“Music First”

GeroPsych ◽  
2018 ◽  
Vol 31 (1) ◽  
pp. 17-30 ◽  
Author(s):  
Dane L. Shiltz ◽  
Tara T. Lineweaver ◽  
Tim Brimmer ◽  
Alex C. Cairns ◽  
Danielle S. Halcomb ◽  
...  
Keyword(s):  
Usual Care ◽  
Psychological Symptoms ◽  
Care Facility ◽  
Care Group ◽  
Music Listening ◽  
Term Care ◽  
Antipsychotic Medications ◽  
Risk Of Death ◽  
Extended Care ◽  
Individualized Music

Abstract. Existing research has primarily evaluated music therapy (MT) as a means of reducing the negative affect, behavioral, and/or cognitive symptoms of dementia. Music listening (ML), on the other hand, offers a less-explored, potentially equivalent alternative to MT and may further reduce exposure to potentially harmful psychotropic medications traditionally used to manage negative behavioral and psychological symptoms of dementia (BPSD). This 5-month prospective, naturalistic, interprofessional, single-center extended care facility study compared usual care (45 residents) and usual care combined with at least thrice weekly personalized ML sessions (47 residents) to determine the influence of ML. Agitation decreased for all participants (p < .001), and the ML residents receiving antipsychotic medications at baseline experienced agitation levels similar to both the usual care group and the ML patients who were not prescribed antipsychotics (p < .05 for medication × ML interaction). No significant changes in psychotropic medication exposure occurred. This experimental study supports ML as an adjunct to pharmacological approaches to treating agitation in older adults with dementia living in long-term care facilities. It also highlights the need for additional research focused on how individualized music programs affect doses and frequencies of antipsychotic medications and their associated risk of death and cerebrovascular events in this population.

scholarly journals Feasibility Study of a Digital Screen-Based Calming Device for Managing BPSD During Care

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 755-755
Author(s):  
Gloria Gutman ◽  
Avantika Vashisht ◽  
Taranjot Kaur ◽  
Ryan Churchill ◽  
Amir Moztarzadeh ◽  
...  
Keyword(s):  
Usual Care ◽  
Psychological Symptoms ◽  
Care Home ◽  
Routine Care ◽  
Care Staff ◽  
Successful Implementation ◽  
Term Care ◽  
Item Checklist ◽  
And Control

Abstract MindfulGarden (MG) is a digital device resembling a flat screen TV, with touchless sensors that react to voice and motion. In this study 13 long-term care home residents aged 74-100 exhibiting Behavioural and Psychological Symptoms of Dementia (BPSD) were randomized to treatment and control groups. On days 1-3 the treatment group received usual care plus exposure to MG during morning and evening care - events well documented to be problematic for residents and care staff; controls received usual care only. On day 4 both groups were exposed to MG with verbal cueing. A 26-item checklist was used to record frequency and types of disruptive BPSD exhibited; care duration was recorded in minutes. There was a trend toward reduction of BPSD and duration of care during morning care. Findings suggest that verbal cueing may be important for successful implementation of MG in calming residents with dementia during routine care.

Abstract T P405: Improvement in Midline Shift is Associated with Survival After Decompressive HemiCraniectomy in Large Hemispheric Infarctions

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Joanna I Ramiro ◽  
Rajat Dhar ◽  
Eli Feen ◽  
Abhay Kumar
Keyword(s):  
Hospital Mortality ◽  
Care Facility ◽  
Imaging Data ◽  
Midline Shift ◽  
Term Care ◽  
Nihss Score ◽  
Decompressive Hemicraniectomy ◽  
Long Term Care Facility ◽  
Risk Of Death ◽  
Neuro Imaging

Background and Purpose: It remains uncertain which patients with malignant edema after large hemispheric infarction (LHI) remain at risk of death despite decompressive hemicraniectomy (DHC). We investigated factors associated with in-hospital mortality in a cohort of patients with LHI who underwent DHC. Methodology: This retrospective cohort study conducted over a five-year period identified 24 LHI patients who underwent DHC. Patient demographics, pre- and post-DHC clinical and neuro-imaging data were recorded (including midline shift [MLS] at the level of lateral ventricles). These variables were then analyzed in relation to in-hospital mortality. Results: Patients were predominantly male (17/24), with mean age of 55±15 years and baseline NIHSS score of 18.5± 4. Despite DHC, performed at a median of 52 hours, mortality still occurred in 9 patients (38%), with 11 (46%) going to acute rehabilitation and remainder to long-term care facility (LTC). Patients had a mean pre-operative MLS of 11 ± 3 mm. When compared with a head CT obtained 48 hours after DHC, MLS improved the most in patients going to rehabilitation (by 6 ± 4.2 mm), compared to those going to LTC (3.2 ± 5 mm), while the least improvement was seen in those who died (1 ± 5 mm). Survivors had significant improvement in MLS (5.3 ± 4.4 mm) compared to the non-survivors (1 ± 5 mm), p = 0.04. The survivors were also significantly younger (50 ± 17 years) compared to those who died (62 ± 7 years). Thirteen patients (54% of the cohort) received intracranial pressure (ICP) monitors ipsilateral to the infarct during DHC but measured ICPs were statistically similar in survivors vs non-survivors. Other variables (baseline NIHSS score, MLS and time to surgery) did not predict death in the cohort. Conclusion: Mortality remains high in LHI patients even after DHC. Improvement in MLS after DHC appears to separate survivors from non-survivors while post-DHC ICPs do not. However, our sample size is small and additional studies with larger population sizes are required for validation of our findings.

scholarly journals TOP CITED PAPERS IN INTERNATIONAL PSYCHOGERIATRICS: 4. EFFECTS OF INDIVIDUALIZED VS. CLASSICAL “RELAXATION” MUSIC ON THE FREQUENCY OF AGITATION IN ELDERLY PERSONS WITH ALZHEIMER'S DISEASE AND RELATED DISORDERS

2009 ◽  
Vol 21 (4) ◽  
pp. 667-671 ◽  
Author(s):  
Linda A. Gerdner
Keyword(s):  
Pilot Study ◽  
Staff Development ◽  
Management Strategies ◽  
Care Facility ◽  
Care Recipient ◽  
Clear Understanding ◽  
Elderly Persons ◽  
Music Intervention ◽  
Term Care ◽  
Individualized Music

While working as a staff development coordinator in a long-term care facility during the mid to late 1980s I witnessed agitation in persons with dementia (PWD) and the negative effects that these behaviors had on both the caregiver and the care recipient. Published research findings validated the widespread prevalence of this problem. Management strategies at the time focused primarily on chemical and physical restraints which, in and of themselves, were fraught with adverse effects. Shortly thereafter I enrolled in graduate school where I focused my efforts on exploring this problem with a clear understanding that there was a need for alternative interventions that were relatively inexpensive and could be readily and easily implemented by trained staff. These efforts eventually led to the development of individualized music as an intervention for the management of agitation in PWD. Individualized music is defined as music that has been integrated into the person's life and is based on personal preference (Gerdner, 1992). Extensive clinical experience along with findings from a pilot study (Gerdner, 1992) served as the foundation for the development of intervention guidelines (Gerdner, 1996) and a mid-range theory of individualized music intervention for agitation (IMIA) (Gerdner, 1997). The publication of the original pilot study (Gerdner and Swanson, 1993) generated a considerable amount of interest resulting in further efforts toward testing the effects of individualized music for the management of agitation in PWD (Casby and Holm, 1994; Cohen-Mansfield and Werner, 1997; Devereaux, 1997; Thomas et al., 1997; Clark et al., 1998). The strengths and limitations of these studies were used to design a more rigorous methodology using a larger sample for the purpose of testing the propositions of IMIA and the effects of individualized music when compared to classical “relaxation” music on the frequency of agitation in PWD. The findings of this study were published in International Psychogeriatrics (Gerdner, 2000). As of January 2009, this article has been cited in 91 scholarly publications and was the impetus for additional studies conducted in the U.S.A., Sweden, Japan and Taiwan. These efforts have resulted in an expanding body of research to support the use of this intervention for the management of agitation (Ragneskog et al., 2001; Janelli et al., 2002; Suzuki et al. 2004; Sung et al., 2006; 2008; Park, 2008).

scholarly journals PECULIARITIES OF CLINICAL MANAGEMENT OF ASTHMA DURING CORONAVIRUS DISEASE (COVID-19) PANDEMIC

2021 ◽  
Vol 29 (4) ◽  
pp. 44-47
Author(s):  
L. I. Konopkina
Keyword(s):  
Usual Care ◽  
Clinical Management ◽  
Care Group ◽  
Care Utilization ◽  
Risk Of Death ◽  
Systemic Corticosteroids ◽  
Long Term Treatment ◽  
Inhaled Budesonide

PECULIARITIES OF CLINICAL MANAGEMENT OF ASTHMA DURING CORONAVIRUS DISEASE (COVID-19) PANDEMIC L. I. Konopkina Abstract The review is dedicated to the problem of interrelations between asthma (A), COVID-19 and inhaled corticosteroid (ICS) therapy. According to Global Initiative for Asthma (GINA) long-term treatment with systemic corticosteroids may lead to significant immunosuppression. Potentially, this is associated with higher risk of incidence and severity of viral infections. That was the reason why WHO in the beginning of 2020 had not granted recommendation for using systemic corticosteroids in COVID-19 patients if not indicated for other causes (including A and COPD exacerbations, usually requiring short course of oral corticosteroids). In Spring 2021 GINA renewed its recommendations on COVID-19 in A patients considering the grade of A symptoms control. It was demonstrated that patients with well-controlled A (mild to moderate) were neither at higher risk of COVID-19 occurrence nor of its more severe course. The risk of death from COVID-19 was also not increased in patients with well-controlled A. Moreover, in A patients 50 years of age and older, regularly taking ICS and admitted to hospital due to COVID-19, the mortality rate was lower than in other hospitalized patients. Today, it is important to debate whether ICS may interfere with the possibility of getting infected by coronavirus. It is well known that budesonide is one of most often prescribed ICS molecule. Budesonide in vitro has demonstrated a potential antiviral effect against different types of SARS-CoV-2. There are several ongoing studies in vivo: NCT04416399 (Great Britain; completed), NCT04355637 (Spain), NCT04193878, NCT04377711 (USA), NCT04331470 (Iran), NCT04330 (South Korea). The results of STOIC study, organized and conducted by Oxford university scientists, are of special interest. It was demonstrated that outpatient use of budesonide in COVID-19 patients reduced the risk of hospitalization and emergency care utilization by 90 %. There was a statistically significant reduction in symptoms intensity and time to clinical cure. Interim results of PRINCIPLE study suggested that early treatment with inhaled budesonide shortetens recovery time by a median of three days (comparing with usual care). In Budesonide Turbohaler group 32 % patients reached sustain recovery within 14 days of randomization (comparing with 22 % of patients in usual care group). Conclusion. Despite interim character of presented clinical trials data in this review, use of inhaled budesonide in COVID-19 patients, from our point of view, may be considered in particular clinical cases after a obligatory discussion with the patient.

The Effects of Individualized Music Listening on Affective, Behavioral, Cognitive, and Sundowning Symptoms of Dementia in Long-Term Care Residents

2021 ◽  
pp. 089826432110334
Author(s):  
Tara T. Lineweaver ◽  
Tonya R. Bergeson ◽  
Kendall Ladd ◽  
Heather Johnson ◽  
Donald Braid ◽  
...  
Keyword(s):  
Nursing Home ◽  
Neuropsychiatric Symptoms ◽  
Nursing Home Residents ◽  
Standardized Assessments ◽  
Music Listening ◽  
Term Care ◽  
Positive Effects ◽  
Direct Observations ◽  
New Applications ◽  
Individualized Music

Objectives This study aimed to replicate music’s positive effects on dementia-related symptoms, determine whether a 6-month intervention would lead to greater positive outcomes than typical 3- to 4-month interventions, and examine changes in sundowning symptoms after music listening. Methods 282 nursing home residents with dementia listened to personalized music playlists 1–3 times weekly for 30 minutes across 6 months. Standardized assessments of affect, behavior, and cognition and direct observations of sundowning symptoms comprised the outcomes. Results Results documented significant improvements in residents’ general neuropsychiatric symptoms, agitation, and depression across the first 3 months, but no additional improvements across the subsequent 3 months. Seven sundowning symptoms significantly improved following music listening, with some (e.g., disengagement) being more amenable to music than others (e.g., aggression). Discussion Results support short-term individualized music listening as an effective non-pharmacological approach for improving dementia-related symptoms in nursing home residents and suggest new applications of music-related interventions.

scholarly journals An Outbreak of COVID-19 among mRNA-Vaccinated Nursing Home Residents

Vaccines ◽  
2021 ◽  
Vol 9 (8) ◽  
pp. 859
Author(s):  
Fabrizio Faggiano ◽  
Maicol Andrea Rossi ◽  
Tiziana Cena ◽  
Fulvia Milano ◽  
Antonella Barale ◽  
...  
Keyword(s):  
Healthcare Workers ◽  
Long Term Care ◽  
Nursing Home Residents ◽  
Care Facility ◽  
Risk Of Infection ◽  
Term Care ◽  
Long Term Care Facility ◽  
Risk Of Death ◽  
The North

An outbreak was described among the guests of a Long-Term Care Facility in the North of Italy. Among 23 guests, 20 of whom were fully vaccinated with BNT162b2 vaccine, the outbreak led to a final count of 11 positive guests, 9 of whom were vaccinated, and 4 positive healthcare workers, of whom only 1 was vaccinated. Eight of the positive guests (six vaccinated and two unvaccinated) had symptoms that in five cases (three vaccinated and two unvaccinated) led to death. The risk of infection and the risk of death appeared not to be correlated with the health status neither with the serological titer, but only with age.

scholarly journals Benefits of Computer Engagement in Older Adults with Dementia

2021 ◽  
Vol 7 ◽  
pp. 233372142199299
Author(s):  
Scott W. Sautter ◽  
Anna S. Ord ◽  
Aisha Azher ◽  
Amy Chidester ◽  
Paul F. Aravich
Keyword(s):  
Older Adults ◽  
Technology Use ◽  
Challenging Behaviors ◽  
Care Facility ◽  
Well Being ◽  
Advanced Dementia ◽  
Term Care ◽  
Antipsychotic Medications ◽  
Mild Dementia ◽  
Professional Caregiver

Objectives: Two pilot studies aimed to determine the effects of individual computer engagement on behavioral health outcomes in individuals with dementia. The focus was on participants’ mental health, challenging behaviors, antipsychotic medications, and professional caregiver stress. Methods: Two pilot randomized control trials were conducted. First trial involved residents with advanced dementia in a long-term care facility. The second trial involved residents with mild dementia in an assisted living setting. The participants in the experimental group in both studies were provided with guided iN2L computer engagement followed by unrestricted use. Results: Statistically reliable improvements were found in both studies for participants’ emotional well-being and professional caregiver stress. Reliable improvements in cognition and depression were found in the mild dementia study, but not in the advanced dementia study. No statistically reliable changes were observed for antipsychotic medications or challenging behaviors. Discussion: Computer engagement was associated with improvements in participants’ emotional well-being and with a reduction in professional caregiver stress. Results should be interpreted with caution in the context of high attrition. Future studies may build upon these pilot findings and examine effects of technology use on mood and cognition in larger samples of older adults across a wider range of outcome measures.

scholarly journals 1824. Herpes Simplex Encephalitis: Outcomes from a 10-Year Retrospective Single-Center Case Series

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S39-S40
Author(s):  
Christina A Snider ◽  
Jona Banzon ◽  
Adarsh Bhimraj ◽  
Gary W Procop ◽  
Johanna Goldfarb
Keyword(s):  
Overall Survival ◽  
Herpes Simplex ◽  
Cleveland Clinic ◽  
Case Series ◽  
Care Facility ◽  
The United States ◽  
Initial Symptom ◽  
Term Care ◽  
Risk Of Death

Abstract Background Herpes simplex virus (HSV) is the most common cause of infectious encephalitis in the United States. While early treatment with acyclovir has improved acute management, long-term morbidity and mortality remain high and warrant further characterization. Methods We retrospectively identified adult patients (≥18 years) with HSE admitted to the Cleveland Clinic Main Campus and affiliated regional hospitals from April 2006 to June 2016. HSE diagnosis was concordant with Infectious Disease Society of America Encephalitis Guidelines. HSE diagnosis was confirmed in that HSV-1 DNA was detected in cerebrospinal fluid (CSF) by polymerase chain reaction (PCR) assay for all patients included in this study. Patients for which HSV-2 was detected in the CSF were excluded to avoid inclusion of HSV meningitis. Clinical information was collected in a REDCap database and analyzed by descriptive statistics. Patients were indexed at the date of admission, and Kaplan–Meier analysis was used to estimate overall survival. Results We identified 32 patients with confirmed HSE. The median patient age was 62 years (interquartile range [IQR] 45–72). All patients received treatment with intravenous (IV) acyclovir, with a median treatment duration of 24 days (IQR 19–30). The median time from initial symptom onset to IV acyclovir treatment was 5 days (IQR 3–8). Three patients (9%) died during the hospitalization course, 16 (50%) were discharged to a nursing facility, 11 (35%) returned home, and two (6%) transitioned to an acute care facility (Figure 1). Within three months of discharge, 15 (47%) patients were readmitted, six (19%) of which readmitted for HSE relapse. The overall survival rate at one month was 84% and 74% at 12 months (Figure 2). At outpatient follow-up, cognitive deficits were self-reported by 19 (66%) patients, followed in frequency by motor (31%) and sensory deficits (7%). Conclusion Despite appropriate treatment with IV acyclovir, HSE survivors frequently experienced severe morbidities after initial hospitalization, including HSE relapse, discharge to long-term care facilities, and neurocognitive impairment. Risk of death was highest within one month of admission. Further investigation is needed to optimize treatment of HSE to improve mortality and to reduce permanent neurologic deficits. Disclosures All Authors: No reported Disclosures.

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