The effect of day care centres for people with dementia
An estimated 68,000 people suffer from dementia in Norway in 2010. At least half of those with dementia in Norway live... more
An estimated 68,000 people suffer from dementia in Norway in 2010. At least half of those with dementia in Norway live in their own homes. One of the main areas of dementia care is to establish organized day care services for these.
The Norwegian Knowledge Centre for Health Services summarized the available research on the effects that suitable day activity has on preventing or delaying admission to an institution and whether it has the effect of social inclusion, increasing function and quality of life.
Main Findings
We included eight trials. They showed inconsistent results and all conclusions are based on findings from studies with low or very low methodological quality. The results must be interpreted with great caution.
It is uncertain whether the use of adapted day care for people with dementia may contribute to delay in admission to nursing homes / hospitals (two studies - low / very low quality).
Adapted day care may help: to slightly lower the incidence of behavioral problems (five studies - very low quality)
less burden on their families (three trials - very low quality)
less use of psychotropic drugs of the type (one study - very low quality)
Adapted day care does not appear to influence the level of functioning of persons with dementia.
We can not answer the question of costs related to the offer.
Biomarkers for diagnosing Alzheimer's Disease and other dementia.
by Andy Kahn
lzheimer's disease (AD), the most common cause of dementia in older individuals, is a debilitating neurodegenerative disease for which there is no definitive cure as of now. It destroys the neurons in parts of the brain, chiefly the hippocampus, which is a region involved in coding memories. Alzheimer's disease gives rise to an irreversible progressive loss of cognitive functions and of functional autonomy. The earliest signs of AD may be mistaken for simple forgetfulness, but in those who are eventually diagnosed with the disease, these initial signs inexorably progress to more severe symptoms of mental deterioration. While the time it takes for AD to develop will vary from person to person, advanced signs include severe memory impairment, confusion, language disturbances, personality and behavior changes, and impaired judgement. Persons with AD may become non-communicative and hostile. As the disease ends its course in profound dementia, patients are unable to care for themselves and often require institutionalization or professional care in the home setting. While some patients may live for years after being diagnosed with AD, the average life expectancy after diagnosis is eight years.
Methods and compositions relating to Alzheimer's disease are done by analyzing the proteins that are differentially... more
Methods and compositions relating to Alzheimer's disease are done by analyzing the proteins that are differentially expressed in the brain in the Alzheimer's disease state. These are very much different from the proteins in normal brain.
Dementia is one of the major public health problems of the geriatric population. But off late it seems to affecting even those in their thirties. Increasing numbers of patients with dementia are imposing a major financial burden on health systems around the world. More than half of the patients with dementia have Alzheimer's disease (AD). The prevalence and incidence of AD have been shown to increase exponentially. The prevalence for AD in Europe is 0.5% for ages 60-69 years, 4.2% for ages 70-79 years, and 13.8% for ages 80-89 years. The survival time after the onset of AD is approximately from 3 to 10 years. Death occurs as the brain cells are starved of the energy and nutrients.
Alzheimer's disease (AD), the most common cause of dementia in older individuals, is a debilitating neurodegenerative disease for which there is no definitive cure as of now. It destroys the neurons in parts of the brain, chiefly the hippocampus, which is a region involved in coding memories. Alzheimer's disease gives rise to an irreversible progressive loss of cognitive functions and of functional autonomy. The earliest signs of AD may be mistaken for simple forgetfulness, but in those who are eventually diagnosed with the disease, these initial signs inexorably progress to more severe symptoms of mental deterioration. While the time it takes for AD to develop will vary from person to person, advanced signs include severe memory impairment, confusion, language disturbances, personality and behavior changes, and impaired judgement. Persons with AD may become non-communicative and hostile. As the disease ends its course in profound dementia, patients are unable to care for themselves and often require institutionalization or professional care in the home setting. While some patients may live for years after being diagnosed with AD, the average life expectancy after diagnosis is eight years.
In the past, AD could only be definitively diagnosed by brain biopsy or upon autopsy after a patient died. These methods, which demonstrate the presence of the characteristic plaque and tangle lesions in the brain, are still considered the gold standard for the pathological diagnoses of AD. However, in the clinical setting brain biopsy is rarely performed and diagnosis depends on a battery of neurological, psychometric and biochemical tests, including the measurement of biochemical markers such as the ApoE and tau proteins or the beta-amyloid peptide in cerebrospinal fluid and blood.
Biomarkers may possibly possess the key in the next step for diagnosing AD and other dementia. A biological marker that fulfils the requirements for the diagnostic test for AD would have several advantages. An ideal biological marker would be one that identifies AD cases at a very early stage of the disease, before there is degeneration observed in the brain imaging and neuropathological tests. A biomarker could be the first indicator for starting treatment as early as possible, and also very valuable in screening the effectiveness of new therapies, particularly those that are focused on preventing the development of neuropathological changes. A biological marker would also be useful in the follow-up of the development of the disease.
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Seen by:Residential Respite Care: The Caregivers' last resort
by Sandra Jones
Phillipson L & Jones SC (2011) Residential Respite Care: The Caregivers' last resort. Journal of Gerontological Social Work 54(7), 691-711
Understanding the beliefs that caregivers of people with dementia have in regard to the use of residential respite may... more Understanding the beliefs that caregivers of people with dementia have in regard to the use of residential respite may inform strategies to address low service utilisation. In this article, the application of theory in qualitative research with 36 caregivers provides insight into why most delay service use. Although some believe that service use may increase caregiving longevity, others position service use in conflict with normative values, and may hold beliefs that negative outcomes will result from utilisation. To address caregivers' beliefs to support service use, improvements are required to service promotion, as well as to models of care.
Sweet Old Things and Dirty Old Men[England and Rust] submission
Inspired by William F. May’s writings on the vices and virtues of the elderly we offer our reflections on his ideas as... more Inspired by William F. May’s writings on the vices and virtues of the elderly we offer our reflections on his ideas as they are revealed by Muriel Spark’s novel, Memento Mori.. May argues that exempting the old from moral criticism positions them as “moral nonentities” and relieves the old, their caretakers, and society of moral responsibility. We, the coauthors of this paper, are from two different disciplines, namely Renaissance and medieval literature (Martha Rust), and social work and critical gerontology (Suzanne England). We offer our individual readings of the ways the novel illustrates May’s ideas, and conclude with our thoughts about how our collaboration opened up space in our own thinking and for continuing cross-disciplinary dialogu
In search of `the good life' for demented elderly
publisehd in Medicine Health Care and Philosophy, 2003
It may seem paradoxical to speak of the goodlife for demented elderly. Many people consider dementia to be a... more
It may seem paradoxical to speak of the goodlife for demented elderly. Many people consider dementia to be a life-wrecking disease and nursing homes to be terrible places. Still, it is relevant to ask how we can make life as good as possible for demented nursing home residents. This paper explores what three standard philosophical accounts of well-being — subjective preference theory, objectivist theories, and hedonism — have to say about the good life for demented people. It is concluded that the relevant differences between the various philosophical theories manifest themselves not so much in their general account of the substantial content of the good life but in a number of specific controversies. These concern the nature of well-being, the necessity of endorsement by the patient, the value of experience and the need for experiences to be rooted in reality. Moreover, it is argued that further research should pay detailed attention to the process of dementia and to the effects of this process on patients' identities, self-conceptions, capacities, preferences, values and the like, and that a narrative approach which incorporates the factor time may offer a more comprehensive account of the good life for demented elderly.
Single ability among activities of daily living as a predictor of agitation
by Roger Watson
Li-Chan Lin, Shiao-Chi Wu, Chieh-Chun Kao, Yu-Ling Tzeng, Roger Watson and Sai-Hung Tang (2008) Journal of Clinical Nursing, 18, 117–123
Aims. The aims of this study were to investigate whether the interaction effect between restraint and functional... more
Aims. The aims of this study were to investigate whether the interaction effect between restraint and functional ability, and single ability during activities of daily living can predict agitation among residents with dementia.
Background. Agitated behaviour is one of the most common symptoms of dementia and might endanger the patients themselves, caregivers and institutions. However, the prevalence of problem behaviours and its associated factors at long-term care facilities in Taiwan are less understood.
Design. A direct observation was used to observe the agitated behaviours of residents with dementia in special care units.
Methods. Residents of dementia special care units who were diagnosed with dementia in eight long-term care facilities were recruited. Measurements included: demographic data, the Barthel Index, the Mini-Mental State Examination and the Cohen- Mansfield Agitation Inventory.
Results. The number of subjects who were identified with problem behaviours was 163 (43.5%). Significant differences in sex, being restrained, restrained time, age, family visits, functional status and mental status were found between the agitated and non-agitated groups. However, mental status, family visits, walking ability, being restrained and getting in and off toilet were five independent factors associated with agitated behaviours after controlling for all other factors.
Conclusions. It is recommended that strategies be constructed to encourage the family to periodically visit older residents and to develop restraint-free environments in long-term care facilities.
Relevance to clinical practice. Residents with dementia require significant daily living support and behaviour management as their illness progress.
