Suitable e-Health Solutions for Older Adults with Dementia or Mild Cognitive Impairment: Perceptions of Health and Social Care Providers in Quebec City

BACKGROUND Coronavirus disease 2019 has forced worldwide the implementation of unprecedented restrictions to control its rapid spread and mitigate its impact. The Spanish government has enforced social distancing, quarantine and home confinement. This restriction of daily life activities and separation from loved ones may lead to social isolation and loneliness with health-related consequences in community-dwelling older adults with mild cognitive impairment or mild dementia and their caregivers. Additionally, an inadequate access to healthcare and social support services may aggravate chronic conditions. Technology home-based interventions emerge for combating social isolation and loneliness preventing the risk of viral exposure. OBJECTIVE The aim of this cohort study is to explore, analyze and determine the impact of social isolation on: 1) cognition, quality of life, mood, technophilia and perceived stress of community-dwelling older adults with mild cognitive impairment or mild dementia, and on caregiver burden; 2) health and social care services access and utilization, and 3) cognitive, social and entertainment use of ICTs. METHODS This study will be conducted in the Spanish region of Andalucía (Málaga). In total 200 dyads, consisting of a person with mild cognitive impairment or mild dementia (PMCI/MD) and their informal caregiver will be contacted by telephone. Potential respondents will be participants of the SMART 4 MD (N=100) and TV-AssistDem (N=100) clinical trials. RESULTS The change in means in the variables will be analyzed comparing baseline results in the previous studies with those during and after confinement using the ANOVA test of repeated measures or the non-parametric Friedman test if appropriate. The performance of a multivariate analysis of variance (ANCOVA) to introduce possible covariates will also be contemplated. A 95% confidence level will be used. CONCLUSIONS If the hypothesis is proven, these findings will demonstrate the negative impact of social isolation due to the COVID-19 confinement on cognition, quality of life, mood, and perceived stress of community-dwelling older adults with mild cognitive impairment and mild dementia, the impact on technophilia, caregiver burden, and health and social care services access and utilization; and the cognitive, social and entertainment use of ICTs during the COVID-19 confinement and afterwards. CLINICALTRIAL NCT: 04385797

Download Full-text

Dementia and mild cognitive impairment in prisoners aged over 50 years in England and Wales: a mixed-methods study

Health Services and Delivery Research ◽

10.3310/hsdr08270 ◽

2020 ◽

Vol 8 (27) ◽

pp. 1-116

Author(s):

Katrina Forsyth ◽

Leanne Heathcote ◽

Jane Senior ◽

Baber Malik ◽

Rachel Meacock ◽

...

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Service Provision ◽

Prevalence Rate ◽

Social Care ◽

Care Pathway ◽

Prison Population ◽

Care Needs ◽

England And Wales ◽

Health And Social Care

Background People aged ≥ 50 years constitute the fastest-growing group in the prison population of England and Wales. This population has complex health and social care needs. There is currently no national strategy to guide the development of the many-faceted services required for this vulnerable population; therefore, prisons are responding to the issue with a range of local initiatives that are untested and often susceptible to failure if they are not fully embedded in and securely funded as part of commissioned services. Objectives The objectives were to establish the prevalence of dementia and mild cognitive impairment in prisoners in England and Wales and their health and social care needs; validate the six-item cognitive impairment test for routine use in prisons to aid early and consistent identification of older prisoners with possible dementia or mild cognitive impairment; identify gaps in current service provision; understand the first-hand experiences of prisoners living with dementia and mild cognitive impairment; develop a care pathway for prisoners with dementia and mild cognitive impairment; develop dementia and mild cognitive impairment training packages for staff and prisoners; and produce health economic costings for the care pathway and training packages. Design This was a mixed-methods study. Setting The study setting was prisons in England and Wales. Participants Prisoners aged ≥ 50 years and multiagency staff working in prison discipline and health and social care services took part. Results Quantitative research estimated that the prevalence rate of suspected dementia and mild cognitive impairment in the prison population of England and Wales is 8%. This equates to 1090 individuals. Only two people (3%) in our sample had a relevant diagnosis in their health-care notes, suggesting current under-recognition of these conditions. The prevalence rate in prisons was approximately two times higher among individuals aged 60–69 years and four times higher among those aged ≥ 70 years than among those in the same age groups living in the community. The Montreal Cognitive Assessment screening test was found to be more effective than the six-item cognitive impairment test assessment in the older prisoner population. Qualitative research determined that staff and prisoners lacked training in knowledge and awareness of dementia and mild cognitive impairment, and this leads to problematic behaviour being viewed as a disciplinary issue rather than a health issue. Local initiatives to improve the lives of prisoners with dementia and mild cognitive impairment are often disadvantaged by not being part of commissioned services, making them difficult to sustain. Multidisciplinary working is hampered by agencies continuing to work in silos, with inadequate communication across professional boundaries. A step-by-step care pathway for prisoners with dementia and mild cognitive impairment was developed, and two tiers of training materials were produced for staff and prisoners. Limitations Our prevalence rate was based on the results of a standardised assessment tool, rather than on clinical diagnosis by a mental health professional, and therefore it may represent an overestimation. Furthermore, we were unable to distinguish subcategories of dementia. We were also unable to distinguish between a likely diagnosis of dementia and other conditions presenting with mild cognitive impairment, including learning disability, severe depression and hearing impairment. Questionnaires regarding current service provision were collected over an extended period of time, so they do not reflect a ‘snapshot’ of service provision at a particular point. Conclusions We hypothesise that implementing the step-by-step care pathway and the training resources developed in this study will improve the care of older prisoners with dementia and mild cognitive impairment. Future work The care pathway and training materials should be evaluated in situ. Alternatives to prison for those with dementia or mild cognitive impairment should be developed and evaluated. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 27. See the NIHR Journals Library website for further project information.

Download Full-text

Health and social care providers’ perspectives of older people’s drinking: a systematic review and thematic synthesis of qualitative studies

Age and Ageing ◽

10.1093/ageing/afaa005 ◽

2020 ◽

Vol 49 (3) ◽

pp. 453-467 ◽

Cited By ~ 2

Author(s):

Bethany Kate Bareham ◽

Eileen Kaner ◽

Liam Spencer ◽

Barbara Hanratty

Keyword(s):

Older Adults ◽

Alcohol Use ◽

Social Care ◽

Service Providers ◽

Qualitative Studies ◽

Care Providers ◽

Thematic Synthesis ◽

Care Recipients ◽

Health And Social Care ◽

The Impact

Abstract Background alcohol may increase risks to late-life health, due to its impact on conditions or medication. Older adults must weigh up the potential risks of drinking against perceived benefits associated with positive roles of alcohol in their social lives. Health and social care workers are in a key position to support older people’s decisions about their alcohol use. Objective to systematically review and synthesise qualitative studies exploring health and social care providers’ views and experiences of older people’s drinking and its management in care services. Method a pre-specified search strategy was applied to five electronic databases from inception to June 2018. Grey literature, relevant journals, references and citations of included articles were searched. Two independent reviewers sifted and quality-appraised articles. Included study findings were analysed through thematic synthesis. Results 18 unique studies were included. Four themes explained findings: uncertainty about drinking as a legitimate concern in care provision for older people; the impact of preconceptions on work with older adults; sensitivity surrounding alcohol use in later life; and negotiating responsibility for older adults’ alcohol use. Discipline- and country-specific patterns are highlighted. Conclusions reservations about addressing alcohol could mean that service providers do not intervene with older adults. Judgements of whether older care recipients’ drinking warrants intervention are complex. Providers will need support and training to recognise and provide appropriate intervention for drinking amongst older care recipients.

Download Full-text

Frailty and Home Confinement during the COVID-19 Pandemic: Results of a Pre-Post Intervention, Single Arm, Prospective and Longitudinal Pilot Study

Journal of Frailty & Aging ◽

10.14283/jfa.2021.9 ◽

2021 ◽

pp. 1-2

Author(s):

C.P. Launay ◽

L. Cooper-Brown ◽

V. Ivensky ◽

O. Beauchet

Keyword(s):

Older Adults ◽

Social Isolation ◽

Social Care ◽

Assessment Tool ◽

Community Dwelling ◽

Phone Call ◽

Care Providers ◽

Care Plans ◽

Health And Social Care ◽

Community Dwelling Older Adults

The COVID-19 pandemic had severe consequences for older adults. First, COVID-19 was associated with more severe medical complications and an increased mortality rate in older compared to younger adults (1). Second, home confinement, an intervention that reduces the spread of COVID-19, was associated with adverse consequences for the older community-dwelling population (2). It broke down social networks and the continuum of primary care, resulting in medication or food delivery issues, psychological fallout and increasing frailty risks (3). Frailty assessment provides insight into the degree of older community dwellers’ health status vulnerability, social isolation and adverse health event risks, and it should be assessed before interventions are proposed (3). We designed a short assessment tool known as “Evaluation SOcio-GERiatrique” (ESOGER) for Montreal’s homebound community-dwelling older adults (3). In a phone call, ESOGER briefly assessed frailty and social isolation and provided recommendations, facilitating contact with health or social care providers who initiate appropriate health and social care plans (3). This study aims to examine the longitudinal effects of ESOGER on frailty and social isolation in Montreal’s homebound community-dwelling older adults.

Download Full-text

What older adults and their caregivers need for making better health-related decisions at home: a participatory mixed methods protocol

BMJ Open ◽

10.1136/bmjopen-2020-039102 ◽

2020 ◽

Vol 10 (11) ◽

pp. e039102

Author(s):

Claudia Lai ◽

Paul Holyoke ◽

Karine V Plourde ◽

Simon Décary ◽

France Légaré

Keyword(s):

Older Adults ◽

Decision Making ◽

Decision Support ◽

Mixed Methods ◽

Home Care ◽

Social Care ◽

Phase 1 ◽

Care Providers ◽

Health And Social Care ◽

Health Related

IntroductionShared decision making is an interpersonal process whereby healthcare providers collaborate with and support patients in decision-making. Older adults receiving home care need support with decision-making. We will explore what older adults receiving home care and their caregivers need for making better health-related decisions.Methods and analysisThis two-phase sequential exploratory mixed methods study will be conducted in a pan-Canadian healthcare organisation, SE Health. First, we will create a participant advisory group to advise us throughout the research process. In phase 1 (qualitative), we will recruit a convenience sample of 15–30 older adults and caregivers receiving home care to participate in open-ended semi-structured interviews. Phase 1 participants will be invited to share what health-related decisions they face at home and what they need for making better decisions. In phase 2 (quantitative), interdisciplinary health and social care providers will be invited to answer a web-based survey to share their views on the decisional needs of older adults and their caregivers. The survey will include questions informed by findings from qualitative interviews in phase 1, and a workbook for assessing decisional needs based on the Ottawa Decision Support Framework. Finally, qualitative and quantitative results will be triangulated (by methods, investigator, theory and source) to develop a comprehensive understanding of decision-making needs from the perspective of older adults, caregivers and health and social care providers. We will use the quality of mixed methods studies in health services research guidelines and the Checklist for Reporting the Results of Internet E-Surveys checklist.Ethics and disseminationEthics approval was obtained from the research ethics boards at Southlake Regional Health Centre and Université Laval. This study will inform the design of decision support interventions. Further dissemination plans include summary briefs for study participants, tailored reports for home care decision makers and policy makers, and peer-reviewed publications.Trial registration numberNCT04327830.

Download Full-text

Geriatric health in Bangladesh during COVID-19: challenges and recommendations

10.31235/osf.io/x2b8w ◽

2020 ◽

Author(s):

Md Mahbub Hossain ◽

Hoimonty Mazumder ◽

Samia Tasnim ◽

Tasmiah Nuzhath ◽

Abida Sultana

Keyword(s):

Older Adults ◽

Social Care ◽

Systems Approach ◽

The Elderly ◽

Healthcare Services ◽

Access To Healthcare ◽

Care Providers ◽

Mortality And Morbidity ◽

Health And Social Care ◽

Novel Coronavirus

The novel coronavirus disease (COVID-19) is impacting health globally, whereas older adults are highly susceptible and more likely to have adverse health outcomes. In Bangladesh, the elderly population has been increasing over the past few decades, who often live with poor socioeconomic conditions and inadequate access to healthcare services. These disparities are likely to increase amid COVID-19, which may result in high mortality and morbidity among Bangladeshi older adults. We recommend that multifaceted interventions should be adopted for strengthening social care and health systems approach to ensure wellbeing, promote preventive measures, and facilitate access to healthcare among older adults in Bangladesh. Such multipronged measures would require policy-level commitment and collaborative efforts of health and social care providers and institutions to protect health and wellbeing among this vulnerable population during the COVID-19 pandemic.

Download Full-text

Toward Identifying Mild Cognitive Impairment in Hispanic and African American Adults

Perspectives of the ASHA Special Interest Groups ◽

10.1044/persp2.sig2.110 ◽

2017 ◽

Vol 2 (2) ◽

pp. 110-116

Author(s):

Valarie B. Fleming ◽

Joyce L. Harris

Keyword(s):

Older Adults ◽

African American ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Healthcare Access ◽

Communication Disorders ◽

Healthcare Systems ◽

Prevention Education ◽

Education Management ◽

African American Adults

Across the breadth of acquired neurogenic communication disorders, mild cognitive impairment (MCI) may go undetected, underreported, and untreated. In addition to stigma and distrust of healthcare systems, other barriers contribute to decreased identification, healthcare access, and service utilization for Hispanic and African American adults with MCI. Speech-language pathologists (SLPs) have significant roles in prevention, education, management, and support of older adults, the population must susceptible to MCI.

Download Full-text