Efficacy and Generalizability of Falls Prevention Interventions in Nursing Homes: A Systematic Review and Meta-analysis
To determine the efficacy of fall intervention programs in nursing homes (NHs) and the generalizability of these interventions to people living with cognitive impairment and dementia.
Atypical chest pain is of diverse origin. Typically, we initially consider cardiac etiology. When pain appears non-cardiac, there is a tendency to underestimate the illness, especially if the patient has neuropsychiatric illness. Our resident with dementia and anxiety disorder had chest pain; the diagnosis was unexpected.
Psychotropic medications are often prescribed to manage behavioral and psychological symptoms of dementia (BPSD) in nursing home (NH) residents, although these medications may lack efficacy for BPSD and can have adverse effects. NHs can receive a deficiency of care citation for inappropriate psychotropic medication use (F-758 tag). To promote more effective dementia care, some states specify dementia-specific training requirements for NH nursing staff. The occurrence of F-758 citations related to care of residents with dementia was examined in relation to the presence of state-level dementia-specific in-service training re...
Many older adults do not plan for their LTSS needs. When older adults experience a health crisis (e.g. hospitalization, worsening dementia), family members must often react to the crisis. With PCORI funding, we developed PlanYourLifespan.org (PYL.org) as a national, free, publicly available website that enables older adults and families to understand future needs and plan for what they will need as they age. Different than end-of-life planning, PYL.org focuses on what LTSS people will need when they are in their 80 ’s, 90’s, and 100’s.
Most behaviour assessment tools used in long-term care (LTC) involve retrospective reports. These assessments are prone to errors in recall and provide little opportunity to identify the context of behaviours. Furthermore, these assessments are often underused, prone to incomplete and inaccurate data collection, and the results can be difficult to analyze. To address these problems, we developed a Dementia Observations (DObs) mobile application for direct observation of behaviour symptoms. Direct observation of behaviour provides more detail about the frequency, duration, precipitants, and patterns.
Up to 38% of individuals with advanced dementia experience clinical depression. Although studies demonstrate lower rates of clinical depression as dementia advances, this may be attributed to the difficulty of assessment at this stage. Clinical interviews are thorough in assessing depression, though they are time- and resource-contingent. As such, healthcare providers often turn to screening tools or scales. However, conventional tools for assessing depression have problems with validity in this population.
Symptoms of delirium are common in the post-acute care setting, particularly in patients who have dementia or are approaching the end of life. When behavioral measures fail to adequately manage symptoms, there are few alternative options. Antipsychotic medications have long been the mainstay of pharmacologic treatment for delirium, despite a paucity of evidence for efficacy and newer data suggestive of possible harms. Moreover, the use of a new antipsychotic medication in veterans admitted to a short-term rehabilitation center is seen as potentially inappropriate and negatively affects the CMS/Medicare Quality Indicator (QI) profile.
At San Francisco Veterans Affairs Health Care System (SFVA) Community Living Center (CLC), most veterans have dementia plus co-occurring mental illness. Many demonstrate distressed behavior that interferes with care. CLC restorative care and mental health staff identified the need to improve engagement of veterans with dementia or behavioral challenges, and improve care partner training. Along with researchers at SFVA, they implemented PLI É, a novel integrative group exercise program for people with dementia.
Behavioral Psychological Symptoms of Dementia (BPSD) are described as symptoms of apathy, agitation, inappropriate vocalization, aggression, wandering, and resistiveness to care. Not managing BPSD appropriately can cause an increase in frustration, stress, and burnout amongst staff members, and negatively impacts the health and quality of life for residents with dementia. Psychotropic medications are often administered to residents with BPSD in long-term care facilities and can lead to adverse effects such as an increase in falls, mortality, cardiovascular events, and hospitalizations.
Individuals with dementia who exhibit adverse behaviors are often treated with psychotropic medications despite harmful side effects and recommendations to use non-pharmacological interventions. Cognitive Stimulation Therapy (CST) has consistently been shown to improve cognitive functioning and quality of life (QOL) in individuals with mild to moderate dementia, and reduce the number of adverse behaviors.
Post-traumatic hydrocephalus (PTH) or secondary normal pressure hydrocephalus (NPH) are common complications that follow traumatic brain injury (TBI). PTH clinical features are similar to NPH and can be characterized by a triad of gait apraxia, cognitive deficits, and urinary incontinence. Symptoms may progress to psychomotor slowing, dementia, and the need for institutionalized care. Additionally, patients with TBI often experience a loss of impulse control, aggressive behaviors, and personality changes.