Adaptation of an eHealth Intervention: iSupport for Carers of People with Rare Dementias.

'iSupport' is an online psychoeducation and skills development intervention created by the World Health Organisation to support people with dementia. This project adapted iSupport for carers of people with rare dementias (iSupport RDC), creating a new resource to support the health and wellbeing of this underserved population. The adaptation involved three phases: (1) Co-design methods to generate preliminary adaptations; (2) Analysis of phase one findings informing adaptations to iSupport to develop; iSupport RDC; (3) Post-adaptation survey to ascertain participant agreement with the adaptations in iSupport RDC. Fourteen participants contributed, resulting in 212 suggested adaptations, of which 94 (92%) were considered practical, generalisable, and aligned with iSupport principles. These adaptations encompassed content and design changes, including addressing the challenges of rare dementias (PCA, PPA, LBD, and FTD). iSupport RDC represents a significant adaptation of the WHO iSupport intervention. Its tailored nature acknowledges the unique needs of people caring for someone with a rare dementia, improving their access to specialised resources and support. By extending iSupport to this population, it contributes to advancing dementia care inclusivity and broadening the understanding of rare dementias. A feasibility study is underway to assess iSupport RDCs acceptability, with prospects for cultural adaptations to benefit carers globally.

eHealth and Web-Based Interventions for Informal Carers of People With Dementia in the Community: Umbrella Review.

BACKGROUND: The prevalence of dementia is increasing, and there are many associated problems that family members face as informal carers, including emotional, physical, and financial difficulties. There are benefits for a person with dementia to live at home for as long as possible, and therefore, supporting their informal carers is crucial. The growing interest in supporting carers through internet-based interventions is evidenced by the volume of systematic reviews on this topic. It is now appropriate to systematically examine this body of work and provide an overview of the literature. OBJECTIVE: This umbrella review aimed to identify the most effective internet-based intervention content and delivery method to support those caring for someone with dementia living in the community. METHODS: PsycINFO, Web of Science, CINAHL, MEDLINE, Cochrane Library, and PubMed were searched for systematic reviews examining the effectiveness of web-based interventions for informal carers of people with dementia. A total of 3 reviewers extracted data and evaluated the quality of the papers. To ascertain the extent to which the systematic reviews reported on the same evidence, the proportion of overlap between their included studies was calculated. Qualitative research findings were extracted and reported. RESULTS: A total of 21 papers were included in the study. The quality of the review papers was mainly rated as low to moderate, and 10% (2/21) of papers were of high quality. The findings suggest that multicomponent interventions were the most effective in supporting carers. These included combinations of cognitive behavioral therapy and relaxation strategies, educational resources, and online support groups. Interventions that were delivered on the web but included sessions with a personal element, such as telephone contact, showed the best results. When comparing the studies reviewed in all the review papers, a moderate overlap was noted. However, when comparing individual reviews with each other, they showed a high overlap of the included studies. CONCLUSIONS: Mixed delivery methods and intervention content showed the most effective results in supporting those caring for people with dementia. However, many papers do not separate the results for differing intervention contents or delivery; this needs to be considered when drawing conclusions. There was an overlap among the studies included in the reviews. This suggests a lack of current research on the effectiveness of web-based interventions for people caring for a person with dementia. There was also a lack of consistency in the outcome measures across all papers. Future studies can involve updating research on the effectiveness of these interventions while distinguishing between different intervention types, thus creating guidelines for the use of standardized measures to enable comparisons of intervention effects and improve the scientific quality of the overall research. TRIAL REGISTRATION: PROSPERO CRD42021241559; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=241559.

The Effectiveness of Mindfulness-Based Stress Reduction on the Psychological Functioning of Healthcare Professionals: a Systematic Review.

OBJECTIVES: Burnout and occupational stress are frequently experienced by healthcare professionals (HCPs). Mindfulness-based stress reduction (MBSR) has been found to improve the psychological health outcomes of HCPs. To date, systematic reviews and meta-analyses have primarily focused upon empirical investigations into the reduction of stress amongst HCPs using MBSR and are limited to empirical studies published before December 2019. This systematic review aimed to update the current evidence base and broaden our understanding of the effectiveness of MBSR on improving the psychological functioning of HCPs. METHODS: Three electronic databases (Medline, Psych Info and Web of Science) were searched without time frame restrictions. Quantitative studies included randomised controlled trials, clinical controlled trials, pre-post designs and studies with up to a 12-month follow-up period. All studies included in the review employed a MBSR programme, standardised measures of psychological functioning and qualified HCPs as participants. RESULTS: Using PRISMA guidelines thirty studies were included in the review. The reviewed literature suggested that MBSR was effective in reducing HCPs experiences of anxiety, depression and stress. MBSR was also found to be effective in increasing HCP levels of mindfulness and self-compassion. However, MBSR did not appear as effective in reducing burnout or improving resilience amongst HCPs. Abbreviated MBSR programmes were found to be as effective as the traditional 8-week MBSR programmes. CONCLUSIONS: MBSR is an effective intervention which can help improve the psychological functioning of HCPs. Recommendations include improving the overall quality of the studies by employing more robust controlled designs with randomisation, increased sample sizes with heterogeneous samples, and making active comparisons between interventions used.

An Assessment Method for Identifying Acceptable and Effective Ways to Present Demands to an Adult With Dementia.

Simple instructions are often recommended for presenting demands to people with dementia; however, simple instructions may be perceived as authoritative and may not be appropriate for all individuals. We conducted a demand assessment with a woman with dementia who engaged in problem behaviors in response to direct instructions. We measured latency to compliance and verbal behavior when demands were presented as questions, rules, simple instructions, or demands embedded in social chatter. In contrast to the other conditions, simple instructions resulted in the most undesirable behavior and were least likely to evoke compliance. We conducted an intervention in which demands were phrased as requests for assistance.

An unavoidable bump: A meta-synthesis of psychotherapists' experiences of navigating therapy while pregnant.

Despite psychotherapists' pregnancy being a common occurrence with recognised impacts for both clients and clinicians, there remains a dearth of empirical qualitative investigations into the lived experiences of these health professionals. This meta-synthesis therefore aims to generate novel insights and understandings of the experiences of 157 pregnant therapists by integrating the research findings of thirteen qualitative studies exploring the experiences of pregnant and newly post-partum psychotherapists. Utilising Noblit and Hare's (1988) meta-ethnographic approach, papers were analysed with a view to capturing shared experiences across studies, alongside points of divergence. Analysis led to the development of four key concepts: Identity Changes, Pregnancy necessitates Disclosure, Therapeutic Challenges and Guilt. Pregnancy was related to a multitude of personal and professional challenges, with the impact being most pronounced in the accounts of primiparous, child and trainee therapists. Key clinical implications include the need for continued exploration of the therapeutic impact of pregnancy in both supervision and therapy, revisions to supervisory working practices, prompt disclosure of therapist pregnancy and subsequent reductions to therapeutic fidelity. Future research directions are discussed within.

Lounge Layout to Facilitate Communication and Engagement in People with Dementia.

The design of care settings for people with dementia is often guided by expert opinion rather than empirical data. We evaluated the effect of arranging lounge furniture in different configurations on communication, engagement with activities, and indices of happiness in people with dementia. We found that the common configuration of chairs placed around the outside of the room resulted in the least of all 3 behaviors. Communication occurred most when the furniture was arranged in groups, and engagement occurred most when the furniture layout maximized the salience of available activities.

Knowingly not wanting to know: Discourses of people diagnosed with mild cognitive impairment.

Mild cognitive impairment is a heterogeneous clinical state whereby assessed cognitive changes over time may progress to dementia, remain stable or revert to back to normal. This study aimed to identify, through discourse analysis, how people with a diagnosis of mild cognitive impairment used language in order to reveal the societal views and shared meanings of the diagnosis, and the positions taken by people. Seven people with mild cognitive impairment were interviewed, and three discourses emerged during analysis. One of the discourses revealed was 'Not Knowing' about mild cognitive impairment. Furthermore, in the absence of a coherent discourse related to mild cognitive impairment, participants went on to position themselves between two more familiar discourse; 'Knowing' about ageing and dying and 'Not Wanting to Know' about dementia. Clinicians must consider how information is presented to people about mild cognitive impairment, including where mild cognitive impairment is positioned in respect to normal ageing and dementia.

Language changes in bilingual individuals with Alzheimer's disease.

BACKGROUND: Alzheimer's disease (AD) in those who are bilingual is becoming increasingly prevalent in modern society, yet little is known about the impact of AD on the bilingual's two languages. AIMS: To gather information from the available literature on AD and bilingual individuals. METHODS & PROCEDURES: The first author searched three electronic databases for relevant articles and retrieved 186 articles. Nine articles met the inclusion criteria and were selected for this review. Various research methods employed in assessing language changes in bilingual individuals with AD were captured. MAIN CONTRIBUTION: Preliminary findings suggest that both controls and bilingual individuals with Alzheimer's disease (BIAD) were more able on language-related tasks in their dominant language compared with their non-dominant language. The current literature would suggest that both languages in bilingual individuals are equally affected by AD; however, there is room to explore preliminary data on the fact that the non-dominant language, and indeed the dominant language, is more sensitive to AD. CONCLUSIONS & IMPLICATIONS: More robust, clinically relevant research designs that test current theoretical frameworks are needed to inform the development of appropriate assessments, diagnosis and person-centred care for bilingual individuals with AD.

Older People's Discourses About Euthanasia and Assisted Suicide: A Foucauldian Exploration.

PURPOSE OF THE STUDY: This study aims to contribute an alternative understanding of the position of older people in the euthanasia and assisted suicide (EU/AS) debate. DESIGN AND METHODS: Seven interviews were analyzed using Foucauldian discourse analysis, to explore concepts like knowledge, power, subjectification and surveillance. RESULTS: The participants presented a "confused and conflicted" discourse, expressing the view that EU/AS is a family affair, whilst also articulating a strong sense of self-determination. Although a discourse of the medicalization of dying through medical control and surveillance was endorsed, an alternative discourse of "dying outside the medical gaze" emerged. Participants, who were in favor of EU/AS, felt "voiceless," as apparent double standards were applied in the debate, and powerful others, for example, physicians and politicians, seemed reluctant to engage. Within an "aged death" discourse, the anticipated dependency on poor care from (professional) others, made participants consider EU/AS as ways of avoiding this stage of life and the associated loss of dignity. IMPLICATIONS: By using Foucauldian discourse analysis, alternative power relationships were revealed which might give a different interpretation to the concept of the "slippery slope." Societal discourses and related behaviors, which devalue the dependent and old, might become internalized by older people, leading them to consider EU/AS as preferable end-of-life options.