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1.
BMC Geriatr ; 22(1): 56, 2022 01 16.
Article in English | MEDLINE | ID: covidwho-1635427

ABSTRACT

BACKGROUND: There is sparse evidence on the impact on vulnerable populations of the COVID-19 pandemic. The aim of our study was to explore burden and mental wellbeing (including depressive, anxiety, and stress symptoms) in caregivers of people with dementia during the first wave of the pandemic in Italy and southern Switzerland, two bordering regions severely hit by the COVID-19 pandemic. METHODS: We conducted an online cross-sectional survey with family carers of people with dementia between May and June 2020. We registered socio-demographic characteristics, and information about the relationship with the care recipient, dementia subtype, care inputs from others, and the need of care of the person with dementia. We measured caregiver burden with the Zarit Burden Interview (ZBI), psychological distress with the Depression, Anxiety and Stress Scale (DASS-21), and perceived isolation with the 3-item UCLA Loneliness Scale (UCLALS3). RESULTS: Caregivers (N =571) reported moderate to severe care-related burden (mean=54.30; SD=18.33), moderate anxiety symptoms (mean=10.04; SD=6.93), mild depressive symptoms (mean=11.79; SD=6.12) and mild stress (mean=12.95; SD=5.53), and 72.3% of participants reported to feel lonely. All scores were significantly more severe in Swiss compared to Italian caregivers (all p values<0.001). CONCLUSIONS: We found that caregivers' burden, anxiety symptoms, depression and perceived loneliness were marked during the first wave of the COVID-19 pandemic, in two severely hit bordering countries. Regional differences in the impact of the epidemic on caregivers could be due to contextual, societal, and cultural circumstances. As the pandemic endures, support to caregivers of people with dementia should be proportionate and tailored to needs and adapted to contextual factors.


Subject(s)
COVID-19 , Dementia , Caregivers , Cross-Sectional Studies , Dementia/diagnosis , Dementia/epidemiology , Depression/diagnosis , Depression/epidemiology , Humans , Mental Health , Pandemics , SARS-CoV-2 , Surveys and Questionnaires
2.
Int J Environ Res Public Health ; 19(1)2022 01 04.
Article in English | MEDLINE | ID: covidwho-1613759

ABSTRACT

Social distancing measures imposed because of the COVID-19 pandemic presented challenges to the health and wellbeing of people with dementia, family carers, and healthcare professionals. This study investigated the impact of these measures on all involved in the care for people with dementia. For this qualitative study, 20 family carers and 20 healthcare professionals from home care and long-term care (LTC) participated in a semi-structured interview. Interviews were analysed using an inductive thematic analysis approach. For people with dementia, the social distancing measures resulted in a deterioration of physical health. The impact on their emotional state and behaviour depended on the stage of dementia. Family carers experienced difficulty coping with visiting restrictions, anxiety regarding safety, and changes in carer burden. Healthcare professionals had an increased workload, and felt guilty about adhering to restrictive measures. Differences between home care and LTC were reported (i.e., societal initiatives focussed on LTC, scarcity of activities for community-dwelling people with dementia, use of personal protective equipment more intrusive for home care). The social distancing measures had a negative impact on persons with dementia, their family carers, and healthcare professionals. More attention is needed for community-dwelling people with dementia and family carers in times of social isolation.


Subject(s)
COVID-19 , Dementia , Caregivers , Delivery of Health Care , Dementia/epidemiology , Humans , Pandemics , Physical Distancing , SARS-CoV-2
3.
Health Aff (Millwood) ; 41(1): 105-111, 2022 01.
Article in English | MEDLINE | ID: covidwho-1604345

ABSTRACT

Informal care, or care provided by family and friends, is the most common form of care received by community-dwelling older adults with functional limitations. However, less is known about informal care provision within residential care settings including residential care facilities (for example, assisted living) and nursing homes. Using data from the Health and Retirement Study (2016) and the National Health and Aging Trends Study (2015), we found that informal care was common among older adults with functional limitations, whether they lived in the community, a residential care facility, or a nursing home. The hours of informal care provided were also nontrivial across all settings. This evidence suggests that informal caregiving and some of the associated burdens do not end when a person transitions from the community to residential care or a nursing home setting. It also points to the large role that families play in the care and well-being of these residents, which is especially important considering the recent visitor bans during the COVID-19 epidemic. Family members are an invisible workforce in nursing homes and residential care facilities, providing considerable front-line work for their loved ones. Providers and policy makers could improve the lives of both the residents and their caregivers by acknowledging, incorporating, and supporting this workforce.


Subject(s)
COVID-19 , Dementia , Aged , Caregivers , Humans , Nursing Homes , Residential Facilities , SARS-CoV-2
4.
Int J Environ Res Public Health ; 18(24)2021 12 20.
Article in English | MEDLINE | ID: covidwho-1599165

ABSTRACT

Increasing numbers of people living with dementia (PLWD), and a pressured health and social care system, will exacerbate inequalities in mortality for PLWD. There is a dearth of research examining multiple factors in mortality risk among PLWD, including application of large administrative datasets to investigate these issues. This study explored variation mortality risk variation among people diagnosed with dementia between 2002-2016, based on: age, sex, ethnicity, deprivation, geography and general practice (GP) contacts. Data were derived from electronic health records from a cohort of Clinical Practice Research Datalink GP patients in England (n = 142,340). Cox proportional hazards regression modelled mortality risk separately for people with early- and later- onset dementia. Few social inequalities were observed in early-onset dementia; men had greater risk of mortality. For early- and later-onset, higher rates of GP observations-and for later-onset only dementia medications-are associated with increased mortality risk. Social inequalities were evident in later-onset dementia. Accounting for other explanatory factors, Black and Mixed/Other ethnicity groups had lower mortality risk, more deprived areas had greater mortality risk, and higher mortality was observed in North East, South Central and South West GP regions. This study provides novel evidence of the extent of mortality risk inequalities among PLWD. Variance in mortality risk was observed by social, demographic and geographic factors, and frequency of GP contact. Findings illustrate need for greater person-centred care discussions, prioritising tackling inequalities among PLWD. Future research should explore more outcomes for PLWD, and more explanatory factors of health outcomes.


Subject(s)
Dementia , Cohort Studies , Demography , Geography , Humans , Male , Socioeconomic Factors
5.
PLoS One ; 16(12): e0260506, 2021.
Article in English | MEDLINE | ID: covidwho-1591515

ABSTRACT

BACKGROUND: There has been a shift in focus of international dementia policies from improving diagnostic rates to enhancing the post-diagnostic support provided to people with dementia and their carers. There is, however, little agreement over what constitutes good post-diagnostic support. This study aimed to identify the components of post-diagnostic dementia support. METHODS: We adopted a qualitative design using interviews, focus groups and observation to explore the perspectives of key stakeholders on the content of post-diagnostic dementia support. Purposive sampling was used to identify sites in England and Wales recognised as delivering good practice. Participants included 17 people with dementia, 31 carers, 68 service managers or funders, and 78 frontline staff. Interviews and focus groups were audio recorded and transcribed for analysis. Forty-eight sessions of observation were completed and recorded in fieldnotes. Components were identified through an inductive, thematic approach and cross-checked against national guidelines and existing frameworks; they were subsequently critically reviewed by a range of experts and our mixed stakeholder panel. RESULTS: Twenty distinct components of post-diagnostic support were identified, related to five themes: timely identification and management of needs; understanding and managing dementia; emotional and psychological wellbeing; practical support; and integrating support. The first and last of these were cross-cutting themes facilitating the delivery of a unique constellation of components of post-diagnostic support to each individual living with dementia or dyad at a particular time. CONCLUSIONS: Our work offers an empirically based framework to inform the development and delivery of holistic, integrated and continuous dementia care from diagnosis to end of life. It highlights the relevance of many components to both people living with dementia and their carers. Since the framework was developed in England and Wales, further research is needed to explore the relevance of our components to other sectors, countries and care systems.


Subject(s)
Caregivers/psychology , Dementia/diagnosis , Social Support , Adult , Aged , Aged, 80 and over , Female , Focus Groups , Humans , Interviews as Topic , Male , Middle Aged , Qualitative Research
6.
Front Public Health ; 9: 720180, 2021.
Article in English | MEDLINE | ID: covidwho-1581131

ABSTRACT

Lack of social engagement and the resulting social isolation can have negative impacts on health and well-being, especially in senior care communities and for those living with dementia. Project VITAL leverages technology and community resources to create a network for connection, engagement, education, and support of individuals with dementia and their caregivers, and explores the impact of these interventions in reducing feelings of social isolation and increasing mood among residents during the COVID-19 pandemic. Through two phases, 600 personalized Wi-Fi-enabled iN2L tablets were distributed to 300 senior care communities (55% assisted living communities, 37% skilled nursing communities, 6% memory care communities, and 2% adult family-care homes) to connect and engage residents and their families. Different phases also included Project ECHO, a video-based learning platform, Alzheimer's Association virtual and online education and support for family caregivers, evidence-based online professional dementia care staff training and certification, and Virtual Forums designed to explore ways to build sustainable, scalable models to ensure access to support and decrease social isolation in the future. Tablet usage was collected over an 11-month period and an interim survey was designed to assess the effectiveness of the tablets, in preventing social isolation and increasing mood among residents during the COVID-19 pandemic. A total of 105 care community staff (whose community used the tablets) completed the survey and overall, these staff showed a high level of agreement to statements indicating that residents struggled with loneliness and mood, and that the tablet was useful in improving loneliness and mood in residents and allowing them to stay in touch with family and friends. Additional positive results were seen through a variety of other responses around the tablets and Project ECHO. Overall, the tablets were shown to be an effective way to engage residents and connect them with friends and family, as well as being a useful tool for staff members. A third phase is currently underway in the homes of people with dementia and their family caregivers, which includes tablets and direct access to Alzheimer's Association virtual and online education and support programs.


Subject(s)
Alzheimer Disease , COVID-19 , Dementia , Adult , Alzheimer Disease/epidemiology , Alzheimer Disease/therapy , Dementia/epidemiology , Florida , Humans , Nursing Homes , Pandemics , SARS-CoV-2 , Social Isolation , Technology
7.
Int J Environ Res Public Health ; 19(1)2021 Dec 24.
Article in English | MEDLINE | ID: covidwho-1580827

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) contributed to increasing prevalence of depressive symptoms and other psychological repercussions, particularly in the disease population in Hong Kong. Nonetheless, the caregiver burden of caregivers of persons with dementia (CGPWD), has been under-investigated. AIMS: This study examined the psychological impact and its correlates on the CGPWD in Hong Kong amid the COVID-19 outbreak. METHODS: CGPWD referred from rehabilitation clinics and online seminar were used to recruit participants to complete an online questionnaire by the end of the second-wave of the COVID-19 outbreak (June 2021). To be eligible, either full-time or part-time CGPWD, aged 18 or above, can understand Cantonese, currently reside in Hong Kong and offering care to PWD for at least one year, were recruited. Those CGPWD diagnosed with any type of psychiatric disorder were excluded from this study. The Chinese Center for Epidemiologic Studies Depression Scale (CES-D), Perceived Stress Scale (PSS-10), Generalized Anxiety Disorder (GAD-7), Zarit Burden Interview (ZBI-22), and Nonattachment Scale (NAS-7) were used to measure participants' depression, perceived stress, anxiety symptoms, caregiver burden and wisdom in subjective feelings of internal stress. The modified Medical Outcomes Study Social Support Survey (mMOS-SS) and the SARS Appraisal Inventory (SAI) were also administered to measure participants' perceived support and coping efficacy. Follow-up responses were gathered by the end of third-wave outbreak (October 2021). RESULTS: A total of 51 CGPWD participated, of which, 33 (64.7%) suffered from probable depression (CES-D score ≥ 16). Participants also showed a significant increase in depression symptom scores at the three-month follow-up period (t = 2.25, p = 0.03). CGPWD with probable depression had less non-attachment awareness and higher scores in anxiety, stress, caregiving burden, and coronavirus impact (all p < 0.05) than those without. CONCLUSIONS: High prevalence of depressive symptoms was noted among our CGPWD sample and these symptoms seemed to worsen substantially. Contingent online mental health support should be prioritized to those CGPWD to reduce psychiatric morbidity and the global disease burden.


Subject(s)
COVID-19 , Dementia , Anxiety/epidemiology , Anxiety Disorders , Caregivers , Cross-Sectional Studies , Depression/epidemiology , Hong Kong/epidemiology , Humans , Pandemics , SARS-CoV-2 , Stress, Psychological/epidemiology , Surveys and Questionnaires
8.
Geriatr Nurs ; 42(5): 1230-1239, 2021.
Article in English | MEDLINE | ID: covidwho-1575510

ABSTRACT

The purpose of this study was to systematically examine the association between dementia and mortality among older adults with COVID-19. To do so, we conducted a search of 7 databases for relevant full-text articles. A cohort study and case-control study were included. A meta-analysis was performed to synthesize the pooled odds ratio with a random-effects model. We identified studies that reported mortality among older adults with dementia and non-dementia who have COVID-19. The pooled mortality rates of dementia and non-dementia older adults infected with COVID-19 were 39% (95% CI: 0.23-0.54%, I2 = 83.48%) and 20% (95% CI: 0.16-0.25%, I2 = 83.48%), respectively. Overall, dementia was the main factor influencing poor health outcomes and high rates of mortality in older adults with COVID-19 infection (odds ratio 2.96; 95% CI 2.00-4.38, I2 = 29.7%), respectively. Our results show that older adults with dementia with COVID-19 infection have a higher risk of mortality compared with older adults without dementia. This current study further highlights the need to provide focused care to the older adults with dementia or cognitive impairment who have COVID-19.


Subject(s)
COVID-19 , Dementia , Aged , Case-Control Studies , Cohort Studies , Humans , Observational Studies as Topic , SARS-CoV-2
9.
Infect Control Hosp Epidemiol ; 42(11): 1333-1339, 2021 11.
Article in English | MEDLINE | ID: covidwho-1574858

ABSTRACT

OBJECTIVE: We sought to contain a healthcare-associated coronavirus disease 2019 (COVID-19) outbreak, to evaluate contributory factors, and to prevent future outbreaks. DESIGN: Quasi-experimental cluster-control outbreak evaluation. METHODS: All patients and staff on the outbreak ward (case cluster), and randomly selected patients and staff on COVID-19 wards (positive control cluster) and a non-COVID-19 wards (negative control cluster) underwent reverse-transcriptase polymerase chain reaction (RT-PCR) testing. Hand hygiene and personal protective equipment (PPE) compliance, detection of environmental SARS-COV-2 RNA, patient behavior, and SARS-CoV-2 IgG antibody prevalence were assessed. RESULTS: In total, 145 staff and 26 patients were exposed, resulting in 24 secondary cases. Also, 4 of 14 (29%) staff and 7 of 10 (70%) patients were asymptomatic or presymptomatic. There was no difference in mean cycle threshold between asymptomatic or presymptomatic versus symptomatic individuals. None of 32 randomly selected staff from the control wards tested positive. Environmental RNA detection levels were higher on the COVID-19 ward than on the negative control ward (OR, 19.98; 95% CI, 2.63-906.38; P < .001). RNA levels on the COVID-19 ward (where there were no outbreaks) and the outbreak ward were similar (OR, 2.38; P = .18). Mean monthly hand hygiene compliance, based on 20,146 observations (over preceding year), was lower on the outbreak ward (P < .006). Compared to both control wards, the proportion of staff with detectable antibodies was higher on the outbreak ward (OR, 3.78; 95% CI, 1.01-14.25; P = .008). CONCLUSION: Staff seroconversion was more likely during a short-term outbreak than from sustained duty on a COVID-19 ward. Environmental contamination and PPE use were similar on the outbreak and control wards. Patient noncompliance, decreased hand hygiene, and asymptomatic or presymptomatic transmission were more frequent on the outbreak ward.


Subject(s)
COVID-19 , Dementia , Stroke , Disease Outbreaks , Humans , Infection Control , RNA, Viral , SARS-CoV-2
10.
J Med Internet Res ; 23(2): e26257, 2021 02 22.
Article in English | MEDLINE | ID: covidwho-1574035

ABSTRACT

BACKGROUND: As the COVID-19 pandemic continues, an initial risk-adapted allocation is crucial for managing medical resources and providing intensive care. OBJECTIVE: In this study, we aimed to identify factors that predict the overall survival rate for COVID-19 cases and develop a COVID-19 prognosis score (COPS) system based on these factors. In addition, disease severity and the length of hospital stay for patients with COVID-19 were analyzed. METHODS: We retrospectively analyzed a nationwide cohort of laboratory-confirmed COVID-19 cases between January and April 2020 in Korea. The cohort was split randomly into a development cohort and a validation cohort with a 2:1 ratio. In the development cohort (n=3729), we tried to identify factors associated with overall survival and develop a scoring system to predict the overall survival rate by using parameters identified by the Cox proportional hazard regression model with bootstrapping methods. In the validation cohort (n=1865), we evaluated the prediction accuracy using the area under the receiver operating characteristic curve. The score of each variable in the COPS system was rounded off following the log-scaled conversion of the adjusted hazard ratio. RESULTS: Among the 5594 patients included in this analysis, 234 (4.2%) died after receiving a COVID-19 diagnosis. In the development cohort, six parameters were significantly related to poor overall survival: older age, dementia, chronic renal failure, dyspnea, mental disturbance, and absolute lymphocyte count <1000/mm3. The following risk groups were formed: low-risk (score 0-2), intermediate-risk (score 3), high-risk (score 4), and very high-risk (score 5-7) groups. The COPS system yielded an area under the curve value of 0.918 for predicting the 14-day survival rate and 0.896 for predicting the 28-day survival rate in the validation cohort. Using the COPS system, 28-day survival rates were discriminatively estimated at 99.8%, 95.4%, 82.3%, and 55.1% in the low-risk, intermediate-risk, high-risk, and very high-risk groups, respectively, of the total cohort (P<.001). The length of hospital stay and disease severity were directly associated with overall survival (P<.001), and the hospital stay duration was significantly longer among survivors (mean 26.1, SD 10.7 days) than among nonsurvivors (mean 15.6, SD 13.3 days). CONCLUSIONS: The newly developed predictive COPS system may assist in making risk-adapted decisions for the allocation of medical resources, including intensive care, during the COVID-19 pandemic.


Subject(s)
COVID-19/diagnosis , COVID-19/mortality , Age Factors , Aged , Critical Care/statistics & numerical data , Dementia/epidemiology , Female , Humans , Kidney Failure, Chronic/epidemiology , Length of Stay/statistics & numerical data , Male , Middle Aged , Pandemics , Prognosis , Proportional Hazards Models , ROC Curve , Republic of Korea/epidemiology , Retrospective Studies , Risk Factors , Severity of Illness Index , Survival Rate
11.
Cad. Saúde Pública (Online) ; 37(9): e00028321, 2021. tab, graf
Article in English | LILACS (Americas) | ID: covidwho-1574301

ABSTRACT

Abstract: We aim to examine the effect of the COVID-19 pandemic on the ethnoracial disparities in hospitalizations due to dementia and its related outcomes, in Brazil. A longitudinal panel study was carried out with data extracted from the Hospital Information Systems of the Brazilian Unified National Health System (SIH/SUS). We assessed the number of hospital admission per 100,000 inhabitants, mean inpatient spending, and inpatient mortality rate due to dementia during the first semester of 2019 and 2020. Data were stratified by geographic region and ethnoracial groups (black, mixed, and white) based on skin color. We observed an overall reduction in hospital admissions, mean inpatient spending, and mortality rate between the first semester of 2019 and 2020. However, the reduction of hospitalization rates among black and mixed people was 105.3% and 121.1% greater than in whites, respectively. Mortality rate was decreased by 9% in whites and was increased by 65% and 43% in the black and mixed population, respectively. In the first semester of 2020, black and mixed patients had a higher risk of losing their lives due to dementia than white people. This disparity was not observed in the same period of 2019. In 2020, the inpatient mortality ratio reached the highest values among black individuals in all regions but the North (no data available). Since the beginning of the COVID-19 epidemic in Brazil, ethnoracial disparity in hospital admissions and mortality rates due to dementia has been heightened. Governmental actions and policies to mitigate this indirect effect of the pandemic on the Brazilian population are urgent.


Resumo: O estudo teve como objetivo examinar o efeito da pandemia da COVID-19 sobre disparidades étnico-raciais nas hospitalizações e desfechos relacionados à demência no Brasil. Foi realizado um estudo de painel longitudinal com dados extraídos do Sistema de Informações Hospitalares do Sistema Único de Saúde (SIH/SUS). Avaliamos o número de internações hospitalares por 100 mil habitantes, média de gastos hospitalares e taxa de mortalidade por demência durante o primeiro semestre de 2019 e de 2020. Os dados foram estratificados por região geográfica e grupo étnico-racial (preto, pardo e branco) com base na cor da pele. Observamos uma redução geral nas internações, média de gastos hospitalares e taxa de mortalidade entre o primeiro semestre de 2019 e o mesmo período em 2020. Entretanto, as reduções nas taxas de hospitalização entre pretos e pardos foram 105,3% e 121,1% maiores que em brancos, respectivamente. A taxa de mortalidade diminuiu em 9% entre brancos e aumentou em 65% e 43% entre pretos e pardos, respectivamente. No primeiro semestre de 2020, pacientes pretos e pardos tiveram um risco mais alto de perder a vida por demência quando comparados aos brancos, disparidade essa não havia sido observada no mesmo período de 2019. Em 2020, a razão de mortalidade hospitalar atingiu os níveis mais altos em indivíduos pretos em todas as regiões exceto a Norte (dados não publicados). Desde o início da epidemia de COVID-19 no Brasil, aumentou a disparidade étnico-racial nas internações e taxas de mortalidade por demência. São necessárias medidas e políticas governamentais para mitigar esse efeito indireto da pandemia sobre a população brasileira.


Resumen: El objetivo fue examinar el efecto de la pandemia de COVID-19 respecto a las disparidades étnico-raciales en hospitalizaciones, así como los resultados informados de las mismas, debido a la demencia en Brasil. Se trata de un estudio longitudinal en panel, realizado con datos extraídos del Sistema de Informaciones Hospitalarias del Sistema Único de Salud (SIH/SUS). Evaluamos el número de admisiones hospitalarias por 100.000 habitantes, la media del gasto hospitalario, además de la tasa de mortalidad hospitalaria, debido a la demencia, durante el primer semestre de 2019 y 2020. Los datos fueron estratificados por región geográfica y grupos étnico-raciales (negros, mestizos, y blancos), basados en su color de piel. Observamos en general una reducción en las admisiones hospitalarias, media del gasto hospitalario, y tasa de mortalidad entre el primer semestre de 2019 y 2020. No obstante, la reducción de las tasas de hospitalización entre negros y mestizos fue 105.3% y 121.1% superior, respecto a la de los blancos, respectivamente. La tasa de mortalidad decreció un 9% en blancos y aumentó en un 65% y un 43% en la población negra y mestiza, comparativamente. En el primer semestre de 2020, los pacientes negros y mestizos tenían un riesgo más alto de fallecer, debido a la demencia que la gente blanca, esta disparidad no se observó en el mismo periodo de 2019. En 2020, la ratio de mortalidad hospitalaria alcanzó los valores más altos entre individuos negros en todas las regiones, salvo en el Norte (no había datos disponibles). Desde el principio de la epidemia de COVID-19 en Brasil, la disparidad étnico-racial en las admisiones hospitalarias y tasas de mortalidad, debido a la demencia, se ha incrementado. Son urgentes acciones gubernamentales y políticas para mitigar este efecto indirecto de la pandemia en la población brasileña.


Subject(s)
Humans , Dementia/epidemiology , COVID-19 , Brazil/epidemiology , Pandemics , SARS-CoV-2 , Hospitalization
12.
Hastings Cent Rep ; 51(6): 11-12, 2021 11.
Article in English | MEDLINE | ID: covidwho-1568057

ABSTRACT

Recent outbreaks in Australia and the detection of more virulent SARS-CoV-2 strains suggest that Covid-19 is not yet over. In July 2021, three states in Australia were in lockdown as a result of community transmission of the Delta variant. Despite being effective at mitigating outbreaks, lockdowns could have adverse effects on the elderly and people with dementia. This commentary reviews general lockdown and aged-care lockdown policies in Victoria, New South Wales, and South Australia and highlights how these could affect the well-being of people with dementia and their caregivers. Drawing from literature on Covid-19 and dementia, this commentary provides pragmatic recommendations on how to consider the well-being of people with dementia and their care providers in Covid-19 management policies.


Subject(s)
COVID-19 , Dementia , Aged , Caregivers , Communicable Disease Control , Humans , SARS-CoV-2
14.
J Alzheimers Dis ; 84(2): 883-893, 2021.
Article in English | MEDLINE | ID: covidwho-1518456

ABSTRACT

BACKGROUND: People with advanced dementia often exhibit responsive behaviors such as apathy, depression, agitation, aggression, and psychosis. Non-pharmacological approaches (e.g., listening to music, watching television, doing arts and crafts) are now considered as a first-line strategy to manage responsive behaviors in clinical practice due to the potential risks associated with the antipsychotic medications. To date, no evaluations of immersive non-head mounted virtual reality (VR) experience as a non-pharmacologic approach for people with advanced dementia living in nursing homes have been reported. OBJECTIVE: To evaluate the feasibility (acceptance and safety) of VR experience. METHODS: A single site case series (nonrandomized and unblinded) with a convenience sample (N = 24; age = 85.8±8.6 years; Cognitive Performance Scale score = 3.4±0.6) measuring depression and agitation before and after the intervention. The intervention was a 30-min long research coordinator- facilitated VR experience for two weeks (10 sessions). RESULTS: The intervention was feasible (attrition rate = 0% ; adverse events = 0). A reduction in depression and in agitation was observed after the intervention. However, we suggest extreme caution in interpreting this result considering the study design and small sample size. CONCLUSION: This study provides the basis for conducting a randomized controlled trial to evaluate the effect of VR experience on responsive behaviors in nursing homes. Since our intervention uses a smart remote-controlled projector without a headset, infectious exposure can be avoided following the COVID-19 pandemic-induced physical distancing policy in care homes.


Subject(s)
COVID-19/virology , Nursing Homes , SARS-CoV-2/pathogenicity , Virtual Reality , Aged , Aged, 80 and over , Aggression/psychology , Dementia/psychology , Female , Humans , Male , Quality of Life/psychology
15.
Int J Environ Res Public Health ; 18(21)2021 10 28.
Article in English | MEDLINE | ID: covidwho-1512288

ABSTRACT

Recruiting participants for dementia research takes time. For those who are interested, opportunities to participate can be ad hoc. Delays in finding the right participants can result in studies taking longer to deliver, often requiring funding extensions, and ultimately increasing the cost and limiting the effectiveness of research and evaluation. To address these issues, a digital platform, StepUp for Dementia Research, was developed in 2019 and evaluated through ongoing data analytics, researcher feedback and annual volunteer surveys in 2019 and 2021. Using innovative matching technology, StepUp provides volunteers with an opt-in, secure way of registering interest in dementia studies and allows researchers to access matched volunteers in Australia. As of June 2021, 1070 volunteers registered (78% female), and 25 organizations became 'champions' for StepUp promotion. Of 122 registered researchers, 90 completed training. Forty studies from 17 research/health institutions recruited participants using StepUp. The evaluation demonstrated program feasibility and recruitment efficiency with a high level of satisfaction from users. Evaluation outcomes highlighted disparities in public participation in dementia research (e.g., gender, education and race/ethnicity) and provided valuable insights for further enhancements of StepUp. A concerted and strategic effort is needed by leading registries such as StepUp to ensure narrowing volunteer participation gaps in dementia research.


Subject(s)
Community Participation , Dementia , Australia , Dementia/epidemiology , Female , Humans , Male , Registries , Surveys and Questionnaires
16.
Int J Environ Res Public Health ; 18(21)2021 10 27.
Article in English | MEDLINE | ID: covidwho-1512285

ABSTRACT

The relationship between nurse staffing, physical outcomes of residents, as well as quality of care receives major attention. The impact of staffing levels on residents' ability to organize their everyday life and maintain social contacts, however, has not been analyzed to date. This study examines whether a relationship between the staff-to-resident ratio for registered nurses and nursing home residents with and without dementia aged over 80 exists. Secondary data collected in the project inQS (indikatorengestützte Qualitätsförderung) were used (n = 1782, mean age = 88.14). The analyzed cross-sectional data were collected in winter 2019 in facilities of the Diocesan Caritas Association in Germany. A sum score formed from variables measuring residents' abilities to independently organize their everyday life and maintain social contacts functioned as the dependent variable. A multi-level regression analysis was performed. The results revealed that the ability of residents without dementia was significantly associated with the staff-to-resident ratio of registered nurses. This was not true for residents with dementia. For the latter, however, whether the facility offers a segregated care unit turned out to be significant. Additional and longitudinal research is indispensable to explain the inequality between the two groups analyzed.


Subject(s)
Dementia , Inpatients , Aged , Aged, 80 and over , Cross-Sectional Studies , Humans , Nursing Homes , Workforce
18.
Am J Bioeth ; 21(11): 71-74, 2021 11.
Article in English | MEDLINE | ID: covidwho-1506980
20.
Environ Health ; 20(1): 65, 2021 05 27.
Article in English | MEDLINE | ID: covidwho-1496182

ABSTRACT

BACKGROUND: Alzheimer's disease (AD) and other dementias currently represent the fifth most common cause of death in the world, according to the World Health Organization, with a projected future increase as the proportion of the elderly in the population is growing. Air pollution has emerged as a plausible risk factor for AD, but studies estimating dementia cases attributable to exposure to fine particulate matter (PM2.5) air pollution and resulting monetary estimates are lacking. METHODS: We used data on average population-weighted exposure to ambient PM2.5 for the entire population of Sweden above 30 years of age. To estimate the annual number of dementia cases attributable to air pollution in the Swedish population above 60 years of age, we used the latest concentration response functions (CRF) between PM2.5 exposure and dementia incidence, based on ten longitudinal cohort studies, for the population above 60 years of age. To estimate the monetary burden of attributable cases, we calculated total costs related to dementia, including direct and indirect lifetime costs and intangible costs by including quality-adjusted life years (QALYs) lost. Two different monetary valuations of QALYs in Sweden were used to estimate the monetary value of reduced quality-of-life from two different payer perspectives. RESULTS: The annual number of dementia cases attributable to PM2.5 exposure was estimated to be 820, which represents 5% of the annual dementia cases in Sweden. Direct and indirect lifetime average cost per dementia case was estimated to correspond € 213,000. A reduction of PM2.5 by 1 µg/m3 was estimated to yield 101 fewer cases of dementia incidences annually, resulting in an estimated monetary benefit ranging up to 0.01% of the Swedish GDP in 2019. CONCLUSION: This study estimated that 5% of annual dementia cases could be attributed to PM2.5 exposure, and that the resulting monetary burden is substantial. These findings suggest the need to consider airborne toxic pollutants associated with dementia incidence in public health policy decisions.


Subject(s)
Dementia , Environmental Exposure , Environmental Pollutants , Particulate Matter , Aged , Aged, 80 and over , Cost of Illness , Dementia/economics , Dementia/epidemiology , Environmental Exposure/adverse effects , Environmental Exposure/analysis , Environmental Exposure/economics , Environmental Pollutants/adverse effects , Environmental Pollutants/analysis , Environmental Pollutants/economics , Humans , Incidence , Middle Aged , Particulate Matter/adverse effects , Particulate Matter/analysis , Particulate Matter/economics , Quality of Life , Sweden/epidemiology
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