Community-dwelling People With Dementia Research Articles

Whether and how to store firearms in the home: Qualitative insights from care partner experiences in the Safety in Dementia Trial.

Most people with dementia (PWD) in the United States live in community settings supported by family and/or unpaid care partners. Firearms access is one of many decisions care partners navigate alongside PWD in efforts to prevent injuries and deaths. Conversations about firearms access are socially challenging, although specific challenges to be overcome have not been described. As part of the larger Safety in Dementia Trial, we interviewed care partners about their views and experiences regarding firearms access in the home where the PWD resides. Interviewees were English-speaking adults (≥18 years) in the United States who are unpaid care partners of community-dwelling PWD. Responses to interview discussions related to (1) a desire for safety, and (2) fear of firearm violence was analyzed using a focusing process to categorize views into essential themes. Fifty care partners, who were primarily female (58%), White (66%), adult children (56%), and living in the same household (64%), participated in interviews between February 2023-February 2024. Dominant themes emerging from the focusing technique included (1) firearms as a necessary component of home safety; (2) fear of accidental/impulsive firearm violence; (3) observed risk and "near misses"; and (4) differing views on home firearms as a source of conflict. Thematic descriptions did not differ according to care partner's relationship to the PWD (adult child, spouse, other). Considering whether and how to alter access to firearms where PWD reside can be difficult for care partners to navigate. Care partners expressed a desire to limit firearms access, but worried both about creating conflict with the PWD and the self-defense implications of making firearms inaccessible. Findings were similar across subsets of care partners indicating that standardized tools and messaging to care partners may be effective in promoting safety in homes with PWD.

Understanding acceptance of contactless monitoring technology in home-based dementia care: a cross-sectional survey study among informal caregivers.

There is a growing interest to support home-based dementia care via contactless monitoring (CM) technologies which do not require any body contact, and allow informal caregivers to remotely monitor the health and safety of people with dementia (PwD). However, sustainable implementation of CM technologies requires a better understanding of informal caregivers' acceptance. This study aimed to examine the (1) general acceptance of CM technology for home-based dementia care, (2) acceptance of different sensor types and use scenarios, and (3) differences between accepters and refusers of CM technology. A cross-sectional online survey was conducted among n = 304 informal caregivers of community-dwelling PwD [Mean(SD) age = 58.5 (10.7)] in the Netherlands and Germany. The survey contained a textual and graphical introduction to CM technologies, as well as questions targeting (1) general acceptance of CM technology, (2) acceptance of seven different contactless sensor types, (3) acceptance of five different use scenarios, and (4) caregivers' own and their care recipients' personal characteristics. Data were examined using descriptive and bivariate analyses. Participants' general acceptance of CM technology was slightly positive. We found significant differences in acceptability between contactless sensor types (p < .001). RF-based sensors (e.g., radar) and light sensors were considered most acceptable, whereas camera-based sensors and audio sensors (e.g., microphones, smart speakers) were seen as least acceptable for home-based dementia care. Furthermore, participants' acceptance of different use scenarios for CM technology varied significantly (p < .001). The intention to use CM technology was highest for detecting emergencies (e.g., falls, wandering), and lowest for predicting acute situations (e.g., fall prediction). Lastly, accepters and refusers of CM technology significantly differed regarding gender (p = .010), their relation with the PwD (p = .003), eHealth literacy (p = .025), personal innovativeness (p < .001), usage of safety technology (p = .002), and the PwD's type of cognitive impairment (p = .035) and housing situation (p = .023). Our findings can inform the development and implementation of acceptable CM technology to support home-based dementia care. Specifically, we show which sensor types and use scenarios should be prioritized from the informal caregiver's view. Additionally, our study highlights several personal characteristics associated with informal caregivers' acceptance of CM technology that should be taken into account during implementation.

Learning needs of family caregivers in the Japanese working generation who care for community-dwelling people with dementia: A qualitative research study

Objective: This study investigated and described the learning needs experienced by family caregivers in the Japanese working generation who care for community-dwelling people with dementia (PWD). Methods: This qualitative descriptive study conducted semi-structured in-depth interviews to explore the learning needs experienced by the family caregivers of PWD. 18 family caregivers were recruited via purposive sampling (age range 30-60 years) from two medical facilities, two self-help groups, and 10 prefectural-sponsored counseling facilities in Japan. The collected data were subjected to a qualitative content analysis. Then, the derived learning needs were independently reviewed by two nursing researchers with expertise in qualitative research and family nursing. The Standards for Reporting Qualitative Research (SRQR) recommendations were followed. Results: Four main categories and 20 subcategories were derived to clarify the learning needs of family caregivers in the Japanese working generation who care for community-dwelling PWD. The four main categories included (a) increasing long-term care literacy, (b) dispelling the negative images associated with dementia and long-term care, (c) working on long-term care as a unified team that handles issues concerning caregiving for dementia, and (d) promoting an active role as a member of society. Conclusions: This study clarified specific learning needs that family caregivers in the Japanese working generation experience when caring for community-dwelling PWD, thus, contributing to a more thorough understanding of the associated challenges. In addition, the structured list of learning needs should aid health professionals when conducting assessments and planning interventions, especially when framing these issues from the cultural perspective.

1362 ANTICHOLINERGIC PRESCRIBING HABITS AND ITS ASSOCIATIONS IN A COMMUNITY POPULATION OF PEOPLE LIVING WITH DEMENTIA

Abstract Introduction Many commonly prescribed medications have inadvertent anticholinergic effects. People with Dementia (PwD) are more vulnerable to these effects and at risk of adverse outcomes, the risk being higher with a greater degree of anticholinergic exposure. We investigated prescribing patterns and Anticholinergic burden (ACB) in a cohort of community-dwelling older adults with dementia and aimed to explore the effect of ACB on cognition, mood, and quality of life(QoL). Method The medication and demographic information for 87 (39 female) community-dwelling PwD were obtained from Electronic Care Summaries. We used the German Anticholinergic Burden Scale (GABS) to measure ACB. Additionally, we investigated associations between ACB and cognitive (ADAS-Cog), functional (BADL) and QoL (DemQoL) assessments. Results 28.7% of participants had a clinically significant score (ACB&amp;gt; 2). The most commonly prescribed medications with ACB were Lansoprazole(18.3%), Mirtazapine(12.6%) and Codeine(12.6%). ACB was higher in males and negatively correlated with age, r(87)=-.21,p=.03. There was no association between ACB and cognition, QoL, functional independence, and neuropsychiatric symptoms. Over six months, PLWD with no ACB had a greater negative change in neuropsychiatric symptoms[t(18)=2.27,p=.04] and functional independence[t(23)=-3.8,p=.001], indicating greater dependence and worsening neuropsychiatric symptoms. Conclusion A third of PLWD in the community had clinically significant ACB. No ACB was associated with worsening neuropsychiatric symptoms and functional dependence over a six-month period. Community prescribers should consider regular medication reviews with PLWD and carers to ensure medications are prescribed safely and appropriately.

New psychotropic medication use among Medicare beneficiaries with dementia after hospital discharge.

Hospitalizations among people with dementia (PWD) may precipitate behavioral changes, leading to the psychotropic medication use despite adverse outcomes and limited efficacy. We sought to determine the incidence of new psychotropic medication use among community-dwelling PWD after hospital discharge and, among new users, the proportion with prolonged use. This was a retrospective cohort study using a 20% random sample of Medicare claims in 2017, including hospitalized PWD with traditional and Part D Medicare who were 68 years or older. The primary outcome was incident prescribing at discharge of psychotropics including antipsychotics, sedative-hypnotics, antiepileptics, and antidepressants. This was defined as new prescription fills (i.e., from classes not used in 180 days preadmission) within 7 days of hospital or skilled nursing facility discharge. Prolonged use was defined as the proportion of new users who continued to fill newly prescribed medications beyond 90 days of discharge. The cohort included 117,022 hospitalized PWD with a mean age of 81 years; 63% were female. Preadmission, 63% were using at least 1 psychotropic medication; 10% were using medications from ≥3 psychotropic classes. These included antidepressants (44% preadmission), antiepileptics (29%), sedative-hypnotics (21%), and antipsychotics (11%). The proportion of PWD discharged from the hospital with new psychotropics ranged from 1.9% (antipsychotics) to 2.9% (antiepileptics); 6.6% had at least one new class started. Among new users, prolonged use ranged from 36% (sedative-hypnotics) to 63% (antidepressants); across drug classes, prolonged use occurred in 51%. Predictors of newly initiated psychotropics included length of stay (≥median vs. <median; aOR 1.5, 95% CI: 1.4-1.6) and delirium (aOR 1.8, 95% CI: 1.7-1.9). Hospitalized PWD have a high prevalence of preadmission psychotropic medication use; against this baseline, discharge from the hospital with new psychotropics is relatively uncommon. Nevertheless, prolonged use of newly initiated psychotropics occurs in a substantial proportion of this population.

Music-based interventions for community-dwelling people with dementia: A systematic review.

The majority of people with dementia (PwD) live in the community. Compared to institutionalised PwD, their access to formalised music therapy is limited. Initial works suggest that non-therapist-led music-based interventions (MBIs) may be an accessible and effective alternative. The aim of this review was, therefore, to synthesise evidence on MBIs for community-dwelling PwD. We systematically searched electronic databases (PubMed, PsycInfo, Web of Science) for records reporting on controlled studies of MBIs delivered to community-dwelling PwD. Two reviewers independently screened records according to inclusion/exclusion criteria. A total of 15 relevant publications reporting on 14 studies were initially identified and assessed using the Cochrane risk-of-bias tool for randomised trials (RoB 2) and the risk of bias. In non-randomised studies of interventions (ROBINS-I) tool. A total of 11 records of 10 studies, with a total of n=327 PwD, were included in the synthesis. MBIs consisted either of singing or music listening interventions and were variable in duration. MBIs had immediate positive effects on cognition. Short-term MBIs (lasting 1-4months) benefited cognition, anxiety and pain. Evidence on depressive symptoms was conflicting. The benefits of longer term MBIs (lasting 6+ months) were less apparent. According to GRADE criteria, the overall quality of evidence was moderate to low. The inconsistency in designs, procedures and measures prevents specific conclusions at this stage. Still, the diversity observed in existing studies suggests that there are multiple interesting avenues for researchers to pursue, including the involvement of informal caregivers in MBI delivery. Future studies need to ensure adequate reporting to facilitate continued development. The protocol of this review was pre-registered with the Prospective Register of Systematic Reviews (PROSPERO, Registration Number: CRD42020191606).

Dementia Neuropsychiatric Symptom Frequency, Severity, and Correlates in Community-Dwelling Thai Older Adults

Thailand is experiencing a rapid increase in the number of older people with dementia (PWD). We examined the frequency, severity, and correlates of dementia neuropsychiatric symptoms (NPS) among community-dwelling Thai older adults. This study was based on analysis of baseline data from a larger clinical trial comparing two different implementation approaches of an evidence-based exercise intervention for people with dementia. To be eligible, participants needed to be age 60 and above, have probable dementia, have one or more NPS, be ambulatory, and have an adult (age 18+) family caregiver. In the 353 eligible participants, we examined the correlation between NPS severity and caregiver distress (assessed by the Neuropsychiatric Inventory Questionnaire or NPI-Q) and used ordinary least squares (OLS) regression to examine associations between PWD and caregiver characteristics and NPS severity. NPS frequency varied from 18% for appetite and/or eating changes to 42% for delusions. NPS severity was significantly (p <0.05) associated with caregiver stress for all individual NPS. Among PWD characteristics, higher ADL score (less functional impairment) was inversely associated with NPS total severity (b=-0.16, p <0.05). More physical role limitation was significantly associated with higher NPS total severity (b=0.77, p <0.001). Among caregivers' characteristics, higher burden was significantly associated with higher NPS total severity (b=0.19, p <0.001). Our study found NPS to be common among community-dwelling PWD in Thailand and have adverse impacts on both PWD and family caregivers. These findings highlight the clinical importance of NPS symptoms among Thai older adults.

Incidence of potentially disruptive medical and social events in older adults with and without dementia.

Potentially disruptive medical, surgical, and social events-such as pneumonia, hip fracture, and widowhood-may accelerate the trajectory of decline and impact caregiving needs in older adults, especially among people with dementia (PWD). Prior research has focused primarily on nursing home residents with dementia. We sought to assess the incidence of potentially disruptive events in community-dwelling people with and without dementia. Retrospective cohort study of participants aged 65+ enrolled in the Health and Retirement Study between 2010 and 2018 (n=9346), including a subset who were married-partnered at baseline (n=5105). Dementia was defined with a previously validated algorithm. We calculated age-adjusted and gender-stratified incidence per 1000 person-years and incidence rate ratios of: 1) hospitalization for pneumonia, 2) hip fracture, and 3) widowhood in people with and without dementia. PWD (n=596) were older (mean age 84 vs. 75) and a higher proportion were female (67% vs. 57%) than people without dementia (PWoD) (n=8750). Age-adjusted incidence rates (per 1000 person-years) of pneumonia were higher in PWD (113.1; 95% CI 94.3, 131.9) compared to PWoD (62.1; 95% CI 54.7, 69.5), as were hip fractures (12.3; 95% CI 9.1, 15.6 for PWD compared to 8.1; 95% CI 6.9, 9.2 in PWoD). Point estimates of widowhood incidence were slightly higher for PWD (25.3; 95% CI 20.1, 30.5) compared to PWoD (21.9; 95% CI 20.3, 23.5), but differences were not statistically significant. The association of dementia with hip fracture-but not pneumonia or widowhood-was modified by gender (male incidence rate ratio [IRR] 2.24, 95% CI 1.34, 3.75 versus female IRR 1.31 95% CI 0.92,1.86); interaction term p=0.02). Compared to PWoD, community-dwelling PWD had higher rates of pneumonia and hip fracture, but not widowhood. Knowing how often PWD experience these events can aid in anticipatory guidance and care planning for this growing population.

Reliability of the ICECAP-O Quality of Life Scale With Community-Dwelling People With Dementia

Currently, measures of quality of life used with older people with dementia (PWD) are mainly health related. Health is not an actual attribute of but a means to attain quality of life. The Investigating Choice Experiments for the Preferences of Older People - CAPability index (ICECAP-O) measures attributes of quality of life. While its construct validity has been tested with PWD, no study has yet published data on the reliability of this scale used directly with PWD. In this study, we tested the external (test-retest) reliability of the ICECAP-O with 54 community-dwelling older PWD from the south of England. The ICECAP-O had acceptable test-retest reliability (r = .68, p < .01 and r = .56, p < .01 for raw and tariff scores, respectively). This suggests that the ICECAP-O is both a reliable and valid measure of quality of life for use directly with community-dwelling PWD.

The impact of auditory hallucinations on "living well" with dementia: Findings from the IDEAL programme.

To determine whether auditory hallucinations in community-dwelling people with dementia (PwD) living in the community impacted on quality of life (QoL), subjective wellbeing and life satisfaction. Cross-sectional cohort study. 1251 community-dwelling PwD and caregivers were included in this study. Neuropsychiatric Inventory Questionnaire completed by caregiver interview. Mean differences between the absence and presence of auditory hallucinations were compared to scores on three validated measures of living well: QoL in Alzheimer's disease scale (QoL-AD), World Health Organization-Five Well-being Index and Satisfaction with Life Scale. Analysis of covariance determined the confounding contributions of cognition via Mini-Mental State Examination, depression via Geriatric Depression Scale-10, caregiver stress via Relative Stress Scale and whether antipsychotic drugs were prescribed. Auditory hallucinations were associated with lower scores for QoL (p<0.001, η2 =0.01), wellbeing (p<0.001, η2 =0.02) and life satisfaction (p<0.001, η2 =0.01). After controlling for background measures, which were potential confounds, the relationship between auditory hallucinations and QoL (p=0.04, pη2 =0.01) and wellbeing (p<0.000, pη2 =0.02) remained significant but there was no significant association with life satisfaction. Auditory hallucinations are associated with lower QoL and wellbeing in PwD living in the community. This has implications for targeted therapies in PwD with psychotic symptoms.

Components of Empowerment Among Family Caregivers of Community-Dwelling People With Dementia in Japan: A Qualitative Research Study.

ABSTRACTBackgroundFamily caregivers of people with dementia (PWDs) experience significant physical, psychological, and social burdens. Empowerment, which refers to the process of gaining power in society through behavioral change, is important to coping successfully with care-related burdens. The high burden of care faced by family caregivers in Japan often makes accepting social support difficult for caregivers of PWDs, resulting in feelings of isolation. Clarifying what components constitute empowering experiences for family caregivers of PWDs is necessary to gain a better understanding of their empowerment experiences and to develop relevant support schemes.PurposeThis study was developed to describe the components of empowerment experienced by family caregivers of community-dwelling PWDs in Japan.MethodsThis qualitative descriptive study used semistructured in-depth interviews to explore components of empowerment experienced by family caregivers of adults/older adults with dementia. Purposive sampling was used to recruit 20 family caregivers (age range: 50–87 years) from four self-help groups. A qualitative content analysis method was used to analyze the data. The components derived from the interviews were reviewed by three nursing researchers not directly involved in this study who are specialists in qualitative research and geriatric nursing.ResultsFour categories and 12 subcategories were derived to illuminate the components of empowerment among family caregivers of PWDs. Specifically, these categories were as follows: (a) proactive aspects of dementia care that were acquired through the caregiving experience, (b) creating a relationship that respects PWDs, (c) Building relationships based on mutual understanding of one's surroundings, and (d) understanding the social aspects of dementia care.Conclusions/Implications for PracticeThe findings of this study provide additional understanding of the components of the empowerment experiences of family caregivers of PWDs in Japan and in other East Asian countries experiencing increasing dementia diagnoses and population aging. In addition, the structural components of empowerment offer a useful perspective for health professionals on assessment and intervention that is framed on the cultural characteristics of East Asia. Ultimately, the results suggest that healthcare professionals should develop intervention programs that are tailored to the needs of caregivers at different levels of empowerment.

'I just take them because I know the people that give them to me': A theory-informed interview study of community-dwelling people with dementia and carers' perspectives of medicines management.

Identify facilitators and barriers to successful medicines management for people with dementia (PwD) in primary care from the perspectives of community-dwelling PwD and carers. Semi-structured interviews conducted with PwD and carers in Northern Ireland. The 14-domain Theoretical Domains Framework guided data collection and analysis. Interviews explored participants' experiences and perceptions of medicines management. PwD also completed the Beliefs about Medicines Questionnaire indicating their level of agreement with statements about medicines. Qualitative data were analysed using the framework method and content analysis. Quantitative data were analysed descriptively. Eighteen PwD and 15 carers were interviewed. PwD believed they were competent with medicines management ('beliefs about capabilities'). Most PwD reported having strategies to prompt them to take their medicines ('memory, attention and decision processes'). Carers played an important role in supporting PwD with medicines management ('social influences') and monitoring adherence ('behavioural regulation') and anticipated having to take on a greater role as patients' cognitive impairment worsened ('beliefs about consequences'). Participants highlighted assistance provided by community pharmacies with medicines acquisition and delivery ('environmental context and resources') and placed great trust in primary healthcare professionals ('social influences'). PwD had positive attitudes towards medication and believed strongly in the necessity of their medicines. This is the first study to use a theoretical approach to explore medicines management for community-dwelling PwD. The findings provide new insights into the critical role of carers in facilitating optimal medicines management and will inform future intervention development, in which carers' needs assessment and involvement will be key.

Managing medicines in the time of COVID-19: implications for community-dwelling people with dementia

COVID-19 has changed life beyond recognition for millions of individuals, as countries implement social distancing measures to prevent disease transmission. For certain patient groups, such as community-dwelling older people with dementia (PwD), these restrictions may have far-reaching consequences. Medicines management may be adversely affected and deserves careful thought. PwD face unique challenges with medicines management compared to other older people, often relying upon support from family/carers and primary healthcare professionals. This article considers potential issues that PwD may face with each component of medicines management (prescribing, dispensing, administration, adherence, review), and based on previous research, highlights strategies to support PwD and their carers during this time. Primary healthcare professionals must be attentive to medicines-related needs of community-dwelling PwD, particularly those living alone, both during the pandemic and as restrictions are lifted. Carers of PwD continue to have a critical role to play in medicines management, and also require support.

Respiratory Function and Upper Extremity Functional Activity Performance in People With Dementia: A Shout for Attention

The aim of this study was to explore respiratory function and upper extremity functional activity in people with dementia (PWD) and the associations between these variables and cognitive function (n = 22 institutionalized PWD, 28 community-dwelling PWD, and 26 healthy older people). All measures were significantly lower in PWD who live in an institution, such as a nursing home or long-term care facility or who attend adult daycare than PWD who live in a community dwelling . The values from these two groups were significantly lower than those from healthy older people. Moderate to high negative correlations between upper extremity functional activity and respiratory function (-.73 < rs < -.49) and cognitive function (rs = -.83), and between cognitive function and respiratory function (-.74 < rs < -.58) were identified (p < .001). When adjusted for cognitive function (-.38 < rs < -.29; p < .05), the association between upper limb functional activity and respiratory function decreased. The decline demonstrates the importance of physical activity and cognitive and respiratory function in PWD.

Age Moderates Differences in Performance on the Instrumented Timed Up and Go Test Between People With Dementia and Their Informal Caregivers.

The instrumented Timed Up and Go test (iTUG) affords quantification of the subelements of the Timed Up and Go test to assess fall risk and physical performance. A miniature sensor applied to the back is able to capture accelerations and velocities from which the subelements of the iTUG can be quantified. This study is the first to compare iTUG performance between people with dementia (PWD) and their age-matched caregivers. The aims of this study were to explore how age moderates the differences in performance on the iTUG between PWD and their informal caregivers. Eight-three community-dwelling older PWD and their informal caregivers were recruited for this cross-sectional, observational study. Participants were grouped by age: younger than 70 years, 70 to 79 years, and 80 years and older. Participants wore an inertial sensor while performing the iTUG in their home. The performance of the subelements sit-to-stand, walking, and turning were captured through an algorithm converting accelerations and velocities into performance metrics such as duration and peak velocity. Performance for PWD was compared with caregivers for each age-matched group, and multiple regression models incorporating age, gender, and presence or absence of dementia were computed. People with dementia took longer to turn in the younger than 70-year group, suggesting this may be an early indicator of functional decline in this age group. People with dementia took longer to complete the whole iTUG compared with caregivers in the 70- to 79-year-old group. In the 80+-year-old group, PWD took longer to complete both walking phases, sit-to-stand, and the full iTUG along with displaying slower turning velocity. Multiple regression models illustrated that gender failed to contribute significantly to the model, but age and presence of dementia explained around 30% of the variance of time to complete walking phases, total iTUG, and turning velocity. Differences were evident in performance of the iTUG between PWD and caregivers even after controlling for age. Age moderates the differences observed in performance.

Why do family dementia caregivers reject caregiver support services? Analyzing types of rejection and associated health-impairments in a cluster-randomized controlled intervention trial

BackgroundAlthough there are a number of support services accessible for most family dementia caregivers, many caregivers reject available and affordable support. Previous research suggests that rejections of support services may result from insufficient fit of available services with caregivers’ unmet needs and a lack of acknowledgement of caregivers’ unmet needs and associated support services. The present study investigates (a) the number, proportion and types of caregivers’ rejection on recommended tailored support, (b) socio-demographic and clinical determinants of caregiver’s rejection of both people with dementia (PwD) and caregivers, and (c) caregivers’ health-related variables related to caregivers’ rejection.MethodsCaregivers’ rejection of tailored support services was identified based on a standardized, computerized unmet needs assessment conducted by dementia-specific qualified nurses. The present analysis is based on data of n = 226 dyads of caregivers and their community-dwelling PwD who participated in a general practitioner (GP)-based, cluster-randomized intervention trial. The trial was approved by the Ethical Committee of the Chamber of Physicians of Mecklenburg-Western Pomerania, registry number BB 20/11. Data analyses were conducted using Stata/IC 13.1. We conducted Welch’s t-test, Pearson’s product-moment correlation, and conditional negative binomial regression models with random effects for GP to account for over-dispersed count data.ResultsIn sum, n = 505 unmet needs were identified and the same number of tailored recommendations were identified for n = 171 family dementia caregivers from the intervention group at baseline. For n = 55 family dementia caregivers not a single unmet need and recommendation were identified. A total of 17.6% (n = 89) of the recommendations were rejected by caregivers. Rejection rates of caregivers differed by type of recommendation. Whereas caregivers’ rejection rate on recommendations concerning mental health (3.6%), physical health (2.5%), and social, legal, and financial affairs (0%) were low, caregivers’ rejection rates concerning social integration (especially caregiver supporting groups) was high (71.7%). Thus, the rejections of family dementia caregivers are mainly linked to the delegation to caregiver supporting groups. Caregivers’ rejections were mainly related to personal factors of caregivers (n = 66), service-related factors (n = 6), relational factors (n = 1), and other factors (n = 17).Furthermore, our results showed that the number of caregivers’ rejections was associated with a higher functional status of the PwD and are mainly associated with the rejection of caregiver supporting groups. Thus, caregivers visit supporting groups more often when the PwD shows low abilities in activities of daily living. Importantly, this is independent of the status of cognition and depression of the PwD as well as the physical and mental health of the family dementia caregivers.ConclusionsOur results underline the importance of understanding factors that determine caregivers’ rejection of support services. These need to be specifically addressed in tailored solutions for caregivers’ support services.Trial registrationClinicalTrials.gov Identifier: NCT01401582 (date: July 25, 2011, prospective registered).

89 Randomised Controlled Trial of the Effect of Tai Chi on Postural Balance of People with Dementia

Abstract Introduction We investigated the effect of Tai Chi exercise on postural balance among people with dementia (PWD), and the feasibility of a definitive trial on falls prevention. Method We conducted a randomised controlled trial. Dyads, comprising community-dwelling PWD and their informal carer (N=85), were randomised to usual care (n=43) or usual care plus the intervention (n=42). For the intervention, over 20 weeks, Tai Chi classes were provided weekly and Tai Chi home practice was facilitated by the carer. The primary outcome was the timed up and go test. Secondary outcomes for PWD included functional balance, static balance, fear of falling, cognitive functioning, quality of life, and falls. Secondary outcomes for carers included dynamic balance, static balance, quality of life, and carer burden. Outcomes were assessed six months post-baseline, except for falls, which were collected prospectively over the six-month follow-up period. Results For PWD, there was no significant difference at follow-up on the timed up and go test (mean difference [MD] = 0.82, 95% confidence interval [CI] = -2.17, 3.81, standardised effect size [ES] = 0.14). Among the secondary outcomes, at follow-up, PWD in the Tai Chi group had significantly higher quality of life (MD = 0.051, 95% CI = 0.002, 0.100, ES = 0.51) and a significantly lower rate of falls (rate ratio = 0.35, 95% CI =0.15, 0.81), which was no longer significant when an outlier was removed. Carers in the Tai Chi group at follow-up were significantly worse on the timed up and go test (MD = 1.83, 95% CI = 0.12, 3.53, ES = 0.61). The remaining secondary outcomes were not significant. No serious adverse events were related to participation in Tai Chi. Conclusion With refinement, this Tai Chi intervention has potential to reduce the incidence of falls and improve quality of life among community-dwelling PWD.

Randomised Controlled Trial Of The Effect Of Tai Chi On Postural Balance Of People With Dementia.

PurposeTo investigate the effect of Tai Chi exercise on postural balance among people with dementia (PWD) and the feasibility of a definitive trial on falls prevention.Patients and methodsDyads, comprising community-dwelling PWD and their informal carer (N=85), were randomised to usual care (n=43) or usual care plus weekly Tai Chi classes and home practice for 20 weeks (n=42). The primary outcome was the timed up and go test. All outcomes for PWD and their carers were assessed six months post-baseline, except for falls, which were collected prospectively over the six-month follow-up period.ResultsFor PWD, there was no significant difference at follow-up on the timed up and go test (mean difference [MD] = 0.82, 95% confidence interval [CI] = −2.17, 3.81). At follow-up, PWD in the Tai Chi group had significantly higher quality of life (MD = 0.051, 95% CI = 0.002, 0.100, standardised effect size [ES] = 0.51) and a significantly lower rate of falls (rate ratio = 0.35, 95% CI =0.15, 0.81), which was no longer significant when an outlier was removed. Carers in the Tai Chi group at follow-up were significantly worse on the timed up and go test (MD = 1.83, 95% CI = 0.12, 3.53, ES = 0.61). The remaining secondary outcomes were not significant. No serious adverse events were related to participation in Tai Chi.ConclusionWith refinement, this Tai Chi intervention has potential to reduce the incidence of falls and improve quality of life among community-dwelling PWD [Trial registration: NCT02864056].

Psychosocial Intervention in Couples Coping with Dementia Led by a Psychotherapist and a Social Worker: The DYADEM Trial.

Psychosocial interventions may improve the quality of life of both people with dementia (PWD) and their family caregivers. However, research is inconclusive and focused primarily on the quality of life of either the PWD or the caregiver, rather than on both. Our aim was to evaluate the effect of couple-based interdisciplinary psychosocial intervention in patients with mild-to-moderate dementia on quality of life of both partners. 108 community-dwelling PWD and their caregiving partners were enrolled in this pragmatic randomized controlled trial. The intervention consisted of 7 sessions at participants' homes led by a psychotherapist and a social worker. Quality of life was evaluated at baseline, one, and six-month follow-up for patients and their partners. Mixed effects models have been applied. Intervention allocation was not associated with an improvement in quality of life in either the patients or their partners. In subgroup analyses, intervention was negatively associated with caregiver performance. However, this was only present in those reporting poor relationship quality. Patients in the intervention group who reported good relationship quality were found to have decreased cognitive decline. A couple-based interdisciplinary intervention did not yield improvements in quality of life. This may be the result of a bias caused by an increased awareness due to the intervention. Relationship quality and support in the long-term should be considered when designing and implementing interventions for PWD and their partners.

Factors Influencing Emergency Care by Persons With Dementia: Stakeholder Perceptions and Unmet Needs.

People with dementia (PwD) frequently use emergency care services. To mitigate the disproportionately high rate of emergency care use by PwD, an understanding of contributing factors driving reliance on emergency care services and identification of feasible alternatives are needed. This study aimed to identify clinician, caregiver, and service providers' views and experiences of unmet needs leading to emergency care use among community-dwelling PwD and alternative ways of addressing these needs. Qualitative, employing semistructured interviews with clinicians, informal caregivers, and aging service providers. Wisconsin, United States. Informal caregivers of PwD (n = 4), emergency medicine physicians (n = 4), primary care physicians (n = 5), geriatric healthcare providers (n = 5), aging service providers (n = 6), and community paramedics (n = 3). Demographic characteristics of participants and data from semistructured interviews. Four major themes were identified from interviews: (1) system fragmentation influences emergency care use by PwD, (2) informational, decision-making, and social support needs influence emergency care use by PwD, (3) emergency departments (EDs) are not designed to optimally address PwD and caregiver needs, and (4) options to prevent and address emergency care needs of PwD. Participants identified numerous system and individual-level unmet needs and offered many recommendations to prevent or improve ED use by PwD. These novel findings, aggregating the perspectives of multiple dementia-care stakeholder groups, serve as the first step to developing interventions that prevent the need for emergency care or deliver tailored emergency care services to this vulnerable population through new approaches. J Am Geriatr Soc 67:711-718, 2019.