Author: wythenshawe

Investigating what works to support family carers of people with dementia: a rapid realist review. (J Public Health. 2016 Sep 27)

Advances in longevity and medicine mean that many more people in the UK survive life-threatening diseases but are instead susceptible to life-limiting diseases such as dementia. Within the next 10 years those affected by dementia in the UK is set to rise to over 1 million, making reliance on family care of people with dementia (PWD) essential. A central challenge is how to improve family carer support to offset the demands made by dementia care which can jeopardise carers’ own health. This review investigates ‘what works to support family carers of PWD’.

‘Resilience-building’ is central to ‘what works to support family carers of PWD’. The resulting model and Programme Theories respond to the burgeoning need for a coherent approach to carer support.

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Measuring Ambivalent Feelings in Dementia Family Caregivers: The Caregiving Ambivalence Scale. (The Gerontologist, 2016, Sept 7th)

Ambivalence has been described as simultaneous positive and negative emotional experiences. Although ambivalent feelings are often reported by dementia family caregivers, the effect of these feelings on caregivers’ mental health has not been studied. Furthermore, the measurement of ambivalence specific to caregiving situations has not been studied.
Ambivalent feeling scores significantly contributed to the explanation of caregivers’ depressive and anxious symptoms after controlling for sociodemographic and stressor variables. The CAS shows good psychometric properties that recommend its use as a measure of ambivalent feelings in caregivers and appears to be a relevant variable for understanding caregivers’ mental health.

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Effects of support groups for individuals with early-stage dementia and mild cognitive impairment: an integrative review. (Res Gerontol Nurs. 2016 vol 23, p.1-17)

Support groups have demonstrated promising outcomes for individuals with mild cognitive impairment (MCI) and early-stage dementia (ESD) in previous literature reviews. However, evidence has not been updated since 2007. The current review aimed to update current evidence on the use and effects of support groups for individuals with MCI and ESD and their care partners. Support groups showed positive impacts on participant acceptance of cognitive impairment; performance and satisfaction of meaningful activity; resilience; self-help; and care partner coping self-efficacy, perceived support, and preparation and task effectiveness. Findings also revealed that support groups were well accepted by participants and care partners.

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Development of an activities care crew to support patients. (Nurs Older People. 2016, 28(8) p. 20-25)

Improving care for people with dementia in acute hospitals is a priority in the UK. The Royal Berkshire Hospital in Reading has implemented a range of initiatives, including environmental changes to older people’s care wards, development of workforce skills and knowledge, engagement with third sector providers, use of volunteers, and the development of an activities care crew. This article focuses on the work of the activities care crew. The care crew formation, using monies from vacant posts, has supported the provision of one-to-one nursing and engagement of patients in meaningful activities. Overall, the initiatives have reduced the number of falls with serious harm, improved the experience of people with dementia and their families, and supported partnership working with patients, families and multidisciplinary teams.

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The development of a Home-based and Computerized Cognitive Stimulation Therapy for people living with Dementia: Preliminary results. (Journal of Alzheimer’s Disease, 2016, 53(S24))

This study aimed to develop a Home-based and Computerized version of CST to be performed by the Person With Dementia (PWD) with the support of the caregiver. Materials: The group CST protocol (14 structured sessions) was adapted for the computerized administration, respecting the CST guiding principles, and then implemented on a Tablet. A manual of instructions and toolkit (e.g. lyrics book, map of Italy) were provided with the Tablet. A group of Person with Dementia and caregivers took part to this pilot study. Methods: All the fourteen sessions are usable through a Tablet, with Android v. 4.4 as operating system, and define an Android application (shortly APP), developed in JAVA. Each session is introduced by a video where an operator speaks about the daily activities, followed by Welcome, Karaoke, Reality Orientation and News, the main activity of the day and the concluding part. Neuropsychological assessment was carried out before and after treatment. Results: The platform is user-friendly and satisfactory for the PWD and caregiver. After treatment, PWD had significant increase of performance in some ADAS-COGS subscales (word recall, commands, orientation), functional abilities (DAD total and execution), and caregiver reported a higher sense of competence. Conclusions: The home-based and computerized CST application is a complete and suitable platform for PWD. Discussion: The developed computerized version of CST seems to be a promising tool in offering CST at home to PWD including the caregiver.

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Training programmes for family caregivers of people with dementia living at home: integrative review. (Journal of clinical nursing, Oct 2016, 25(19-20), p 2757-2767)

To establish primary features of training programmes designed to assist family caregivers of people with dementia living at home and to propose a model programme based on literature findings. Due to dementia’s distinctive progression, there is a widely felt need to train family members who undertake the responsibility of caring for relatives diagnosed with this condition to provide positive care, particularly during the early and middle stages of the disease.
This review has identified a set of features transversal to training programmes for family members who undertake the care for individuals with dementia living at home, which will bolster the construction and validation of other programmes in the area. More studies about such programmes need to be implemented, particularly engaged in their conceptual and experimental validation. The results of this review assist nurses by increasing their awareness of the basic assumptions supporting training programmes for family members responsible for individuals with dementia living at home and subsequently enforce them during their interventions with such population.

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Factors influencing the person-carer relationship in people with anxiety and dementia. (Aging & mental health, 2016, 20(10) p. 1055-1062)

The relationship between people with dementia and their carers is complex and has a significant impact on the dementia experience. The aim of this current study was to determine (1) which factors are associated with the quality of the patient-carer relationship and (2) whether these differ between the two perspectives. . People with dementia generally rated the quality of relationship higher, irrespective of level of dementia, depression or anxiety. This study is novel in that it provides a valuable insight into the impact of mental health on relationship quality for both members of the dyad. The findings emphasise the importance of providing interventions which target mood for both parties, and behavioural problems for people with dementia.

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Cognitive Stimulation Therapy (CST) for dementia. (Journal of Alzheimer’s Disease, 2016, 53(S14))

CST is a brief, evidence-based intervention for people with mild to moderate dementia. Complex psychological techniques are embedded within simple, manualised group sessions which aim to stimulate and maximise cognitive skills. These include categorisation, word association and discussion of current affairs, all following guiding principles which encourage the making of new semantic connections to aid learning. More recently, an individualised, carer-led CST programme has been developed and evaluated. This talk will provide an overview of the CST research programme and key findings from three clinical trials. This includes standard CST, longer-term CST and individualised CST (iCST). In summary, changes following group CST may be comparable to those associated with anti-dementia drugs and it is cost-effective. Memory, executive functioning and language were significantly improved, and significant benefits in quality of life were maintained for six months. Individualised CST led to significant improvements in one’s relationship with their caregivers, although cognition did not improve – suggesting the importance of delivery within a group format. The CST research programme has led to changes in service provision in the UK. Government guidelines now recommend routine provision of Cognitive Stimulation, regardless of medication use and as the only non-pharmacological intervention for the cognitive symptoms of dementia. CST provision is now a key standard for memory service accreditation and used in over 66% of UK memory clinics. The World Alzheimer’s Report recommends routine provision of CST in early stage dementia, resulting in its use globally.

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Effect of animal-assisted activity on balance and quality of life in home-dwelling persons with dementia. (Geriatr Nurs. 2016 37(4) p.284-91)

Purpose of the study was to examine if animal-assisted activity with a dog (AAA) in home-dwelling persons with dementia (PWDs) attending day-care centers would have an effect on factors related to risk of fall accidents, with balance (Berg balance scale) and quality of life (Quality of Life in Late-stage Dementia) as main outcome. The intervention consisted of 30 min sessions with AAA led by a qualified dog handler twice a week for 12 weeks in groups of 3-7 participants. The significant positive effect on balance indicates that AAA might work as a multifactorial intervention in dementia care and have useful clinical implication by affecting risk of fall.

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