Siobhan O’Dwyer

Connecting the person with dementia and family: a feasibility study of a telepresence robot

BackgroundMaintenance of communication is important for people with dementia living in long-term care. The purpose of this study was to assess the feasibility of using “Giraff”, a telepresence robot to enhance engagement between family and a person with dementia living in long-term care.MethodsA mixed-methods approach involving semi-structured interviews, call records and video observational data was used. Five people with dementia and their family member participated in a discussion via the Giraff robot for a minimum of six times over a six-week period. A feasibility framework was used to assess feasibility and included video analysis of emotional response and engagement.ResultsTwenty-six calls with an average duration of 23 mins took place. Residents showed a general state of positive emotions across the calls with a high level of engagement and a minimal level of negative emotions. Participants enjoyed the experience and families reported that the Giraff robot offered the opportunity to reduce social isolation. A number of software and hardware challenges were encountered.ConclusionsParticipants perceived this novel approach to engage families and people with dementia as a feasible option. Participants were observed and also reported to enjoy the experience. The technical challenges identified have been improved in a newer version of the robot. Future research should include a feasibility trial of longer duration, with a larger sample and a cost analysis.

Study protocol: a randomised controlled trial of the effects of a multi-modal exercise program on cognition and physical functioning in older women

BackgroundIntervention studies testing the efficacy of cardiorespiratory exercise have shown some promise in terms of improving cognitive function in later life. Recent developments suggest that a multi-modal exercise intervention that includes motor as well as physical training and requires sustained attention and concentration, may better elicit the actual potency of exercise to enhance cognitive performance. This study will test the effect of a multi-modal exercise program, for older women, on cognitive and physical functioning.Methods/designThis randomised controlled trial involves community dwelling women, without cognitive impairment, aged 65–75 years. Participants are randomised to exercise intervention or non-exercise control groups, for 16 weeks. The intervention consists of twice weekly, 60 minute, exercise classes incorporating aerobic, strength, balance, flexibility, co-ordination and agility training. Primary outcomes are measures of cognitive function and secondary outcomes include physical functioning and a neurocognitive biomarker (brain derived neurotrophic factor). Measures are taken at baseline and 16 weeks later and qualitative data related to the experience and acceptability of the program are collected from a sub-sample of the intervention group.DiscussionIf this randomised controlled trial demonstrates that multimodal exercise (that includes motor fitness training) can improve cognitive performance in later life, the benefits will be two-fold. First, an inexpensive, effective strategy will have been developed that could ameliorate the increased prevalence of age-related cognitive impairment predicted to accompany population ageing. Second, more robust evidence will have been provided about the mechanisms that link exercise to cognitive improvement allowing future research to be better focused and potentially more productive.Trial registrationAustralian and New Zealand Clinical Trial Registration Number: ANZCTR12612000451808

The effectiveness of Swedish massage with aromatic ginger oil in treating chronic low back pain in older adults: a randomized controlled trial.

OBJECTIVES To investigate the effects of Swedish massage with aromatic ginger oil (SMGO) on chronic low back pain and disability in older adults compared with traditional Thai massage (TTM). DESIGN Randomized controlled trial. SETTING Massage clinic in Ratchaburi province, Thailand. PARTICIPANTS 164 patients were screened; 140 were eligible, and randomized to either SMGO (n=70) or TTM (n=70). INTERVENTION Trained staff provided participants with a 30-min SMGO or TTM twice a week for five weeks. MEASUREMENT The Visual Analogue Scale (VAS) assessed immediate effect (after each massage) and the short form McGill Pain Questionnaire (MPQ) assessed effectiveness of massage in short-term (six weeks) and long-term (15 weeks). Disability improvement was measured by the Owestry Disability Questionnaire (ODQ) at baseline, short- and long-term. RESULTS Both SMGO and TTM led to significant improvements in pain intensity (p<0.05) and disability (p<0.05) across the period of assessments, indicating immediate, short- and long-term effectiveness. SMGO was more effective than TTM in reducing pain (p=0.04) and improving disability at short- and long-term assessments (p=0.04). CONCLUSIONS These findings suggest that the integration of either SMGO or TTM therapy as additional options to provide holistic care to older people with chronic low back pain could be considered by health professionals. Further research into the use of ginger as an adjunct to massage therapy, particularly TTM, is recommended.

What Effect Does an Animal Robot Called CuDDler Have on the Engagement and Emotional Response of Older People with Dementia? A Pilot Feasibility Study

The development of companion animal robots is of growing interest. These robots have recently been marketed to older adults with dementia as a means of encouraging social engagement and reducing behavioural and psychological symptoms of dementia. This paper outlines the results of a pilot study that sought to assess the feasibility and effect of using a robotic companion animal called CuDDler on engagement and emotional states of five older adults with dementia living in nursing home care. CuDDler is a prototype robot developed in Singapore. Despite their cognitive decline, the study participants raised a number of concerns regarding the feasibility and tolerability of CuDDler. The effectiveness of CuDDler was also limited in these participants, although one participant with visual agnosia benefited greatly from the one-on-one experience. The findings demonstrate the importance of companion robots being developed that are of an appropriate size, weight and shape for older people, including those with dementia, and a realistic animal shape that does not encourage thoughts of it being a toy. Our conclusions indicate the need for further studies on the development and use of companion robots, and investigation of the comparative benefits of social robots both compared to and in association with human interactions.

The effect of foot massage on long-term care staff working with older people with dementia: a pilot, parallel group, randomized controlled trial

BackgroundCaring for a person with dementia can be physically and emotionally demanding, with many long-term care facility staff experiencing increased levels of stress and burnout. Massage has been shown to be one way in which nurses’ stress can be reduced. However, no research has been conducted to explore its effectiveness for care staff working with older people with dementia in long-term care facilities.MethodsThis was a pilot, parallel group, randomized controlled trial aimed at exploring feasibility for a larger randomized controlled trial. Nineteen staff, providing direct care to residents with dementia and regularly working ≥ two day-shifts a week, from one long-term care facility in Queensland (Australia), were randomized into either a foot massage intervention (n=9) or a silent resting control (n=10). Each respective session lasted for 10-min, and participants could receive up to three sessions a week, during their allocated shift, over four-weeks. At pre- and post-intervention, participants were assessed on self-report outcome measures that rated mood state and experiences of working with people with dementia. Immediately before and after each intervention/control session, participants had their blood pressure and anxiety measured. An Intention To Treat framework was applied to the analyses. Individual qualitative interviews were also undertaken to explore participants’ perceptions of the intervention.ResultsThe results indicate the feasibility of undertaking such a study in terms of: recruitment; the intervention; timing of intervention; and completion rates. A change in the intervention indicated the importance of a quiet, restful environment when undertaking a relaxation intervention. For the psychological measures, although there were trends indicating improvement in mood there was no significant difference between groups when comparing their pre- and post- scores. There were significant differences between groups for diastolic blood pressure (p= 0.04, partial η2=0.22) and anxiety (p= 0.02, partial η2=0.31), with the foot massage group experiencing greatest decreases immediately after the session. The qualitative interviews suggest the foot massage was well tolerated and although taking staff away from their work resulted in some participants feeling guilty about taking time out, a 10-min foot massage was feasible during a working shift.ConclusionsThis pilot trial provides data to support the feasibility of the study in terms of recruitment and consent, the intervention and completion rates. Although the outcome data should be treated with caution, the pilot demonstrated the foot massage intervention showed trends in improved mood, reduced anxiety and lower blood pressure in long-term care staff working with older people with dementia. A larger study is needed to build on these promising, but preliminary, findings.Trial registrationACTRN: ACTRN12612000659808.

Pharmacotherapy of Persons with Dementia in Long-term Care in Australia: A Descriptive Audit of Central Nervous System Medications

Background: Neuropsychiatric symptoms of dementia are often treated through the prescription of one or more psychotropic medications. However, limited efficacy and potential harmful side-effects has resulted in efforts to reduce the use of psychotropic medication in this population, particularly for those living in long-term care. Objectives: This study sought to describe the pattern of central nervous system medication usage in older adults with dementia living in long-term care; assess the appropriateness of prescribing against Beers criteria; and detect potential drug interactions from co-administered medications. Methods: A retrospective descriptive audit of the medical records of n=415 residents, aged >60 years with a diagnosis of dementia, from 28 long-term care facilities in Queensland, Australia. Information extracted included the types and usage of regular and Pro Re Nata central nervous system medications. Results: Of those taking medication (n=317), 68% were prescribed at least one potentially inappropriate medication, and there was a significant positive correlation between the number of medications prescribed and the number of potentially inappropriate medications. Two-hundred potential interactions with variable severity were identified from 130 residents on ≥1 medication – 38% were potentially severe interactions, 46% were moderate. Conclusion: This medication audit raises concerns that prescription of medications may still be the first resort to treat behavioural and psychological symptoms of dementia. There is a need for effective and sustainable person-centred interventions that address barriers for appropriate prescribing practice, and involve the collaboration of all healthcare professionals to optimise prescribing and improve the quality of medicines in older people with dementia.

Interventions to build resilience in family caregivers of people living with dementia: a comprehensive systematic review.

BackgroundRecent studies have indicated that family caregivers of people with dementia have higher rates of depression, anxiety and hopelessness, as well as higher levels of burden, stress and distress. Not all caregivers, however, succumb to the negative effects of caring. Caregivers who are able to recover from, resist or adapt to the physical and psychological demands of caring can be considered “resilient”. ObjectivesThe objective of this review was to examine the existing evidence regarding interventions for building resilience in family caregivers of people living with dementia. Inclusion criteria Types of participantsThis review considered studies that included family caregivers of people with dementia. Types of intervention(s)/phenomena of interestStudies investigating interventions to build resilience in family caregivers were considered by the review. For qualitative studies, the phenomena of interest were family caregivers’ experiences of the interventions including factors affecting implementation and their subjective experience of outcomes. ContextStudies conducted in any cultural or geographical context and any settings including participants’ homes in the community, residential aged care or hospital, medical or allied health practice were considered for inclusion. Types of studiesQuantitative studies incorporating experimental and descriptive study designs and qualitative studies, including, but not limited to, phenomenology, grounded theory, ethnography, action research and feminist research were considered for inclusion. OutcomesQuantitative studies were included that contained either objective or subjective outcome measures (or a combination of both). In cases in which proxy measures of resilience were used, only those papers that explicitly related the aims of the intervention and the measurement of outcomes to resilience itself were considered for inclusion. Proxies could include, but were not limited to, self-efficacy, locus of control, perceived burden, psychological wellbeing, strength, coping, positive adjustment and resourcefulness. Qualitative studies were similarly considered for inclusion if they explicitly related the aims of the intervention to resilience. Search strategyEleven electronic databases were searched for research studies published in English in or after 1990. Methodological qualityQuantitative and qualitative studies selected for retrieval were assessed by two independent reviewers for methodological validity using standardized critical appraisal instruments from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) and Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI). Data extractionQuantitative and qualitative data were extracted from publications included in the review using the standardized data extraction tools from JBI-MAStARI and JBI-QARI. Data synthesisIt was not possible to pool quantitative findings for statistical meta-analysis using JBI-MAStARI. Qualitative research findings were too limited to be pooled using the JBI-QARI. The findings are presented in narrative form. ResultsThe review included three publications reporting one quantitative intervention study and one mixed-method intervention study. There was a lack of available studies and, of the two intervention studies that were identified, neither found any statistically significant change in quantitative measures of resilience. Qualitative data suggested positive impacts of a poetry writing intervention and a positive experience of the intervention. Conclusion Implications for practiceThe studies differed in both the nature of the intervention and the way resilience was conceptualized and operationalized. Consequently, it was not possible to offer any recommendations for practice. Implications for researchImplications for research relate to the development of a more comprehensive theory of resilience in family caregivers that can be used to develop and rigorously evaluate reliable and valid measures of resilience in line with that theory. Further, well-designed, sufficiently powered intervention studies informed by theory are needed.

Effect of a robotic seal on the motor activity and sleep patterns of older people with dementia, as measured by wearable technology: A cluster-randomised controlled trial

OBJECTIVES The robotic seal, PARO, has been used as an alternative to animal-assisted therapies with residents with dementia in long-term care, yet understanding of its efficacy is limited by a paucity of research. We explored the effects of PARO on motor activity and sleep patterns, as measured by a wearable triaxial accelerometer. STUDY DESIGN Cluster-randomised controlled trial, involving 28 facilities in Queensland, Australia. Nine facilities were randomised to the PARO group (individual, non-facilitated, 15-min sessions three afternoons per week for 10 weeks), 10 to a plush toy (PARO with robotic features disabled) and nine to usual care. MAIN OUTCOME MEASURES Changes in day- and nighttime motor activity and sleep after the 10-week intervention, as measured by SenseWear® armbands, worn by participants continuously for 24 h at baseline, during two single intervention days in weeks 5 and 10 respectively, and post-intervention (week 15). Analyses followed intention-to-treat, using repeated-measures mixed-effects models. RESULTS After 10 weeks, the PARO group showed a greater reduction in daytime step count than usual care (p = 0.023), and in nighttime step count (p = 0.028) and daytime physical activity (p = 0.026) compared with the plush toy group. At post-intervention, the PARO group showed a greater reduction in daytime step count than the plush toy group (p = 0.028), and at nighttime compared with both the plush toy group (p = 0.019) and the usual-care group (p = 0.046). The PARO group also had a greater reduction in nighttime physical activity than the usual-care group (p = 0.015). CONCLUSIONS PARO may have some effect on motor activity of older people with dementia in long-term care, but not on sleep patterns. Australian New Zealand Clinical Trials Registry (ACTRN12614000508673).

Self-care for academics: a poetic invitation to reflect and resist

Abstract In newspapers and blogs, on Twitter, and in academic papers, stories of struggling academics abound. Substance abuse, depression, failed relationships, and chronic illness are the casualties of a neoliberal university sector that values quantity over quality and demands ever more for ever less. Within the academic literature a growing counter-movement has called for resistance, collective action, and slow scholarship. Much of this work, however, has focused on strategies that can be applied within academia. Little has been written about the activities that academics do outside the university; activities that have no purpose other than enjoyment, rest, and renewal; activities that represent the valuing of the self as a human being, rather than a means of production; activities that could best be defined as self-care. Using reflective practice to construct a poem comprising three voices, this paper explores those activities. This poetic representation is an effort to create time and space for the authors, and a manifesto to encourage other academics to demand and protect the time, space, and reflective practice that are essential to both personal wellbeing and quality research and education.

Identifying people with dementia on Twitter

There is a growing body of research on the use of Twitter by people with health conditions, but it does not include people with dementia. In this brief report, we aim to: (1) determine whether people with dementia are using Twitter; (2) provide an estimate of the number of Twitter account holders who identify as having a diagnosis of dementia; and (3) examine the demographic characteristics of these account holders. Tweetcatcher was used to identify tweets containing the search terms ‘dementia’ or ‘Alzheimer’. These data were systematically searched to locate account holders who identified themselves as having a diagnosis of dementia, and a content analysis was conducted of these account holders’ profiles. Thirty account holders self-identified as having a diagnosis of dementia. The average age of account holders was 59 years and the majority were located in North America or the UK. Although the majority of account holders reported having Alzheimer’s disease or did not specify a type of dementia, some rare forms of dementia were also evident. The sample consisted of relatively young account holders and contained more men, which might suggest that other groups are under-represented on Twitter. The majority of account holders considered themselves a dementia activist or were affiliated with a dementia organisation. The findings suggest that people with dementia, with varying demographic characteristics and a range of diagnoses, are active on Twitter. These account holders are more frequently male, relatively young, and dementia activists.