• Books feature. Psychoanalysis and dementia care: Towards a new relationship...Inside lives

      Morton, Ian (2007)
      Ian Morton discusses the potential benefits for dementia care of closer links with the world of psychoanalysis, recommending a key text for anyone interested in exploring these ideas.
    • Sexuality and dementia

      Bouman, Walter P. (2007)
    • Psychoanalysis and dementia: Understanding disturbance and distress

      Morton, Ian (2007)
      In the second of three articles, Ian Morton looks at how psychoanalytical concepts of anxiety and defence might help our understanding of the distress and disturbance that some individuals experience in dementia.
    • An evaluation of a specialist multiagency home support service for older people with dementia using qualitative methods

      Rothera, Ian; Waite, Jonathan (2008)
      Background: Standard home care support for people with dementia has been criticised in statutory inspection reports, and may lead to unnecessary crises, hospital or care home admissions.; Objective: To establish whether a specialist multiagency home care service for older people with dementia delivered better quality care than standard services, and how any improvements were achieved.; Design: Qualitative study, using semi-structured interviews, focus groups and small group interviews.; Setting: Two demographically similar areas in Nottingham, one served by a specialist home care team, the other by standard services.; Participants: Twenty-seven service users, 18 family carers, 17 home care workers, 20 health/social care professionals, across both services.; Results: The specialist service demonstrated greater flexibility and responsiveness to the particular needs and circumstances of service users and family carers, who were encouraged to participate in routine decision-making and activities. By sharing responsibilities, the specialist service helped reduce carer stress and prevent crises. These outcomes depended on the configuration of the service, including multidisciplinary health and social services input, careworker autonomy and independence, continuous reassessment of clients' circumstances and preferences and the capacity to develop long-term relationships, through careworker continuity. The standard service, which used a task-orientated approach, lacked these characteristics.; Conclusions: This study provides evidence of the benefits of a specialist multiagency home support service over standard home care, in the opinion of service users, carers and careworkers, and defines the operational model that achieves this. Findings confirm best practice recommendations, based on models of dementia care which emphasise respect for 'personhood'.;
    • Temporal trends in the long term risk of progression of mild cognitive impairment: A pooled analysis

      Shiri-Feshki, Mojtaba (2008)
      Background: Mild cognitive impairment (MCI) is a condition that carries a substantial risk of dementia. The exact magnitude of that risk is uncertain because of the variations in the definition of MCI, the setting (such as memory clinic versus community) and, equally importantly, the duration of follow-up. Recently, a number of long term studies have been published with observation periods of 5 years of longer. Methods: In this quantitative review, 15 long term studies were examined and compared with the results from studies using shorter periods of observation, focusing on the annual conversion rate (ACR) of MCI to dementia. Results: The report identified six long term clinical studies conducted in specialist settings and nine long term population studies conducted in the community. Across all cohort studies with completed follow-up, the mean ACR to dementia was 4.2% (95% CI 3.9% to 4.6%). This was lower than the rate reported in studies of less than 5 years' duration. The cumulative conversion rate averaged 31.4% in this sample. The proportion converting to dementia (and Alzheimer's disease) declined with longer observation periods, suggesting that risk of progression diminishes with time. Conclusion: A 10-15% ACR only appears to hold true in clinical samples monitored over a short observation period. Recruitment of older individuals from specialist centres, particularly involving those who complain of cognitive difficulties (subjective memory complaints) will tend to favour high conversion rates. In the first few years of follow-up, many of those with the most adverse risk profile will tend to progress, dropout or die, leaving a cohort of less vulnerable sufferers. However, an inverse temporal relationship was also manifest in those who completed long term follow-up, suggesting other factors are involved such as sampling issues or heterogeneity in MCI itself.
    • Psychoanalysis and dementia: The dynamics of care

      Morton, Ian (2008)
      In this third and final article, Ian Morton focuses on some of the unconscious processes that affect the relationship between paid caregiver and the person with dementia, and on the dynamics of caregiving organisations.
    • Driving ability in people with dementia

      Bouman, Walter P. (2009)
      Background: Previous research has suggested that patients with dementia are impaired at driving relative to normal individuals (betaieliauskas, 2005). As well as identifying a cognitive test battery for predicting safety to drive in people with dementia, we aimed to determine particular driving difficulties experienced by those with dementia. We also aimed to discover whether their performance on the road was related to cognitive abilities. Methods: We re-cruited participants with dementia who were driving and had a diagnosis of dementia, and a comparison control group with no known memory problems. All participants completed a battery of cognitive tests, and were then assessed on the Nottingham Neurological Driving Assessment by an Approved Driving Instructor who was blind to the cognitive test results. This comprised 25 items upon which the driver was scored. Results: 118 patients with dementia and 30 controls completed the whole study. Of the patients with dementia, 27 were unsafe and 91 safe on the road, whilst all controls were safe. Relative to controls, patients with de-mentia were significantly worse at: observations to rear (p = 0.016); driving in traffic lanes (p = 0.039); and obedience of road signs (p = 0.018). Within the group with dementia (n = 118) road performance correlated significantly with four cognitive tests: SDSA Road Sign Rec-ognition (p < 0.001); SDSA Square Matrices Directions (p < 0.05); MMSE (p = 0.001); and BADS Key Search (p < 0.05). Conclusions: Whilst no control participants failed their on road assessment, 22.9% of the patients with dementia did, showing particular difficulty on three measures. Performance on the road correlated well with performance on four cognitive tests. This is consistent with the finding that the battery of cognitive tests successfully predicted safety to drive in patients with dementia.
    • Rate of progression of mild cognitive impairment to dementia - Meta-analysis of 41 robust inception cohort studies

      Shiri-Feshki, Mojtaba (2009)
      Objective: To quantify the risk of developing dementia in those with mild cognitive impairment (MCI). Method: Meta-analysis of inception cohort studies. Results: Forty-one robust cohort studies were identified. To avoid heterogeneity clinical studies, population studies and clinical trials were analysed separately. Using Mayo defined MCI at baseline and adjusting for sample size, the cumulative proportion who progressed to dementia, to Alzheimer's disease (AD) and to vascular dementia (VaD) was 39.2%, 33.6% and 6.2%, respectively in specialist settings and 21.9%, 28.9% and 5.2%, respectively in population studies. The adjusted annual conversion rate (ACR) from Mayo defined MCI to dementia, AD and VaD was 9.6%, 8.1% and 1.9%, respectively in specialist clinical settings and 4.9%, 6.8% and 1.6% in community studies. Figures from non-Mayo defined MCI and clinical trials are also reported. Conclusion: The ACR is approximately 5-10% and most people with MCI will not progress to dementia even after 10 years of follow-up. © 2009 John Wiley & Sons A/S.
    • Independence, wellbeing and choice: Conflict or harmony?

      Beck, Lyndsay (2010)
      Lyndsay Beck reflects on tough choices when working with two older women with dementia living at home.
    • A prospective study of cognitive tests to predict performance on a standardised road test in people with dementia

      Bouman, Walter P. (2010)
      Objective: Previous work by Lincoln and colleagues produced a cognitive test battery for predicting safety to drive in people with dementia. The aim was to check the accuracy of this battery and assess whether it could be improved by shortening it, including additional cognitive tests, and a measure of previous driving. Methods: Participants with dementia, who were driving, were recruited. They were assessed on cognitive tests including measures of concentration, executive function, visuospatial perception, verbal recognition memory, and speed of information processing. Patients were then assessed on the Nottingham Neurological Driving Assessment (NNDA) by an approved driving instructor (ADI), blind to cognitive test results. Results: Seventy-five patients were recruited and completed the cognitive tests. Of these, 65 were assessed on the road. These participants were aged 59-88 (mean = 75.2, SD = 6.8) and 49 were men. Time driving varied from 19 to 73 years (mean = 52.5, SD = 10.0). Thirteen participants were unsafe and 52 safe to drive. Using a cut-off of > 0 to indicate safety to drive, the original predictive equations correctly classified 48 (76.2%) of 63 participants with complete data. Logistic regression including additional tests reduced misclassifications. Conclusions: A lower proportion of participants were found to be unsafe on the road than in previous studies. Nevertheless, the previously identified equation predicted safety to drive in most patients. Including additional tests reduced the misclassification rate but requires independent validation. We suggest that the cognitive test battery might be used in clinical practice to identify patients with dementia who would benefit from on-road assessment. (PsycINFO Database Record (c) 2016 APA, all rights reserved) (Source: journal abstract)
    • Research: support workers play vital role in dementia care

      Schneider, Justine (2010)
      An in-depth observational study of healthcare assistants (HCAs) in dementia wards set out to identify the workforce issues. The study found that healthcare assistants generally worked with compassion and found the caring role immensely satisfying. HCAs took responsibility for the ward atmosphere-emotional, social and environmental. HCAs thought their workplaces were understaffed on the whole and felt largely ignored and undervalued by members of the multidisciplinary team apart from the other direct-care staff. They coped with these problems by forming a close-knit team and supporting each other both on and off the ward. Looking beyond patient-centred care, employers should take into account other dynamics on the ward, notably those between staff members and between staff and relatives, as well as the patient-focused behaviours. ‘Relationshipcentred care’ might be a better description of the aim of the caring process.
    • Actively involving people with dementia in qualitative research

      Repper, Julie (2010)
      Aims and objectives. This paper aims to: Consider the major challenges to involving people with dementia in qualitative research. Critique a process consent framework. Demonstrate the need for nurses and researchers to explore these issues in research and practice with people with dementia. Consider the impact of the Mental Capacity Act 2005 on research with people with dementia. To achieve its aims, the authors will draw on current literature and use examples which explores the use of life story work with people with dementia by taking a qualitative approach. Background. There is acceptance that researchers should consider ways of actively involving people with dementia in research as participants where appropriate to answering specific research questions. Process consent methods have been advocated as an ethical way forward in recruiting and gaining consent for people with dementia, the Mental Capacity Act offers guidance to both practitioners and researchers. Design and method. This paper does not seek to be a comprehensive review of the current literature but is a discussion paper appraising a process consent framework against current literature and drawing on the lead author's PhD study, exploring life story work with older people with dementia. Results and conclusions. The Mental Capacity Act and process consent frameworks compliment one another, and their use should be considered when researching issues affecting older people with dementia. Researchers and practitioners should work more closely to ensure that the principles of process consent are achieved. Process consent models can equally be applied to everyday nursing practice. Relevance to clinical practice. Process consent models can provide an ethical and practical framework to ensure that consent is continually assessed in people with dementia with all clinical interventions. The paper also draws on literature exploring practical ways of involving people with dementia in evaluating service delivery.
    • Men caring for wives or partners with dementia: Masculinity, strain and gain

      Baker, Kevin L.; Connelly, David (2010)
      Over the last three decades, demographic changes in the developed world have meant more older men find themselves in caregiving roles. Little research has been undertaken with male caregivers in dementia care. Although there is general consensus that men construe care differently to women, gender has seldom been treated as an independent variable that can inform supportive interventions. This study, underpinned by an assumption of the benefits of men's differential response to managing illness, sought to explore how facets of masculinity might relate to male caregivers' appraisals of strain and gain in dementia care. Seventy men, currently caring for a partner with dementia, completed questionnaires exploring their gender identity (Personal Attributes Questionnaire), gender role conflict (Gender Role Conflict Scale), and appraisals of carer strain and gain (Brief Zarit Burden Interview and Caregiving Satisfaction Scale). They were also asked to provide demographic information and, since caregiver strain is significantly affected by a care-receiver's cognitive and behavioural difficulties, to complete the revised Memory and Behaviour Problems Checklist. Carers' age and duration of caregiving was broadly representative of previous studies. A series of regression analyses revealed contrasting findings to previous studies. Gender identity did not appear important in carer's evaluations of strain or gain, and only the 'restrictive affectionate behaviour between men' subscale of gender role conflict had explanatory power in analyses with all strain and gain variables. Findings are discussed with regard to response bias and defended masculinity. Consideration is made about how men can successfully access services.
    • Sex, dementia, capacity and care homes

      Bartlett, Peter (2010)
      This paper addresses the appropriate legal and policy approach to sexual conduct involving people with dementia in care homes, where the mental capacity of one or both partners is compromised. Such conduct is prohibited by sections 34-42 of the Sexual Offences Act 2003, but this article asks whether this blanket prohibition is necessarily the appropriate response. The article considers a variety of alternative responses, eventually arguing that clearer guidance regarding prosecution should be issued. © 2010 The Author(s).
    • How to mobilise patients with dementia to a standing position

      Varnam, William (2011)
      Aim: The aim of this study was to determine which intervention used to assist people with dementia from sitting to a standing position was the most effective approach to aid movement.; Method: Focus groups were held with care and therapy staff working in dementia settings to find out the difficulties they encountered when helping someone with dementia to a standing position, and the interventions to overcome these difficulties. Suggested interventions were substantiated against the literature and efficacy of intervention attempts was recorded in a diary. Participants also completed a post-intervention questionnaire to establish their views on how results should be used.; Results: Appropriate interventions led to a positive outcome for participants as they were able to assist people with the minimum of fuss and complexity, and for patients because they received the care they required. No single intervention emerged as being particularly effective and other factors must be considered when interpreting the results.; Conclusion: Participants agreed that interventions should be included in patient handling training programmes.;
    • Ingroup identity as an obstacle to effective multiprofessional and interprofessional teamwork: Findings from an ethnographic study of healthcare assistants in dementia care

      Schneider, Justine (2011)
      Rising dementia incidence is likely to increase pressures on healthcare services, making effective well coordinated care imperative. Yet, barriers to this care approach exist which, we argue, might be understood by focussing on identity dynamics at the frontlines of care. In this article, we draw upon findings from an ethnographic study of healthcare assistants (HCAs) from three dementia wards across one National Health Service mental health trust. Data revealed that the HCAs are a close-knit ‘in-group’ who share low group status and norms and, often highlight their own expertise in order to promote self worth. HCAs’ social identity is considered as a barrier to effective teamwork with strong ingroup behaviour suggested as a consequence of their marginalisation. We explore these findings with reference to social identity theory (Tajfel, ; Turner, ) and discuss implications for delivering multiprofessional and interprofessional care.
    • Evaluation of a medical and mental health unit compared with standard care for older people whose emergency admission to an acute general hospital is complicated by concurrent 'confusion': A controlled clinical trial. Acronym: TEAM: Trial of an Elderly Acute care Medical and mental health unit

      Jones, Rob G. (2011)
      Background: Patients with delirium and dementia admitted to general hospitals have poor outcomes, and their carers report poor experiences. We developed an acute geriatric medical ward into a specialist Medical and Mental Health Unit over an eighteen month period. Additional specialist mental health staff were employed, other staff were trained in the 'person-centred' dementia care approach, a programme of meaningful activity was devised, the environment adapted to the needs of people with cognitive impairment, and attention given to communication with family carers. We hypothesise that patients managed on this ward will have better outcomes than those receiving standard care, and that such care will be cost-effective. Methods/design: We will perform a controlled clinical trial comparing in-patient management on a specialist Medical and Mental Health Unit with standard care. Study participants are patients over the age of 65, admitted as an emergency to a single general hospital, and identified on the Acute Medical Admissions Unit as being 'confused'. Sample size is 300 per group. The evaluation design has been adapted to accommodate pressures on bed management and patient flows. If beds are available on the specialist Unit, the clinical service allocates patients at random between the Unit and standard care on general or geriatric medical wards. Once admitted, randomised patients and their carers are invited to take part in a follow up study, and baseline data are collected. Quality of care and patient experience are assessed in a non-participant observer study. Outcomes are ascertained at a follow up home visit 90 days after randomisation, by a researcher blind to allocation. The primary outcome is days spent at home (for those admitted from home), or days spent in the same care home (if admitted from a care home). Secondary outcomes include mortality, institutionalisation, resource use, and scaled outcome measures, including quality of life, cognitive function, disability, behavioural and psychological symptoms, carer strain and carer satisfaction with hospital care. Analyses will comprise comparisons of process, outcomes and costs between the specialist unit and standard care treatment groups.
    • A rallying call for an evidence based approach to dementia and related policy development

      Dening, Tom; Dening, Tom (2012)
      Open letter to the prime minister and chief medical officer for England Re: There is no evidence base for proposed dementia screening
    • Is the prevalence of dementia changing?

      Dening, Tom (2013)
      Used medical records to compare the prevalence rates of dementia in Rochester, Minnesota, on January 1, 1980, with the rates for January 1, 1975. The overall sex- and age-adjusted rate per 100,000 population for dementia (all types) was 402.5 in 1980 and 388.4 in 1975. For Alzheimer's disease, the same rate was 259.8 in 1980 and 259.5 in 1975. It is concluded that the relatively high mortality rate from all dementias, rather than out-migration, was the major factor in maintaining the same prevalence rate. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
    • Can theory of mind deficits be measured reliably in people with mild and moderate Alzheimer's dementia?

      Choong, Caroline S. M.; Doody, Gillian A. (2013)
      Background: Patients suffering from Alzheimer's dementia develop difficulties in social functioning. This has led to an interest in the study of "theory of mind" in this population. However, difficulty has arisen because the associated cognitive demands of traditional short story theory of mind assessments result in failure per se in this population, making it challenging to test pure theory of mind ability.; Methods: Simplified, traditional 1st and 2nd order theory of mind short story tasks and a battery of alternative theory of mind cartoon jokes and control slapstick cartoon jokes, without memory components, were administered to 16 participants with mild-moderate Alzheimer's dementia, and 11 age-matched healthy controls.; Results: No significant differences were detected between participants with Alzheimer's dementia and controls on the 1st or 2nd order traditional short story theory of mind tasks (p = 0.155 and p = 0.154 respectively). However, in the cartoon joke tasks there were significant differences in performance between the Alzheimer participants and the control group, this was evident for both theory of mind cartoons and the control 'slapstick' jokes.; Conclusion: It remains very difficult to assess theory of mind as an isolated phenomenon in populations with global cognitive impairment, such as Alzheimer's dementia, as the tasks used to assess this cognition invariably depend on other cognitive functions. Although a limitation of this study is the small sample size, the results suggest that there is no measurable specific theory of mind deficit in people with Alzheimer's dementia, and that the use of theory of mind representational models to measure social cognitive ability may not be appropriate in this population.;