Dementia Care Research Articles

The perspectives of people living with dementia and their carers on the role of the general practice nurse in dementia care provision: a qualitative study

Background Models that optimise the role of the general practice nurse have the potential to deliver cost-effective best-practice dementia care in the primary care setting. Patient experience is recognised as a vital contribution to the design, provision and evaluation of healthcare services. The aim of this study was to gain insights into the healthcare needs and experiences of people living with dementia and carers as relevant to the provision of dementia care by general practice nurses. Methods A qualitative design with semi-structured interviews was employed. Data were transcribed verbatim and thematically analysed. Six carers and five people living with dementia who received care from a general practice nurse in the previous 12 months took part in the study. Results Five overarching themes were identified: (1) the general practice nurse and dementia care: a golden opportunity, (2) respectful communication: talk to me and hear what I am saying, (3) person-centred information: tell me what I want to know, (4) provide support: more than just information provision, and (5) include the carer: we are a team. Conclusion This study describes the experiences and healthcare needs of people living with dementia and their carer(s) with regard to the general practice nurse role. These findings can inform strategies to support the general practice nurse provision of dementia care that meet the healthcare needs of people living with dementia and carers.

Playful framings of social robots in dementia care: reconsidering the principle of transparency in interactions with robot animals

Abstract Research on social robots in dementia care has focused on their effects, for example in relation to the patients’ wellbeing or the care-givers’ working environment. Such approaches to social robots treat them as stable objects with a singular function. Combining social gerontology with social studies of science, the current study offers a new angle by asking: How do patients and care-givers in care homes for older people establish a shared definition of the situation in interactions involving robot animals? Drawing on ethnography and multimodal conversation analysis of 211 minutes of video recordings in two care homes in Sweden, we demonstrate the embodied work by which participants in interactions establish activities with robot animals. In contrast to the ideal of transparency in social robotics, we show that a central affordance of the robots is their vagueness, which allows for their inclusion in playful interactions. Playful framings of the robots highlight their social functions and downplay care-giver–patient asymmetries. However, situations where patients resist a playful frame actualise a dilemma of social inclusion, on the one hand, and the right to not participate in play, on the other. Showing this, the article contributes to knowledge on how people age with technology; in particular, it draws attention to the limits of an ideal of transparency when social robots are included in dementia care.

Drug prescriptions in elderly hospitalized patients with cognitive impairment in the Italian Dementia Friendly Hospital project

ObjectiveThe aim of the study was to characterize drug prescription patterns in elderly patients hospitalized in acute wards as a function of cognitive status and staff training.MethodsWe recorded clinical parameters reflecting health status and drug prescriptions at admission, during hospital stay, and at discharge before and after a short staff training on the needs of aged cognitively impaired patients. Participants aged 65 and older had a Mini-Mental State Examination (MMSE) score ≥16. The number of prescriptions, sedative and anticholinergic load, and drug–drug interactions were evaluated. Of the 116 older patients analyzed, 59 patients were cognitively impaired, and 57 were cognitively normal with an MMSE value > 24. Fifty-nine patients (28 CN, 31 CI) were assisted by the hospital health staff after training.ResultsParticipants presented a widespread polypharmacy. Cognitively impaired patients received more prescriptions, more inappropriate prescriptions, had a greater sedative load, and were exposed to more interactions. Staff training had no effect on the prescription pattern.ConclusionThe results suggest that hospitalized cognitively impaired patients are overprescribed psychotropic drugs and have an excessive sedative and anticholinergic load. Interventions designed to improve dementia care practices in health staff that are not also designed to manage drug polypharmacy do not modify prescription patterns.

Abstract 4135206: Patterns of Lifestyle Risk Behaviors for Cardiovascular Disease in Family Caregivers: A Latent Class Analysis

Introduction: Lifestyle risk behaviors for cardiovascular disease (CVD) often co-occur. However, little is known about their behavioral patterns among family caregivers, a population at high risk for CVD. Aims: To identify distinct latent classes of caregivers of lifestyle risk behaviors for CVD and to examine the individual characteristics associated with membership in the identified latent classes. Methods: This study included 643 unpaid family caregivers from the 2019 Health Information National Trends Survey 5 Cycle 3. The assessed lifestyle risk behaviors included cigarette use, non-abstinence from alcohol, low physical activity, long sedentary time, and low fruit and vegetable consumption. These behaviors were dichotomized based on established guidelines or cut-off points. Latent class analysis was performed to identify latent classes based on these lifestyle risk behaviors among caregivers. Subsequently, multinomial logistic regression was used to investigate socio-demographic, health-related, and caregiving characteristics associated with the latent class membership. Results: Three distinct classes were identified (mean age = 55±16 years; 59.3% female; 57.1% non-Hispanic white): “overall healthy, but non-abstainer” (Class 1, 17.1%; reference), “overall unhealthy” (Class 2, 64.1%), and “inactive, but healthy eaters” (Class 3, 18.8%). In unadjusted multinomial logistic regression models, caregivers reporting greater financial hardship (relative risk ratio [95% CI] = 2.5 [1.0-5.9]), higher psychological distress (3.7 [1.9-7.3]), poorer sleep quality (3.3 [1.6-6.8]), longer caregiving hours (2.1 [1.1-3.9]), and providing dementia care (2.3 [1.3-4.3]) were more likely to belong to Class 2, relative to Class 1. In the adjusted model including the significant characteristics above and controlling for age and gender, psychological distress (2.7 [1.2-5.9]) remained significant. No characteristics were significantly associated with membership in Class 3, relative to Class 1. Conclusions: Lifestyle risk behaviors for CVD among caregivers may cluster in distinct patterns that vary by individual characteristics. Caregivers experiencing psychological distress may be particularly at risk for engaging in lifestyle risk behaviors. Our novel findings underscore the importance of adaptive lifestyle modification interventions that target caregiver subgroups with different patterns of health behaviors to promote their cardiovascular health.

The Intersecting Effects of Lifetime Experiences of Homelessness and Incarceration on Cognitive Aging and Dementia Risk Factors in the United States

Abstract Background and Objectives Alzheimer’s disease and related dementias (ADRD) remain a pressing concern in the US, which also has one of the highest incarceration rates worldwide. Existing research has analyzed dementia risk and care among currently incarcerated and homeless populations; this paper fills a gap by examining later-life cognitive disparities facing formerly incarcerated and/or homeless individuals. Research Design and Methods Using Health and Retirement Study data (HRS; 1998–2018), we tested whether formerly homeless and/or incarcerated people had earlier onset of cognitive decline, and whether they were more likely to have modifiable risk factors for ADRD than those without such experiences. We estimated prevalence of mild cognitive impairment (MCI), dementia, and self-reported ADRD diagnosis. We also used repeated observations of cognitive functioning coupled with nested nonlinear regression to examine the onset of accelerated cognitive decline. Results Adjusting for demographic variables, formerly homeless and/or incarcerated participants have increased odds of having risk factors for dementia, including smoking, drinking alcohol, depression, mental illness, and discrimination from healthcare providers and police. Diagnosis of MCI and ADRD were more common among participants reporting a history of incarceration or homelessness. Nested nonlinear regression revealed that previous experiences of incarceration or homelessness—alone or together—are associated with earlier onset of accelerated cognitive decline compared to those who experienced neither. Discussion and Implications This study suggests that, even if they occur earlier in life, homelessness and incarceration experiences may increase risk of poorer cognitive health in late life. Future work is warranted to understand the lifelong consequences linked to this adversity.

Involvement of family caregivers in dementia care research: a scoping review protocol

Abstract Background Family caregivers of people with dementia are a distinct group due to the particularly stressful and time-intensive care situation at home. Despite these challenges, involving them in research is crucial to better understand and address their specific needs. However, little evidence exists regarding a tailored approach for researchers for this group considering their situation at home. Methods A scoping review will be conducted following the Joanna Briggs Institute methodological guidance, including the databases MEDLINE (PubMed), CINAHL, Scopus (Elsevier), and PsycINFO (EBSCO). The review will include family caregivers of people with dementia, regardless of age, gender, or ethnicity, who have been actively involved in research throughout the research process. Moreover, sources of evidence from any country in both English and German are eligible for inclusion. Sources will be screened by two independent reviewers. Results will be extracted using a tailored charting tool and presented in the final report according to the research questions and objectives. Discussion Developing a tailored approach to involve family caregivers of people with dementia in research and development has profound importance to both the scientific community and the target group itself. Systematic review registration Open Science Framework https://doi.org/10.17605/OSF.IO/PMZYV.

Empowering Dementia Communication via Virtual Reality AI-Driven Simulations

The use of effective communication skills is essential for direct care workers to provide quality care for persons living with dementia (PLWD) in long-term service and support settings (LTSS). However, direct care workers often report feeling unprepared, lacking competence in care, and fear interacting with PLWD. This proof-of-concept study proposes Virtual reality Communication Training Optimizing Real-world Interactions (VICTORI) intervention, aiming to develop and evaluate the usability, acceptability, and preliminary effectiveness of virtual reality (VR) simulated communication training for direct care workers using artificial intelligence (AI)-generated patients with dementia. Care-related and social communication scenarios in dementia care will be developed, based on current literature, our validated communication instrument, and AI technology. Six modules consisting of pre-briefing, simulation facilitation, and de-briefing will be developed, refined, and evaluated based on an advisory board of experts and direct care workers’ quantitative and qualitative feedback. To test the usability, acceptability, and effectiveness of the VICTORI intervention, we will use a single group pre- and post-test intervention design, integrating quantitative measures and qualitative semi-structured interviews in this mixed-methods study. Thirty direct care workers will be recruited at two LTSS in North Texas. Direct care workers will participate in six VR-AI simulation commu-nication training sessions that include communication with AI-generated patients, real-time feedback, and detailed evaluation of communication behaviors. Each simulation will be recorded to further evaluate the partici-pant’s communication skills using the Dyadic Communi-cation Observational coding scheme in Dementia care (DCODE). Additionally, participants' potential side effects during VR simulation will be assessed using continuous physiological data and self-reported questionnaires at each simulation session. Communication knowledge and com-petence in dementia care will be assessed before and after training using self-reported questionnaires. Direct care workers will also be interviewed to assess acceptability and satisfaction with the VICTORI training. This proposal will introduce innovative training methods that leverage AI technology into communication training in dementia care. Objective assessments, including AI-based feedback, physiological data, and observational assessments, ensure the reliability and validity of the data to evaluate plausibility of VICTORI intervention.

Economic evaluations of technology-based interventions used to provide care support for people with mild dementia or mild cognitive impairment and their caregivers: A systematic review.

The cost-effectiveness of interventions is a key issue owing to the limited resources of healthcare services. To conduct a systematic review of economic evaluations of technology-based healthcare interventions in care support for people with dementia or mild cognitive impairment (MCI) and their caregivers, and of the tools used to assess effectiveness and costs. The following databases were used: PubMed, National Health Service Economic Evaluation Database, and Health Technology Assessment. A total of 207 articles from 2012 to 2024 were identified and then screened. Seventeen studies were included, of which nine were study protocols. Almost half (n = 8) the interventions were multicomponent. The most common components used in the interventions were cognitive stimulation, physical functioning and continuing support. Regarding the efficiency results of these interventions, only three studies provided a full economic evaluation. The most frequent tools in the economic evaluations used to measure effectiveness (measured in quality-adjusted life years) and costs were the European Quality of Life-5 Dimensions and Resource Utilization in Dementia instruments, respectively. Most of the interventions evaluated were cost-effective. However, these results should be interpreted with caution, given the scarcity of the literature, and further economic evaluations of technology-based healthcare interventions for people with mild dementia or MCI care support and their caregivers are therefore needed. Additionally, a meta-analysis could not be performed due to the heterogeneity of the data.

Technology that CARES: Enhancing dementia care through everyday technologies.

"Everyday technologies" have long been suggested as digital tools to improve life for and enhance care of persons with Alzheimer's disease and related dementias (ADRD). Within this realm, there is a need to balance potential drawbacks of technologies with their ability to positively impact patient and care partner centered outcomes. To facilitate this goal, we endeavored to provide a common language and conceptual structure to understand digital technology use in ADRD care. Specifically, we describe the pathways by which researchers might develop and deploy technology, including via Cognitive offloading, Automation, Remote monitoring, Emotional/social support, and Symptom treatment (CARES). In addition, we highlight emerging issues in technology-based care research and provide relevant caveats regarding application of digital technologies in the real world. This discussion provides a framework to organize science on the application of technologies to ADRD care in the future. HIGHLIGHTS: "Everyday technologies" have long been suggested as digital tools to improve life for and enhance care of persons with Alzheimer's disease and related dementias (ADRD). However, the potential benefits of digital technologies must be balanced against their possible drawbacks. We describe the pathways by which researchers might develop and deploy technology that CARES, including via Cognitive offloading, Automation, Remote monitoring, Emotional/social support, and Symptom treatment. This discussion provides a framework to organize science on the application of digital technologies to ADRD care in the future.

Assessing palliative care needs in patients with dementia: A cross-sectional analysis of an predominantly oldest-old population from a geriatric memory clinic.

In this cross-sectional study, we assessed palliative care (PC) needs in older adults with dementia. Using the NECPAL CCOMS-ICO© 3.1 tool and comprehensive geriatric assessment, 16.25% of the 554 evaluated patients required PC, which had clinical frailty and a moderate stage of dementia. Advanced frailty was associated with the poorest prognosis, according to the PC-based stratification. Our findings support the use of PC assessment in dementia care, which focuses on a person-centered approach while minimizing unnecessary or ineffective treatments and meeting the real-world patient's needs. PC care may fulfill the multidimensional nature of dementia, shifting towards personalized palliative approaches.

Pre and post diagnostic dementia care in four Scottish prisons

Background and purposeThe number of older people in prisons is increasing across the globe. Many have poor physical and mental health, higher prevalence of head injury, cognitive impairment and dementia than found in community populations. Meeting the complex needs of this vulnerable group has become an increasing concern for prison and prison healthcare services. The aim of this multi method qualitative study was to investigate how men with diagnosed or suspected dementia were identified, assessed, and cared for in Scottish prisons. It also explored the lived experience of individuals being assessed for or diagnosed with dementia within four prisons. The data from twenty nine interviews was thematically analysed and used to collaboratively propose principles for dementia care in prison and present the resultant co-designed care pathway.ResultsAt the time of data collection almost all the men known to have a dementia diagnosis or suspected dementia had complex health and social care needs, and some were living with advanced dementia. Prison healthcare staff reported taking a ‘case by case’ approach to their pre- and post-diagnostic care. Meeting these prisoner’s needs was complicated by the absence of organisational leads for care of older adults or people with dementia and there was no pathway or model in place to guide staff. Prison healthcare teams often had difficulty accessing specialist community services to support diagnosis. There was a lack of dementia education and knowledge about how to provide pre and post diagnostic dementia care in this setting amongst staff. The findings arising from this research have informed the co-production of two important evidence informed innovations namely a Model of Care and a pre- and post-diagnostic Care Pathway.ConclusionThis research adds insights critical to understanding the adequacy of current approaches to meeting dementia related needs within the prison setting. To our knowledge this paper offers the first co-produced evidence informed pre- and post- diagnostic dementia care pathway and model of care for use in prisons. These could serve as tools for change that could enable prison healthcare staff to deliver the right care, at the right time, by the right people, and provide an opportunity to assess risk and plan care for the future.

Priorities to Support Care Partners of People Living With Dementia: Results of a Modified Delphi Process.

Objective: To determine priorities for services and policies that better support care partners of people living with dementia. Methods: A modified Delphi process engaged participants from organizations serving people living with dementia and care partners, focusing on historically and currently underserved communities. Eight thematic areas were identified. Participants (N = 40) responded to three surveys, generating ideas, rating each, and ranking priorities. Results: Each survey received 13-17 responses. Top ranked ideas were arrayed across six thematic areas: care partner supports; programs; funding; information; care coordination; and workforce development. Discussion: The Delphi process empowered participants to share knowledge, and respected their opinions. Anonymity removed power imbalances. The survey iterations blended qualitative and quantitative approaches, and built consensus. The Delphi invited the voices of diverse participants; all voices were weighed equally. This process could be extended to efforts to further engage dementia care partners, helping to value their voices in decision-making for services and policies.

Introduction and preliminary psychometric evaluation of the assessment of functional capacity interview for older adults

Measures of complex functional decision-making capacity can greatly aid in assessing mild cognitive impairment (MCI) and facilitating early intervention in dementia care. We examined the ability of the Assessment of Functional Capacity Interview (AFCI) to detect functional differences among older adults who were cognitively unimpaired (CU), or who presented with subjective cognitive decline (SCD) or MCI. A sample of 97 older adults (CU; n = 30, Mage = 74.64 ± 7.42 years; SCD; n = 34, Mage = 72.56 ± 6.43 years; MCI; n = 33, Mage = 78.28 ± 7.55 years) underwent neuropsychological testing and responded to the Financial Capacity Instrument (FCI-SF). Informants completed the Assessment of Functional Capacity (AFCI), an instrument of functional decision-making capacity, and responded to the Social Vulnerability Scale (SVS15) and Amsterdam Instrumental Activity of Daily Living (A-IADL-Q-SV), a measure of functional status, for comparison. According to informant-reported responses, the CU group had significantly lower AFCI total (and domain) scores, H(2) = 27.59, p<.001, relative to MCI. Additionally, the CU group had significantly lower AFCI scores in the Home and Personal Safety domain relative to the SCD group, H(2) = 14.06, p<.05. In the overall sample, AFCI total scores were associated with FCI-SF, SVS15, and A-IADL-Q-SV scores and cognitive measures. Our results demonstrate that the AFCI is sensitive to impairment in safety, social, financial, and medical functioning in MCI and is associated with measures of cognitive functioning and social vulnerability in older adults. Incorporating this instrument as a supplement to cognitive screening instruments may aid in the prevention of hazardous decision-making in older adults.

Implementing palliative and end of life care for people with dementia.

Dementia is characterised by memory loss, behavioural changes and decline of cognitive, social and physical functions and is a life-limiting condition. At the point of diagnosis it is classed as a palliative condition, yet there is limited public and healthcare professional awareness that, once diagnosed, a person will either die of dementia or die with dementia. This article discusses how the recognition and timing of the need for palliative dementia care is pivotal in providing person-centred care. The authors explore factors such as optimal prognostication, advance care planning, staff education and accessing support from palliative and end of life care teams and Admiral Nurses. The authors also use a fictional case study to demonstrate best practice in palliative dementia care.

The Evolution in Dementia Caregiving Research: NIA's Catalyst Role.

This article celebrates the National Institute of Aging (NIA)'s successes over the past fifty years in advancing the science base informing the need for and response to dementia caregiving. In parallel with other public and private efforts, insightful NIA leadership supported by funding initiatives established the field of dementia caregiving research. In support of the health and well-being of family caregivers, NIA was a catalyst of innovation that led to numerous evidence-based caregiving interventions informed by basic research on care tasks and consequences. As evidence of the impending burden of dementia care on US families mounted, NIA-funded multidisciplinary collaboratives of researchers generated comprehensive models of family caregiving across diverse populations. Today, the dementia caregiving evidence base is shaping public policy and making possible dementia caregiving support services in health systems and community-based organizations. NIA continues to support the scientific study of dementia caregiving with a collaboratory of leading scientists and by making available state-of-the-art datasets and encouraging standardized research methodologies. NIA's leadership in the field of dementia caregiving research has never been more significant as the number of persons living with dementia in the US approaches 7 million, and the value of family caregiving is estimated to be $350 billion.

Dignity in people with dementia: A concept analysis.

Background: Dignity, an abstract and complex concept, is an essential part of humanity and an underlying guiding principle in healthcare. Previous literature indicates dignity is compromised in people with dementia (PwD), but those PwD maintain the capacity to live with dignity with appropriate external support. Alzheimer's disease and related dementias (ADRDs) lead to progressive functional decline and increased vulnerability and dependence, leading to heightened risks of PwD receiving inappropriate or insufficient care that diminishes dignity. Considering the increased disease prevalence and the continuously escalating costs of dementia care, establishing a productive value-based guideline may prevent suffering, maximize dignity, and thus promote quality of life (QoL).Aim: The goal of this project is to identify actionable targets for integrating dignity harmoniously and practically into care planning and management for PwD.Research Design: We conducted a concept analysis using Walker and Avant's eight-step process. A comprehensive literature search was conducted (PubMed and CINAHL) with the keywords "dignity," "dementia," "Alzheimer's disease," and "dementia care."Results: A total of 42 out of 4910 publications were included. The concept of dignity in PwD is operationalized as the promotion of worthiness and the accordance of respect that allows the presence and expression of a person's sense of self, regardless of physical, mental, or cognitive health. The concept has two subdimensions: absolute dignity which encompasses the inherent self and relative dignity characterized by its dynamic reflective nature. Worthiness and respect are the two main attributes, while autonomy is an underlying component of dignity. Specific antecedents of dignity in PwD are empowerment, non-maleficence, and adaptive environmental scaffolding. As a consequence of facilitating dignity in PwD, QoL may be enhanced.Conclusion: As a foundational and necessary humanistic value, incorporating dignity into dementia care can lead to efficient and effective care that optimizes QoL in PwD throughout their disease progression.

Knowledge, Attitudes and Confidence in Providing Dementia Care to Older Adults Among Nurses Practicing in Hanoi, Vietnam: A Cross‐Sectional Study

ABSTRACTBackgroundNurses' competencies are crucial in providing effective dementia care in healthcare settings for older people. Understanding nurses' current knowledge, attitudes and confidence in this area is essential for developing education programmes for healthcare professionals to improve patient care. The purpose of this study was to assess the knowledge, attitudes and confidence related to providing dementia care among nurses practicing in geriatric hospital wards and nursing homes in Hanoi, Vietnam.MethodsA total of 269 out of 313 (response rate was 86%) full‐time nurses working at six geriatric wards in hospitals and nursing homes in Hanoi were surveyed using three self‐administered questionnaires: the Dementia Knowledge Assessment Scale (DKAS), Dementia Attitude Scale (DAS) and the Confidence in Dementia Scale (CODE). Multiple regression models were constructed to identify factors associated with dementia care knowledge, attitudes and confidence.ResultsThe overall mean scores of nurse's knowledge, attitudes and confidence were 28.1 ± 8.0, 102.1 ± 13.4 and 28.3 ± 6.4, respectively. A positive correlation was reported between the knowledge and attitude scores and between the attitudes and confidence scores. Greater seniority (β: 0.29; 95% CI: 0.03–0.56) and having learned information through colleagues or experts (β: 3.02; 95% CI: 0.88–5.16) were associated with better dementia knowledge. A higher level of dementia training desirability was associated with increased knowledge (β: 0.74; 95% CI: 0.28–1.20) and favourable attitudes (β: 0.94; 95% CI: 0.15–1.74), whereas frequent exposure to dementia cases was associated with higher confidence (β: 3.56; 95% CI: 1.39–5.73) and more favourable attitudes (β: 3.96; 95% CI: 0.27–7.66).ConclusionOur study highlights deficits in knowledge, low levels of social comfort in nurses' attitudes towards people with dementia and a lack of confidence in providing effective care among nurses practicing in healthcare settings for older adults in Hanoi, Vietnam. With the ageing of the population and with increasing numbers of persons living with dementia, our findings suggest the importance of improving the training of nurses to specifically address these deficits.Implications for PracticeMultidisciplinary consultation meetings need to be encouraged in the healthcare workplace setting as well as ensuring the presence of qualified counsellors for care teams working with older adults in non‐hospital settings.Training about non‐cognitive symptoms of dementia and demonstrating effective verbal and non‐verbal communication skills is critical and should be integrated into nurse's educational training.

E-Learning Modules for the Care of Caregivers of Older Filipinos

As the population ages, so does the challenge to the care of older people with mental health problems. Geriatric syndromes such as delirium, dementia, and depression are amenable to medical management. Beyond care of the patient, however, is care for the caregiver. Behavioral and Psychological symptoms of Dementia (BPSD) such as agitation, aggression, and delusions increase the risk of caregiver stress. This may lead to strain of individual carers and household members, increasing the patient’s risk for poor care, abuse, or institutionalization. Caregiver education and skills training help reduce the level of caregiver stress. These are usually delivered face to face during clinic visits or training modules by dementia care professionals. However, remote alternatives for education, learning and counselling became essential during the COVID-19 pandemic. E-workbooks and online learning modules on dementia, delirium, and depression written by professionals in the Philippines and Asia Pacific are available. An example is the Dementia Community Toolkit in English and its Filipino adaptation. The latter was developed by the Institute on Aging, National Institutes of Health, University of the Philippines Manila, with support from the Mental Health Unit of WHO WPRO. Patient support groups such as the Alzheimer’s Disease Association of the Philippines likewise developed online learning materials. These were and are still freely available via their websites and the webinars have been uploaded in internet and social media sites. The efficacy and acceptability of remote education to reduce informal caregiver burden, negative mood, and quality of life was published in a Cochrane meta-analysis. The authors analyzed experimental trials on information, training, or support compared to usual treatment, waitlist, or attention controls. Following several eligibility criteria, they identified 26 studies with 2367 participants in their review. Although most studies were of low quality and had uncertain risks of bias, there was small evidence that training plus support modules resulted in an improvement of caregiver knowledge. Training alone had no benefit on knowledge. Furthermore, there was no significant effect on patient institutionalization, caregiver burden depression, or quality of life. The article on E-Learning on knowledge on the 3Ds of Geriatric Psychiatry is a good start in understanding the capacity of well-educated Filipino caregivers to improve their knowledge on the subject. Beyond individual knowledge, E-learning modules have the capacity to guide families and communities in reducing ageism and improve patient care for older people with dementia, depression, and delirium. Further experimental studies are needed using locally developed modules. The bigger challenge is accessibility and acceptability of remote learning materials for the greater majority of informal caregivers with lower levels of education and poor access to online resources.

Horticultural therapy impact on people with dementia

BackgroundDementia is a progressive disease, and as the disease progresses, many families seek help through activities and therapies. In contrast to some other therapies, horticultural therapy (HT) is widely accepted by most people with dementia (PWD) because it invites them to the natural world.ObjectivesTo explore whether HT emotional and communication measures (i.e. appropriate expression of emotions, ability to communicate with others) are higher than in other activities offered to PWD in adult day care centers (ADCC) and continuing care retirement community (CCRC), and whether there is a difference between the impact of HT on the number of “positive actions” (communication actions and actions that fit the guided activity) vs. the other activities.Research design and methodsFifty-one PWD attending ADCCs and living in one CCRC were recruited to a structured HT activity and other activities that took place in the ADCCs and CCRC. The activity took place over 10 weeks. The effects were assessed using Dementia Care Mapping (DCM) and questionnaires.ResultsPaired t-tests found that higher levels of mood and behavior were observed during HT activities compared to the other activities. Also, communication and function actions were higher in the HT activities as compared to the other activities.Discussion and implicationsThis study adds to the growing evidence of the benefits of HT for PWD regardless of past experience in gardening/agriculture. HT seems to provide high therapeutic benefits and should be more prevalent in centers caring for PWD.

Evaluation of the Interdisciplinary Care Home-bAsed Reablement Program (I-CHARP) for People Living With Cognitive Impairment and Dementia in Care Homes.

Major knowledge and practice gaps exist in aged care home services to support independence of older people with dementia. This research evaluates an adaptation of a community-based rehabilitation model for care homes, namely Interdisciplinary Care Home-bAsed Reablement Program (I-CHARP), by examining whether (and, if so, how) I-CHARP produces its intended effects and how this programme can be practicably implemented, sustained and scaled up across care homes in Australia. I-CHARP is a 4-month bio-behavioural-environmental rehabilitation model of care, integrated in care home services, supported through the deployment of an implementation strategy, the Research Enabled Aged Care Homes (REACH) network. It consists of (1) 8-12 full individual sessions and additional eight brief follow-ups per resident, tailored to the resident's needs, delivered primarily by a team of an occupational therapist, registered nurse and other allied health staff; (2) environmental modifications/assistive devices up to the value of $400 per resident; and (3) engagement of intervention care home staff, managers and regular visitors. An overarching evaluation approach is participatory action research using a cluster quasi-experimental design and mixed methods. It involves testing of the implementation strategy (REACH network and other approaches) while observing/gathering information on the intervention (I-CHARP) and related outcomes in three cycles. Participants include residents (aged ≥ 60 years with early stages of dementia) and care staff from 16 care homes. Care quality indicators, health care costs, field notes and semi-structured interviews/focus groups with intervention site staff, regular visitors and managers will provide further insights into I-CHARP processes and implementation issues. In the final phase of the project, an Agile Implementation Playbook will be developed for the delivery of reablement care that can be used in routine practice across care homes in Australia. The study findings will also inform future policy development and strategic directions for dementia care in care homes. Australian New Zealand Clinical Trial Registry, ACTRN12623000885695 Registered 16 August 2023, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=386088. 1.0 dated 20 July 2023.