Jenny Abbey

Thickened fluids for people with dementia in residential aged care facilities.

AIM This systematic review aimed to establish best practice in relation to thickened fluids for people with dementia living in residential aged care facilities. METHODS This review considered all types of studies that examined the prescription and administration of thickened fluids to people with dementia in residential aged care facilities. English-language articles published from 1995 to 2008 were sought in a comprehensive search of an extensive range of databases, online sources and unpublished literature. Two independent reviewers critically appraised each article using the relevant Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information (JBI-SUMARI) instruments, then data were extracted from those articles that met the inclusion criteria. No meta-analysis was possible because of significant clinical and methodological heterogeneity, therefore results are reported narratively. RESULTS From 112 papers originally identified, 14 met the inclusion criteria and formed the basis of the findings. Nine studies recommend the use of thickened fluids as a strategy to maintain adequate fluid intake for persons with dementia with dysphagia in residential aged care and four papers recommend their use for people with dementia in general. One paper reported that the use of thickened fluids was found to be acceptable to older people in the event of dementia and dysphagia. CONCLUSIONS From the retrieved data, evidence-based best practices cannot be concluded. It can, however, be cautiously inferred that thickened fluids may be effective for residents with dementia if set guidelines are instituted.

EVIDENCE SYNTHESIS: Appropriateness of using a symbol to identify dementia and/or delirium

Aim  The main objective of this systematic review was to evaluate any published and unpublished evidence regarding the appropriateness of developing a symbol for dementia and/or delirium, which could be used in a variety of settings to indicate that a person has dementia and/or delirium. Methods  Using the methods of the Joanna Briggs Institute, we conducted a systematic search of a wide range of databases, Internet resources and unpublished literature. Papers meeting the inclusion criteria were critically appraised by two independent reviewers. Data were extracted, using the standardised tool from the Joanna Briggs Institute, from those papers considered to be of sufficient quality. Because of significant methodological heterogeneity, no meta-analysis was possible and results are presented narratively instead. Results  From a total of 37 retrieved papers, 18 were found to be of sufficient relevance and quality to be included in the review. There was general consensus among the literature that a symbol for dementia is appropriate in the acute care setting. It was also clear from the research that an abstract symbol, as opposed to one that explicitly attempts to depict dementia, was most acceptable to staff, people with dementia and their carers. Conclusions  Both staff and health consumers seem to have largely positive perceptions and attitudes towards the use of a symbol for dementia. Families and carers of people with dementia are frequently concerned about their loved one wandering away and becoming lost and unable to identify themselves, and these concerns seem to outweigh any reservations they hold about the use of a symbol or some other identifier. In healthcare settings the use of symbols to indicate special needs seems well established and widely accepted. However, regarding the use of a symbol for dementia in the broader community, there remain concerns about issues such as stigmatisation and the potential for victimisation of this vulnerable population and so further research is indicated.AIM The main objective of this systematic review was to evaluate any published and unpublished evidence regarding the appropriateness of developing a symbol for dementia and/or delirium, which could be used in a variety of settings to indicate that a person has dementia and/or delirium. METHODS Using the methods of the Joanna Briggs Institute, we conducted a systematic search of a wide range of databases, Internet resources and unpublished literature. Papers meeting the inclusion criteria were critically appraised by two independent reviewers. Data were extracted, using the standardised tool from the Joanna Briggs Institute, from those papers considered to be of sufficient quality. Because of significant methodological heterogeneity, no meta-analysis was possible and results are presented narratively instead. RESULTS From a total of 37 retrieved papers, 18 were found to be of sufficient relevance and quality to be included in the review. There was general consensus among the literature that a symbol for dementia is appropriate in the acute care setting. It was also clear from the research that an abstract symbol, as opposed to one that explicitly attempts to depict dementia, was most acceptable to staff, people with dementia and their carers. CONCLUSIONS Both staff and health consumers seem to have largely positive perceptions and attitudes towards the use of a symbol for dementia. Families and carers of people with dementia are frequently concerned about their loved one wandering away and becoming lost and unable to identify themselves, and these concerns seem to outweigh any reservations they hold about the use of a symbol or some other identifier. In healthcare settings the use of symbols to indicate special needs seems well established and widely accepted. However, regarding the use of a symbol for dementia in the broader community, there remain concerns about issues such as stigmatisation and the potential for victimisation of this vulnerable population and so further research is indicated.

Thickened fluids for people with dementia in residential aged care facilities

mestically or internationally to assist families, carers, or health/legal professionals in deciding what, if any, aspects of their financial affairs a person with dementia can responsibly manage. In parallel with client assessments conducted by the Office of the Adult Guardian (OAG), the aim of this research is to test a set of brief, well-validated instruments. Social competency and contextual measures, concepts often overlooked in traditional assessments, will also be included. It expected the research protocol will yield more comprehensive data regarding an individual’s capacity to manage their finances. Methods: Two hundred clients (M1⁄460þyears, 60% female), referred from the OAG for competency review, will be assessed using six empirically validated instruments. The standardized instruments will measure the participants’ mental status (3MS), levels of anxiety (GAI) depression (GDS) hallucinations and delusions (NPIQ), social competency (SVS), and changes to daily living activities (IQCODE). All measures will be embedded within a contextual interview, and administered to participants and their carers. Results: A detailed description of the protocol will be presented. Each of the instruments above has a clinical cut-off score but in this protocol are used in conjunction with the contextual interview to yield a holistic view of the client. Our findings will be compared to judgements made by the OAG regarding the individual’s capacity to manage finances. Conclusions: Creating an empirically valid protocol that is brief, comprehensive, and easily administered by most health professionals, has ‘‘real-world’’ applicability and the potential to tangibly impact on policies regarding assessments of an older individual’s financial capabilities. Introduction: Malnutrition is estimated to affect between 17 and 65% of residents in residential care. Oral liquid nutritional supplements (OLNS) are one strategy utilised to help prevent malnutrition in people with dementia living in residential aged care facilities (RACFs), while tube feeding is an alternative method of nutritional maintenance. The aim of this mixed methods research was to investigate and describe the effectiveness, prescription and administration of OLNS for people with dementia living in RACFs. Methods: Following a systematic literature review, retrospective chart audits (n1⁄444) and seven focus groups (n1⁄455 participants, including Registered Nurses, Assistants in Nursing, Chefs and kitchen staff) were conducted. Charts audited were reviewed and results collated using predetermined questions. Focus groups were audio taped, transcribed and responses collated. Focus group questions regarding OLNS:Wastage; Resident acceptance and responses; Prescription, effectiveness and benefits; andStaff education. Results: Focus groups: OLNS are well accepted by people with dementia living in RACFs. Chart Audits identified a non standardized approach including: Inadequate assessment and evaluation processes; Haphazard documentation; Inadequate monitoring and irregular evaluation Poor consultation processes with staff, residents, family and health professionals; and Significant variation in staff training and education although there is no evidence to suggest this has had an adverse effect on residents. Conclusions: An outcome of this research will be to facilitate the development and implementation of recommended evidence-based guidelines for health professionals working with residents with dementia living in aged care facilities.

Exploring the biggest challenges for family caregivers of people with severe dementia

This approach combines evaluation of the psychometric evidence, with a review of the academic literature for impact, and consultation with clinical experts in the field about the suitability of instruments. The instrument categories reviewed included: dementia staging and descriptive assessments, associated behavioral symptoms, cognition, function, social isolation, health-related quality of life, multi-attribute utility measures, and patient and carer satisfaction with treatment. Five leading instruments in each domain / category were selected for detailed review and judgment based on the following criteria: availability of instrument, psychometric evidence of reliability and validity, availability of normative and clinical reference data, instrument length, administration time and burden, ease of scoring, ability to be used with the various severity levels of dementia, cost considerations, and the applicability for routine care. Results: This detailed review and consultation process resulted in a number of measures being recommended for routine use with dementia patients. As an example, three instruments are recommended for the assessment of HRQOL in dementia; the QOL-AD and the DEMQOL for mild to moderate dementia and the QUALID for late stage dementia only. Conclusions: The poster outlines the recommended measures for each domain of assessment. Additional issues addressed included the use of proxy (informant) measurement and the application of these instruments to cultural and linguistically diverse populations.

Trial of multidimensional in-home intervention to support carers of people living with dementia

S FOR THE NATIONAL DEMENTIA RESEARCH FORUM SEPTEMBER 18–19, 2008 SYDNEY, AUSTRALIA 1 TRIAL OF MULTIDIMENSIONAL IN-HOME INTERVENTION TO SUPPORT CARERS OF PEOPLE LIVING WITH DEMENTIA J. Abbey, S. Sacre, E. Palk, D. Oxlade, J. Marshall, E. Tierney, S. Hassall, D. Huston, L. Carlson, N. Fraser, T. Hamilton, Queensland University of Technology, Kelvin Grove, QLD, Australia; Returned Services League Care, Fortitude Valley, QLD, Australia; Blue Care, Wynnum, QLD, Australia; Home And Community Care (HACC), QLD, Australia Introduction: Caregiving has been linked with negative mental and physical consequences for carers including depression, strain, and social isolation. A systematic review was conducted and it was determined that the most effective interventions for carers were home-based psychosocial interventions. In particular, Resources for Enhanced Alzheimer’s Caregiver Health (REACH) II, a US based six year study that delivered a multidimensional psychosocial intervention across several states resulting in Quality of Life improvements for carers, emerged as a model of interest. Methods: Informed by the REACH II project, the study is a randomized controlled trial with carers of people with dementia from S.E. Queensland participating in either the control or intervention condition. During 9 home visits and 3 phone sessions intervention participants received psycho-education and skills training including well-being, mood management and stress reduction techniques, and strategies for managing behaviours of concern. All participants will complete a suite of measures pre and post trial including the SF-36v2 Health Survey, Center for Epidemiologic Studies Depression Scale (CES-D), and the Perceived Stress Scale. Results: Baseline data were collected Jan-Mar 2008 and final data collection will commence at the completion of the intervention in October 2008. At baseline, participants (n 1⁄4 33) across both conditions reported stress levels above the norm (m 1⁄4 16, sd 1⁄4 7.5) on the Perceived Stress Scale and 41% scored as depressed on the CES-D scale. Conclusions: It is anticipated that this skill building model will emerge as an effective support strategy for carer/ recipient dyads in Australia. 2 UNDERSTANDING THE BARRIERS TO RECOGNITION AND MANAGEMENT OF DELIRIUM IN THE ACUTE POST-SURGICAL SETTING J. Abbey, J. Mccrow, E. Whiting, S. Pandy, D. Parker, S. Sacre, Queensland University of Technology, Kelvin Grove, QLD, Australia; The Prince Charles Hospital, Northside Hospital Service District, Chermside, QLD, Australia; University of Queensland, St Lucia, QLD, Australia Background: Delirium is a transient mental disorder, characterised by an acute change in cognition, consciousness and a decreased ability to focus, sustain or shift attention. Increased age and dementia are important risk factors for delirium and there is commonly a difficulty by health care providers in differentiating between delirium and dementia. Post-surgical delirium has been shown to be a significant problem in the elderly person. If not recognised or managed appropriately it has been shown to be associated with increased mortality and morbidity for these persons. This study investigated current assessment and management practices and potential barriers to accurate assessment of delirium, within a major Australian tertiary referral hospital. Methods: 315 participants aged 65þ were recruited from a pre surgical cohort over a six month period in 2007. They were assessed by a trained nurse researcher, using a Mini Mental State Examination (MMSE) and Confusion Assessment Method (CAM). Post surgical CAM assessments were performed on participants and patient records were audited. Following identification of delirium in a participant by the research nurse, staff and family interviews were conducted to discover staff and family attitudes to identification and management practices of the participant with delirium. Staff focus groups were conducted at completion of the study to ascertain what current practices were followed in relation to the assessment, diagnosis and management of delirium within the study facility. Results: The research team detected a prevalence rate for delirium of 4.1% in the sample studied. Of these, all were recognised by the hospital staff as being confused, but none were identified as having delirium. Furthermore, while confusion was found and treated, there was no systematic format to treatment or diagnostic plans. Conclusions: Focus group and interview analysis showed that under-detection of delirium in this study occurred as a result of insufficient knowledge about the disorder and also as a result of a failure to utilise standardised screening tools. Recommendations arising from this study include the implementation of evidence based practice guidelines for management of patients with delirium. 1552-5260/09/

The effectiveness and appropriateness of a palliative approach to care for people with advanced dementia: a systematic review

– see front matter 2009 The Alzheimer’s Association. All rig Alzheimer’s & Dementia 5 (2009) e1–e9 3 FOLLOW-UP OF MILD COGNITIVE IMPAIRMENT AND RELATED DISORDERS OVER 4 YEARS IN ADULTS IN THEIR SIXTIES: THE PATH THROUGH LIFE STUDY K. J. Anstey, N. Cherbuin, H. Christensen, R. Burns, C. RegladeMeslin, A. Salim, R. Kumar, A. F. Jorm, P. Sachdev, Australian National University, Canberra, Australia; University of Melbourne, Melbourne, Australia; University of New South Wales, Sydney, Australia Background: There are few published data on the prevalence and incidence of mild cognitive disorders in young-old adults. This project aimed to estimate prevalence and incidence rates of Mild Cognitive Impairment and related disorders, and conversion to dementia. Methods: The data are drawn from the PATH Through Life Study, a community cohort study. Baseline assessment in 2001-2002 included 2551 60-64 year-olds with 2222 participating in a four-year follow-up. Those screened positive with a cognitive assessment received clinical assessment for diagnoses of mild cognitive disorders or dementia using established clinical criteria as previously published (Kumar et al 2005). Prevalence and incidence rates for the cohort were estimated with predictive regression models. Results: Annual incidence of dementia was 0.25%. Wave 2 prevalence of Mild Cognitive Impairment was 4.2%, Age Associated Memory Impairment was 2.4%, Age-Associated Cognitive Decline was 7.6%, Mild Neurocognitive Disorders was 12.87% and other cognitive disorder was 7.3%. The prevalence of any diagnosis of any mild cognitive disorder (Any-MCD) was 29.5% and the annual incidence rate for Any-MCD was 5.7%. Agreement for specific diagnoses between Waves 1 and 2 was fair to poor (0 to 47.0%) but agreement for Any-MCD over 4 years was 89.0%. Conclusions: Diagnoses of mild cognitive disorders do not predict dementia at four year follow-up in young-old adults. Prevalence rates for mild cognitive disorders vary greatly depending on criteria and age of assessment.