Judy McCrow

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from 1995 to 2008 were sought in a comprehensive search of an extensive range of databases, online sources and unpublished literature.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.

Development and review of vignettes representing older people with cognitive impairment

This paper describes a process undertaken to develop and review five clinical vignettes to be used in geriatric nursing educational research. The purpose of this process was to provide valid depictions of delirium and its subtypes and distinguish delirium from dementia. Five vignettes depicting hospital bedside interactions between nursing staff, family, and an older patient who displayed signs of one of the following conditions: delirium (hyper and hypoactive types respectively), dementia, or delirium (both types) superimposed on dementia were constructed. Vignette accuracy and reliability were established using a multistage process that culminated in formal review by a group of ten international nursing and medical delirium experts. The final five vignettes accurately depicted the given scenario as agreed by the experts and were at an appropriate level of simplicity and clarity. Given the increased interest in vignettes for both nursing research and educational purposes, the described method of vignette development and review has the ability to assist other vignette developers in creating reliable representations of their desired clinical scenarios.

Management of delirium in medicine: Experience of a Close Observation Unit

A new model of care for the management of patients with delirium was developed and evaluated.

Australian family and professional carer attitudes to locator technologies used to manage wandering-related elopement and getting lost associated with dementia

S FOR THE NATIONAL DEMENTIA RESEARCH FORUM SEPTEMBER 24–25, 2009 SYDNEY, AUSTRALIA 1 AUSTRALIAN FAMILY AND PROFESSIONAL CARER ATTITUDES TO LOCATOR TECHNOLOGIES USED TO MANAGE WANDERING-RELATED ELOPEMENT AND GETTING LOST ASSOCIATED WITH DEMENTIA E. Beattie, J. McCrow, W. Kearns, S. Applegarth, Queensland University of Technology, Brisbane, QLD, Australia; University of South Florida, Tampa, FL, USA; James A. Haley Veterans Administration Hospital, Tampa, FL, USA Background: People with dementia (PwD) who wander risk injury, getting lost, and death. Technological development supports devices that enable PwD to access safe areas while limiting unsafe or unaccompanied locomoting. The purpose of this study was to explore Australian stakeholder attitudes about these technologies and compare outcomes with those from a previous U.S. study. Methods: Nine semistructured focus group sessions (N 1⁄4 65) were held with home health care workers, nurses, cognitively intact nursing home residents, family carers of PwD, allied health care professionals, and police. Initially, participants received information on alarm and locator technologies and then discussed device design, functional elements (eg, size, weight, body placement, and reliability), cost, and social implications. Results: Participants saw locator devices as a viable option for possible rapid recovery of lost PwD but not a foolproof solution. For caregivers, device management and cost were major issues, consistent with U.S. attitudes. Employed carers and police were concerned about the fit of technologies with family carer preferences and public policy relating to location and recovery practices. Cognitively intact nursing home residents consistently raised the issues of the burden of care involved in wandering management for both staff and other residents. All participants were keenly aware of ethical issues related to technologies and the need for continued personal surveillance of PwD who have compromised environmental mastery. Conclusions: Australian participants, as in the U.S. study, supported the use of technology to manage wandering behavior in PwD but raised a number of important ethical and practical issues requiring further discussion. 2 ON-ROAD ASSESSMENT FOR PEOPLE WITH DEMENTIA: HOW TO ACHIEVE THE GOLDILOCKS POINT (NOT TOO EASY, NOT TOO HARD, BUT JUST RIGHT) A. Berndt, E. May, P. Darzins, University of South Australia, Adelaide, SA, Australia; Monash University, Melbourne, VIC, Australia Background: Dementia syndromes impair cognitive, visuospatial abilities and judgment required for safe driving. When driving task demands exceed the capacity, driving failure occurs. On-road assessments should be designed to assess the task-capacity nexus to avoid erroneous test outcomes within local road environments. Methods: Drivers were recruited through a memory clinic: 86 men and 29 women; aged 48 to 88 years; mean, 75 years (standard deviation, 6.7); Mini-mental score range, 10 to 30; mean, 23 (standard deviation, 3.7). On-road assessments used a standard test route in dual control vehicles, with two observers. Driver performance was operationalized by 12 defined error categories. The test route included multiple ‘‘traps,’’ places where drivers could easily make errors, such as stop-sign controlled intersections. Results: The error and task-item relationships of the on-road driving performance of 115 drivers (50 pass and 65 fail) were analyzed. Drivers with fewer and less severe errors had higher cognitive scores (P 1⁄4 .0001). As expected, common traps resulted in common errors. Critical errors were less common. Critical errors occurred in both complex and simple traffic situations. Critical errors were not related to driving fatigue during the test. Conclusions: Design of on-road assessments influences driver errors. Overall driving performance must be judged in relation to the on-road assessment characteristics. Adequate samples of task items are needed. Weighting of scores should account for errors ’’forced’’ by the design (eg, being ’’caught’’ by the traps) versus ’’unforced’’ errors that result from poor driving habits or from critical dementia-related driving failure. 3 CHALLENGES TO IMPLEMENTING AN EVIDENCE-BASED PARTNERSHIP MODEL IN AN AUSTRALIAN RESIDENTIAL CARE SETTING M. Bramble, W. Moyle, D. Shum, Griffith University, Brisbane, QLD, Australia Background: This partial replication study tested the effects of a best practice model of dementia care, the Family Involvement in Care (FIC) intervention, in an Australian residential care setting. Originally trialled and implemented in North America with successful outcomes, this intervention sought to establish therapeutic partnerships between family (n1⁄4 30) and staff caregivers (n1⁄4 31). Study findings highlight the critical need for research to be conducted in a practice environment in which there is support at the policy and management level for skilled nursing staff and managers to lead and support the implementation of the research. Methods: This controlled trial study used a mixed-method sequential design to test the success of the partnership intervention and provide evidence of its effectiveness in the Australian clinical setting. The intervention was empirically and theoretically driven by using person-environment and role theory to examine improvement in knowledge, stress, and satisfaction outcomes for families and staff. Results: Postintervention interviews provided strong evidence of family support for the partnership concept. However, the intervention was not successful in achieving beneficial outcomes, with post-test family measures reflecting decreased satisfaction with management effectiveness [t (29) 1⁄4 2.64, P <. 05] and staff caregivers [t (55) 1⁄4 2.18, P <. 05] compared with the control site. Conclusions: The major barrier to success was lack of clinical leadership and staff trained and committed to sustain the partnership. Successful implementation of care-directed interventions requires attention to staff recruitment and investment in education to build professional capacity and staff skills in the specialist area of dementia care. 1552-5260/09/

Recruitment of Individuals With Dementia and Their Carers for Social Research: Lessons Learned From Nine Studies

– see front matter 2009 The Alzheimer’s Association. All rig Alzheimer’s & Dementia 5 (2009) e10–e17 4 THE HOSPITAL DEMENTIA SERVICES PROJECT D. Gibson, B. Draper, R. Karmel, A. Peut, P. Anderson, G. Brien, I. Seebus, University of Canberra, Canberra, ACT, Australia; University of New South Wales, Sydney, NSW, Australia; Australian Institute of Health and Welfare, Canberra, ACT, Australia Background: The acute care of people with dementia in hospital is complex, with prolonged length of stay, increased risk of delirium, and a strong association with entry into residential aged care (RAC) after discharge. It is hypothesized that hospitals with resources and policies that focus on quality

Delirium care: Real-world solutions to real-world problems

Many health and social care research studies report difficulties recruiting sufficient numbers of participants, adding to time and money expenditures and potentially jeopardizing the generalizability of findings. The current article reports the effectiveness and resource requirements of recruitment strategies used in nine dementia-related studies conducted in Australia. Articles, notices, or advertisements in targeted specialist newsletters were the most cost-effective method of recruitment. The use of service providers to aid recruitment yielded mixed results, but was lengthy in terms of research time. Online and social media were low cost but not reliably effective in terms of recruitment potential. Despite using multiple strategies to maximize recruitment, significant challenges were encountered achieving the required sample sizes; in most cases these challenges resulted in delays in the recruitment phase. Implications for researchers in the fields of dementia and general social/health research are discussed. [Res Gerontol Nurs. 2018; 11(3):119-128.].

A study on the state of hydration, in relation to cognition, for older, hospitalised patients

Implementation research into delirium care is lacking. Exploiting known practice barriers to understand what management strategies work best in delirium is a means of prioritising care interventions. A consensus approach to determining priority interventions in delirium was derived and related to reference standards in health‐care practice.

Dyadic Nutritional Status of Community-Dwelling People with Dementia and Family Caregivers

Results: At baseline, 676 (16.1%) men were frail, as defined by having ≥3 deficits (FRAIL scale ≥ 3). In multivariate cross-sectional analysis, low vitamin D status, defined by the lowest quartile of 25(OH)D values (<52.9 nmol/l), was associated with increased prevalent frailty (odds ratio [OR] 1.96, 95% confidence interval [CI] 1.52 to 2.52) in comparison to the highest quartile of 25(OH)D values (>81.6 nmol/l). After a mean period of 5.3 years, the adjusted OR of being frail at follow-up for men with low vitamin D and having zero deficit at baseline (FRAIL scale = 0) was 1.56 (95% CI 1.07 to 2.27). Low vitamin D also predicted all-cause mortality over a period of up to 9.2 years (hazards ratio 1.20, 95% CI 1.02 to 1.42), independent of baseline frailty and other covariates.

Establishing validity of delirium-focused clinical vignettes for use in a web-based nurse education intervention

The objective of the EVIDEM-EXERCISE study was to evaluatethe effectiveness of an exercise regime as a therapy for the behaviouraland psychological symptoms of dementia (BPSD). A pragmatic, ran-domized, controlled, single-blind, parallel-group trial of a dyadic exer-cise regime (tailored walking) for community-dwelling individuals withBPSD and their carers was undertaken. The primary outcome wasBehavioural and Psychological Symptoms as measured by the Neuro-Psychiatric Inventory at week 12. Results show no significant differ-ence of NPI score at week 12 between the group receiving the dyadicexercise regime and those that did not. Secondary outcome measure ofcaregiver’s burden was significantly improved; caregiver burden dou-bled by week 12 for the control group participants, but decreased forthose receiving the exercise intervention. In conclusion, this study foundthat regular simple exercise does not improve BPSD but did seem toattenuate changes of caregiver burden.Studies about intimacy in old age have mostly focused on institutionalized life-long marriages. Little research has focused on re-partnering in later life and the impact these relationships have on life satisfaction. Framed by Giddens’ Transformation of intimacy and Laslett’s Third age, as well as changing social and demographical conditions, this paper focuses on how different forms of new intimate relationships impact on life satisfaction in later life. Qualitative interviews were conducted with a strategic sample of 28 Swedes, 63–91 years, who were married, cohabiting and living apart together in new intimate heterosexual relationships initiated after the age of 60 or who were currently dating. The results showed the significance of new intimate relations the experience of life satisfaction in later life: The importance of being needed and confirmed by one’s partner, for intimacy and sexuality, for unloading children’s care responsibility, for sharing experiences in everyday life and for safety. The results also showed the importance of the partner as a resource for new experiences and a healthier life style. In conclusion, the results will be theorized in a time frame: First, in the light of new post (re)productive free time in the third age. Second, in the light of the finite remaining life-time. The results from the qualitative study will be contextualized by results from a representative survey on intimate relations among 3 000 60-90 year old Swedes (data collection has just finished).It is often argued that in late modernity sex has escaped its reproductive cage and people form pure relationships, based on mutual satisfaction. Ironically, although older people are per definitio ...

Understanding the barriers to recognition and management of delirium in the acute post-surgical setting

dementia via video consultation (VC) also collected data regarding the diagnosis of depression via video conferencing. Methods: This was a multi-site study in which a specialist carried out a cognitive assessment via VC with the patient and their carer. A second interview was carried out face to face (FTF) by a second specialist on the same day. This VC/FTF pairing was referred to as VF. Inter-rater reliability was assessed between specialists by using overall proportional agreement (PO) and kappa (k). Data on the presence of depression were collected from each specialist. Results: One hundred fifty-five participants, referred by their general practitioner for a specialist assessment at one of four participating Memory Disorder Clinics (MDCs), were divided into two groups: VF (n 1⁄4 82) or FTF (n 1⁄4 73). Seventy-five were men. The average age was 76 years (standard deviation [SD], 9; 54 to 95). The mean Standardised Mini-Mental State Examination Score was 23.8 (SD, 4.4; 8 to 30). Overall agreement via VC (PO 1⁄4 0.793; k 1⁄4 0.37; P 1⁄4 .12) was at similar levels to agreement for FTF (PO 1⁄4 0.767; k 1⁄4 0.31, P 1⁄4 .13). Conclusions: The identification of depression in this patient group was a secondary analysis within a study designed to examine the reliability of the diagnosis of dementia in patients referred to an MDC. The results suggest that recognizing depression via VC is reliable, but further studies are required because this population is not representative of a typical population in which the suitability of VC for the diagnosis of depression would be tested.