Aging & Mental Health

Sella, Enrico; Toffalini, Enrico; Canini, Luca; Borella, Erika

doi: 10.1080/13607863.2022.2056879pmid: 35352595

Abstract Objectives This review aimed to examine the available evidence about non-pharmacological interventions (NPIs) aimed at improving sleep quality in older adults without insomnia or dementia. Methods: Studies on NPIs targeting older adults’ sleep were searched in the PsycInfo, PubMed and Scopus databases, with no restriction on publication year up to September 2021. Studies on NPIs for older adults with no diagnosed sleep disorders were included, while those on pharmacological therapies and/or concerning pathological samples were excluded. The risk of bias was assessed using tools based on Joanna Briggs’ criteria. The data extracted were meta-analyzed using random effects models for subgroups of NPIs. Results: Of the 1,893 records identified, 31 studies on NPIs (N = 2,224; range of mean ages: 60-78 years) were analyzed. All NPIs improved self-reported sleep quality, albeit to a different extent (physical activity: d=.97 − 95% CI=.62, 1.32-; psychological/psychoeducational, or NPIs that combined more than one sleep-targeting activity: d range: .21 to .97). Only the NPIs based on physical activity improved objectively-measured sleep, d=.31 (.04, .57). The methodological quality of most studies was limited. Conclusion: The most often used NPIs targeting sleep rely on physical activity and sensory stimulation with promising results on sleep quality for the former. More data are needed on psychological/psychoeducational NPIs and combined interventions in order to test their effectiveness. The methodological weaknesses of the available studies suggest they their findings should be interpreted with caution. Supplemental data for this article is available online at http://dx.doi.org/10.1080/13607863.2022.2056879

Linden, Iris; Hevink, Maud; Wolfs, Claire; Perry, Marieke; Dirksen, Carmen; Ponds, Rudolf

doi: 10.1080/13607863.2022.2084505pmid: 35763442

Abstract Objective To explore the preferences of people with memory complaints (PwMC) and their significant others regarding starting a diagnostic trajectory for dementia. Methods A systematic literature search was conducted in PubMed, PsycINFO, CINAHL, Web of Science, and Embase. Selection of abstracts and papers was performed independently by two researchers. Methodological quality was assessed with the Mixed Method Appraisal Tool. Result sections of the selected papers were thematically synthesized. Results From 2497 citations, seven qualitative studies and two mixed methods studies published between 2010 and 2020 were included. Overall quality of the studies was high to moderate. A thematic synthesis showed that preferences for starting a diagnostic trajectory arose from the feeling of needing to do something about the symptoms, beliefs on the necessity and expected outcomes of starting a diagnostic trajectory. These views were influenced by normalization or validation of symptoms, the support or wishes of the social network, interactions with health care professionals, the health status of the PwMC, and societal factors such as stigma and socioeconomic status. Conclusion A variety of considerations with regard to decision-making on starting a diagnostic trajectory for dementia were identified. This emphasizes the need to explore individual preferences to facilitate a timely dementia diagnosis.

Ko, Bumsuk; Kim, Kyungsuk

doi: 10.1080/13607863.2022.2076207pmid: 35604070

Abstract Objectives There are various type of music-related memory and different aspects of impairment caused by dementia. The purpose of this scoping review was to identify methods and map key concepts in assessing music-related memory in people with dementia. Method The review was conducted using the five steps in the framework proposed by Arksey and O’Malley. Databases and other sources were searched to identify relevant studies, and data selection and abstraction were performed. Results A total of 35 studies that met the selection criteria were finally selected and analysed. We confirmed that the assessment of music-related memory can be systematically classified as assessing short-term or long-term memory, explicit or implicit memory, depending on the type of memory. Regarding the key concept of assessing music-related memory, we mapped a conceptual framework for the interrelationships between music and memory from a person-centered perspective. Conclusion Comprehensive information on music-related memory obtained through the assessment will be helpful for a holistic understanding of the person with dementia. In addition, it will provide meaningful information for specific planning and application of musical experiences that can be effectively used in music therapy. Further research is needed to establish the reliability and validity of the assessment.

Borchard, Jay; Bindoff, Aidan; Farrow, Maree; Kim, Sarang; McInerney, Fran; Doherty, Kathleen

doi: 10.1080/13607863.2022.2042188pmid: 35195059

Abstract Objectives This study compared discussion board involvement between family carers and non-carers in the Understanding Dementia Massive Open Online Course (UD-MOOC). Methods A mixed methods observational cohort study of family carers and non-carers was undertaken over the February-April 2020 UD-MOOC. Discussion board engagement was measured as number of posts and replies and examined longitudinally using mixed models. Discussion topics were explored through structural topic models (STM). Subsequently, thematic analysis of STM derived-topic exemplars was conducted to contextualise these discussions. Results Family carers were (n = 2320) found to post (p < 0.001) and reply (p = 0.029) significantly more often than non-carers (n = 2392). Of the 32-STM derived-topics, meaningful activities (mean Δ = 0.007, 95% CrI [0.005–0.100]), personal stories of diagnosis (mean Δ = 0.007, 95% CrI [0.005–0.009]), and family history of dementia (mean Δ = 0.006, 95% CrI [0.004–0.008]) were discussed significantly more frequently by family carers compared to non-carers. Conclusion These results may reflect underlying motivational differences and circumstantial relevance. Perhaps the greater engagement by family carers is related to a sense of having inadequate relevant offline social resources, where engagement in the UD-MOOC discussion boards may serve as means to share experiences with others.

Cantu, Phillip A.; Aranda, María P.

doi: 10.1080/13607863.2022.2048358pmid: 35266850

Abstract Objectives Caregivers play a key role in supporting older Mexican Americans, who are less likely to enter nursing facilities than other racial/ethnic groups in the US. However, there is little research on how Neuropsychiatric symptoms (NPS) affect relationship quality between caregivers and care recipients. Method Using data from the 2015 wave of the Hispanic Established Populations for Epidemiologic Studies of the Elderly (H-EPESE) (n = 416) study of older (age 85+) Mexican Americans, we examined relationship quality and NPS with ordered logistic regression. Relationship quality was measured using positive (enjoyment, appreciation) and negative (nerves, argue) assessments. NPS were categorized into hyperactivity, affective, and psychosis symptoms. Results Hyperactivity symptoms were associated with appreciation, arguing, and nerves. Psychosis symptoms were associated with arguing and nerves. Spousal caregivers were more likely to report arguing and nerves and less likely to report feeling appreciated. Enjoyment assessments were not associated with NPS. Conclusion Relationship quality is related to behavioral changes in late life. Mexican American caregivers negatively evaluate their relationships, not in response to care tasks per se, but when the older person exhibits behavioral problems. The relationship between NPS and negative relationship assessments may be due to unanticipated behavior changes in late life and stigma around psychiatric symptomatology.

Mansfield, Elise; Cameron, Emilie C.; Boyes, Allison W.; Carey, Mariko L.; Nair, Balakrishnan; Hall, Alix E.; Sanson-Fisher, Rob W.

doi: 10.1080/13607863.2022.2053833pmid: 35356837

Abstract Objectives Carers of people with dementia experience significant physical, emotional, and social burdens. Needs assessment can provide important information to assist services in providing support to carers to reduce these burdens. However, few studies have examined the prevalence of unmet needs experienced by carers of people with dementia using a quantitative instrument. This study aimed to examine the prevalence and type of unmet needs experienced by carers of people with dementia in Australia. Methods This was a cross-sectional survey of carers providing support to community-dwelling individuals living with dementia. Carers were recruited through geriatric clinics, aged care providers, support services and community organisations. Consenting carers completed a survey including an 80-item study-specific unmet needs instrument for carers (UNI-C) and sociodemographic characteristics. Descriptive statistics were used to identify the most prevalent unmet needs reported by carers. Results A total of 169 carers (response rate 47%) completed the survey. Most (87%) carers reported at least one unmet need. Carers reported a median of 16.0 (IQR = 24.0; max = 58) out of a possible 80 unmet needs. The most frequently endorsed unmet needs spanned a range of areas including emotional wellbeing, accessing health and aged care services, managing apathy, and finding information. Conclusion This study highlighted that a large proportion of carers experience unmet needs associated with caring for someone with dementia. Developing and rigorously testing interventions to meet carers’ commonly reported unmet needs are warranted. Supplemental data for this article is available online at https://doi.org/10.1080/13607863.2022.2053833 .

Carter, L.; Yadav, A.; O’Neill, S.; O’Shea, E.

doi: 10.1080/13607863.2022.2068128pmid: 35603799

Abstract Objective To estimate the additional impact of dementia on in-patient length of stay (LOS) and related costs in Irish acute hospitals. Both principal and secondary diagnosis effects are estimated and valued. Methods This is a cross-sectional study based on administrative data collected on all public hospital in-patient discharges in Ireland for people aged 65 years and older in 2019. Coarsened exact matching (CEM) was undertaken to account for observed confounders between dementia and non-dementia groups, while generalised linear modelling (GLM) was used to compare differences in LOS. Results Patients with a principal diagnosis of dementia spent on average 17.5 (CI: 15.42, 19.56; p < .01) d longer in hospital than similar patients with no principal diagnosis of dementia. LOS was 6.7 (CI: 6.31, 7.14; p < .01) d longer for patients with a secondary diagnosis of dementia compared to similar patients with no secondary diagnosis of dementia. The additional annual cost of care for patients in hospitals with a secondary (principal) diagnosis of dementia was €62.0 million (€13.2 million). Conclusions This study highlights the economic impact of extended LOS for patients with dementia in Irish acute hospitals. Addressing specific dementia-related needs of people in hospital is likely to optimise resource use and decrease health care costs in acute care settings.

Rosi, Alessia; Govoni, Stefano; Del Signore, Federica; Tassorelli, Cristina; Cappa, Stefano; Allegri, Nicola

doi: 10.1080/13607863.2022.2084507pmid: 35773241

Abstract Objectives This study investigated the short-term impact and the retention of a dementia care intervention for healthcare staff working in an Italian acute hospital setting. Additionally, we identified the predictors of improvement across the intervention. Method Sixty-two healthcare staff from an Italian public hospital participated in a dementia care intervention consisting of 5 modules delivered in a 5-hour training program focusing on dementia management, knowledge, and care. A pre-test/post-test and six-months follow-up design was used to evaluate participants’ changes in knowledge, attitudes, and confidence in dementia. Results The intervention significantly improved healthcare staff’s dementia knowledge and confidence immediately after the end of the intervention. No significant changes were observed from post-test to follow-up, indicating retention of these outcomes over six months. Regarding attitude to dementia, we found an immediate improvement only in the Recognition of Personhood scale. Looking at the predictors of improvement, healthcare staff with lower levels of knowledge, attitudes, and confidence in dementia at pre-test were those who improved more following the intervention. Conclusion These findings provide further evidence that dementia care interventions are suitable initiatives to promote knowledge and skills required to manage the needs of people with dementia in an acute hospital setting.

McDowell, Cynthia; Tamburri, Nicholas; Smith, André P.; Dujela, Carren; Sheets, Debra J.; MacDonald, Stuart W. S.

doi: 10.1080/13607863.2022.2084508pmid: 35731828

Abstract Objectives Music-based interventions are postulated to mitigate cognitive decline in individuals with dementia. However, the mechanisms underlying why music-based interventions facilitate cognitive benefits remain unknown. The present study examines whether a choral intervention can modulate patterns of cognitive change in persons with dementia and whether within-person variation in affect is associated with this change. Methods Thirty-three older adults with dementia engaged weekly in the Voices in Motion (ViM) study consisting of 3 choral seasons spanning 18-months. Performance on the Mini-Mental State Examination (MMSE) and the Positive and Negative Affect Schedule was assessed monthly within each choral season using a longitudinal intensive repeated-measures design. Three-level multilevel models were employed to disaggregate between- and within-person effects across short- (month-to-month) and long-term (season-to-season) intervals. Results ViM participants exhibited an annual MMSE decline of 1.8 units, notably less than the clinically meaningful 3.3 units indicated by non-intervention literature. Further, variability in negative affect shared a within-person time-varying association with MMSE performance; decreases in negative affect, relative to one’s personal average, were linked to corresponding improvements in cognitive function. Conclusion Engagement in the ViM choral intervention may attenuate cognitive decline for persons with dementia via a reduction of psychological comorbidities such as elevated negative affect.

Angelou, Kylie; McDonnell, Colin; Low, Lee-Fay; du Toit, Sanetta H.J.

doi: 10.1080/13607863.2022.2098910pmid: 35822455

Abstract Objectives Residents living with dementia in residential aged care facilities (RACFs) have reduced access to, and opportunities for, participation in meaningful activities. This leads to increased social isolation and disengagement. Intergenerational programs aim to overcome these issues. Allied health students piloted a live-intergenerational program (LIP), living onsite at a residential aged care facility (RACF) while volunteering for 30 h a month. The purpose of this study was to explore the impact and practicalities for implementing a LIP in an Australian RACF. Methods This qualitative descriptive pilot study was undertaken to explore the diverse perspectives of various stakeholders. Qualitative data were collected during group discussions directed by the nominal group technique with live-in-students. Interviews were conducted with staff members, relatives, facility management and volunteers. All qualitative data were analysed thematically. Results Two overarching themes emerged. The first, community of care, indicated how care partners and the care context, organisational support and being a live-in-student supported the sustainability of the program. Live-in-students’ accessibility promoted opportunities for occupational and social engagement of residents when staff was less available. The second, a collective based on belonging and shared doing, highlighted the program’s potential impact and uncovered the development of a collective based on shared belonging. Conclusion The LIP highlighted the potential for new dimensions to person-centred care. The pilot study demonstrated intergenerational contact within aged residential care supported the evolvement of a collective and promoted a social approach for ageing well. Further research is needed to identify the long-term impact of the LIP and explore the feasibility of expanding the program.