identified, of which 1 RCT examined CCIs in individuals with SCD, 18 RCTs with MCI, and 6 RCTs with dementia. Most interventions were conducted with personal computers. Meta-analyses with 12 RCTs showed significant effects of computer-based cognitive interventions for people with MCI in the domains memory, working memory, attention/concentration/processing speed and executive functioning, but no significant improvements in global cognition and language. Regarding dementia a meta-analysis pooled with 4 RCTs demonstrated a tendency towards, but no significant increase of memory functions (SMD 0.33, CI 95% [-0.10, 0.77]). One RCT regarding SCD reported significant improvements in memory functions for participants conducting a cognitive training on a personal computer. CONCLUSIONS: The results demonstrated that CCIs have beneficial effects on domain-specific cognition in people with MCI but no significant effects on people with dementia. In terms of SCD, one study showed significant improvements in memory functions. It seems that the beneficial effect for cognitive preservation or improvement due to CCIs occurs at the earliest intervention state. However, more research on SCD is needed. TRIAL REGISTRATION: PROSPERO International Prospective Register of Systematic Reviews CDR42020184069.

Fall prevention in hospitals and nursing homes: Clinical practice guideline.

BACKGROUND: Falls and their consequences are particularly common in older adults in hospitals and long-term care (LTC) facilities. AIM: To avoid falls and their consequences, and provide nurses with an overview of all relevant research literature on fall prevention, and a practice guideline on fall prevention in older adults was developed. METHODS: The development process included a systematic literature review to identify systematic reviews and primary studies on the topic of fall prevention, an assessment of the study quality, the preparation of meta-analyses to summarize the results, and the application of the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to grade the scientific literature. The guideline panel and an external multidisciplinary team graded the recommendations using the Delphi method. In addition, the panel and team formulated expert opinions. RESULTS: A total of 79 randomized controlled trials on fall prevention were identified, which formed the basis of the recommendations. Strongly recommended measures for both settings included multifactorial interventions, professionally supported body exercise interventions, and education and counselling interventions. The panel and team did not recommend the use of a specific assessment tool for fall risk assessment, low-floor beds in hospitals, or body exercise interventions in frail residents. LINKING EVIDENCE TO ACTION: During the development of this guideline, particular attention was paid to collecting evidence-based knowledge relevant to practice. By applying the recommendations, the outlined nursing care is justified, enabling healthcare personnel to achieve the overriding goal of providing optimal care to persons at risk of falling. Evidence for several fall prevention interventions was graded as very low. Sound intervention studies are necessary to strengthen the confidence in the evidence for low-floor beds, alarm sensor systems, medication review, and staff education in hospitals.

Humanoid socially assistive robots in dementia care: a qualitative study about expectations of caregivers and dementia trainers.

OBJECTIVE: To examine the expectations of informal caregivers, nurses, and dementia trainers regarding the support of (physical and psychosocial) human needs by humanoid social assistive robots (SARs) in dementia care. METHODS: A qualitative study was conducted with 11 homogeneous focus groups of informal caregivers, nurses and dementia trainers providing dementia care at home, in adult daycare centers, or in nursing homes. A qualitative content analysis was performed using a concept- and data-driven coding frame. RESULTS: Focus group discussions with 52 individuals were held. Participants reported mostly positive expectations and stated that SARs could offer potential support in all components of human needs, especially in avoiding danger (e.g. recognise danger, organise help), communication/contact with others (e.g. enable telephone calls, provide company), daily activities (e.g. remind of appointments, household obligations), recreational activities (e.g. provide music), eating/drinking (e.g. help cook), and mobility/body posture (e.g. give reminders/instructions for physical exercise). Participants also mentioned some negative expectations in all human needs, predominantly in communication/contact with others (e.g. loss of interpersonal interaction) and avoiding danger (e.g. scepticism regarding emergencies). CONCLUSION: Participants stated that SARs had great potential to provide assistance in dementia care, especially by reminding, motivating/encouraging and instructing people with dementia. Informal caregivers and nurses also considered them as useful supportive devices for themselves. However, participants also mentioned negative expectations, especially in communication/contact with others and avoiding danger. These findings demonstrate the support caregivers and dementia trainers expect from humanoid SARs and may contribute to their optimisation for dementia care.

Geringe Attraktivität des Pflegeberufs bei Auszubildenden: COVID 19 hat die Belastungen verschärft.

BACKGROUND: As in other countries, the situation of nurses in training has changed in Austria during the COVID 19 pandemic. Therefore, the aim of this survey was to show the challenges faced by nurses in training during the COVID 19 pandemic in order to help shape a better future for nursing students. METHOD: All nursing students in Austria were invited to take part in an electronic survey between November 26, 2020 and March 1, 2021. The questionnaire contained nine quantitative and two open questions. RESULTS: 610 nursing students participated. 39.6% had a negative view of the nursing profession in times of the pandemic. There were reports of increased physical and psychological stress during their time on the wards. CONCLUSION: The results of this survey provide an overview of the situation of nurses in training during the COVID 19 pandemic. It became clear that the conditions for students in nursing have to be improved and requirements such as pay and better working conditions implemented.

Effects of a Humanoid Socially Assistive Robot Versus Tablet Training on Psychosocial and Physical Outcomes of Persons With Dementia: Protocol for a Mixed Methods Study.

BACKGROUND: New technologies, like socially assistive robots (SARs), may have the potential to support caregivers at home. Still, the evidence for people with dementia in home care is unclear because a lot of studies are performed in a laboratory or institutional setting, and mainly use robots in prototype stages. OBJECTIVE: This study aims to explore the effects of the refined, commercially-available, humanoid SAR Pepper combined with a tablet PC-based dementia training program (Coach Pepper) versus an exclusively tablet PC-based dementia training program on psychosocial and physical outcomes of people with dementia living at home, including caregivers and dementia trainers. We hypothesize that Coach Pepper has a more positive effect on the primary outcome motivation (stable or decreased apathy) of people with dementia. METHODS: A mixed methods study will be performed, including a randomized controlled, parallel, 2-arm study with a complementary qualitative part. This sample includes 40 PWD living at home and 40 relatives, each complemented with five professional caregivers and dementia trainers. The intervention group will receive Coach Pepper (a SAR connected with a tablet PC-based dementia training program), and the control group will receive exclusively tablet PC-based training without the SAR. The duration of the intervention will be three weeks per household. Data will be collected at baseline and during and after the intervention by standardized questionnaires, sensor data of the robot, and tablet PC, as well as semistructured interviews, focus groups, and observation. RESULTS: To date, no results are available for this study protocol. The study intervention started in May 2019 and will end in Spring 2020. CONCLUSIONS: The intervention of this study can be seen as a nonpharmacological intervention, including cognitive and physical training by a robot. This study will help to further refine SAR for the specific needs of people with dementia living at home. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/14927.