Teamwork and Nurse Care Coordination in Home Healthcare.

Home healthcare agencies provide interdisciplinary care to millions of individuals annually. Care is typically led by registered nurses who often determine additional disciplines need to be included in the plan of care. We found that, although persons living with dementia represent about 30% of the home healthcare population, data from our home healthcare system showed that over a 1-year period with 36,443 home care episodes, only 29.6% had one or more social worker visits. Recognizing Alzheimer's disease-related dementia as a terminal condition and shifting toward a palliative care approach can be a challenge in home healthcare where care is focused on restorative care or rehabilitative goals with a primary focus on improvement in condition. The goal of this article is to present insights into nurse-led care coordination and teamwork and provide implications for practice.

Using AI-Based Technologies to Help Nurses Detect Behavioral Disorders: Narrative Literature Review.

BACKGROUND: The behavioral and psychological symptoms of dementia (BPSD) are common among people with dementia and have multiple negative consequences. Artificial intelligence-based technologies (AITs) have the potential to help nurses in the early prodromal detection of BPSD. Despite significant recent interest in the topic and the increasing number of available appropriate devices, little information is available on using AITs to help nurses striving to detect BPSD early. OBJECTIVE: The aim of this study is to identify the number and characteristics of existing publications on introducing AITs to support nursing interventions to detect and manage BPSD early. METHODS: A literature review of publications in the PubMed database referring to AITs and dementia was conducted in September 2023. A detailed analysis sought to identify the characteristics of these publications. The results were reported using a narrative approach. RESULTS: A total of 25 publications from 14 countries were identified, with most describing prospective observational studies. We identified three categories of publications on using AITs and they are (1) predicting behaviors and the stages and progression of dementia, (2) screening and assessing clinical symptoms, and (3) managing dementia and BPSD. Most of the publications referred to managing dementia and BPSD. CONCLUSIONS: Despite growing interest, most AITs currently in use are designed to support psychosocial approaches to treating and caring for existing clinical signs of BPSD. AITs thus remain undertested and underused for the early and real-time detection of BPSD. They could, nevertheless, provide nurses with accurate, reliable systems for assessing, monitoring, planning, and supporting safe therapeutic interventions.

Caring for People Living With Dementia in Saudi Arabia: The Perspective of Nurses as Primary Caregivers.

Dementia is a progressive condition and an umbrella term used to describe a set of symptoms that affects many older adults. Older adults living with dementia often experience social stigma, which can impact their quality of life. Most people with dementia need the assistance of a caregiver in order to enhance their health. The present study seeks to explore the perspective of nurses as the primary caregivers of people living with dementia in Saudi Arabia, focusing on the challenges faced by nurses and their reactions to these challenges. A descriptive qualitative approach using semi-structured interviews with 10 nurses with experience caring for people living with dementia from 2 hospitals in Jeddah, Saudi Arabia. Using thematic analysis, 4 main themes were identified: (1) types of support, (2) challenges when caring for people living with dementia, (3) society's views on people living with dementia, and (4) nurses' perceptions of dementia. The nurses stated that people living with dementia do not receive sufficient support from their families. Most participants believed that public awareness about dementia is insufficient. Increased efforts to raise public awareness about dementia could include harnessing social norms around family structure and respect for elders to improve care provided to people living with dementia.

Assessing the Quality of ChatGPT Responses to Dementia Caregivers' Questions: Qualitative Analysis.

Background: Artificial intelligence (AI) such as ChatGPT by OpenAI holds great promise to improve the quality of life of patients with dementia and their caregivers by providing high-quality responses to their questions about typical dementia behaviors. So far, however, evidence on the quality of such ChatGPT responses is limited. A few recent publications have investigated the quality of ChatGPT responses in other health conditions. Our study is the first to assess ChatGPT using real-world questions asked by dementia caregivers themselves. objectives: This pilot study examines the potential of ChatGPT-3.5 to provide high-quality information that may enhance dementia care and patient-caregiver education. Methods: Our interprofessional team used a formal rating scale (scoring range: 0-5; the higher the score, the better the quality) to evaluate ChatGPT responses to real-world questions posed by dementia caregivers. We selected 60 posts by dementia caregivers from Reddit, a popular social media platform. These posts were verified by 3 interdisciplinary dementia clinicians as representing dementia caregivers' desire for information in the areas of memory loss and confusion, aggression, and driving. Word count for posts in the memory loss and confusion category ranged from 71 to 531 (mean 218; median 188), aggression posts ranged from 58 to 602 words (mean 254; median 200), and driving posts ranged from 93 to 550 words (mean 272; median 276). Results: ChatGPT's response quality scores ranged from 3 to 5. Of the 60 responses, 26 (43%) received 5 points, 21 (35%) received 4 points, and 13 (22%) received 3 points, suggesting high quality. ChatGPT obtained consistently high scores in synthesizing information to provide follow-up recommendations (n=58, 96%), with the lowest scores in the area of comprehensiveness (n=38, 63%). Conclusions: ChatGPT provided high-quality responses to complex questions posted by dementia caregivers, but it did have limitations. ChatGPT was unable to anticipate future problems that a human professional might recognize and address in a clinical encounter. At other times, ChatGPT recommended a strategy that the caregiver had already explicitly tried. This pilot study indicates the potential of AI to provide high-quality information to enhance dementia care and patient-caregiver education in tandem with information provided by licensed health care professionals. Evaluating the quality of responses is necessary to ensure that caregivers can make informed decisions. ChatGPT has the potential to transform health care practice by shaping how caregivers receive health information.

Nurse Practitioner Care, Scope of Practice, and End-of-Life Outcomes for Nursing Home Residents With Dementia.

Importance: Nursing home residents with Alzheimer disease and related dementias (ADRD) often receive burdensome care at the end of life. Nurse practitioners (NPs) provide an increasing share of primary care in nursing homes, but how NP care is associated with end-of-life outcomes for this population is unknown. Objectives: To examine the association of NP care with end-of-life outcomes for nursing home residents with ADRD and assess whether these associations differ according to state-level NP scope of practice regulations. Design, Setting, and Participants: This cohort study using fee-for-service Medicare claims included 334 618 US nursing home residents with ADRD who died between January 1, 2016, and December 31, 2018. Data were analyzed from April 6, 2015, to December 31, 2018. Exposures: Share of nursing home primary care visits by NPs, classified as minimal (<10% of visits), moderate (10%-50% of visits), and extensive (>50% of visits). State NP scope of practice regulations were classified as full vs restrictive in 2 domains: practice authority (authorization to practice and prescribe independently) and do-not-resuscitate (DNR) authority (authorization to sign DNR orders). Main Outcomes and Measures: Hospitalization within the last 30 days of life and death with hospice. Linear probability models with hospital referral region fixed effects controlling for resident characteristics, visit volume, and geographic factors were used to estimate whether the associations between NP care and outcomes varied across states with different scope of practice regulations. Results: Among 334 618 nursing home decedents (mean [SD] age at death, 86.6 [8.2] years; 69.3% female), 40.5% received minimal NP care, 21.4% received moderate NP care, and 38.0% received extensive NP care. Adjusted hospitalization rates were lower for residents with extensive NP care (31.6% [95% CI, 31.4%-31.9%]) vs minimal NP care (32.3% [95% CI, 32.1%-32.6%]), whereas adjusted hospice rates were higher for residents with extensive (55.6% [95% CI, 55.3%-55.9%]) vs minimal (53.6% [95% CI, 53.3%-53.8%]) NP care. However, there was significant variation by state scope of practice. For example, in full practice authority states, adjusted hospice rates were 2.88 percentage points higher (95% CI, 1.99-3.77; P < .001) for residents with extensive vs minimal NP care, but the difference between these same groups was 1.77 percentage points (95% CI, 1.32-2.23; P < .001) in restricted practice states. Hospitalization rates were 1.76 percentage points lower (95% CI, -2.52 to -1.00; P < .001) for decedents with extensive vs minimal NP care in full practice authority states, but the difference between these same groups in restricted practice states was only 0.43 percentage points (95% CI, -0.84 to -0.01; P < .04). Similar patterns were observed in analyses focused on DNR authority. Conclusions and Relevance: The findings of this cohort study suggest that NPs appear to be important care providers during the end-of-life period for many nursing home residents with ADRD and that regulations governing NP scope of practice may have implications for end-of-life hospitalizations and hospice use in this population.

Loneliness and social isolation among informal carers of individuals with dementia: A systematic review and meta-analysis.

OBJECTIVES: This systematic review and meta-analysis aimed to determine the prevalence of loneliness and social isolation among informal carers of individuals with dementia and to identify potential influencing factors. METHODS: We conducted a comprehensive search across 10 electronic databases, including PubMed, Cochrane, Embase, Web of Science, PsycINFO, CINAHL, Scopus, Chinese Biomedical, China National Knowledge Internet, and WANFANG. Our search strategy covered the inception of the databases up to September 16, 2023, with an updated search conducted on March 8, 2024. Prevalence estimates of loneliness and social isolation, presented with 95% confidence intervals, were synthesized through meta-analysis. Subgroup analyses and meta-regression were employed to explore potential moderating variables and heterogeneity. RESULTS: The study encompassed 27 research papers involving 11,134 informal carers from 17 different countries. The pooled prevalence of loneliness among informal carers of individuals with dementia was 50.8% (95% CI: 41.8%-59.8%), while the pooled prevalence of social isolation was 37.1% (95% CI: 26.7%-47.6%). Subgroup analyses and meta-regression indicated that various factors significantly influenced the prevalence of loneliness and social isolation. These factors included the caregiving setting, study design, the intensity of loneliness, geographical location (continent), data collection time, and the choice of assessment tools. CONCLUSIONS: This study underscores the substantial prevalence of loneliness and social isolation among informal carers of individuals with dementia. It suggests that policymakers and healthcare providers should prioritize the development of targeted interventions and support systems to alleviate loneliness and social isolation within this vulnerable population.

General practice nurse perceptions of barriers and facilitators to implementation of best-practice dementia care recommendations-a qualitative interview study.

INTRODUCTION: With an aging population and a growing prevalence of people living with dementia, the demand for best-practice dementia care in general practice increases. There is an opportunity to better utilise the nurse role within the primary care team to meet this increasing demand in the provision of care for people living with dementia. However, general practice nurses have limited knowledge in the provision of best-practice care for people living with dementia and their carer(s). A number of best-practice dementia care recommendations contained in the Australian Clinical Practice Guidelines and Principles of Care for People with Dementia have been identified as highly relevant to the role of the general practice nurse. AIMS: To explore general practice nurses' perspectives on published best-practice dementia care recommendations relevant to their role and identify barriers and facilitators to their implementation into clinical practice. METHODS: Thirteen Australian general practice nurses took part in this qualitative interview study. The research questions for this study were addressed within a paradigmatic framework of social constructionism. Data were transcribed verbatim and thematically analysed. RESULTS: There was a high level of agreement between general practice nurses that the recommendations were important, reflected best-practice dementia care and were relevant to their role. However the recommendations were perceived as limited in their usefulness to nurses' clinical practice due to being too vague and lacking direction. Four main themes were identified describing barriers and facilitators to operationalising best-practice dementia care.: creating a comfortable environment; changing approach to care; optimising the general practice nurse role and working collaboratively. Nine sub-themes were described: physical environment; social environment; complexity of care; care planning for the family; professional role and identity, funding better dementia care, education, networking and resources; different roles, one team; and interagency communication. CONCLUSION: This study identified several factors that need addressing to support general practice nurses to integrate best-practice dementia care recommendations into daily clinical practice. The development of interventions needs to include strategies to mitigate potential barriers and enhance facilitators that they perceive impact on their delivery of best-practice care for people living with dementia and their carer(s). The knowledge gained in this study could be used to develop multi-faceted interventions informed by theoretical implementation change models to enable the general practice nurse to operationalise best-practice dementia care recommendations.

Community support for families affected by dementia.

This paper provides and overview of the community support services that may be available for people with dementia and their family carers. The authors introduce dementia, including the impact of the diagnosis on both the person with dementia and the wider family. Using a case study approach, the authors describe the support available, spanning health and social care and third sector organisations. They discuss how this support can enable people with dementia and their carers to maintain wellbeing and cope with the impact of dementia. This article will be of interest to community nurses, and health and social care professionals more generally, who may encounter families affected by dementia in community settings. Having a good knowledge of the support available and how to access it will allow community nurses to capitalise on the health promotion opportunities presented to them, when they come into contact with families affected by dementia in the course of their day-to-day practice.

Effectiveness of a health education program for people with dementia and their family caregivers: An intervention by nurse practitioners.

PURPOSE: This study assesses the effectiveness of a health education program on caregiving outcomes for people with dementia and their families. METHODS: This quasi-experimental study involved 250 people with dementia and their family caregivers. Behavioral problems in people with dementia were assessed using the Chinese version of the Cohen-Mansfield Agitation Inventory-community form. Family caregiver outcomes were measured using the Agitation Management Self-Efficacy Scale, Caregiver Preparedness Scale, Competence Scale, and Community Resource Awareness and Utilization Assessment. RESULTS: Following the intervention, the experimental group demonstrated significant improvements in terms of self-efficacy, preparedness, competence, and awareness and utilization of community resources among family caregivers. Additionally, the experimental group exhibited lower levels of behavioral problems among people with dementia. CONCLUSIONS: This study helped improve caregiving outcomes for people with dementia and their family caregivers. Therefore, outpatient healthcare providers can utilize these findings to enhance care for this population.

Usability, Acceptability, and Preliminary Effectiveness of a Peer-Delivered and Technology-Supported Mental Health Intervention for Family Caregivers of People With Dementia: Field Usability Study.

BACKGROUND: Family caregivers of people with dementia are critical to the quality of life of care recipients and the sustainability of health care systems but face an increased risk of emotional distress and negative physical and mental health outcomes. OBJECTIVE: The purpose of this study was to examine the usability, acceptability, and preliminary effectiveness of a technology-based and caregiver-delivered peer support program, the Caregiver Remote Education and Support (CARES) smartphone or tablet app. METHODS: A total of 9 adult family caregivers of people with dementia received the CARES intervention, and 3 former family caregivers of people with dementia were trained to deliver it. Quantitative data were collected at baseline and at the end of the 2-week field usability study. Qualitative data were also collected at the end of the 2-week field usability study. RESULTS: The field usability study demonstrated that a 2-week peer-delivered and technology-supported mental health intervention designed to improve burden, stress, and strain levels was experienced by former and current family caregivers of people with dementia as acceptable. Current family caregivers rated CARES as above average in usability, whereas the caregiver peer supporters rated CARES as marginally usable. CARES was associated with non-statistically significant improvements in burden, stress, and strain levels. CONCLUSIONS: This field usability study demonstrated that it is possible to train former family caregivers of people with dementia to use technology to deliver a mental health intervention to current family caregivers of people with dementia. Future studies would benefit from a longer trial; a larger sample size; a randomized controlled design; and a control of covariables such as stages of dementia, years providing care, and severity of dementia symptoms.

Effects of a dementia educational programme using virtual reality on nurses in an acute care hospital: A pre-post comparative study.

BACKGROUND: Poor awareness of dementia care by healthcare professionals affects the quality of care for people living with dementia in acute care settings. OBJECTIVES: This study examined the effectiveness of a virtual reality-based educational programme for dementia for nurses working in acute care hospitals in Japan. METHODS: A dementia education programme for nurses was designed. The programme comprised short movies, virtual reality videos based on the short movies, a lecture, discussions and role-playing based on the experimental learning model. Virtual reality video content was created to promote empathy for people living with dementia through a first-person experience of dementia. The educational programme involved nurses working in an acute care hospital in the Tokyo Metropolitan area. Before and after the programme, we employed structured questionnaires using validated instruments to assess participants' attitudes towards people living with dementia, their intentions of helping behaviour and their confidence in providing dementia care. RESULTS: Seventy-six nurses participated in and completed the pre- and post-tests. The mean age was 34.9 ± 9.2 years, and 90.8% of the participants were female. A paired t-test showed significant before-after improvement in the participants' attitudes towards people living with dementia (41.9 ± 5.1 vs. 44.5 ± 4.8), intentions of helping behaviour towards people living with dementia (10.8 ± 2.5 vs. 12.8 ± 2.1) and confidence in providing dementia care (25.9 ± 6.7 vs. 29.2 ± 6.0). CONCLUSION: The programme effectively improved nurses' attitudes towards people living with dementia and confidence in providing dementia care in acute care settings. Future research is important to explore the long-term effects of this programme and its effects on actual dementia care. IMPLICATIONS FOR PRACTICE: The dementia education programme may promote person-centred care in acute hospitals. Future studies should consider the provision of more flexible programs so that nurses can more easily participate in them.

Profiles of Dementia Caregivers according to Psychosocial and Resource Variables. Importance of Kinship.

The present study aims to analyze the existence of different profiles in family caregivers of people with dementia according to psychosocial and resource variables. In addition, it aims to study whether there is a greater representation of each kinship group in each of the profiles and if there are differences in emotional distress among such profiles considering the kinship with the care-recipient. Participants were 288 family dementia caregivers, divided into four kinship groups (wives, husbands, sons and daughters). Psychosocial (familism, dysfunctional thoughts and experiential avoidance), resource (leisure activities and social support) and outcomes (depressive, anxious and guilt symptomatology) variables were collected. A hierarchical cluster analysis using Ward's method, an exploratory factor analysis of two fixed factors and contingency tables were performed. Five clusters were obtained: Low psychosocial vulnerability-High resources, Low psychosocial vulnerability-Low resources, Mixed, High psychosocial vulnerability-High resources, and High psychosocial vulnerability-Low resources. Results suggested that clusters associated with lower distress were the Low psychosocial vulnerability-High resources and the High psychosocial vulnerability-High resources. Clusters associated with higher distress were the Low psychosocial vulnerability-Low resources and Mixed. High levels of dysfunctional thoughts, familism and experiential avoidance do not always have a maladaptive function. This could depend on sociocultural and resource variables such as the kinship with the caregiver or perceived social support. The identification of profiles of family caregivers potentially needing protection and vulnerable to psychological distress could help to increase the effectiveness of interventions aimed at this population.

Peer Support for Caregivers of People Living with Posterior Cortical Atrophy in Melbourne, Australia: A Feasibility Study.

Posterior Cortical Atrophy (PCA) is a rare form of young-onset dementia that causes early visuospatial and visuoperceptual deficits. The symptom profile of Posterior Cortical Atrophy leads to very specific care needs for those affected, who often rely on informal caregivers (including friends and family). Rare dementia support groups can be useful for both patients and their caregivers to assist with knowledge sharing, psychoeducation, and the provision of psychosocial support. Despite this, few such support groups exist. The purpose of this study was to examine a PCA support group for caregivers of individuals living with PCA. We held a structured psychoeducation support group comprised of four sessions with the aim being to provide education, strategies for the management of the disease, and peer support. Caregivers' mental health and quality of life were assessed. The results of our study showed that support group participation was a positive experience and assisted with increasing the knowledge of caregivers and fostering social connections. We suggest that peer support groups may be beneficial for both people living with PCA and their caregivers. We recommend that future quantitative and qualitative research is conducted to further assess health-promotion benefits to people living with PCA and their caregivers, and to assess their development and implementation in different contexts.

The effect of combining an e-learning module with s Virtual Dementia Tour® on knowledge and attitudes toward person-centered dementia care in prelicensure nursing education.

BACKGROUND: Due to the global prevalence of dementia the U. S. Department of Health and Human Services' National Plan to Address Alzheimer's Disease recommended that healthcare professionals prepare to address the complex needs of people with dementia. To address this gap, nursing programs adopted experiential learning methods. While such methodologies are increasingly used, limited evidence exists to inform best teaching practices. PURPOSE: This study evaluated the combined effect of an e-learning module with a virtual simulation on nursing students' knowledge and attitudes of dementia. METHODS: The study followed quasi-experimental design with a cross-over and pretest/posttest design. A convenience sample of nursing students was recruited from three public universities in the Southeast United States. RESULTS: Significant improvements in attitudes toward people with dementia were found in students with previous dementia care experience or those employed to provide services to people with dementia. Experience was a stronger predictor of attitudes than education. However, the reliability of the Dementia Knowledge Assessment Scale was not sufficient in this study. SIGNIFICANCE: The findings may inform best practices in nursing education to prepare graduates to provide quality care for people with dementia.

Feasibility and Preliminary Impact of a Web-Based Mind Body Intervention for Older Dementia Caregivers.

BACKGROUND: Mind-body interventions focused on intentional breathing and movement have been found to mitigate the negative effects of caregiving such as such as stress, psychosocial distress, and emotional distress associated for persons living with Alzheimer's disease and related dementias. OBJECTIVE: The objective was to assess the feasibility and acceptability and preliminary impacts of our 12-week mind body intervention "Gentle Yoga and Yogic Breathing" for caregivers of persons living with dementia on health outcomes including mutuality, depression and anxiety, loneliness and social support, quality of life, and physical function. METHODS: We conducted a single-group cohort study in which 20 caregivers were enrolled. Data were collected at baseline and at the 12-week post-intervention endpoint. RESULTS: The intervention was acceptable; 75% (n = 15/20) completed the study; 16 completed post-study questionnaires. Very few experienced technical issues; 31% (n = 3) most commonly reported as poor internet connectivity, 75% (n = 12/16) perceived a health benefit, 88% (n = 14/16) perceived improved day-to-day mood, and 100% (n = 16/16) would recommend the intervention to other caregivers. Although there was minimal change from baseline to 12 weeks, for health outcomes, there were very small improvements noted in anxiety and overall health. There were no reported adverse events. CONCLUSION: The intervention was well received and is feasible and acceptable for future studies of stress and health management interventions for caregivers of persons living with dementia.Registered with https://www.ClinicalTrials.gov (NCT03853148).

Do clinical guidelines support person-centred care for women affected by dementia: A content analysis.

BACKGROUND: Dementia disproportionately affects women including persons living with dementia and caregivers. Person-centered care, rather than disease-focused, is recommended to improve care for affected persons including caregivers. General practitioners play a central role in dementia care but find it challenging due to inadequate training. The study aimed to assess if and how dementia guidelines provide clinicians with guidance on person-centred care for women affected by dementia. METHODS: We searched for publicly available English-language guidelines on the overall management of dementia in MEDLINE, EMBASE and the Guidelines International Network repository. We employed deductive and summative content analysis, and categorized person-centered care guideline content based on established frameworks, and conveyed our results using summary statistics, text, and tables. RESULTS: We reviewed 15 guidelines published from 2006 to 2020 in eight countries. Few (4, 23%) involved persons living with dementia or caregivers in guideline development. Regarding general person-centred care, guidelines mostly addressed the domains of exchange information (93%), share decisions (93%), enable self-management (93%) and address emotions (87%), while few offered content on manage uncertainty (33%) or foster a healing relationship (13%). Regarding dementia-specific person-centred care, most guidelines addressed intersectionality (tailoring care for diverse characteristics) (80%), but few included content on the domains of quality of life (67%), dignity (53%) or sex/gender issues (20%). Even when mentioned, the guidance was typically brief. We identified 32 general and 18 dementia-specific strategies to achieve person-centered care by compiling information from these guidelines. CONCLUSIONS: This study identified inconsistent and insufficient guideline content on person-centred care for women with dementia. Compiled strategies for achieving person-centred care could be used by developers to enhance existing and future dementia guidelines; and inform the development of policies or programs, education, tools for clinicians, and quality improvement measures for evaluating dementia care. Future research is crucial for promoting person-centred dementia care for women living with dementia.

El arte gráfico como medio de comunicación y cuidados en personas con demencia temprana y Alzhéimer / A arte gráfica como meio de comunicação e cuidado em pessoas com demência precoce e Alzheimer / Graphic art as a means of communication and care in people with early dementia and Alzheimer’s

El presente trabajo analiza la repercusión de la técnica de grabadono tóxica Collagraph, en personas con Demencia tempranatipo Alzhéimer, en el programa de educación artística “Retalesde una vida”. El objetivo es conectar a los participantes conprogramas de carácter cultural para fomentar la comunicacióne interacción entre participantes. La experiencia se llevó a caboen el Centro de Referencia Estatal para personas con Alzheimery otras Demencias de Salamanca (CREA). Una vez adaptadala metodología del taller a las características personales y desalud de las personas enfermas de Alzheimer, se considera lautilización del grabado genera importantes beneficios en losparticipantes, relacionados con el incremento de la inteligenciacristalizada, la conducta prosocial y la valoración positiva desí mismos, favoreciendo la inclusión social y familiar.Asimismo, el empleo del grabado puede ofrecer un soporte deayuda terapéutica individual y cooperativa a los participantes,desarrollar habilidades funcionales, sociales y cognitivas, ampliandosus recursos emocionales y disfrutar de la experiencia. A suvez fortalecen su autoestima y seguridad ante su capacidady valía. Por último, planteamos una serie de pautas para laplanificación e implementación de este proceso artístico paraque sirva de referente a profesionales de la salud.(AU)

The present work analyzes the repercussion of the non-toxic engraving technique Collagraph, in people with EarlyAlzheimer’s Dementia, in the artistic education program “Retalesde una vida”. The objective is to connect the participants withprograms of a cultural nature to encourage communication and interaction between participants. The experience wascarried out at the State Reference Center for people withAlzheimer’s and other Dementias of Salamanca (CREA). Oncethe methodology of the workshop has been adapted to thepersonal and health characteristics of people with Alzheimer'sdisease, it is considered that the use of engraving generatesimportant benefits in the participants, related to the increasein crystallized intelligence, prosocial behavior and positiveassessment. of themselves, favoring social and family inclusion.Likewise, the use of engraving can offer support for individualand cooperative therapeutic help to the participants, developfunctional, social and cognitive skills, expanding theiremotional resources and enjoying the experience. In turn,they strengthen their self-esteem and security in the faceof their ability and worth. Finally, we propose a series ofguidelines for the planning and implementation of this artisticprocess so that it serves as a reference for health professionals.(AU)

O presente trabalho analisa a repercussão da técnica degravura atóxica Collagraph, em pessoas com DemênciaInicial de Alzheimer, no programa de educação artística“Retales de una vida”. O objetivo é conectar os participantes aprogramas de cunho cultural para estimular a comunicação ea interação entre os participantes. A experiência foi realizadano Centro Estadual de Referência para Pessoas com Alzheimere outras Demências de Salamanca (CREA). Uma vez quea metodologia da oficina foi adaptada às característicaspessoais e de saúde das pessoas com doença de Alzheimer,considerase que o uso da gravura gera importantes benefíciosnos participantes, relacionados ao aumento da inteligênciacristalizada, comportamento prósocial e avaliação positivade si mesmos, favorecendo a inclusão social e familiar.Da mesma forma, o uso da gravura pode oferecer suporte paraajuda terapêutica individual e cooperativa aos participantes,desenvolver habilidades funcionais, sociais e cognitivas, ampliandoseus recursos emocionais e desfrutando da experiência. Porsua vez, fortalecem sua auto-estima e segurança diante de suacapacidade e valor. Por fim, propomos uma série de diretrizespara o planejamento e implementação desse processo artísticopara que sirva de referência para os profissionais de saúde.(AU)

Do people with dementia and carers get what they need? Barriers in social care and carers needs assessments.

BACKGROUND: People with dementia and unpaid carers need to go through a social care or carers needs assessment to access and receive subsidised or fully-funded social care. With no previous evidence, this qualitative study aimed to provide insights into the access to, experiences of receiving and conducting social care or carers needs assessments, and access to social care. METHODS: Unpaid carers of people with dementia and professionals conducting social care or carers needs assessment living or working in England were interviewed remotely about their experiences between April and August 2023. Topic guides were co-produced with two unpaid carers, and both were supported to code anonymised transcripts. Thematic analysis was used to analyse the data. FINDINGS: Twenty-seven unpaid carers (n = 21) and professionals (n = 6) participated. Four themes were generated: (1) Issues with accessing needs assessments, not the process; (2) Knowledge of needs assessments and the health and social care system; (3) Expectations of unpaid carers; and (4) Post-assessment unmet needs. The most prominent barriers unpaid carers and their relatives with dementia encountered were awareness of and access to needs assessment. Unpaid carers were mostly unaware of the existence and entitlement to a needs assessment, and sometimes realised they had participated in one without their knowledge. Professionals described the pressures on their time and the lack of financial resources within services. CONCLUSIONS: To facilitate improved access to dementia care and support for carers, the pathway to accessing needs assessments needs to be clearer, with better integration and communication between health and social care.

Family Caregivers' Management of Behavioral Expressions of Dementia.

BACKGROUND AND OBJECTIVES: Behavioral expressions of dementia are often stressful for family caregivers to manage as they strive to ensure their relative's needs are met. Guided by Lazarus and Folkman's Transactional Model of Stress and Coping, we identified specific behaviors that disrupt daily routines and challenge the achievement of caregiving goals, and the approaches and strategies caregivers employ to address them. RESEARCH DESIGN AND METHODS: We conducted semistructured interviews with 30 family caregivers in rural Appalachia caring for a relative living with dementia. Analysis involved use of open and focused coding processes to identify the ways caregivers managed behaviors and bar graphs to examine management approaches relative to categories of behaviors and caregiver demographic and emotional well-being variables. RESULTS: Analyses revealed 10 types of behavioral expressions of dementia associated with confusion, irritability, and resistance to engaging in necessary activities of daily living. Caregiver approaches to managing behaviors included gentle persuasion, being harsh by yelling or threatening, being persistent in expecting the person with dementia to complete the tasks at hand, disengaging by postponing the activity, and employing a combination of strategies. Approaches differed across types of behavior and caregiver demographics and had varying effects on caregiver well-being. DISCUSSION AND IMPLICATIONS: Uncovering specific behaviors family caregivers of persons living with dementia found bothersome, caregivers' adaptive strategies for managing behaviors, and the impact of those approaches provides new information to inform training on effective dementia caregiving practices and development of targeted intervention programs for dementia care.

Experiences of Indonesian people with dementia and carers undertaking an online-delivered exercise program.

Participating in physical activity is beneficial for older people with dementia. Little is known however about the perceptions of people living with dementia undertaking an online-delivered exercise program. This study aimed to explore the experiences and perceptions of older people with dementia and their carers in Indonesia participating in an online-delivered exercise program, and factors that may influence acceptability to the program. An exploratory qualitative study design using semi-structured interviews was used. Data were recorded, transcribed verbatim, translated into English, and analyzed thematically. Twelve participants with dementia (mean age = 63.3 years) and 30 carers (26 family carers and 4 paid carers) (mean age = 37.9 years) were interviewed separately. Seven themes were identified: (i) Motivating factors to participate; (ii) Benefits for people with dementia; (iii) Impacts on carers; (iv) Challenges and enablers to exercising; (v) Carers' strategies for exercise engagement; (vi) Roles, relationships and supports; and (vii) Participants' receptiveness to online delivery of the exercise program. This study illustrated that an online-delivered exercise program was acceptable for people with dementia and their carers in Indonesia and reinforced the importance of carers' support for the exercise program. These findings can help physiotherapists and other exercise practitioners in considering the aspects of delivery that people with dementia and their carers value in participating in online-delivered exercise programs.