Nordic Studies on Alcohol and Drugs
Elevated alcohol consumption among geriatric psychiatric in-patients
Although a clear relationship has been established between elevated alcohol consumption and psychiatric problems in old age, there are few descriptions of the prevalence of elevated alcohol consumption in older adults who have been referred to geriatric psychiatric treatment.
To describe the prevalence of self-reported elevated alcohol consumption in men and women referred to geriatric psychiatry wards in Norway, and to explore factors associated with elevated alcohol consumption.
This cross-sectional study includes data from a registry of geriatric psychiatry patients aged ≥ 65 years from December 2016 until December 2018. The outcome measure was reported elevated alcohol consumption assessed with the short version of the Alcohol Use Disorders Identification Test (AUDIT-C). The analyses used demographic data as well as a measure of cognitive function, psychiatric diagnosis and use of psychotropic drugs.
In total, 367 patients (131, 35.7% men) with a mean (SD) age of 74.7 (7.6) years were included. Of these patients, 27% scored above the pre-set cut-off for elevated alcohol consumption according to AUDIT-C (≥ 3 and 4 for women and men, respectively). The prevalence of elevated alcohol did not differ by gender. In adjusted logistic regression analysis, older age, living with someone and use of antidepressants were associated with reduced odds for reporting elevated alcohol consumption (OR 0.93, 95% CI 0.89–0.96; OR 0.54, 95% CI 0.31–0.97; and 0.54, 95% CI 0.32–0.92, respectively).
A relatively high proportion of psychiatric patients aged 65 years or older reported elevated alcohol consumption, regardless of diagnosis. Older age, living with someone and use of antidepressants were associated with lower odds for elevated alcohol consumption.
International Journal of Qualitative Studies on Health and Well-being
Awareness of dementia and coping to preserve quality of life: a five-year longitudinal narrative study
To examine how people (<65 years) with young-onset dementia (YOD) express awareness of dementia and how they seem to handle awareness as a strategy to preserve quality of life over time.
A longitudinal qualitative study with individuals with YOD was performed with interviews every 6 months over 5 years for a maximum of 10 interviews. The interviews were analysed by modified grounded theory adapted to narrative inquiry.
Awareness is a complex, multidimensional concept. Awareness of dementia is predisposed by personality, life history and established coping styles. The main coping styles during dementia—live in the moment, ignore the dementia, and make the best of it—seem to be rather consistent throughout disease progression. Transitions in the life situation may change the individual’s awareness of dementia.
Unawareness of dementia may have an important adaptive function for preserving quality of life. Increasing awareness of dementia must be approached with reflexivity and great sensitivity.
Dementia prevention, intervention, and care: 2020 report of the Lancet Commission
The number of older people, including those living with dementia, is rising, as younger age mortality declines. However, the age-specific incidence of dementia has fallen in many countries, probably because of improvements in education, nutrition, health care, and lifestyle changes. Overall, a growing body of evidence supports the nine potentially modifiable risk factors for dementia modelled by the 2017 Lancet Commission on dementia prevention, intervention, and care: less education, hypertension, hearing impairment, smoking, obesity, depression, physical inactivity, diabetes, and low social contact. We now add three more risk factors for dementia with newer, convincing evidence. These factors are excessive alcohol consumption, traumatic brain injury, and air pollution. We have completed new reviews and meta-analyses and incorporated these into an updated 12 risk factor life-course model of dementia prevention. Together the 12 modifiable risk factors account for around 40% of worldwide dementias, which consequently could theoretically be prevented or delayed. The potential for prevention is high and might be higher in low-income and middle-income countries (LMIC) where more dementias occur.
Our new life-course model and evidence synthesis has paramount worldwide policy implications. It is never too early and never too late in the life course for dementia prevention. Early-life (younger than 45 years) risks, such as less education, affect cognitive reserve; midlife (45–65 years), and later-life (older than 65 years) risk factors influence reserve and triggering of neuropathological developments. Culture, poverty, and inequality are key drivers of the need for change. Individuals who are most deprived need these changes the most and will derive the highest benefit.
BMC Health Services Research, 2020
What are the needs of people with dementia in acute hospital settings, and what interventions are made to meet these needs? A systematic integrative review of the literature
Research aiming to improve the hospital experience for patients with dementia and their informal carers is strongly recommended. The present review aimed to describe the research on interventions to meet the needs of people with dementia in acute hospital settings regarding physical environment, organization of care, and staff knowledge of dementia and competence in person-centred care. An integrative review design was applied. We searched for studies in PubMed, Ovid Medline, Cinahl, Embase, Swemed+, and Cochrane databases using the Mixed Methods Appraisal Tool (MMAT) for quality evaluation. Twenty-seven articles were included, describing the perspectives of people with dementia, informal carers, and professional carers. The MMAT score ranged from two to four. Twelve studies described needs and experiences, mostly using a qualitative design. Common themes and results were synthesized. The studies identified a need to enhance staff competence regarding dementia and person-centred care. Fifteen studies described interventions: two were qualitative; three used mixed method, and 10 were quantitative, of which two were randomized controlled trials and eight were observational studies. Five types of interventions were identified. Three types could positively impact staff knowledge about dementia and person-centred care. One type was experienced as positive regarding organisation of care for patients with dementia. None of the intervention studies found evidence for effects on the identified needs regarding physical environment.
The included studies suggest that staff need more knowledge regarding dementia and person-centred dementia care and that training interventions implemented to enhance staff competence had promising results. However, there is a need for research on the needs of patients with dementia in acute hospital settings regarding physical environment and effect of design elements. There is also a scarcity of intervention studies focusing on the effect of models of care that support the psychosocial needs of patients with dementia.
The experience of attending a farm-based day care service from the perspective of people with dementia: A qualitative study
People with dementia have different needs, and it is important to have variation in the services that
are offered for this population. Farm-based day care aims to meet this diversity in need, but research
on such services is lacking. The present study provides knowledge about how people with dementia
experience attending farm-based day care services in Norway. Ten semi-structured interviews were
conducted for five different services, while the participants were at the farm. The interviews were
analysed in accordance with the content analysis of Graneheim, U., & Lundman, B. (2004) [Nurse
Education Today, 24(2), 105-112] and revealed three main categories that included (1) social relations,
(2) being occupied at the farm, and (3) individually tailored service. The findings were summarised in
the overall theme that attending day care at a farm makes me feel like a real participant. Our findings
indicate that the farm-based day cares in the present study provide person-centred care. The farm
setting facilitates services that are tailored to the individual, where the participants get to use their
remaining resources and spend time outdoors. Further, farm-based day care was described as being
suitable for people with or without farm experience and must be seen as an important supplement to
regular day care for those who could benefit from a more active service.
Tanja Ibsen, Siren Eriksen
Profiles of Met and Unmet Needs in People with Dementia According to Caregivers’ Perspective: Results from a European Multicenter Study
Objectives: This exploratory study aimed at investigating profiles of care needs in people with mild to moderate dementia and examined variables associated with these profiles.
Design: A longitudinal international cohort study.
Setting and participants: The baseline data of 447 community-dwelling dyads of people with dementia and their caregivers from the Access to Timely Formal Care (Actifcare) Study were included for analysis.
Methods: A latent class analysis was applied to identify profiles of needs, measured with the Camberwell Assessment of Need for the Elderly as rated by the caregiver. We examined sociodemographic (eg, relative stress scale) and clinical characteristics (eg, neuropsychiatric inventory) associated with these profiles.
Results: Four distinct need profiles were identified through latent class analysis. These comprised a «no need» profile (41% of the sample), a «met psychological needs» profile (25%), a «met social needs» profile (19%), and an «unmet social needs» profile (15%). A larger impact of caregiving on the caregiver’s life as indicated by a higher relative stress scale score was associated with the «unmet social needs» profile.
Conclusions and implications: In this large European sample, there was a subgroup of persons with dementia with high «unmet social needs» whose caregivers simultaneously perceived high stress in their caregiving tasks. Identification of these profiles may help provision of appropriate support for these people.
Dementia and Geriatric Cognitive Disorders
The Power of EEG to Predict Conversion from Mild Cognitive Impairment and Subjective Cognitive Decline to Dementia
Introduction: The aim of this study was to examine if quantitative electroencephalography (qEEG) using the statistical pattern recognition (SPR) method could predict conversion to dementia in patients with subjective cognitive decline (SCD) and mild cognitive impairment (MCI).Methods: From 5 Nordic memory clinics, we included 47 SCD patients, 99 MCI patients, and 67 healthy controls. EEGs analyzed with the SPR method together with clinical data recorded at baseline were evaluated. The patients were followed up for a mean of 62.5 (SD 17.6) months and reexamined.Results: Of 200 participants with valid clinical information, 70 had converted to dementia, and 52 had developed Alzheimer’s disease. Receiver-operating characteristic analysis of the EEG results as defined by a dementia index (DI) ranging from 0 to 100 revealed that the area under the curve was 0.78 (95% CI 0.70-0.85), corresponding to a sensitivity of 71%, specificity of 69%, and accuracy of 69%. A logistic regression analysis showed that by adding results of a cognitive test at baseline to the EEG DI, accuracy could improve. Conclusion: We conclude that applying qEEG using the automated SPR method can be helpful in identifying patients with SCD and MCI that have a high risk of converting to dementia over a 5-year period. As the discriminant power of the method is of moderate degree, it should be used in addition to routine diagnostic methods.
The Meaning of Dignity for Older Adults: A Meta-Synthesis
Dignified care is a central issue in the nursing care of older adults. Nurses are expected to treat older adultswith dignity, and older adults wish to be treated in a dignified manner. Researchers have recommendedinvestigating the concept of dignity based on specific contexts and population groups. This meta-synthesisstudy aims to explore the understandings of dignity from the perspective of older adults in the Nordiccountries. Synthesising findings from qualitative studies on older adults’ experiences of dignity has providedimportant insight into what can be essential for dignified care in a Nordic context. The importance ofvisibility and recognition for the experience of dignity is an overarching theme in all the studies. Theparticipants’ descriptions mostly implicated an existence dominated by a lack of recognition. The olderadults do not feel valued as people or for their contribution to society and strive to tone down theirillnesses in an attempt to become more visible and acknowledged as people. Toning down their illnesses andmasking their needs can protect their independence. At the same time, becoming less visible can leave themwithout a voice. The metaphorical phrase protected and exposed by a cloak of invisibility is used to express theauthors’ overall interpretation of the findings. Lack of recognition and being socially invisible is a genuinethreat to older adults’ dignity.
Journal of geriatric psychiatry and neurology, 2020
Young- and Late-Onset Dementia: A Comparative Study of Quality of Life, Burden, and Depressive Symptoms in Caregivers
To compare the quality of life, burden, and depressive symptoms of caregivers of individuals with young-onset dementia (YOD) and late-onset dementia (LOD).Using a cross-sectional design, a convenience sample of 110 dyads of individuals with dementia and their caregivers, all living in the community, was included. The care recipients completed assessments about cognition, quality of life, and awareness of disease. Caregivers’ quality of life, resilience, depressive and anxiety symptoms, hopelessness, and burden of care were assessed.A significant difference was found in caregivers’ burden and depressive symptoms according to the age of onset. However, there was no difference in caregivers’ quality of life between YOD and LOD groups. In both groups, a linear regression analysis indicated that caregivers’ perspective of quality of life of care recipient and caregivers’ hopelessness were associated with their quality of life. In addition, in the LOD group, caregivers’ burden was associated with their perspective of the quality of life of care recipient, type of kinship, and presence of emotional problems. In the YOD group, caregivers’ burden was associated with duration of caregiving role, cohabitating with care recipient, and their anxiety symptoms. Caregivers’ depressive symptoms were associated with anxiety symptoms in the YOD group, whereas hopelessness was associated with caregivers’ depressive symptoms in both the groups.Our findings suggest that the factors that affect quality of life, burden, and depressive symptoms of caregivers of individuals with LOD differ from those that affect the caregivers of individuals with YOD.
Journal of multidiciplinary healthcare, 2020
Community Health Care Workers’ Experiences on Enacting Policy on Technology with Citizens with Mild Cognitive Impairment and Dementia
Purpose: Assistive technologies and digitalization of services are promoted through health policy as key means to manage community care obligations efficiently, and to enable older community care recipients with mild cognitive impairment (MCI) and dementia (D) to remain at home for longer. The overall aim of this paper is to explore how community health care workers enacted current policy on technology with home-dwelling citizens with MCI/D.
Participants and Methods: Twenty-four community health care workers participated in one of five focus group discussions that explored their experiences and current practices with technologies for citizens with MCI/D. Five researchers took part in the focus groups, while six researchers collaboratively conducted an inductive, thematic analysis according to Braun & Clarke.
Results: Two main themes with sub-themes were identified: 1) Current and future potentials of technology; i) frequently used technology, ii) cost-effectiveness and iii) “be there” for social contact and 2) Barriers to implement technologies; i) unsystematic approaches and contested responsibility, ii) knowledge and training and iii) technology in relation to user-friendliness and citizen capacities.Conclusion: This study revealed the complexity of implementing policy aims regarding technology provision for citizens with MCI/D. By use of Lipsky’s theory on street-level bureaucracy, we shed light on how community health care workers were situated between policies and the everyday lives of citizens with MCI/D, and how their perceived lack of knowledge and practical experiences influenced their exercise of professional discretion in enacting policy on technology in community health care services. Overall, addressing systematic technology approaches was not part of routine care, which may contribute to inequities in provision of technologies to enhance occupational possibilities and meaningful activities in everyday lives of citizens with MCI/D.