Primary care patterns among dual eligibles with Alzheimer's disease and related dementias.

BACKGROUND: Primary care is essential for persons with Alzheimer's disease and related dementias (ADRD). Prior research suggests that the propensity to provide high-quality, continuous primary care varies by provider setting, but the settings used by Medicare-Medicaid dual-eligibles with ADRD have not been described at the population level. METHODS: Using 2012-2018 Medicare data, we identified dual-eligibles with ADRD. For each person-year, we identified primary care visits occurring in six settings. We calculated descriptive statistics for beneficiaries with a majority of visits in each setting, and conducted a k-means cluster analysis to determine utilization patterns, using the standardized count of primary care visits in each setting. RESULTS: Each year from 2012 to 2018, at least 45.6% of dual-eligibles with ADRD received a majority of their primary care in nursing facilities, while at least 25.2% did so in physician offices. Over time, the share relying on nursing facilities for primary care decreased by 5.2 percentage points, offset by growth in Federally Qualified Health Centers (FQHCs) and miscellaneous settings (2.3 percentage points each). Dual-eligibles relying on nursing facilities had more annual primary care visits (16.1) than those relying on other settings (range: 6.8-10.7 visits). Interpersonal care continuity was also higher in nursing facilities (97.0%) and physician offices (87.9%) than in FQHCs (54.2%), rural health clinics (RHCs, 46.6%), or hospital-based clinics (56.8%). Among dual-eligibles without care continuity, 82.7% were assigned to a cluster with few primary care visits. CONCLUSIONS: A trend toward care in different settings likely reflects improved access to patient-centered primary care. Low rates of interpersonal care continuity in FQHCs, RHCs, and physician offices may warrant concern, unless providers in these settings function as a care team. Nonetheless, every healthcare system encounter presents an opportunity to designate a primary care provider for dual-eligibles with ADRD who use little or no primary care.

Reflexión sobre el sentido del sufrimiento en la enfermedad del Alzheimer / Reflexion on the meaning of suffering in alzheimer's disease

En el transcurso de la vida, las personas experimentan diferentes momentos y circunstancias que las conducen al sufrimiento, la mayoría de veces sin encontrarle un sentido lógico y racional. La enfermedad desarrolla en la persona sufrimiento. Un hecho tan evidente y a la vez tan misterioso que provoca en los profesionales sanitarios un desafío terapéutico difícilmente abordable.Es importante señalar que el sufrimiento es una parte muy importante de la propia enfermedad ya que configura el modo de ser de la persona y la manera que tiene ésta de enfrentarse a dicha experiencia desagradable. En el caso de la enfermedad de Alzheimer (EA), la dificultad de hacer frente a este desafío terapéutico se vuelve más intrincado aún al ser una patología neurológica, progresiva e irreversible, comportando, debido a su mal pronóstico y su progresiva evolución, un empeoramiento secuencial de la persona, en la que se ven agravados entre otras, la capacidad de expresión y el uso del lenguaje. El sufrimiento no tratado contribuye a la reducción de la calidad de vida y puede conducir a un aumento de los síntomas conductuales y psicológicos en usuarios con la EA.“¿Por qué?” suele ser la pregunta más repetida en momentos de abatimiento, incertidumbre, desconcierto, enfermedad. Una pregunta de sentido entorno al sufrimiento que busca una respuesta esperanzadora y que encierra tras de sí la grandeza de un misterio específico de cada persona.En este sentido, a través del presente estudio, se busca indagar en el sentido del sufrimiento en pacientes con EA. (AU)

In the course of life, people experience different moments and circumstances that lead to suffering, the vast majority of times without finding a logical and rational meaning. The disease develops in the person suffering. A fact so evident and at the same time so mysterious that it causes healthcare professionals a therapeutic challenge that is difficult to board.It is important to point out that suffering is a very important part of the illness itself, since it configures the way of being of the person and the way he has to face this unpleasant experience. In the case of Alzheimer’s disease, the difficulty of facing this therapeutic challenge becomes even more intricate as it is a progressive and irreversible neurological pathology, leading to, due to its poor prognosis and progressive evolution, a sequential worsening of the person disease, in which the capacity for expression and the use of language are aggravated among others. Suffering did not contribute to the reduction in quality of life and may lead to an increase in behavioral and psychological symptoms in users with Alzheimer’s disease. «Why?» It is usually the most repeated question in moments of dejection, uncertainty, bewilderment, illness. A meaningful question around suffering that searches for a hopeful answer and that holds behind it the greatness of a specific mystery of each person.In this sense, through this study, we seek to investigate the meaning of suffering in patients with Alzheimer’s disease. (AU)

Efectividad de un programa comunitario de apoyo a cuidadores de pacientes con demencia: escuela del cuidar / Effectiveness of a community support program for caregivers of patients with dementia: school of care

Objetivo: conocer las necesidades que expresan los cuidadores de pacientes con demencia en relación a aspectos formativos, de apoyo psicosocial, resolución de problemas y entrenamiento de habilidades. Diseñar, implementar y evaluar un programa comunitario de apoyo a cuidadores de pacientes con demencia que mejore su calidad de vida como cuidador y su experiencia de cuidar. Método: estudio de metodología mixta según la guía de la Medical Research Council sobre evaluación de intervenciones complejas, en tres fases. Fase 1: Modelización y operativización de la intervención (cualitativo). Fase 2: Estudio cuasi-experimental pre/post-intervención con medidas repetidas antes y después de la intervención y a los seis meses. Fase 3: Evaluación del programa de intervención (cualitativo).La población objeto de estudio son los cuidadores de pacientes no institucionalizados con diagnóstico de demencia, con grado de dependencia 1, 2 o pendientes de grado de las comarcas del Montsiá y Baix Ebre (Tarragona, España) en el ámbito de Atención Primaria, para el periodo 2020-2022. Conclusiones: realizar un estudio de metodología mixta desde la Atención Primaria y con colaboración ciudadana permitirá el diseño de una intervención adaptada la realidad de los sujetos de estudio. Su aplicación podría ser relevante ya que, si se confirman los objetivos propuestos, este estudio establecería una base para modificar el abordaje a los cuidadores y el apoyo que deben recibir, iniciándose desde el momento del diagnóstico del paciente, minimizando la sobrecarga del cuidador, mejorando su calidad de vida y su apoyo social.(AU)

Objectives: to understand the needs expressed by caregivers of patients with dementia regarding aspects of training, psychosocial support, solution of problems and training in skills. To design, implement and evaluate a community support program for caregivers of patients with dementia, which will improve their quality of life as caregivers and their caring experience. Method: a mixed methodology study according to the Medical Research Council guidelines on evaluation of complex interventions, in three stages. Stage 1: Modelling and implementation of the intervention (qualitative). Stage 2: Quasi-experimental pre-post intervention study with measurements repeated before and after the intervention and at six months. Stage 3: Evaluation of the intervention program (qualitative).The population object of the study are caregivers of non-institutionalized patients with diagnosis of dementia, with degree of dependence 1 or 2 or pending degree, in the Montsiá and Baix Ebre regions (Tarragona, Spain) in the Primary Care setting, for the 2020-2022 period. Conclusions: to conduct a mixed methodology study from Primary Care and with collaboration by citizens will allow to design an intervention adapted to the reality of the study subjects. Its application could be relevant, because if the objectives are confirmed, this study would establish the basis for modifying the way to address caregivers and the support they must receive, by being initiated since patient diagnosis, reducing caregiver overload to a minimum, and improving their quality of life and social support.(AU)

The Application of Convolutional Neural Network Model in Diagnosis and Nursing of MR Imaging in Alzheimer's Disease.

The disease Alzheimer is an irrepressible neurologicalbrain disorder. Earlier detection and proper treatment of Alzheimer's disease can help for brain tissue damage prevention. The study was intended to explore the segmentation effects of convolutional neural network (CNN) model on Magnetic Resonance (MR) imaging for Alzheimer's diagnosis and nursing. Specifically, 18 Alzheimer's patients admitted to Indira Gandhi Medical College (IGMC) hospital were selected as the experimental group, with 18 healthy volunteers in the Ctrl group. Furthermore, the CNN model was applied to segment the MR imaging of Alzheimer's patients, and its segmentation effects were compared with those of the fully convolutional neural network (FCNN) and support vector machine (SVM) algorithms. It was found that the CNN model demonstrated higher segmentation precision, and the experimental group showed a higher clinical dementia rating (CDR) score and a lower mini-mental state examination (MMSE) score (P < 0.05). The size of parahippocompalgyrus and putamen was bigger in the Ctrl (P < 0.05). In experimental group, the amplitude of low-frequency fluctuation (ALFF) was positively correlated with the MMSE score in areas of bilateral cingulum gyri (r = 0.65) and precuneus (r = 0.59). In conclusion, the grey matter structure is damaged in Alzheimer's patients, and hippocampus ALFF and regional homogeneity (ReHo) is involved in the neuronal compensation mechanism of hippocampal damage, and the caregivers should take an active nursing method.

Síndrome de sobrecarga en cuidadores de Alzheimer. Revisión sistemática / Overload syndrome in Alzheimer’s caregivers. Systematic review

El progresivo envejecimiento de la sociedad hace que se disparen los índices de enfermedades asociadas a la senectud como es el caso de la enfermedad de Alzheimer (EA), la cual produce un deterioro cognitivo progresivo ge-nerando gran dependencia a los afectados y cuyo cuidado suele recaer en un único cuidador, con frecuencia conllevado una gran carga de trabajo y un deterioro de su salud. La presente revisión sistemática tiene como objetivo profundizar en el conocimiento sobre los factores relacionados con la sobrecarga en cuidadores informales de EA. Los hallazgos derivados de los estudios confirman el predominio de las mujeres en las tareas relacionadas con el cuidado. También queda de manifiesto la presencia de altos niveles de carga en cuidadores de EA y la existencia de factores moderadores, como la resiliencia, las estrategias de afrontamiento, los aspectos positivos del cuidado, la religiosidad, la autoeficacia o el apoyo social percibido (AU)

The progressive aging of society causes the rates of diseases associated with senescence to skyrocket, such as Alzheimer’s disease (AD), which produces a progressive cognitive deterioration generating great dependence on those affected and whose care usually falls on a single caregiver, often with a heavy workload and deteriorating health. The objective of this systematic review is to deepen our understanding of the factors related to overload in informal caregivers of AD. The findings derived from the studies confirm the predominance of women in care-related tasks. The presence of high levels of burden on AD caregivers and the existence of moderating factors, such as resilience, coping strategies, positive aspects of care, religiosity, self-efficacy or perceived social support are also evident (AU)

"Sometimes Life Throws You a Curve Ball": The Lived Experiences of an Individual With Early-Onset Alzheimer's Disease and His Family.

INTRODUCTION: Individuals with early-onset Alzheimer's disease face many challenges and barriers older adults with late-onset Alzheimer's do not. Unfortunately, information about early-onset Alzheimer's disease is in its infancy stage in comparison with late-onset Alzheimer's. PURPOSE/AIMS: The purpose of this study was to examine the lived experiences of a 54-year-old man with early-onset Alzheimer's disease and his family (wife, sister, and mother) to understand the effects on the family unit. DESIGN: Interpretive phenomenology was used to guide this study. METHODS: All participants completed 2 in-person one-on-one interviews, and a final interview was completed online. Field notes, member checks, and triangulation were used to enhance the study's credibility. RESULTS: This article focuses on the theme "'A big curve ball': Disruption of the life cycle." Participants indicated the major financial and social challenges experienced by Joe and his wife. Furthermore, participants emphasized the importance of acceptance and maintaining a positive attitude to help cope with Joe's diagnosis. CONCLUSIONS: The accounts of Joe and his family shed light on an area relatively void in the literature. In addition, Joe's experiences may provide comfort for other families facing early-onset Alzheimer's disease. The implications for community health nurses in assisting individuals with early-onset Alzheimer's disease and their families are discussed.

Paciente con Alzheimer en fase moderada y su familia: análisis bibliográfico de un caso clínico / Patient with Alzheimer in moderate phase and his family: bibliographic analysis of a clinical case

Presentación del caso: Paciente de 76 años residente en un centro geriátrico, con Alzheimer en fase moderada, que manifiesta agitación y estrés ante una situación incómoda. Ante la aparición de estos cambios conductuales, tanto la enfermera a su cuidado como la familia desconocen cómo actuar. Objetivos: Identificar, con base en la literatura científica, las intervenciones de enfermería más efectivas para manejar y prevenir cambios conductuales en una persona con Alzheimer en fase moderada y valorar la integración familiar en dichas estrategias de cuidado. Revisión bibliográfica: Se realizó una búsqueda bibliográfica en las bases de datos CINAHL y PubMed, seleccionándose 7 artículos. Resultados: Se han identificado cuatro tipos de intervenciones de enfermería para el manejo y prevención de cambios conductuales: sensitivas, ambientales, físicas y psicoemocionales. Existen escasas intervenciones desarrolladas en centros geriátricos que integren a la familia en el cuidado de los pacientes. Conclusión: La ejecución de las intervenciones de enfermería seleccionadas podrá favorecer una mejoría tanto en el manejo como en la prevención de los cambios conductuales. La realización de dichas actividades por parte de la unidad familiar incrementa los efectos positivos en la familia, la residente y en el equipo de enfermería. Sin embargo, se precisa un número mayor de estudios que integren a la familia para poder generalizar los resultados (AU)

Case presentation: 76-year-old patient living in a geriatric centre with moderate-phase Alzheimer, who shows agitation and stress in an uncomfortable situation. Faced with the appearance of these behavioural changes, both the nurse in charge and the family do not know how to act. Objectives: To identify the most effective nursing interventions to manage and prevent behavioural changes in a person with Alzheimer’s in a moderate phase, and assess family integration into these care strategies. Literature review: A bibliographic search was carried out on the CINAHL and PubMed databases, selecting 7 articles. Results: Four types of nursing interventions have been identified for the management and prevention of behavioural changes: sensory, environmental, physical and psycho-emotional. There are few interventions developed in geriatric centres that integrate the family in the care of patients. Conclusion: The implementation of the selected nursing interventions creates an improvement in both the management and prevention of behavioural changes. The implementation of such activities by the family unit increases the positive effects on the family, the resident and the nursing team. However, more studies that integrate the family are needed to generalize the results (AU)

Nursing home admissions for persons with dementia: Role of home- and community-based services.

OBJECTIVE: To examine the relationship between Medicaid home- and community-based services (HCBS) generosity and the likelihood of nursing home (NH) admission for dually enrolled older adults with Alzheimer's disease and related dementias (ADRD) and their level of physical and cognitive impairment at NH admission. DATA SOURCES: National Medicare data, Medicaid Analytic eXtract, and MDS 3.0 for CY2010-2013 were linked. STUDY DESIGN: Eligible Medicare-Medicaid dual beneficiaries with ADRD were identified and followed for up to a year. We constructed two measures of HCBS generosity, breadth and intensity, at the county level for older duals with ADRD. Three binary outcomes were defined as follows: any NH placement during the follow-up year for all individuals in the sample, high (vs. not high) physical impairment, and high (vs. not high) cognitive impairment at the time of NH admission for those who were admitted to an NH. Logistic regressions with state-fixed effects and county random effects were estimated for these outcomes, respectively, accounting for individual- and county-level covariates. DATA EXTRACTION METHODS: The study sample included 365,310 community-dwelling older dual beneficiaries with ADRD who were enrolled in fee-for-service Medicare and Medicaid between October 1, 2010, and December 31, 2012. PRINCIPAL FINDINGS: Considerable variations of breadth and intensity in county-level HCBS were observed. We found that a 10-percentage-point increase in HCBS breadth was associated with a 1.4 (p < 0.01)-percentage-point reduction in the likelihood of NH admission. Among individuals with NH admission, greater HCBS breadth was associated with a higher level of physical impairment, and greater HCBS intensity was associated with a higher level of physical and cognitive impairment at NH admission. CONCLUSIONS: Among community-dwelling duals with ADRD, Medicaid HCBS generosity was associated with a lower likelihood of NH admission and greater functional impairment at NH admission.

"My backpack is so heavy": Experiences of Latino caregivers of family with early-onset Alzheimer's.

BACKGROUND/OBJECTIVES: While it is well-known that caregiving can have adverse effects on the physical and mental health of informal caregivers and their families, caregivers of those with early-onset Alzheimer's Disease (EOAD) may have distinct needs. Little is written about the experiences of Latino caregivers of family members with EOAD, especially inherited forms. This study's objective was to explore the experiences and needs of Latino caregivers of persons with EOAD. METHODS: Five focus group discussions (FGDs) were conducted among 27 informal caregivers of Latinos with EOAD who were recruited through an AD clinic in Los Angeles. RESULTS: The stress of caregiving was compounded by other pressures and worries, such as taking care of young children, providing financially for family, caregivers' own co-morbidities, and contemplating their own risk of inheriting EOAD. Resources for monolingual Spanish speakers were scarce. Participants had two primary unmet needs: information and support services. Participants lacked information about how to provide appropriate care, which heightened fears. Difficulty in obtaining a diagnosis from physicians who were uninformed about EOAD was also common. Recommended topics for informational campaigns included how-to videos on caring for a loved one but also topics related to self-care for caregivers. CONCLUSIONS: Our results underscore the need to tailor programs for caregivers of family members with EOAD. Educational campaigns could help to dispel myths and misconceptions, reduce stigma associated with EOAD, and encourage more people to seek timely care. Additional psychosocial support, such as support groups, could build solidarity and self-efficacy. Better access to dual-language information and support could encourage early help-seeking but also improve caregivers' quality of life as they manage long-term caregiving responsibilities.

The Effects of Aerobic Exercise on Psychological Functioning in Family Caregivers: Secondary Analyses of a Randomized Controlled Trial.

BACKGROUND: The responsibility and stress of being a family caregiver are associated with reduced physical and mental health. PURPOSE: To examine whether a 24-week aerobic exercise program improves multiple aspects of psychological functioning in family caregivers. METHODS: Family caregivers of patients with Alzheimer's disease and other dementias (n = 68) were recruited and randomized into either an aerobic exercise group (n = 34) or a waitlist control group (n = 34). The exercise group was assigned a 24-week aerobic training program that incrementally increased the intensity, duration, and frequency of the exercise program until 150 min of moderate to vigorous activity were completed per week by the ninth week. Twelve measures of psychological functioning were administered at baseline and compared with responses completed following the intervention. RESULTS: Multilevel modeling revealed significant decreases in caregiver burden (ß = -4.60, 95% confidence interval [CI] = [-8.82, -0.38], RLMM2 = 0.11) and depression (ß = -2.59, 95% CI = [-4.79, -0.38], RLMM2 = 0.13), as well as increases in mastery (ß = 1.78, 95% CI = [0.09, 3.46], RLMM2 = .04) in the exercise intervention group compared to the control group. CONCLUSION: Family caregivers report high levels of depression and caregiver burden. Engagement in a 24-week exercise intervention can ameliorate the perceived burden of caregiving, symptoms of depression, and their sense of mastery.

Differences in cognitive performance between informal caregivers and non-caregivers.

Extensive literature exists documenting the relationship between stress and cognition. Caregiving for an individual with Alzheimer's disease can be aunique and chronic stress experience due to the increasing dependency of the care-recipient as the disease progresses. The current study examines the relationship between stress and cognitive performance in 47 dementia caregivers compared to 47 noncaregiver control participants matched on age, gender, and education. Participants completed measures assessing stress (measured via the Perceived Stress Scale) and seven domains of cognition including episodic memory, working memory, executive functioning, attention, visuospatial processing, processing speed, and implicit memory. Results showed that caregivers had poorer performance than non-caregivers on certain measures of episodic memory, working memory, and executive functioning; while no significant differences were observed on measures of attention, visuospatial processing, processing speed, or implicit memory. In addition, when controlling for general stress, caregiver performance on measures of processing speed and visuospatial processing was also poorer than non-caregivers. By controlling for levels of general stress that may not be related to caregiving, these results show that differences in cognitive performance are unlikely to be explained by general stress alone.

The effectiveness of a couple-based intervention for people living with mild Alzheimer's disease and their spousal caregivers in Korea.

BACKGROUND AND OBJECTIVES: We evaluated the effectiveness of a Korean version of the Couples Life Story Approach (CLSA-K), a structured life-review program originally developed in the U.S. to help older adults with dementia and their spousal caregivers engage with each other and improve their quality of life.Research design and methods: Fifty mild people living with mild Alzheimer's disease and their spouses were recruited and 37 couples completed the five-week CLSA-K program. Data on psychosocial outcomes-i.e., depressive symptoms, talkativeness, mutuality (for both caregivers and care recipients) and burden (for caregivers)-were collected one week prior to (Time 1) and one week after the intervention (Time 2). Using repeated measures generalized linear models, we examined the differences in the amounts and patterns of the changes in outcomes according to age, gender, and the care-recipients' level of cognitive impairment. RESULTS: Some participants benefited from the CLSA-K program, while others did not. For caregivers, mental health, and marital quality remained stable, while caregiver burden increased among those with spouses who had moderate levels of cognitive impairment. For care-recipients, younger and male participants showed increased talkativeness. DISCUSSION AND IMPLICATIONS: CLSA-K appears to be promising for specific subgroups of participants in Korea. Multi-component or other approaches may be more beneficial for other couples. Cultural differences as well as social positions may play a role in the acceptability and efficacy of the couple-based intervention.

Cuidado del paciente con enfermedad de Alzheimer

Fundamento:la enfermedad de Alzheimer constituye una de las demencias más frecuente. Es una enfermedad devastadora que afecta la calidad de vida del paciente y de sus familiares.Objetivo:argumentar qué evidencia científica existe acerca de los cuidados del paciente con enfermedad de Alzheimer.Métodos:se realizó una revisión bibliográfica sistemática para desarrollar un análisis crítico reflexivo de documentos durante los meses de septiembre-octubre de 2019. Se utilizaron las bases de datos bibliográficas: PubMed, CUMED, CINAHL, CUIDEN PLUS, Lilacs y Metabuscador Google Scholar. Los términos de búsqueda incluyeron las palabras clave en inglés y en portugués, para su delimitación se utilizó el tesauro de Descriptores en Ciencias de la Salud (DeCS). El operador booleano utilizado fue el AND. Se siguieron los principios de análisis de contenido, la identificación de significados que se señalaban de forma más repetitiva, la consistencia, explicaciones y relaciones de estos, a través de todos los estudios incluidos en la revisión.Resultados:el modelo de Kristen M. Swanson necesita ser aplicado por el personal de Enfermería a los adultos mayores que padecen de enfermedad de Alzheimer para brindar cuidados de calidad a estos adultos mayores.Conclusiones:la sistematización y el análisis de los documentos identificados sirvieron para comprender la definición y caracterización de la enfermedad de Alzheimer. El abordaje y los enfoques de otros autores en el contexto internacional y nacional, permitieron adaptar el Modelo de Kristen M. Swanson para el cuidado de enfermería en adultos mayores con enfermedad de Alzheimer.[AU]

Cuidados ao idoso com doença de Alzheimer: estudo descritivo - exploratório / Care measures for older adults with Alzheimer's disease: a descriptive - exploratory study / Atención al adulto mayor con Alzheimer: estudio descriptivo - exploratorio

OBJETIVOS: identificar sob a ótica do enfermeiro o cuidado ao idoso com Doença de Alzheimer e qual o principal desafio para sua realização. MÉTODO: estudo descritivo-exploratório, qualitativo, realizado no período de agosto e setembro de 2017, com 15 enfermeiros atuantes na clínica médica masculina e feminina de um Hospital Escola localizado em um município do estado da Paraíba. Os dados foram coletados por meio de entrevistas e registros em notas de campo, tendo sido submetidos à Análise de Conteúdo. RESULTADOS: emergiram quatro categorias temáticas: Compreensão dos enfermeiros sobre a Doença de Alzheimer; Assistência ao idoso e à família; Ausência de capacitação; e Rejeição dos familiares diante do diagnóstico. CONCLUSÃO: os enfermeiros possuem um conhecimento limitado quanto ao cuidado do idoso com Alzheimer. Esse déficit de conhecimentos pode trazer consequências na assistência ao idoso com Alzheimer, assim como para os seus familiares.

OBJECTIVES: to identify from the perspective of the nurse the care provided to older adults with Alzheimer's Disease and what the main challenge for its realization is. METHOD: a descriptive-exploratory and qualitative study, conducted in August and September 2017, with 15 nurses working in the male and female medical clinic of a Teaching Hospital located in a municipality in the state of Paraíba. Data was collected through interviews and records in field notes, and were subjected to Content Analysis. RESULTS: four thematic categories emerged: Nurses' understanding of Alzheimer's Disease; Assistance to the older adult and the family; Lack of training; and Rejection of family members in the face of diagnosis. CONCLUSION: nurses have limited knowledge about the care of older adults with Alzheimer's Disease. This knowledge deficit can have consequences in the care of older adults with Alzheimer's Disease, as well as for their family members.

OBJETIVOS: identificar, desde la perspectiva del enfermero, la atención al adulto mayor con enfermedad de Alzheimer y cuál es el principal desafío para su implementación. MÉTODO: se trata de estudio cualitativo, descriptivo-exploratorio, realizado entre agosto y septiembre de 2017, con 15 enfermeros que trabajan en la clínica médica masculina y femenina de un Hospital Escuela ubicado en un municipio del estado de Paraíba. Los datos fueron recolectados a través de entrevistas y registros en notas de campo, y fueron sometidos a Análisis de Contenido. RESULTADOS: surgieron cuatro categorías temáticas: conocimiento de los enfermeros sobre la Enfermedad de Alzheimer; Atención al adulto mayor y a la familia; Falta de capacitación; y Rechazo de los familiares ante el diagnóstico. CONCLUSIÓN: los enfermeros tienen un conocimiento limitado sobre la atención al adulto mayor con Alzheimer. Este desconocimiento puede tener consecuencias para la atención de las personas mayores con Alzheimer, así como para sus familias.

Webconferência: abordagem integral ao idoso com demência - Telessaúde ES 24/09/2014

Abordagem Integral ao Idoso com demência: Doença de Alzheimer e outras demências.

WebPalestra: Doença de Alzheimer, diagnóstico precoce para que?

Como reconhecer os primeiros sinais e sintomas da Doença de Alzheimer e outras demências, em sua fase incial, seja no domicilio ou na unidades de saúde e que providências tomar junto a pessoa adoecida,sua familia e a unidade de saúde.

Community-Engaged Research with Vietnamese Americans to Pilot-Test a Dementia Caregiver Intervention.

Caring for a family member with Alzheimer's disease (AD) or a related dementia is stressful, and this may especially be the case for racial/ethnic minority caregivers. This study examined the feasibility and acceptability of a pilot intervention for Vietnamese American dementia caregivers. A secondary, exploratory aim was to examine post-intervention effects on AD knowledge and psychosocial outcomes. Of the 87 individuals contacted, 32 met inclusion criteria. Of this number, 14 enrolled in the study with 11 caregivers completing the intervention, and 10 of the 11 completing 3-month follow-up data. Caregivers provided positive feedback on the intervention and had higher scores on AD knowledge and self-efficacy in seeking support services post-intervention, with the effect on self-efficacy maintained at 3-month follow-up. Recruitment for the intervention was difficult; however, once caregivers came to the first session, they were engaged and found the classes informative. Recommendations for a future intervention are discussed.

Missing the Mark: The Complexity of African American Dementia Family Caregiving.

Alzheimer's disease and related dementias (ADRDs) have a significant impact on families. Family nurses are in an ideal position to address the needs of families affected by ADRD. However, to be most effective, family nurses and researchers need culturally appropriate theories to guide practice and research. On November 17, 2018, five nurse researchers presented findings of their research with African American families at the Gerontological Society of America's annual meeting. The results reported and the lively discussion that ensued suggested that the current paradigms framing research and practice with African American families affected by ADRD may not be adequate. There is a need to consider culturally congruent, family-centered theories to guide research and practice with this population of families.

Affective temperament traits may explain high expressed emotion in caregivers of patients with Alzheimer's disease.

BACKGROUND: The negative interactions between Alzheimer's disease (AD) patients and their caregivers may provoke criticism, hostility, and emotional overinvolvement that characterise highly expressed emotion (EE) attitudes. In this study, we hypothesised that affective temperament traits of AD caregivers are related to their high EE levels independent from other patient and caregiver characteristics. METHODS: Eighty AD patients were assessed through Clinical Dementia Rating Scale (CDR), and Mini-Mental State Examination. Expressed Emotion Scale (EES), Temperament Evaluation of Memphis, Pisa, Paris and San Diego auto-questionnaire, and Hamilton Depression Rating Scale were applied to the caregivers. The high (n = 41) and low EE caregivers (n = 39) were compared with respect to some sociodemographic and clinical characteristics of the patients and caregivers, and affective temperament traits of caregivers. The associations of caregiver EES scores with multiple variables related to patients and caregivers were examined by Pearson correlation tests. We performed multiple linear regression analysis to determine the possible predictors of total EES scores. RESULTS: High EE caregivers had significantly higher depressive, cyclothymic, and anxious temperament traits than in low EE subjects. A weak positive correlation was found between the total EES scores and Personal Care scores of CDR. Home and hobbies subscale scores of CDR had a moderately significant positive correlation with total EES scores. There was also moderate significant positive correlations between total EE scores and depressive, cyclothymic, anxious, and irritable temperament traits. Linear regression analysis indicated that depressive temperament significantly predicted the high levels of caregiver EE. CONCLUSION: These findings suggest that caregivers' depressive temperament is predominantly related to their EE levels even after controlling for the severity of AD, and lower educational level of caregivers. Our results may provide evidence that high EE might be a reflection of caregivers' depressive temperament traits, in accordance with the trait hypothesis.