A model for identifying potentially inappropriate medication used in older people with dementia: a machine learning study.

BACKGROUND: Older adults with dementia often face the risk of potentially inappropriate medication (PIM) use. The quality of PIM evaluation is hindered by researchers' unfamiliarity with evaluation criteria for inappropriate drug use. While traditional machine learning algorithms can enhance evaluation quality, they struggle with the multilabel nature of prescription data. AIM: This study aimed to combine six machine learning algorithms and three multilabel classification models to identify correlations in prescription information and develop an optimal model to identify PIMs in older adults with dementia. METHOD: This study was conducted from January 1, 2020, to December 31, 2020. We used cluster sampling to obtain prescription data from patients 65 years and older with dementia. We assessed PIMs using the 2019 Beers criteria, the most authoritative and widely recognized standard for PIM detection. Our modeling process used three problem transformation methods (binary relevance, label powerset, and classifier chain) and six classification algorithms. RESULTS: We identified 18,338 older dementia patients and 36 PIMs types. The classifier chain + categorical boosting (CatBoost) model demonstrated superior performance, with the highest accuracy (97.93%), precision (95.39%), recall (94.07%), F1 score (95.69%), and subset accuracy values (97.41%), along with the lowest Hamming loss value (0.0011) and an acceptable duration of the operation (371s). CONCLUSION: This research introduces a pioneering CC + CatBoost warning model for PIMs in older dementia patients, utilizing machine-learning techniques. This model enables a quick and precise identification of PIMs, simplifying the manual evaluation process.

The Psychological Symptoms and Their Relationship to the Quality of Life Among Dementia Patients Caregivers.

The study aims to identify psychological symptoms (depression and anxiety) and their relationship to the quality of life among dementia patients' caregivers, and whether there are differences in the level of each of them due to the gender variable. The study follows the correlational approach, with a sample of 174 dementia patients' caregivers. To pursue the analysis, the study uses 3 measurement tools: anxiety, depression, and quality of life. The results show that the level of depression, anxiety, and quality of life among dementia patients' caregivers is moderate. It also finds that there is a positive relationship between anxiety and depression, and there is a negative relationship between quality of life and anxiety and depression. There are no differences in the level of depression and anxiety due to gender, as the study finds female caregivers to have a higher level of quality of life.

[Examination of Factors Related to Quality Evaluation of Dementia Nursing Care in Acute Hospitals].

The purpose of this study is to clarify factors related to the quality evaluation of dementia nursing care in acute hospitals. We conducted a survey that consisted of individual attributes, organizational attributes, knowledge about dementia, ethical behavior scales, and quality evaluation of dementia nursing. The number of valid responses was 835. The dependent variable was the quality assessment of dementia nursing, and the independent variable was the variables in which there were significant differences in the quality evaluation of dementia nursing care and the univariate analysis of each variable. Multiple regression analysis results showed that the factors related to the quality assessment of dementia nursing were "risk aversion" and "good care" of ethical behavior. The ethical behavior of "risk aversion" meant to sense the distress felt by dementia patients and to avoid pain and danger in the hospitalization environment. It was suggested that enhancing the ethical behavior of "good care", which means always thinking and acting for the best while searching for the will of dementia patients, may lead to quality evaluation of dementia nursing.

Extracting the latent needs of dementia patients and caregivers from transcribed interviews in japanese: an initial assessment of the availability of morpheme selection as input data with Z-scores in machine learning.

BACKGROUND: Given the increasing number of dementia patients worldwide, a new method was developed for machine learning models to identify the 'latent needs' of patients and caregivers to facilitate patient/public involvement in societal decision making. METHODS: Japanese transcribed interviews with 53 dementia patients and caregivers were used. A new morpheme selection method using Z-scores was developed to identify trends in describing the latent needs. F-measures with and without the new method were compared using three machine learning models. RESULTS: The F-measures with the new method were higher for the support vector machine (SVM) (F-measure of 0.81 with the new method and F-measure of 0.79 without the new method for patients) and Naive Bayes (F-measure of 0.69 with the new method and F-measure of 0.67 without the new method for caregivers and F-measure of 0.75 with the new method and F-measure of 0.73 without the new method for patients). CONCLUSION: A new scheme based on Z-score adaptation for machine learning models was developed to predict the latent needs of dementia patients and their caregivers by extracting data from interviews in Japanese. However, this study alone cannot be used to assign significance to the adaptation of the new method because of no enough size of sample dataset. Such pre-selection with Z-score adaptation from text data in machine learning models should be considered with more modified suitable methods in the near future.

A Five-Year Clinical Course of Potential Phenocopy Syndrome of Behavioral Variant Frontotemporal Dementia: A Case Report and Literature Review.

Frontotemporal dementia is a neurocognitive disorder that affects language, behavior, or executive functioning. This disease includes a spectrum of presentations that includes multiple variants. The phenocopy syndrome of the behavioral variant of frontotemporal dementia mimics the behavioral variant of frontotemporal dementia. Patients with this condition show a decline in personality, social conduct, and cognitive ability but often display no signs of neurological imaging and exhibit slow progression. This case focuses on a now 70-year-old male who has shown signs of behavioral changes with a slowly progressive clinical course and minimal findings on positron emission tomography (PET) scan, but moderate changes seen on MRI. This report details a clinical presentation of an individual potentially with phenocopy syndrome of behavioral variant frontotemporal dementia and provides context to how symptoms can be managed to better help assist patients and their caregivers.

Differences in Neurotransmitters Level as Biomarker on Sleep Effects in Dementia Patients with Insomnia after Essential Oils Treatment.

This study aimed to examine the effects of several essential oils on insomnia in dementia patients following transdermal treatment (aromatherapy). The mean change rates (%) of sleep biomarkers were compared between the single essential and jojoba (vehicle) oil massage groups in this study. The lavender (L) essential oil massage group demonstrated a significant decrease in the mean change rate (%) of 24-h urinary free cortisol, whereas the valerian (V) essential oil massage group demonstrated a significant increase in the mean change rate (%) of serum 5-hydroxytryptamine. In addition, a significant increase in the mean change rate (%) of 24-h urinary norepinephrine was observed in the chamomile (C) essential oil massage group only. Based on these results, valerian, lavender, and chamomile oils were mixed in different ratios to produce blending oils A (L:C:V=2:2:1), B (L:C:V=3:1:1) and C (L:C:V=1:3:1). The highest level of serum 5-hydroxytryptamine was observed after administering blending oil A. These results suggest that blending oil A might possess therapeutic effects against insomnia. Overall, it is hypothesized that the optimally blended essential oil will produce synergic effects when combined with hypnotic drugs.

A Critical Study on the Impact of Dementia on Older People Undergoing Treatment in Care Homes.

Maximum healthcare needs for older people are complex due to diseases, comorbidities, or disabilities, including long-term or mental and physical health issues. Various residential and nursing care homes help care for older people, especially those with special medical needs. Among these special medical needs, dementia is one medical condition requiring exceptional care for the affected to prevent adverse effects of the situation they usually encounter. Dementia is a health condition that involves impairments to memory and thinking due to any injury or disease-causing damage to the brain. Older people suffer from different diseases, which cause cognitive disability and long-term ailments and directly affect patients' quality of life. Given the cognitive impairment dementia causes to older people, it is difficult for the care providers to accurately assess the impact on every individual to formulate a person-centered care plan. During the COVID-19 pandemic, due to administrative restrictions on social distancing to prevent transmission of this disease, caregivers and elderly persons feel tremendous mental stress, further aggravating their problems because of loneliness. Thus, there is a requirement to do the study and analyze the effects on older people to provide quality and person-centered care. Due to the above factors as significant challenges in the current context, there is an ardent need for the results of variegated studies besides a thorough analysis of available literature analyzed to provide proper evidence to the care providers. It will pave the way for understanding the actual impact of the condition in its natural context. In this regard, a literature review and the results of the studies are discussed. This research brings into the limelight all those factors in the context of previous studies and data analysis of the current situation.

Readiness for the aging population in private dental practices.

Background: As more adults reach advanced age with natural teeth, there is an increasing need for dental and dental hygiene practices to provide care for older adults and individuals living with dementia. Little is known about how well these populations are accommodated in private practice. Methods: Following approval from the Research Ethics Board at Mount Allison University, a survey was sent to the 517 practising dental hygienists in New Brunswick, Canada. They were asked to rate on 5-point scales their geriatric oral care knowledge, their willingness to receive more education on the topic, and how frequently they adjusted their care provision to meet the needs of older (age 70+) clients and those living with dementia. Results: A total of 121 dental hygienists responded (23.4% response rate). Overall, respondents were willing to learn more about geriatric care, but lacked knowledge about the oral health effects of certain medications frequently used by older adults, and about techniques for accessing the oral cavity of clients with dementia. Many accommodations recommended by geriatric specialists were not consistently carried out. Discussion: Given that older adults and adults with dementia make up an increasingly large part of the population in need of oral care, geriatric and dementia oral care needs should be emphasized in dental and dental hygiene practices and continuing education for dental hygienists. Conclusion: More research is required on the impact of integrating accommodations for older clients and clients with dementia into clinical practice, as well as how oral care is experienced by these populations.

Contexte: Un plus grand nombre d'adultes ont toujours leurs dents naturelles lorsqu'ils atteignent un âge avancé. Il est donc de plus en plus nécessaire que les cabinets dentaires et d'hygiène dentaire fournissent des soins aux personnes plus âgées et aux personnes atteintes de démence. On ignore dans quelle mesure ces populations sont accueillies dans les cabinets privés. Méthodologie: À la suite de l'approbation du comité d'éthique de la recherche de l'Université Mount Allison, un sondage a été envoyé aux 517 hygiénistes dentaires en exercice au Nouveau-Brunswick, Canada. Ils ont été invités à évaluer, sur une échelle de 5 points, leurs connaissances en matière de soins buccodentaires gériatriques, leur intérêt à recevoir davantage de formation sur le sujet et la fréquence à laquelle ils ont adapté leur prestation de soins pour répondre aux besoins des clients plus âgés (70 ans et plus) et des personnes atteintes de démence. Résultats: En tout, 121 hygiénistes dentaires ont répondu au sondage (un taux de réponse de 23,4 %). Dans l'ensemble, les répondants voulaient en savoir davantage sur les soins gériatriques, mais ne connaissaient pas les effets sur la santé buccodentaire de certains médicaments fréquemment utilisés par les personnes âgées ni les techniques utilisées pour accéder à la cavité buccale des clients atteints de démence. De nombreux accommodements recommandés par les spécialistes en gériatrie n'ont pas été systématiquement mis en œuvre. Discussion: Les cabinets dentaires et d'hygiène dentaire et la formation continue des hygiénistes dentaires doivent souligner les besoins des adultes plus âgés et des adultes atteints de démence puisque ceux-ci représentent une part de plus en plus importante de la population nécessitant des soins buccodentaires. Conclusion: Des recherches supplémentaires sont nécessaires sur les conséquences de l'intégration des accommodements pour les clients plus âgés et les clients atteints de démence dans la pratique clinique, ainsi que sur la façon dont ces populations perçoivent les soins buccodentaires.

[The psychological process and its longitudinal of family caregivers involved in associations for families of dementia patients].

AIM: This study aimed to explore the psychological and dynamic process of modification and evaluate its time-series peculiarity in family caregivers involved in associations for the families of dementia patients. METHODS: The current study included 39 family caregivers involved in two associations for the families of dementia patients. Five-year free group conversations in the family caregivers were recorded and converted into a verbatim record. The KJ method was then used to encode and group the verbatim record. After analyzing grouped terms and structuring the psychological and dynamic process of modification, time periods of the psychological status were determined based on the psychological process and the time-oriented perspective. The verbatim record extracted by the KJ method was analyzed by text-mining and a cluster analysis in order to assess validity of the psychological process and its time division. In addition, the appearance ratio of the texts extracted in each time period were analyzed to determine the longitudinal peculiarity in the psychological and dynamic process. RESULTS: The psychological process of family caregivers was classified broadly into four components: (1) recognizing and identifying problems, (2) seeking help and dealing with problems, (3) remedying and evaluating problems, and (4) feeling effective and empowering oneself to overcome problems. The validity of the psychological process and its time division was supported by text-mining and a cluster analysis. The appearance ratio of the texts extracted in each time period was quasi-periodic and recursive rather than transient. CONCLUSIONS: The psychological and dynamic process elucidated in the current study consists of four major components participants experience when involved in associations for the families of dementia patients. Although this process may not have originated in associations for the families of dementia patients, a quasi-periodic and recursive tendency in the appearance ratio of extracted texts is a notable feature. In dementia care, it is vital to foresee emerging challenges on a constant basis and attempt precedent, forecasting-type care. Being involved in associations for the families of dementia patients facilitates the administration of forecasting-type care.

Caring for older people with dementia in the emergency department.

BACKGROUND: Admission to an emergency department (ED) may expose the older person with dementia to a range of negative consequences, including a deterioration in their behavioural symptoms. The authors conducted a review of primary research relating to the experiences of older people with dementia, their carers and ED nurses, to understand how these experiences might inform nursing practice. METHODS: Integrative review with a search of the electronic databases of Medline, CINAHL and PSYCHINFO using specified inclusion and exclusion criteria. RESULTS: Three themes were identified: carers and older people with dementia-waiting and worrying; nurses juggling priorities; and strategies for improvement-taking a partnership approach. CONCLUSION: Older people with dementia may be exposed to disparities in treatment in the ED. A practice partnership between carers and ED nurses may help to prevent this. ED nurses need support to blend technical- and relationship-centred care. Participatory research exploring the experiences of older people with dementia, their carers and ED nurses is needed.

The role of caregiver burden in the familial functioning, social support, and quality of family life of family caregivers of elders with dementia.

Objective: The present study aimed to examine the role that caregiver burden plays in the familial functioning, social support, and quality of family life (QOFL) of caregivers of elderly family members with dementia. Methods: A survey was conducted with 200 primary caregivers of elderly dementia patients who resided in prefecture "S". The questionnaire consisted of items that required demographic information, the Japanese versions of the Zarit Burden Inventory (ZBI) and the Family Adaptability and Cohesion Evaluation Scales (FACES II), and scales that measure quality of family life and social support. On the basis of the median ZBI score (i.e., 30.8), participants were divided into two groups: group A (i.e., ZBI score < 30) and group B (i.e., ZBI score > 30). Stepwise multiple regression analysis was conducted with QOFL as the dependent variable. Version 24 of the Statistical Package for the Social Sciences for Windows was used to conduct all the statistical analyses; the statistical significance level was specified as 0.05. Results: Group A and B obtained average ZBI scores of 18.5 and 43.8, respectively. The study targeted 81 patients from group A (average age = 61.0 years) and 77 patients from group B (average age = 61.7 years). Time that was spent on caregiving tasks was significantly higher for group B, when compared to group A. In addition, significant differences in cohesion and adaptability, which are two dimensions that are measured by the FACES II, and QOFL emerged between the two groups. The results of the multiple regression analysis showed that cohesion (ß = 0.38), practical support (ß = 0.32), adaptability (ß = 0.30), and living arrangement (ß = -0.12) significantly predicted QOFL. Conclusion: Family cohesion and adaptability are indicators of healthy familial functioning. In order to improve the QOFL of caregivers of elderly dementia patients, it is necessary to strengthen emotional ties, maintain emotional attachment, and flexibly respond to the burden of nursing care and changes in power structures and role relationships.

Impact of Caregiving for Dementia Patients on Healthcare Utilization of Caregivers.

The elderly, whom are vulnerable to the physical, mental and chronic diseases of aging, are the fastest growing segment of the US population. Dementia is of particular concern in this population, and caregivers of people with dementia are subjected to psychological, physical, emotional and functional stress. The purpose of this study was to investigate the impact of caregiving for dementia patients on health care services utilization of caregivers and to examine if caregivers utilize more healthcare services than the control group. The study recruited a total of 143 people in control and non-control groups through non-probability convenience sampling. The control group (non-caregivers) comprised of 71 people, whereas the experimental group (caregivers) consisted of 72 participants. The focus of the study was the health care utilization questionnaire, asking the caregiver about the frequency of specific health care services utilization-including medication use in the last six months, on the scale from 0 to 10. Results were statistically significant for each of the healthcare service utilization when comparing caregivers to the control group. By providing adequate support and assistance in form of support groups, we can alleviate caregivers' burden and more effectively address the needs of caregivers-thereby reducing the utilization of healthcare services.

[The future development of dementia diseases in Germany-a comparison of different forecast models]. / Die zukünftige Entwicklung von Demenzerkrankungen in Deutschland ­ ein Vergleich unterschiedlicher Prognosemodelle.

Dementia is one of the most frequent diseases of people aged 65 and older. As a result of the upcoming demographic transition, a significant increase is expected to the current number of around 1.7 million dementia patients. A precise estimate of this increase is especially important for decision-makers and payers to the health-care system. This study examined the effects of different assumptions on the future frequency of disease using a time-discrete Markov model with population-related and disease-specific components. Based on health insurers' administrative data from AOK Baden-Württemberg, we determined age- and gender-specific prevalence rates, incidence rates, and mortality differences of dementia patients and combined them with demographic components from German population statistics. As a result, our Markov model showed a 20 to 25% higher number of dementia patients in 2030, compared to the results of the status quo projection applied in most previous studies, with the assumption of constant prevalence rates over time. Hence, our results indicate that even in the medium term payers will have to face significant increases in dementia-related health expenditures. By 2060, the number of dementia patients in Germany would rise to 3.3 million assuming a further increase to life expectancy and constant incidence rates over time. The assumption of a compression of the morbidity would reduce this number to 2.6 million.

The role of caregiver burden in the familial functioning, social support, and quality of family life of family caregivers of elders with dementia / Journal of Rural Medicine

Objective: The present study aimed to examine the role that caregiver burden plays in the familial functioning, social support, and quality of family life (QOFL) of caregivers of elderly family members with dementia. Methods: A survey was conducted with 200 primary caregivers of elderly dementia patients who resided in prefecture “S”. The questionnaire consisted of items that required demographic information, the Japanese versions of the Zarit Burden Inventory (ZBI) and the Family Adaptability and Cohesion Evaluation Scales (FACES II), and scales that measure quality of family life and social support. On the basis of the median ZBI score (i.e., 30.8), participants were divided into two groups: group A (i.e., ZBI score < 30) and group B (i.e., ZBI score > 30). Stepwise multiple regression analysis was conducted with QOFL as the dependent variable. Version 24 of the Statistical Package for the Social Sciences for Windows was used to conduct all the statistical analyses; the statistical significance level was specified as 0.05. Results: Group A and B obtained average ZBI scores of 18.5 and 43.8, respectively. The study targeted 81 patients from group A (average age = 61.0 years) and 77 patients from group B (average age = 61.7 years). Time that was spent on caregiving tasks was significantly higher for group B, when compared to group A. In addition, significant differences in cohesion and adaptability, which are two dimensions that are measured by the FACES II, and QOFL emerged between the two groups. The results of the multiple regression analysis showed that cohesion (β = 0.38), practical support (β = 0.32), adaptability (β = 0.30), and living arrangement (β = −0.12) significantly predicted QOFL. Conclusion: Family cohesion and adaptability are indicators of healthy familial functioning. In order to improve the QOFL of caregivers of elderly dementia patients, it is necessary to strengthen emotional ties, maintain emotional attachment, and flexibly respond to the burden of nursing care and changes in power structures and role relationships.

New Proposal of Private Insurance Program for Dementia Patients: Design of Sustainable Private Insurance Program in Korea.

The purpose of this study is to examine interventions and supporting systems by dementia stage, take a look at dementia insurance policies in Korea and the United States, and present Korean private insurance programs for dementia patients. According to the study, our suggestions of a design of private insurance products for Korean dementia patients are as follows. First, the products should support people aged 80 and older. Second, new products should include the mild stage dementia in the insurance coverage. Third, non-pharmacological treatments, such as the cognitive stimulation, the cognitive training, and exercises need to be covered through the new private insurance. Fourth, the private insurance should be contained home health care services in its coverage. These suggestions can reduce the dependence of the public insurance, help people choose appropriate treatments for themselves, and give people a good opportunity to improve the effect of dementia treatment and to increase the satisfaction of patients and their families.

New Proposal of Private Insurance Program for Dementia Patients: Design of Sustainable Private Insurance Program in Korea

The purpose of this study is to examine interventions and supporting systems by dementia stage, take a look at dementia insurance policies in Korea and the United States, and present Korean private insurance programs for dementia patients. According to the study, our suggestions of a design of private insurance products for Korean dementia patients are as follows. First, the products should support people aged 80 and older. Second, new products should include the mild stage dementia in the insurance coverage. Third, non-pharmacological treatments, such as the cognitive stimulation, the cognitive training, and exercises need to be covered through the new private insurance. Fourth, the private insurance should be contained home health care services in its coverage. These suggestions can reduce the dependence of the public insurance, help people choose appropriate treatments for themselves, and give people a good opportunity to improve the effect of dementia treatment and to increase the satisfaction of patients and their families.

Empathy dolls: are they a source of cross-contamination between patients?

Following a cluster of two patients with identical strains of Clostridium perfringens prosthetic joint infections on an ortho-geriatric ward in a teaching hospital in England, investigations were conducted into infection control practices. It emerged that empathy dolls were being used to help alleviate agitation in dementia patients; this had been introduced without consultation with the infection prevention and control team. Environmental testing of the doll pre and post laundry at different temperatures helped to establish the types and numbers of organisms present. This testing enabled our unit to provide guidance on the optimum strategy for decontamination and safe use of these dolls.

Mini-Emotional State Examination for dementia patients.

AIM: Emotional functions, as well as cognitive functions, are critical factors to assess in the care and management for dementia patients. In addition to the Mini-Mental State Examination (MMSE), we have developed a Mini-Emotional State Examination (MESE) for the examination of emotional functions in patients with dementia. METHODS: MESE consists of a two-part questionnaire. The first probes emotional functions within the five senses (visual, auditory, tactile, smell and taste). The second explores more complex and comprehensive emotional functions including feelings of tenderness, violence, happiness and sadness, as well as emotional responses to more general human, moral and social phenomena. The questionnaire comprises 30 questions and is scaled to a 30-point healthy maximum. A total of 40 dementia patients in Sendai Tomizawa Hospital were tested with MESE. RESULTS: MESE point scores were roughly parallel to the scores on the MMSE, but MESE scores were widely distributed, independent of MMSE score. MESE scores in nine patients exceeded 23 points. CONCLUSION: The difference in distribution of MMSE and MESE scores show that cognitive and emotional functions are independently affected in dementia, and therefore assessment of both these functions should be cared taken into consideration in the care and management of dementia patients.

Abuse tendency among dementia caregivers: a qualitative research / 中国实用护理杂志

Objective To explore the feelings of the caregivers of dementia patients,and find the resource of the caregiver's abuse tendency to dementia patients in community.Methods The data of 10 caregivers were collected through deep interviews,and the Colaizzi analysis method was used to analyze the data.Results Through repeatedly reading,arranging,analysis,separation,and theme refining,five themes were drawn:lack of related knowledge and care skills,care tasks making caregivers tired,the economic burden,lack of social support,low sense of worth.Conclusions When concerning the problems caused by dementia patients,it's necessary to appeal the society and government to provide feasible service and assistance on the issue of abuse tendency,which is produced by the caregivers during the process of taking care of them.

A study on the positive affect among dementia caregivers / 中国实用护理杂志

Objective To explore the positive affect of dementia caregivers.Methods Questionnaire method was used to investigate seventy-six dementia caregivers (the dementia group)and seventy-six non-dementia caregivers(the control group).Results The total score and the score of each dimension in the dementia group was significantly lower than those got from the control group.Conclusions Dementia caregivers can feel the positive affect from dementia patients.Compared with non-dementia caregivers,dementia caregivers feel lower positive affect,especially positive feedback from dementia patients.