Kate Irving

Target risk factors for dementia prevention: a systematic review and Delphi consensus study on the evidence from observational studies

Dementia has a multifactorial etiology, but the importance of individual health and lifestyle related risk factors is often uncertain or based on few studies. The goal of this paper is to identify the major modifiable risk factors for dementia as a first step in developing an effective preventive strategy and promoting healthy late life cognitive functioning.

Delirium: a new appraisal of an old problem

Delirium is a prevalent condition associated with high morbidity and mortality. Studies investigating delirium date back centuries but the subject has received increased attention in the last two decades. This recent attention focuses on, risk factors, early recognition, consequences and management of delirium. The aim of this paper was to provide an updated review of issues concerning the assessment and identification of delirium. Assessment is central to the effective management but delirium continues to be under-recognized by the healthcare team. This review sets the scene for the following papers on practice and the future direction for the management of delirium.

Dementia risk in renal dysfunction : a systematic review and meta-analysis of prospective studies

Objective: Renal dysfunction has been linked with increased risk for cognitive impairment and dementia, but studies are conflicting. For that reason, the aim of the present systematic review and meta-analysis is to summarize the best available evidence on the prospective association between potential markers of renal dysfunction and development of cognitive impairment or dementia. Methods: Medline, Embase, and Cochrane Database of Systematic Reviews were searched for potential publications until August 1, 2016. Studies were eligible if they fulfilled the following criteria: population-based study, prospective design, ≥100 participants, aged ≥45 years, ≥1 year follow-up, and cognition/dementia outcomes. Where appropriate, random effects meta-analyses were conducted yielding pooled odds ratios (OR) and 95% confidence intervals (CI). Results: Twenty-two out of 8,494 abstracts fulfilled the eligibility criteria. Sufficient evidence was found for albuminuria, mixed results for estimated glomerular filtration rate (eGFR), insufficient support for cystatin C, and tentative evidence for serum creatinine and creatinine clearance. Meta-analyses of 5 studies representing 27,805 persons showed a 35% increased risk of cognitive impairment or dementia in those with albuminuria (OR 1.35, 95% CI 1.06–1.73, p = 0.015), whereas eGFR <60 mL/min/1.73 m2 showed no significant association (OR 1.28, 95% CI 0.99–1.65, p = 0.063). No meta-analyses could be done for serum creatinine, creatinine clearance, or cystatin C. Conclusions: The overall evidence for an association between renal dysfunction and cognitive impairment or dementia is modest. Evidence suggests that albuminuria is associated with higher odds of developing cognitive impairment or dementia.

Delirium, nursing practice and the future

The preceding papers have outlined the issues of under-recognition of delirium, aspects of assessment to improve this situation and presented an alternative discursive construction of delirious patients. With respect to the understandings from the first two papers, the authors intend to suggest a direction for future practice and research in the area of delirium. The discussion will start with an overview of current international practice. Approaches focussing on the specific care of team members or on multidisciplinary care have been reported as well as approaches that focus on a clinical expert such as a nurse specialist or those that focus care of patients with delirium in a specific identified clinical setting. The literature represents variable evidence of the success, or otherwise, of different initiatives. The authors intend to provoke debate on the care of delirious patients and indicate the priorities for the future management of delirium.

Modifiable risk factors for prevention of dementia in midlife, late life and the oldest-old: Validation of the LIBRA index

BACKGROUND Recently, the LIfestyle for BRAin health (LIBRA) index was developed to assess an individuals prevention potential for dementia. OBJECTIVE We investigated the predictive validity of the LIBRA index for incident dementia in midlife, late life, and the oldest-old. METHODS 9,387 non-demented individuals were recruited from the European population-based DESCRIPA study. An individuals LIBRA index was calculated solely based on modifiable risk factors: depression, diabetes, physical activity, hypertension, obesity, smoking, hypercholesterolemia, coronary heart disease, and mild/moderate alcohol use. Cox regression was used to test the predictive validity of LIBRA for dementia at follow-up (mean 7.2 y, range 1-16). RESULTS In midlife (55-69 y, n = 3,256) and late life (70-79 y, n = 4,320), the risk for dementia increased with higher LIBRA scores. Individuals in the intermediate- and high-risk groups had a higher risk of dementia than those in the low-risk group. In the oldest-old (80-97 y, n = 1,811), higher LIBRA scores did not increase the risk for dementia. CONCLUSION LIBRA might be a useful tool to identify individuals for primary prevention interventions of dementia in midlife, and maybe in late life, but not in the oldest-old.

Support networks of older people living in the community

Aim.  The aim of the study was to identify the social support networks of older people living in the community in Ireland using Wengers (1994) network typology. Background.  The population of older people in the community is increasing. With increasing age and changes in family circumstances a substantial proportion of older people will require social, psychological and instrumental support. However a lack of adequate social support networks for vulnerable older people can result in poor health, loneliness and isolation. Method.  A national, cross-sectional telephone survey of 683 people aged between 65 and 99 years was undertaken using the Practitioner Assessment of Network Type as the basis for identifying social support networks. Results.  The results demonstrated that the majority of older people were living in stable and supportive social networks and reported high levels of contact with family, friends and neighbours. However, a significant minority of older people were living in vulnerable networks. Older people in these networks are susceptible to loneliness, isolation and poor emotional and physical health. Conclusion.  Through the identification of people in vulnerable networks, nurses working both in the hospital and community setting can ensure that formal support is aimed at providing care to older people who do not have access to informal care networks. Furthermore, the predictive utility of the Practitioner Assessment Network Type (PANT) can enable nurses to identify people at risk of poor social support.

Case study in SenseCam use as an intervention technology for early-stage dementia

Dementia is a growing concern with an estimated 41,740 in Ireland and 35.6 million people living with dementia worldwide. In the absence of a medical cure for dementia, pervasive technologies are emerging to support people with dementia. Among such applications is lifelogging, which involves continuously wearing technology to capture a large part of the wearers life emerging. The recorded data allows clinicians and others to detect behaviour changes or help in memory recall. This study explores the use of SenseCam lifelogging technology as a therapeutic intervention for people with early stage dementia. Based on the principles of cognitive stimulation therapy CST it aims to engage them in meaningful discussions about their recent past as captured in the SenseCam images. These discussions offer potential to help maintain the persons identity. The preliminary findings from the first case study highlight some functional issues of SenseCam use within CST principles.

The virtual gateway: opening doors in delirium teaching and learning.

Delirium is a common, serious and potentially preventable problem. It is argued here that knowledge and skills for effective assessment and treatment of delirium cannot be considered ‘specialist’. Rather, delirium is a problem that requires a healthcare team approach to assessing patients, identifying risks or symptoms and reducing precipitating factors. Research from the preceding decade suggests that the clinical reality is falling short of this ideal with the result that many cases of delirium go undetected and many precipitating factors are not reduced where this is indeed possible. This presents a challenge for the education of nursing and medical students and for the development of qualified staff in practice. The current paper outlines an educational approach, e-learning, which increases access for learners, integrates knowledge and skill development and promotes active, problem-based learning.

Life-Long Collections: Motivations and the Implications for Lifelogging with Mobile Devices

In this paper the authors investigate the motivations for life-long collections and how these motivations can inform the design of future lifelog systems. Lifelogging is the practice of automatically capturing data from daily life experiences with mobile devices, such as smartphones and wearable cameras. Lifelog archives can benefit both older and younger people; therefore lifelog systems should be designed for people of all ages. The authors believe that people would be more likely to adopt lifelog practices that support their current motivations for collecting items. To identify these motivations, ten older and ten younger participants were interviewed. It was found that motivations for and against life-long collections evolve as people age and enter different stages, and that family is at the core of life-long collections. These findings will be used to guide the design of an intergenerational lifelog browser.

Automatically recommending multimedia content for use in group reminiscence therap

This paper presents and evaluates a novel approach for automatically recommending multimedia content for use in group reminiscence therapy for people with Alzheimers and other dementias. In recent years recommender systems have seen popularity in providing a personalised experience in information discovery tasks. This personalisation approach is naturally suited to tasks in healthcare, such as reminiscence therapy, where there has been a trend towards an increased emphasis on person-centred care. Building on recent work which has shown benefits to reminiscence therapy in a group setting, we develop and evaluate a system, REMPAD, which profiles people with Alzheimers and other dementias, and provides multimedia content tailored to a given group context. In this paper we present our system and approach, and report on a user trial in residential care settings. In our evaluation we examine the potential to use early-aggregation and late-aggregation of group member preferences using case-based reasoning combined with a content-based method. We evaluate with respect to accuracy, utility and perceived usefulness. The results overall are positive and we find that our best-performing approach uses early aggregation CBR combined with a content-based method. Also, under different evaluation criteria, we note different performances, with certain configurations of our approach providing better accuracy and others providing better utility.