Rick Yiu Cho Kwan

Can Smartphones Enhance Telephone-Based Cognitive Assessment (TBCA)?

TBCA has emerged to solve the limitations of administering cognitive assessments face-to-face. The recent development of telephones and knowledge advances in the area of cognitive impairment may affect the development of TBCA. The purpose of this paper is to discuss how smartphones can be used to enhance the applicability of TBCA, which has previously been administered by conventional telephone. This paper will first review, describe and critique the existing TBCA instruments. It will then discuss the recent developments in tele-technology, the popularity of tele-technology among the elderly, potential benefits and challenges in using smartphones for cognitive assessment, and possible future developments in this technology. In the systematic review, eighteen TBCA instruments were identified. They were found to be valid in differentiating between people with and without dementia. TBCA was previously found to be launched on a conventional telephone platform. The advances in understanding of cognitive impairment may demand that telephones be equipped with more advanced features. Recently, the development and penetration of smartphones among the elderly has been rapid. This may allow the smartphone to enhance its TBCA applicability by overcoming the limitations of the conventional telephone, rendering the TBCA more efficient in addressing the increasing demand and complexity of cognitive assessments in the future. However, more research and technology developments are needed before smartphones can become a valid platform for TBCA.

Acupressure for Managing Agitation in People with Dementia: Design of a Protocol Using the Delphi Technique

Background: Preliminary studies support the effect of acupressure in managing agitation in people with dementia (PWD). However, procedures for the selection of intervention ingredients and specifications of the implementation techniques are lacking. This lack of information hinders further studies on the effect of acupressure and its subsequent clinical uses. The aim of this study was to develop an acupressure protocol and to identify its specifications. Methods: This study employed the Delphi technique, an approach to gain consensus on intervention ingredient selection to formulate the acupressure protocol through rounds of consultation among a panel of experts. Consensus of the protocol is considered when agreements on each ingredient reach and exceed 80%. Results: We invited 6 eligible traditional Chinese medicine (TCM) practitioners into the expert panel. An acupressure protocol with 100% agreement was developed in 3 rounds of consultation. Five acupoints and seven implementation specifications were identified. Conclusions: This study identifies the key intervention ingredients of acupressure and displays their procedures. The results support the notion that identification of acupressure ingredients for managing agitation in PWD by the Delphi technique is feasible. This study also identifies some intervention implementation specifications that have not been reported earlier, although the dosage (i.e. the frequency and duration) could not be well justified by the experts based on their clinical experience and the TCM theory. The study results suggest that further studies should focus on identifying the ideal dosage to be used and subsequently examine the effect of this standardized acupressure protocol as implemented by lay caregivers in randomized controlled trials.

Knowledge, Practice, and Attitude of Nursing Home Staff Toward the Use of Physical Restraint: Have They Changed Over Time?

PURPOSE Use of physical restraints is common in nursing homes, although empirical evidence has shown it to be a hazardous measure. This article aims to understand whether there were any changes in nursing home staffs knowledge, attitudes, and practices of using physical restraints in Hong Kong, after years of deliberation on this topic. METHODS A questionnaire about the knowledge, attitude, and practice of using physical restraint was sent to all 298 staff members in four nursing homes in Hong Kong run by a nongovernmental organization. The results were compared with previous findings from 1999 using the same questionnaire. RESULTS Overall, the staff had satisfactory knowledge of the daily application of physical restraints, such as the operational procedure and daily assessment. Concerning the conceptual knowledge of minimizing physical restraint use, their performance in the survey was less satisfactory. For example, only 6.6% of respondents were aware that residents had a right to reject the use of physical restraints, and 70% believed that there were no good alternatives to restraints. They showed appropriate attitudes in their practice of daily use of physical restraints. Compared with the previous study in 1999, a significant improvement was found in the attitudes (p = .0014) and practice (p = .0002) of using restraints, but there was no difference in their knowledge test results (p = .29). CONCLUSIONS The results of this study show a significant improvement among the nursing home staff in terms of their attitudes and practice of using restraints. In-service training for nursing staff should focus more on their knowledge of ethical considerations and the hands-on practice of using alternative devices (e.g., motion detectors or anti-slip pads). CLINICAL RELEVANCE The findings of this study suggest that in-service training for nursing staff should focus more on their knowledge of ethical considerations, the principles of using physical restraint, and the alternatives to restraint in order to fill the knowledge gaps of staff and improve the quality of care in nursing homes.

Effects of play activities program for nursing home residents with dementia on pain and psychological well-being: Cluster randomized controlled trial: Play activity for older adults with dementia

The prevalence of chronic pain among nursing home residents with dementia is high. This present study aimed to explore the effectiveness of a play activities program among nursing home residents with dementia.

The use of smartphones for wayfinding by people with mild dementia

The aim of this study was to explore the acceptability, feasibility and usability of older people with mild dementia to use smartphone for wayfinding. Thirty cognitively normal older people and 16 people with mild dementia were recruited to participate in a wayfinding trial in the free-living environment. Five feasibility and three acceptability markers were compared between the groups. Content analysis on the video-recorded trial processes and individual interviews was employed to identify the usability issues. The results found that there were no significant between-group differences on the feasibility markers, except that the people with mild dementia needed significantly more time to complete the wayfinding trial and workshop; or on the acceptability items. Sensory/cognitive impairment and GPS signal reliability affected their usability. Mild dementia does not limit the older people to use smartphones for wayfinding in the free-living environment. Future studies should examine the efficacy and safety of smartphone to promote outdoor independence of the people with mild dementia.

A simplified 10-step Tai-chi programme to enable people with dementia to improve their motor performance: a feasibility study:

Objective: To evaluate the feasibility and preliminary effects of a simplified 10-step Tai-chi programme to improve the motor performance of people with dementia. Design: A two-arm, single-blinded cluster randomized controlled trial, registered with ClinicalTrials.gov (NCT03341091). Setting: Community health centres. Participants: Twenty-six dyads of people with dementia and their family caregivers were recruited, with mean (SD) ages of 82.2 (7.43) and 51.3 (18.97), respectively. Interventions: The experimental group underwent a 16 week 10-step simplified Tai-chi training programme, with additional measures to enhance engagement. The control group joined recreational activities organized by the centres. Main outcome measure(s): The feasibility assessment included recruitment, attrition, adherence to, and engagement in the Tai-chi programme. The preliminary effects were assessed by the participants’ performance in mobility tests. Results: Preliminary feasibility was established, with an acceptable recruitment rate of 58% (26 out of 45 assessed dyads) and a high attendance rate of 81% (25.88 out of 32 Tai-chi sessions). There was positive engagement in the training sessions, and no adverse incidents. However, five participants withdrew from the Tai-chi group, for a high attrition rate of 38%, and the mean home practice time decreased between weeks 8 and 16. In most of the motor performance tests, a slight but insignificant improvement was observed in the Tai-chi group compared to the control group. Conclusion: A tailored Tai-chi programme for people with dementia using a dyadic approach has been found to be feasible. However, stronger support must be provided to family caregivers to improve the participants’ sustained participation.

A Randomized Controlled Trial Examining the Effect of Acupressure on Agitation and Salivary Cortisol in Nursing Home Residents with Dementia

Background: Acupressure has been used to manage agitation in people with dementia because it is safe and inexpensive. However, its effect on agitation and at the biochemical level is uncertain. Methods: This randomized controlled trial examined the effect of acupressure on agitation, as measured by the Cohen-Mansfield Agitation Inventory (CMAI); and on salivary cortisol, as measured at baseline (T0) and in the 3rd (T1), 5th (T2), and 8th (T3) weeks. There were 119 agitated residents with dementia randomized into 3 groups: acupressure (n = 39), sham (n = 41), and usual-care group (n = 39). Results: A downward trend in agitation over time was noted in the acupressure group, which almost reached a level of significance in interaction effects between groups and time points (p = 0.052). Post hoc pairwise tests in the acupressure group showed that acupressure significantly reduced agitation at T2 (mean difference -6.84, 95% CI -10.60, -3.08) compared to baseline. Significant interaction effects between groups and time points were observed on the level of salivary cortisol (p = 0.022). Conclusion: Acupressure is a multicomponent intervention that can reduce agitation. Acupoint activation may not be a significant component in reducing agitation, although this result may have been limited by the inadequate sample size. Acupressure is effective in reducing salivary cortisol in people with dementia.

EFFECTS OF ACUPRESSURE ON AGITATION AND STRESS IN NURSING HOME RESIDENTS WITH DEMENTIA

postmenopausalwomen.We testedwhether supplementationwith resveratrol (a phytoestrogen) could improve their cerebrovascular function and cognitive performance and overall well-being. Methods: Eighty community dwelling postmenopausal women aged 45-85 years were randomised to take resveratrol (resVida , 2 x 75 mg/ day) or placebo for 14 weeks and changes in the following were assessed: cognitive tests for executive function, semantic, verbal and visuospatial working memory; transcranial Doppler ultrasound recording of percent increase of blood flow velocity in the middle cerebral artery to both cognitive testing and hypercapnia (breathing carbogen gas for 3 min), which assessed neurovascular coupling capacity and global vasodilatation respectively. Rating scales from selfreports of pain, sleep,menopausal symptoms,mood states and quality of life using Short-Form 36 were averaged to provide a composite score representing overall well-being. Results:Compared to placebo, supplementation with resveratrol elicited 17% increases in cerebrovascular responsiveness (CVR) to both the hypercapnic (P1⁄40.010) and cognitive stimuli (P1⁄40.002). The latter was an overall response to the cognitive test battery. Therewere also increases in CVR to verbal memory (P1⁄40.041) and in overall cognitive performance (p1⁄40.020) that correlated with the enhancement of neurovascular coupling capacity (r1⁄40.327, P1⁄40.048). We also found a significant reduction in perception of pain (P<0.001), attributable to age-related osteoarthritis, and an improvement in overall well-being (P1⁄40.008) following supplementation; both outcomes correlated with the treatment change in CVR to hypercapnia. Neither pain reduction nor boosting of overall well-being significantly correlated with the improvement of cognitive performance. Conclusions:This is the first demonstration that regular consumption of a modest dose of resveratrol can enhance cognition and overall well-being and reduce pain perception in postmenopausal women; all of which were partially attributed to enhancement of cerebrovascular function. Further investigation elucidating the underlyingmechanisms involving circulatory function and age-related chronic pain iswarranted. Our findings offer a promising new approach for reducing the heightened risk of accelerated cognitive decline in this population.

A Computerized Cognitive Assessment Method in a Nurse-Led Clinic: A Comparative Study With the Traditional Pencil-and-Paper Approach.

This article reports our experience in developing a computerized cognitive assessment method in a nurse-led clinic. The assessment and report-writing time and the accuracy of using a computer as an assessment medium were compared with assessments that use the traditional pencil-and-paper method. The attitudes of professionals and service users toward the computerized approach were also collected. The results found that the computerized approach not only helped to reduce the time spent making assessments and writing reports but also improved the accuracy of the assessment when compared with the pencil-and-paper method. Most of the professionals and service users who were interviewed responded positively toward computerized assessments. The experience gained in this study will also help us to standardize our assessment procedures, promote communication among members of the clinical team, and facilitate data management and clinical research.