Siobhan T. O'Dwyer

Protocol for Fit Bodies, Fine Minds: a randomized controlled trial on the affect of exercise and cognitive training on cognitive functioning in older adults

BackgroundDeclines in cognitive functioning are a normal part of aging that can affect daily functioning and quality of life. This study will examine the impact of an exercise training program, and a combined exercise and cognitive training program, on the cognitive and physical functioning of older adults.Methods/DesignFit Bodies, Fine Minds is a randomized, controlled trial. Community-dwelling adults, aged between 65 and 75 years, are randomly allocated to one of three groups for 16 weeks. The exercise-only group do three 60-minute exercise sessions per week. The exercise and cognitive training group do two 60-minute exercise sessions and one 60-minute cognitive training session per week. A no-training control group is contacted every 4 weeks. Measures of cognitive functioning, physical fitness and psychological well-being are taken at baseline (0 weeks), post-test (16 weeks) and 6-month follop (40 weeks). Qualitative responses to the program are taken at post-test.DiscussionWith an increasingly aged population, interventions to improve the functioning and quality of life of older adults are particularly important. Exercise training, either alone or in combination with cognitive training, may be an effective means of optimizing cognitive functioning in older adults. This study will add to the growing evidence base on the effectiveness of these interventions.Trial RegistrationAustralian Clinical Trials Register: ACTRN012607000151437

Suicidal ideation in family carers of people with dementia: a pilot study

The objective of this pilot study was to gather preliminary evidence on suicidal ideation in family carers of people with dementia.

Quality of life in people living with dementia in nursing homes.

Purpose of review To describe the impact of living in a nursing home on quality of life (QoL) in people living with dementia. Recent findings People with dementia are likely to spend time in a nursing home, particularly in the late stage of the syndrome when declining functional and cognitive ability add to the burden of community care. Although it is commonly assumed that QoL decreases for people with dementia once they are placed into a nursing home, the reviewed studies suggest that self-ratings of QoL are significantly higher than staff and family ratings, several nonpharmacological interventions may increase QoL and further research is needed that focuses on the influence of care provision. Summary Dementia is associated with a reduced QoL that can be partly caused by environment, staff attitudes and limited relationships. Although people with dementia experience variations in QoL across the trajectory of the syndrome, there is evidence that they can communicate their preferences and have meaning in their lives when key factors related to QoL are addressed. Some of these key factors include meaningful time use through activities focused on their interests, social engagement, positive staff attitudes and an environment that allows connection with others.

Effect of an interactive therapeutic robotic animal on engagement, mood states, agitation and psychotropic drug use in people with dementia: a cluster-randomised controlled trial protocol.

Introduction Apathy, agitated behaviours, loneliness and depression are common consequences of dementia. This trial aims to evaluate the effect of a robotic animal on behavioural and psychological symptoms of dementia in people with dementia living in long-term aged care. Methods and analysis A cluster-randomised controlled trial with three treatment groups: PARO (robotic animal), Plush-Toy (non-robotic PARO) or Usual Care (Control). The nursing home sites are Australian Government approved and accredited facilities of 60 or more beds. The sites are located in South-East Queensland, Australia. A sample of 380 adults with a diagnosis of dementia, aged 60 years or older living in one of the participating facilities will be recruited. The intervention consists of three individual 15 min non-facilitated sessions with PARO or Plush-Toy per week, for a period of 10 weeks. The primary outcomes of interest are improvement in agitation, mood states and engagement. Secondary outcomes include sleep duration, step count, change in psychotropic medication use, change in treatment costs, and staff and family perceptions of PARO or Plush-Toy. Video data will be analysed using Noldus XT Pocket Observer; descriptive statistics will be used for participants’ demographics and outcome measures; cluster and individual level analyses to test all hypotheses and Generalised Linear Models for cluster level and Generalised Estimation Equations and/or Multi-level Modeling for individual level data. Ethics and dissemination The study participants or their proxy will provide written informed consent. The Griffith University Human Research Ethics Committee has approved the study (NRS/03/14/HREC). The results of the study will provide evidence of the efficacy of a robotic animal as a psychosocial treatment for the behavioural and psychological symptoms of dementia. Findings will be presented at local and international conference meetings and published in peer-reviewed journals. Trial registration number Australian and New Zealand Clinical Trials Registry number ACTRN12614000508673 date registered 13/05/2014.

Suicidal ideation and resilience in family carers of people with dementia: A pilot qualitative study

Objectives: Family carers of people with dementia have higher than average rates of depression, anxiety and hopelessness. While these are all risk factors for suicide, there has been no research on suicidal ideation in this population. The aims of this pilot study were to conduct an initial exploration of carers’ experiences of suicidality and identify factors associated with risk and resilience, which could be used to guide further research. Method: A descriptive qualitative approach was taken. In-depth interviews were conducted with nine carers of people with dementia (four male, five female) and transcripts were analysed thematically. Results: Three themes were identified in the data – ‘experiences of suicidal ideation’, ‘risk factors’ and ‘resilience’. Four of the nine participants had experienced suicidal thoughts and two had made preparations for a suicidal act. Risk factors included pre-existing mental health problems, physical health conditions, and conflict with other family or care staff. Factors positively associated with resilience included the use of positive coping strategies, faith, social support and personal characteristics. Conclusion: Some people contemplate suicide while caring for a family member with dementia. Further research is required to confirm the rate of suicidal ideation in the caring population and the relative contribution of factors associated with risk and resilience. In the meantime, service providers and health professionals should be taking steps to identify and support carers currently experiencing suicidal thoughts.

Exploring the effect of foot massage on agitated behaviours in older people with dementia: A pilot study

Aim:  To explore the effects of foot massage on agitated behaviours in older people with dementia living in long‐term care.

Homicidal ideation in family carers of people with dementia

Objective: Family carers of people with dementia have higher than average rates of suicidal ideation, but there has been no research on homicidal ideation in this population. The aim of this study was to explore thoughts of homicide in family carers of people with dementia. Method: A descriptive qualitative approach was taken. Twenty-one Australian carers (7 men, 14 women) participated in individual, in-depth interviews and the transcripts were analysed thematically. Results: Seven themes were identified in the data – active thoughts of homicide; understanding homicidal thoughts in others; passive thoughts of death; euthanasia; homicidal thoughts in other caregiving situations; abuse; and disclosing thoughts of harm. Two of the 21 participants had actively contemplated the homicide of their care recipient, four expressed a passive desire for the care recipients death, and four reported physically or verbally abusing the care recipient. Only one carer had previously disclosed these experiences. Conclusion: Homicidal ideation is a real and significant phenomenon among family carers of people with dementia. Service providers and health professionals are encouraged to identify and support carers contemplating homicide, but to do so in a way that recognises the broader social context of carer burden.

Foot massage versus quiet presence on agitation and mood in people with dementia: A randomised controlled trial

BACKGROUND There is increasing interest in using complementary and alternative treatments to manage behavioural and psychological symptoms of dementia such as agitation, aggression and depressed mood. OBJECTIVE To compare the effect of foot massage (intervention) and quiet presence (control) on agitation and mood in people with dementia. DESIGN A randomised controlled trial using a within-subjects, crossover design. SETTINGS Five long-term care facilities in Brisbane, Australia. The primary outcome was the Cohen-Mansfield Agitation Inventory (CMAI) and the secondary outcome was the Observed Emotion Rating Scale (OERS). The screening and data collection research assistants, families, and care staff were blinded to participant allocation. PARTICIPANTS Participants of the study were 55 long-term care residents aged 74-103 years (mean age 86.5), with moderate to severe dementia and a history of agitated behaviour according to the Pittsburgh Agitation Scale. A computer-program randomised participants to 10-min foot massage (intervention) or quiet presence (control), every weekday for 3 weeks. RESULTS A carry-over effect was identified in the data, and so the data was treated as a parallel groups RCT. The mean total CMAI increased in both groups (reflecting an increase in agitation) with this increase greater in the quiet presence group than the foot massage group (p=0.03). There was a trend towards a difference on OERS General Alertness, with a positive change in alertness for participants in the foot massage group (indicating reduced alertness) and a negative change for participants in the quiet presence group (indicating increased alertness) (F(1,51)=3.88, p=0.05, partial ή(2)=0.07). CONCLUSIONS The findings highlight the need for further research on the specific conditions under which massage might promote relaxation and improve mood for people with dementia. The unfamiliar research assistants and variations in usual activity may have contributed to the increase in agitation and this needs further research. TRIAL REGISTRATION ACTRN12612000658819.

Foot massage and physiological stress in people with dementia: a randomized controlled trial

BACKGROUND The anxiety associated with unfamiliar surroundings, the disorientation and mental confusion, and the social isolation that accompanies dementia can often create increased stress for people living in long-term care settings. Such a response is thought to affect the autonomic nervous system and result in emotional and physical symptoms of distress that may be manifested as agitation. There is the potential for such distress to influence the physiological response and in particular Blood Pressure and Heart Rate. A relaxation intervention such as massage may influence the physiological stress response. METHODS This randomized controlled trial aimed to compare the effect of foot massage (FM) versus a control activity (quiet presence, QP) on physiological stress response (i.e., blood pressure [BP] and heart rate [HR]) in people living with moderate-to-severe dementia in long-term-care settings. RESULTS Fifty-three residents were randomized to intervention (10-minute FM) or control group (QP). While the FM group experienced a greater reduction in HR than the control group, these reductions were not significantly different between groups (p=0.83; see Table 1 ), or across time (p=0.46). Both groups experienced a reduction in systolic BP and diastolic BP, while the mean reduction in systolic BP was greater for those in the FM group. CONCLUSIONS While the findings do not provide strong support for FM, the finding that both conditions allowed the person with dementia to rest in the presence of another human being is of importance in the care of people with dementia. The close presence of another person may in fact promote relaxation and therefore improve BP and HR measures.

Feeling that life is not worth living (death thoughts) among middle-aged, Australian women providing unpaid care

OBJECTIVE To identify the proportion of female carers who experience death thoughts and the factors associated with these thoughts, using data from the Australian Longitudinal Study on Womens Health (ALSWH). METHODS A cross-sectional analysis of the fifth ALSWH survey was conducted. 10,528 middle-aged women provided data on caring and death thoughts, 3077 were carers and 2005 of those were included in the multivariate analysis. RESULTS 7.1% of female carers had felt life was not worth living in the previous week and were classified as having experienced death thoughts, compared with 5.7% of non-carers (p=.01). Carers with death thoughts had poorer physical and mental health, higher levels of anxiety, lower levels of optimism, and reported less social support (p<.01). In a multivariate model social support, mental health, carer satisfaction, and depressive symptoms significantly predicted death thoughts. Carers with clinically significant depressive symptoms were four times more likely to experience death thoughts than those without. Carers who were satisfied with their role were 50% less likely to have experienced death thoughts than those who were dissatisfied. CONCLUSIONS A small but significant proportion of female carers experience death thoughts and may be at risk for suicide. These findings add to the growing body of evidence on suicide-related thoughts and behaviours in carers and have implications for health professionals and service providers.