Letter to Kajiwara et al. ‘Letter in response to “Impacts of a multicomponent intervention programme on neuropsychiatric symptoms in people with dementia and psychological health of caregivers: a feasibility pilot study”’

In China, the ageing population and the prevalence of dementia are projected to escalate significantly by 2050 resulting in a substantial increase in health and economic burden on caregivers, healthcare facilities, healthcare providers and communities. There is no published national dementia policy or strategy in China. This case report describes significant barriers contributing to diagnostic problems and inadequate care of dementia through the case of an older female in rural China, whose condition deteriorated due to neuropsychiatric and functional symptoms of undiagnosed dementia. Intersectoral collaboration between care organisations facilitated delivery of a non-pharmacological intervention programme which was associated with improvements in the patient’s functional and neuropsychiatric symptoms. The case demonstrates that recruitment and training of a wider range of health and care professionals and caregivers in a systematic approach to non-pharmacological interventions could help overcome barriers to the specialised care needs of people with dementia where resources are lacking.

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A multicomponent psychosocial intervention among people with early-stage dementia involving physical exercise, cognitive stimulation therapy, psychoeducation and counselling: Results from a mixed-methods study

Dementia ◽

10.1177/14713012211040683 ◽

2021 ◽

pp. 147130122110406

Author(s):

Sofie S Skov ◽

Maj Britt D Nielsen ◽

Rikke F Krølner ◽

Laila Øksnebjerg ◽

Sigurd M Rønbøl Lauridsen

Keyword(s):

Quality Of Life ◽

Pilot Study ◽

Cognitive Functioning ◽

Early Stage ◽

Psychosocial Interventions ◽

Cognitive Stimulation ◽

Cognitive Stimulation Therapy ◽

Multicomponent Intervention ◽

People With Dementia

Background There is increasing awareness of the benefits of both physical and psychosocial interventions to empower and benefit people with dementia and their caregivers. However, the potential additional benefits of combining physical and psychosocial interventions have only been sparsely explored. The aim of this pilot study was to investigate the acceptability and potential impact of a multicomponent intervention comprising physical exercise, cognitive stimulation therapy (CST), psychoeducation and counselling for people with early-stage dementia. Design A 15-week multicomponent group-based intervention was offered to people with early-stage dementia in Denmark ( N = 44). A mixed-methods design combining interviews, observations, tests of cognitive and physical functioning and an interviewer-assisted questionnaire on quality of life was applied to (1) investigate acceptability of the intervention, including whether people with dementia and their caregivers found the intervention meaningful and (2) to explore and assess changes in participants’ physical and cognitive functioning and quality of life. The study was conducted between June 2018 and August 2019. Results The pilot study demonstrated that the multicomponent intervention was acceptable for people with early-stage dementia and their caregivers. Test results did not show significant changes in measures of participants’ physical and cognitive functioning or quality of life. However, qualitative data revealed that participants perceived the intervention as meaningful and found that it had a positive influence on their physical and social well-being. In addition, interaction and support from peers and staff members was considered important and rewarding. Conclusion This multicomponent intervention constitutes a meaningful and beneficial activity for people with early-stage dementia and their caregivers. It provides an opportunity to engage in social interactions with peers and experience professional support. The study also underlines the importance of providing prolonged and sustainable interventions for people with dementia to maintain personal and social benefits.

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BEHAVIORAL ACTIVATION FOR FAMILY CAREGIVERS OF PEOPLE WITH DEMENTIA: A SYSTEMATIC REVIEW AND META-ANALYSIS

Innovation in Aging ◽

10.1093/geroni/igz038.407 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S109-S109

Author(s):

Xinyi Xu ◽

Rick Kwan ◽

Angela Y M Leung

Keyword(s):

Systematic Review ◽

Physical Health ◽

Family Caregivers ◽

Psychological Health ◽

Behavioral Activation ◽

Positive Impact ◽

Meta Analysis ◽

Neuropsychiatric Symptoms ◽

People With Dementia ◽

Physical And Psychological Health

Abstract Behavioural activation (BA) aims to increase positive response-contingent environmental reinforcement and help caregivers to engage in pleasant and constructive activities, and therefore improve psychological and physical health among family caregivers of people with dementia (PWD). However, knowledge of the effectiveness of BA in this population remains limited. The current study applied a systematic review and meta-analysis in order to determine the effectiveness of BA among family caregivers of PWD. Literature was searched in PubMed, Medline, CINAHL, Cochrane, Embase and PsycINFO published from March 1988 to March 2018. Seven Randomized Control Trials (RCT)s evaluating the effects of BA in family caregivers of PWD were eligible to be included in this review. Cochrane’s guideline was used in order to measure risk of bias and extract data. A random effects model was used to pool the effect size. Family caregivers of PWD receiving BA that only for caregivers demonstrated a statistically significant reduction in depression (n=3; 311 participants; Cohen’d=0.55; 95% CI: 0.30 to 0.81; P<0.001). BA also had a positive impact on interlukin-6, negative affect of caregiving, relationship satisfaction, dysfunctional thoughts and distress related to neuropsychiatric symptoms of PWD for family caregivers. The available evidence suggests that future studies are needed to focus on better ways of administering BA to family caregivers of PWD, to improve their physical and psychological health. Meanwhile, more RCTs to investigate the effects of BA on psychological and physical health for family caregivers of PWD is needed.

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A Multicomponent Home-Based Intervention for Neuropsychiatric Symptoms in People With Dementia and Caregivers’ Burden and Depression: A 6-Month Longitudinal Study

Journal of Geriatric Psychiatry and Neurology ◽

10.1177/08919887211023593 ◽

2021 ◽

pp. 089198872110235

Author(s):

Antonis A. Mougias ◽

Foteini Christidi ◽

Dionysia Kontaxopoulou ◽

Mariyanna Zervou ◽

Dimitra Kostoglou ◽

...

Keyword(s):

Activities Of Daily Living ◽

Daily Living ◽

Neuropsychiatric Symptoms ◽

Cognitive Status ◽

Significant Deterioration ◽

Care Recipients ◽

Multicomponent Intervention ◽

People With Dementia ◽

Home Based ◽

Home Based Intervention

Objectives: Many people with dementia live in their home and require ongoing care, which is often provided by informal family caregivers. Thus, we examined the effectiveness of a multicomponent home-based intervention by evaluating its impact on a) neuropsychiatric symptoms of people with dementia and b) burden and depression of their caregivers. Methods: During the first 6 months of this prospective single-center study, we applied a home-based multicomponent intervention in 205 dyads of care-recipients and caregivers. In further analyzes, we included only dyads of caregivers and care-recipients with available data both at baseline and 6-month follow-up (N = 144). All assessments were conducted at home and included sociodemographic features, care-recipients’ clinical data, cognitive status (Mini-Mental State Examination), activities of daily living (Instrumental Activities of Daily Living; Katz Index of Independence in Activities of Daily Living), neuropsychiatric symptoms (Neuropsychiatric Inventory), and caregivers’ burden (Zarit Burden Inventory) and depression (Center for Epidemiological Studies-Depression). Results: We found significant decreases in the severity (pFDR = 0.002) and associated distress (pFDR = 0.001) of neuropsychiatric symptoms, as well as caregivers’ burden (pFDR = 0.004) and depressive symptoms (pFDR = 0.001). As expected, there was significant deterioration in care-recipients’ cognitive status (pFDR = 0.005) and measures of activities of daily living (pFDR < 0.005). Conclusion: Despite the progressive course of dementia, the home-based multicomponent intervention was effective in decreasing caregivers’ burden and depression and minimizing care-recipients’ neuropsychiatric symptoms’ severity and associated distress after 6 months. Our study highlights the establishment of home-based care units as an advantageous solution, specifically for family members seen to have a “taken-for-granted” role in dementia caring.

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411 - Implementing the STrAtegies for RelaTives (START) intervention in Portugal – preliminary findings

International Psychogeriatrics ◽

10.1017/s1041610220002641 ◽

2020 ◽

Vol 32 (S1) ◽

pp. 127-127

Author(s):

Fatima Urzal ◽

Ana Quintão ◽

Catarina Santos ◽

Nuno Moura ◽

Ana Banazol ◽

...

Keyword(s):

Pilot Study ◽

Coping Strategies ◽

Family Caregivers ◽

Clinical Training ◽

Unmet Needs ◽

Depression Scale ◽

Subjective Impression ◽

Implementation Challenges ◽

People With Dementia ◽

The Uk

IntroductionAs in other countries, Portuguese family caregivers have unmet needs regarding information and distress. START (STrAtegies for RelaTives) is a manual-based coping intervention for families of people with dementia, including coping strategies and stress-management components, by Livingston and colleagues (https://www.ucl.ac.uk/psychiatry/research/mental-health-older-people/projects/start). In the UK, START has been clinically effective, immediately and continuing even after 6-years, without increasing costs. Clinical training and supervision ensures treatment fidelity. In Portugal, these kind of interventions are less available and, when provided, are mostly supportive and fail to address coping strategies. Paradoxically, recruitment may also prove challenging.ObjectivesWe describe the development of the Portuguese translation of START, incorporating guidance from the UK team, and a pilot study of delivery to family caregivers of people with dementia. We will also discuss the challenges of recruiting participants and delivering the intervention.MethodWe translated the START intervention and recruited family caregivers from neurology and psychiatry outpatients, in a central hospital in Lisbon. Our baseline assessment included the Hospital Anxiety and Depression Scale and the Zarit Burden Interview. The pilot is still ongoing at time of submitting, so we focus on recruitment, baseline assessments and process issues.ResultsDuring a three-month period, we recruited six caregivers. Five were primary caregivers (spouses or adult children) who had been caring for their relatives for 2 up to 10 years. Two caregivers met the international cutoff for clinically relevant affective disorder . The most frequent motivators for taking part were learning to communicate with their relatives and increasing knowledge to build community resources. Overall, the subjective impression of the therapist in charge is that the intervention seems acceptable and promising.Discussion/ConclusionsThis pilot study will eventually lead to an improved version of the Portuguese version of the START manual. So far, the intervention seems appropriate for selected caregivers in Portugal. However, response to striking unmet needs, particularly basic home support, may need to precede interventions like START. We look forward to concluding the intervention study and analyzing the implementation challenges, as a basis to inform a wider-scale trial.

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Non-Pharmacologic Interventions for Caregivers of People With Dementia in Latin America: A Review

Innovation in Aging ◽

10.1093/geroni/igaa057.881 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 275-276

Author(s):

Jose Aravena ◽

Jean Gajardo ◽

Laura Gitlin

Keyword(s):

Quality Of Life ◽

Latin America ◽

Depressive Symptoms ◽

Latin American ◽

Randomized Clinical Trials ◽

Social Inequalities ◽

Neuropsychiatric Symptoms ◽

People With Dementia ◽

Person With Dementia

Abstract In a scenario of increasing longevity and social inequalities, Latin-America is an important contributor to the worldwide dementia burden. Caregivers’ health is fundamental to maintain the person with dementia quality of life. However, caregiving is a culturally sensible role that requires tailored solutions. The aim is to synthesize the evidence about non-pharmacologic interventions targeted to caregivers of people with dementia in Latin-American contexts. A comprehensive review of interventions in caregivers and persons with dementia in Latin-American countries was conducted using MEDLINE, Embase, PsycINFO, and Scopus with studies published until January 27th, 2020. Randomized clinical trials of non-pharmacologic interventions targeted to caregivers of people with dementia or dyads where included. Qualitative synthesis of the evidence was presented and analyzed. Overall, 9 pilot RCT were included for the final analysis (6 Brazil, 1 Colombia, 1 Mexico, 1 Perú). The biggest study recruited 69 caregivers and the smallest 13 dyads, with follow-up range of 3-6 months. 5 control groups received at least some other non-standard care type of intervention. 8 were targeted exclusively to caregivers (4 group intervention, 3 individual, and 1 combined) and 1 multicomponent intervention. Most frequent measured outcomes were caregiver’s burden, anxiety, depressive symptoms, and quality of life, and person with dementia neuropsychiatric symptoms. Individual interventions report better results in caregiver parameters such as burden and depressive symptoms and person with dementia neuropsychiatric symptoms. Group interventions presented mixed results. Nevertheless, the quality of evidence was low. There is a critical need to study interventions for caregivers in Latin-American contexts.

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Physical Activity and its Influencing Factors in Community-Dwelling Older Adults With Dementia: A Path Analysis

Clinical Nursing Research ◽

10.1177/10547738211033928 ◽

2021 ◽

pp. 105477382110339

Author(s):

Bei Li ◽

Xiuxiu Huang ◽

Chenchen Meng ◽

Qiaoqin Wan ◽

Yongan Sun

Keyword(s):

Physical Activity ◽

Older Adults ◽

Path Analysis ◽

Neuropsychiatric Symptoms ◽

Community Dwelling ◽

Cross Sectional ◽

People With Dementia ◽

The Status ◽

Path Analysis Approach ◽

Community Dwelling Older Adults

Dementia is prevalent in worldwide, and increases the care burden and potential costs. Physical activity (PA) has been increasingly shown to be beneficial for them. This was a cross-sectional observational study aiming to investigate the status of PA among community-dwelling older adults with dementia in Beijing or Hangzhou, China, and verify the relationships between neuropsychiatric symptoms, activities of daily living (ADL), caregivers’ fear of patients’ falling and their PA using a path analysis approach. The level of PA among 216 included people with dementia was low. PA was related to the neuropsychiatric symptoms, with ADL and caregivers’ fear of patients’ falling have mediation roles. The findings indicated that person-centered strategies related to the management of these symptoms might be helpful to improve ADL, relieve caregivers’ concerns about them falling and consequently foster positive participation in PA.

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Interventions to reduce sickness absence among healthcare workers: a systematic review

International Journal of Emergency Services ◽

10.1108/ijes-05-2018-0028 ◽

2019 ◽

Vol 8 (2) ◽

pp. 147-162

Author(s):

Laura Simmons ◽

Arwel W. Jones ◽

Niro Siriwardena ◽

Christopher Bridle

Keyword(s):

Systematic Review ◽

Influenza Vaccination ◽

Sickness Absence ◽

Healthcare Workers ◽

Healthcare Services ◽

Primary Outcome Measure ◽

Healthcare Sector ◽

Intervention Programme ◽

Content Type ◽

Multicomponent Intervention

Purpose Sickness absence is a major concern for healthcare services and their employees with healthcare workers having higher sickness absence rates compared to the general population. The purpose of this paper is to systematically review randomised control trials (RCTs) that aimed to reduce sickness absence among healthcare workers. Design/methodology/approach A systematic review was conducted that aimed to include RCTs with study participants who were employed in any part of the healthcare sector. This review included any type of intervention with the primary outcome measure being sickness absence. Findings Seven studies were included in the review and consisted of one exercise-only intervention, three multicomponent intervention programmes, two influenza vaccination interventions and one process consultation. Three studies (exercise-only, one multicomponent intervention programme and one influenza vaccination intervention) were able to demonstrate a reduction in sickness absence compared to control. Research limitations/implications Due to the lack of high-quality evidence, this review identified that there are currently no interventions that healthcare organisations are able to use to effectively reduce sickness absence among their employees. This review also highlights the importance of a standardised measure of sickness absence for healthcare staff, such as shifts. Originality/value To the authors’ knowledge, this is the first systematic review to synthesise such evidence among healthcare workers.

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