Assessment of the Risk of Depression in Residents Staying at Long-Term Care Institutions in Poland During the COVID-19 Pandemic Depending on the Quality of Cognitive Functioning

Background: The development of the COVID-19 pandemic has prompted the implementation of many procedures to safeguard against further increases in illness. Unfortunately, this has drastically reduced residents’ contact with their families, which has increased feelings of loneliness and isolation. This is particularly difficult in long-term care facilities, where the risk of developing depression is higher than in the general population.Objectives: The aim of the study was to assess the risk of depression among the residents of long-term care institutions in Poland during the COVID-19 pandemic and to determine the relationship between the risk of depression and the occurrence of cognitive impairment in the study group.Methods: The study included 273 residents from long-term care institutions in Poland. The risk of depression was determined based on an originally designed questionnaire. The cognitive state of the subjects was assessed using the screening test Mini-Mental State Examination (MMSE). Both the depression risk assessment and the MMSE test were conducted twice: in March and December 2020.Results: In March, severe dementia was present in 28.2% of the residents and normal MMSE scores were observed in 16.1% of the subjects; in December, the prevalence of severe dementia increased to 31.1% and that of normal scores decreased to 10.3%. In March, no participant was found to be at high risk of depression and moderate risk was observed in 14.3% of the subjects; in December, 2.6% of the residents had a high risk score and 45.4% had a moderate risk score. Statistical analysis revealed that higher MMSE scores correspond with a higher risk of depression.Conclusion: A higher risk of depression was observed with the development of the pandemic. Residents with cognitive impairment were characterised by a lower risk of depression compared to individuals with normal MMSE scores. During the study, progression of cognitive impairment was observed in the residents.

Treatment of noncognitive neuropsychiatric disorders in Alzheimer's disease

Alzheimer's disease (AD) is the most common neurodegenerative disease, which is caused by cerebral amyloidosis. Noncognitive neuropsychiatric disorders (NСNPDs) include emotional, behavioral disorders, as well as psychotic symptoms. NСNPDs are almost an obligatory manifestation of this disease, accompany cognitive impairment and are detected at all stages of the disease – from preclinical to the severe dementia stage. As an example, we present a case report of a female patient with mild dementia in AD in whom Akatinol memantine administration resulted in the stabilization of a cognitive defect within one year and a decrease in the severity of emotional and behavioral disorders. The article discusses the indications and contraindications for antipsychotic administration in this disease, NСNPDs treatment in AD, which includes nonpharmacological and pharmacological methods. Accurate analysis of NСNPDs allows to predict the disease course, optimize the treatment, and thereby improve the quality of life of the patient and his relatives and caregivers.

Engaging Direct Care Providers in the Implementation of Montessori Programming for Dementia

There is a need to engage direct care providers such as certified nursing assistants (CNAs) explicitly in efforts to implement innovative programming in long-term care environments. This presentation will outline engagement strategies that supported the implementation of Montessori programming in a community of 20 individuals living with severe dementia. Examples about positioning the CNA at the center of decision making, negotiating and building trust, cultivating opportunities for mutual consultation, creating spaces for new ideas to emerge, and synthesizing diverse perspectives will be highlighted. Although the program achieved positive outcomes on a number of measures including decreased responsive behaviors from people living with dementia, decreased negative qualities of relationships between CNAs and persons with dementia, and increased positive qualities of relationships between CNAs and persons with dementia, this presentation will focus on the “how” of engagement between the project team and the CNAs by highlighting qualitative data.

Hip Accelerometry Activity Patterns Improve Machine Learning Prediction of 1-Year MoCA Score Change

We tested whether free-living hip accelerometry measures improved prediction of 1-year change in Montreal Cognitive Assessment (MoCA) scores beyond clinically available information. We analyzed data (n=126) from predominantly African American (78.2%) older adults without moderate-severe dementia residing near our geriatrics clinic. Age (73.6 ±6.1 years), gender, education, comorbidities, income, and MoCA performance were collected at baseline; participants then wore a right hip, triaxial Actigraph accelerometer (30Hz) continuously for 7 days. A MoCA was repeated at 1 year. Six measures were calculated from the daytime (7am-5pm) data: mean/variance of hourly counts per minute, mean/variance of daily percent of time spent in the lowest activity quartile, and mean/variance of daily percent of time spent in the highest activity quartile. In a random forest model containing baseline MoCA, demographics and comorbidities, the accelerometry measures improved prediction of 1-year MoCA performance by ~17.8%. Accelerometry data may be clinically useful for predicting early cognitive decline.

Adapting Montessori Programming for Aging and Dementia With Implementation Strategies

There is a need to translate research findings to support the wider adoption of person-centered care into typical long-term care environments across the world. Montessori for Aging and Dementia is one mechanism to support person-centeredness, dignity and autonomy of older adults living in long-term care environments. In this presentation, strategies used to support the implementation of Montessori for Aging and Dementia in a long-term care community of 20 people living with severe dementia will be highlighted. Implementation support was provided through capturing and sharing local knowledge, ongoing training and consultation, and tailoring communication supports. Through the use of these iterative strategies, the program was successfully adapted to include people living with severe dementia. While key findings of the project included improvements on a variety of observational and staff administered measures, the focus of this presentation will be on the relationships between the Montessori program’s fidelity, local needs and implementation strategies.

Gait, physical function, and physical activity in three groups of home-dwelling older adults with different severity of cognitive impairment – a cross-sectional study

Background The research on associations between gait, physical function, physical activity (PA), and cognitive function is growing. Still, clinical assessments of cognitive function and motor function is often kept separate. In this study, we aimed to look at a broad range of measures of gait, physical function, and PA in three groups of home-dwelling older adults with no or questionable dementia, mild dementia, and moderate/severe dementia. Methods This cross-sectional study included 100 home-dwelling older adults, recruited from an outpatient geriatric memory clinic. Severity of dementia was categorised using the clinical dementia rating scale (CDR), with no or questionable dementia (CDR score 0 and 0.5), mild dementia (CDR score 1) and moderate/severe dementia (CDR score 2 and 3). We used thigh worn accelerometers to measure daily PA, the Short Physical Performance Battery (SPPB) to measure physical function, and an electronic gait mat to evaluate gait characteristics. Associations between severity of dementia and measures of PA, physical function, and gait characteristics were assessed by linear regression. Results Participants’ (mean age 78.9 (SD 6.7) years, 57% women) average gait speed was 0.93 m/sec, and average upright time was 301 min/day. Statistically significant associations were found for the severity of dementia and gait speed (p=0.002), step time (p=0.001), physical function (SPPB, p=0.007), and PA (upright time, p=0.031), after adjusting for age. Overall, having no or questionable dementia was associated with faster gait speed (mean difference 0.163 (95% CI: 0.053 to 0.273)), shorter step time (-0.043 (-0.082 to -0.005)), better SPPB score (1.7 (0.5 to 2.8)), and longer upright time (78.9 (18.9 to 139.0)), compared to those with mild dementia. Furthermore, having no or questionable dementia was also associated with faster gait speed and better SPPB scores, as compared to those with moderate to severe dementia. No evidence of any differences was found between the participants with the mild dementia versus the moderate to severe dementia. Conclusions After adjusting for age, we found that the no or questionable dementia group to be associated with better gait and physical function, and more PA, as compared with the two groups with mild or moderate/severe dementia. Evaluation of gait, physical function, and PA can add clinically important information of everyday functioning in memory clinics meeting geriatric patients, but investigations on how to use these results to guide interventions are still needed.

Dementia Care: Addressing Pain and Maximizing Comfort

Pain is common in older people who have Dementia, and is associated with a number of chronic and acute conditions. There is evidence that as many as 83% of nursing home residents experience pain that often goes unrecognized or inappropriately treated. Pain has a powerful effect on mood, sleep quality, functional ability, and overall quality of life. Rejecting care due to pain is very common among patients with Dementia. An association between pain and increased agitation has been noted, Significant reduction of agitation and psychotropic usage have been demonstrated by pain treatment in patients with moderate to severe dementia. This project was conducted in six memory care units with 150 residents at 815 bedded long-term geriatric care facility. All residents in memory care units from May 2018 to December 2019 were individually assessed for pain management, rejection of care, usage of psychotropics, falls and physical altercations. Trained interdisciplinary staff to evaluate pain by using PAIN AD. Educated interdisciplinary team on pharmacological and non-pharmacological pain management, and Pain management has improved from 40% to 90%, Rejection of care reduced from 80% to 30%. Usage of antipsychotics reduced by 12%. Falls reduced from 12% to 2%. Physical altercations reduced to zero. Staff call out due to work related injury significantly reduced. Staff verbalized improved job satisfaction and increased morale.

Whose Decision Is It? Perspectives on Agency Involvement in Determining Paid Caregivers' Roles in Dementia Care

Individuals living at home with dementia often rely on a team of caregivers and health care providers. Yet little is known about how the role of paid caregivers within this team is determined. We identified patients with moderate to severe dementia (n=9) and conducted individual interviews with their care teams (family caregiver, paid caregiver, physician) (n=27) to explore perspectives on paid caregiver roles. Participants disagreed on who determined the paid caregiver’s role. Agencies were perceived to set limitations on the scope of care (particularly by physicians) but agency care plans were often seen as inadequate and failing to capture important nuances of care. Most family caregivers believed they should guide what paid caregivers did in the home, while most paid caregivers reported relying on their own experience and knowledge. Understanding and addressing these differing perceptions is critical to improving the quality of paid care in the home.

ABOUT DEMENTIA

Dementia is a general term used to describe a loss of memory that keeps getting worse - or is 'progressive'. There can be many different causes, they will all involve loss of memory, but they have other symptoms which are different according to the cause. Dementia often starts off with just memory problems, but can also involve: difficulty planning and carrying out day-to-day tasks, difficulty communicating and changes in mood, judgement or personality. Aim of this article is to identify spread of dementia in 200 patients who have not been diagnosed before . Research was done in ONCO center of Adjara during 2014-2015 , involved 200 patients , female-130 , male-70, . For diagnosis of dementia we studied anamnesis, physical data, psychic and cognitive development of patient, family members were questioned often because of the difficulties patients had to explain symptoms they experienced. All patients had CT scan and evaluated bey Vavilov Method. Arterial Hypertension ,Discirculatory encephalopathy -171, Cancer-5 , Parkinson disease-10 , endocrine disorders-14 , family history of dementia -3 were noted in patients . From 200 patient examined 170 were diagnosed with dementia , Light dementia(10%). experienced memory deterioration Average quality dementia (55%) , During severe dementia (35%). Some risk factors for dementia, such as genetics and age . Cannot be changed. but researchers continue to explore the impact of other risk factors on brain health and prevention of dementia.