Older Adults with Alzheimer’s Disease Who Have Used an Automatic Medication Dispenser for 3 or More Years

This article describes four older adults with Alzheimer’s disease and comorbidities who used an automatic medication dispenser (AMD) to continue pharmacotherapy for these chronic diseases and who remained at home living either alone or with an older spouse. The AMDs were used for 3 to 4.5 years. The patients scored at least 21 on the Mini-Mental State Examination, and their dosing regimen involved taking the medication once or twice per day throughout this period. The caregivers filled the devices with medications once every 1 to 2 weeks and continuously monitored the patients’ conditions nearly every day. Additionally, one caregiver changed how the device is used to accommodate a participant’s conditions. As a result of using the device, medication adherence remained good, and caregiver burden was reduced. The results indicate that an AMD can be used as a long-term medication management tool for some older adults with dementia when caregivers provide continued support, as described above. Further research is needed to clarify the necessary conditions for using an AMD and to identify benefits for older adults with dementia to use AMDs to take medication on a long-term basis.     

Training in Long-Term Care Facilities

Abstract

Caregivers can make a difference in the quality of life of residents in long-term care facilities (LTC) through the application of behavioral management techniques. This is widely accepted, but has little supporting data. In reality, a clear definition of the practice of caregiving in these facilities does not yet exist. Here, we present an overview of extant training in an LTC facility, identify problems, and point to core modules for such training. We also discuss quality of care in these settings. We discuss studies that support these ideas. We then discuss what we call the necessary ingredients of care. These involve the caregiver, the resident, and the system. Importantly, all must be committed for quality indicators to change.     

A Review of Animal-Assisted Interventions in Long-Term Care Facilities

Past research fails to make connections comparing appropriate settings for the benefits of different species of therapy and resident animals in long-term care facilities specifically for the elderly. Two types of animal-assisted interactions (therapy and resident) and four animal species (birds, cats, dogs, and fish) were compared. The findings were sorted into five categories of benefits (behavioral, mental, physical, physiological, and social) and three additional structural variables (affordability, accessibility, and cons). Appropriate activities for each species were also suggested. The review revealed it is important for the facility to consider its budget, number and ailments of residents, type of preferred accessibility, and preferred goal. By being aware of different characteristics of each animal species, such as benefits and affordability, facilities would be able to make an informed decision when considering which animal-assisted intervention would be an appropriate fit for their residents.     

The Feasibility of Adopting an Evidence-Informed Tailored Exercise Program within Adult Day Services: The Enhance Mobility Program

This article uses the RE-AIM framework to evaluate the feasibility of implementing Enhance Mobility (EM), a tailored, evidence-informed group exercise and walking program for older adults with dementia, into an adult day services center. Participant physical performance outcomes were measured at baseline and 8 months. Program staff were interviewed to understand implementation challenges. Participant outcomes did not change significantly, though gait speed improved from limited to community ambulation levels. Implementation challenges included space reallocation and adequate staffing. Adopting EM in adult day services is feasible, and has potential to reach older adults who could benefit from tailored exercise.     

Exploring Staff Clinical Knowledge and Practice with LGBT Residents in Long-Term Care: A Grounded Theory of Cultural Competency and Training Needs

ABSTRACT

Objectives: Existing literature shows that LGBT residents are likely to face suboptimal care in LTC facilities due to prejudice and discriminatory policies. The aim of this project was to assess the LGBT cultural competency of staff working in LTC facilities, identify their current training needs, and develop a framework for understanding LGBT cultural competency among LTC staff and providers.

Methods: This grounded theory study comprised data from focus groups of interdisciplinary staff from three LTC facilities.

Results: Results suggested that LTC staff struggle with how to be sensitive to LGBT residents’ needs. Tension appeared to exist between wanting to provide an equal standard of care to all LTC residents and fearing they would show “favoritism” or “special treatment,” which might be viewed as unprofessional. Participants indicated training could help to address the ambivalence they experience about providing sensitive care to subpopulations of residents who face stigma and oppression.

Conclusions: LTC staff stand to benefit from cultural competency training focused on LGBT residents. Training should be not only informational in nature, but also facilitate greater self-awareness and self-efficacy with respect to providing care to LGBT people.     

Dissemination and Implementation of Evidence-Based Dementia Care Using Embedded Pragmatic Trials

There are many nonpharmacologic interventions tested in randomized clinical trials that demonstrate significant benefits for people living with Alzheimer's disease (AD) and AD-related dementia, their care partners, or professional care providers. Nevertheless, with few exceptions, proven interventions have not been translated for delivery in real-world settings, such as home care, primary care, hospitals, community-based services, adult day services, assisted living, nursing homes, or other healthcare systems (HCSs). Using embedded pragmatic clinical trial (ePCT) methods is one approach that can facilitate dissemination and implementation (D&I) of dementia care interventions. The science of D&I can inform the integration of evidence-based dementia care in HCSs by offering theoretical frameworks that capture field complexities and guiding evaluation of implementation processes. Also, D&I science can suggest evidence-based strategies for implementing dementia care in HCSs. Although D&I considerations can inform each stage of dementia care intervention development, it is particularly critical when designing ePCTs. This article examines fundamental considerations for implementing dementia-specific interventions in HCSs and how best to prepare for successful dissemination upstream in the context of ePCTs, thereby illustrating the critical role of the D&I Core of the National Institute on Aging Imbedded Pragmatic Alzheimer's Disease and AD-Related Dementias Clinical Trials Collaboratory. The scientific premise of the D&I Core is that having the “end” in mind, upfront in the design and testing of dementia care programs, can lead to decision-making that optimizes the ultimate goal of wide-scale D&I of evidence-based dementia care programs in HCSs. J Am Geriatr Soc 68:S28–S36, 2020 .     

Pre-dinner administration increases the efficacy of proton pump inhibitors on refractory GERD symptoms in connective tissue disease patients

Background

A significant proportion of patients with connective tissue disease (CTD) have gastric esophageal reflux disease (GERD) symptoms despite receiving proton pump inhibitors (PPIs). Although pre-meal administration of PPIs is recommended in Western countries, the benefit of this administration timing in Japanese CTD patients with refractory GERD symptoms has not been proven.

Objective

To determine whether pre-dinner administration of PPIs is more efficacious for refractory GERD symptoms in Japanese CTD patients.

Methods

CTD patients receiving oral PPIs were instructed to take PPIs 1 h before dinner. Gastrointestinal symptoms were evaluated with frequency scale for the symptoms of GERD (FSSG) and gastrointestinal symptom rating scale (GSRS) before and after the intervention.

Results

Pre-dinner administration of PPIs significantly improved FSSG total score, from a median of 8 to 6.5 (P = 0.005). Pre-dinner administration was more effective in patients with overt GERD symptoms (from median 18 to 10, P < 0.001) than in those with mild GERD symptoms (from median 2 to 2, P = 0.201). In addition to reflux syndrome, pre-dinner administration of PPIs significantly decreased abdominal pain syndrome and constipation syndrome of GSRS.

Conclusion

Pre-dinner administration of PPIs may increase their efficacy in Japanese CTD patients with GERD, especially those with overt symptoms.     

Coronavirus Disease 2019 in Geriatrics and Long-Term Care: The ABCDs of COVID-19

The pandemic of coronavirus disease of 2019 (COVID-19) is having a global impact unseen since the 1918 worldwide influenza epidemic. All aspects of life have changed dramatically for now. The group most susceptible to COVID-19 are older adults and those with chronic underlying medical disorders. The population residing in long-term care facilities generally are those who are both old and have multiple comorbidities. In this article we provide information, insights, and recommended approaches to COVID-19 in the long-term facility setting. Because the situation is fluid and changing rapidly, readers are encouraged to access frequently the resources cited in this article. J Am Geriatr Soc 68:912–917, 2020     

老年期痴呆74例脑CT径线测量与神经心理测评观察

目的观察老年期痴呆患者头颅CT与神经心理测评的特点。方法通过Hackinski缺血指数表区分血管性痴呆（VD）及阿尔茨海默病（AD）,将有关的头颅CT径线和神经心理测评量表进行对比。结果①AD组和VD组头颅CT扫描各径线比较,差异具有统计学意义（P〈0.05）。②AD组和VD组简易智力状态检查表（MMSE）总分比较有统计学意义（P〈0.05）。AD和VD组与对照组比较,部分MMSE因子分差异有统计学意义（P〈0.05或P〈0.01）。③AD组和VD组小脑沟条数差异具有统计学意义（P〈0.05）。结论 AD组大脑萎缩及痴呆程度重于VD组,而小脑萎缩则不尽然。结合CT检查和神经心理测评仍是鉴别VD及AD的有效方法 。     

Activity Preferences and Satisfaction Among Older Adults in a Veterans Administration Long-Term Care Facility

Activities can be a nonpharmacological intervention for depression in long-term care. To address the activity needs of men, 183 residents of a VA long-term care facility were surveyed about activity interests, past and present, and activity satisfaction. With a 30% return rate, residents reported 85% overall satisfaction with activities and identified television as the most preferred activity, past and present. Bingo, movies, and listening to music ranked high for current activities. Prayer, reading, and pets increased in popularity. Current satisfaction with flea markets, pool, and gardening decreased from prior levels of satisfaction. Model making and arts and crafts activities were rated poorly. Long-term care facilities may want to expand television-based activities for older men in ways that promote increased socialization and mental activity.     

Identifying Preferences in Persons with Dementia: Systematic Preference Testing vs. Caregiver and Family Member Report

One problem facing professional caregivers of dementia patients involves identifying preferences in patients with impaired verbal abilities. Long-term care staff often rely on the opinions of family or trial and error to discover patient preferences despite the availability of empirical methods for assessing preferences in nonverbal populations. The purpose of this study was to examine whether caregivers and family members could accurately determine the preferences of dementia patients. Patient preferences were determined using an empirical preference assessment while caregivers and family completed a self-report measure concerning their opinions about patient preferences. Results indicated that family and staff were relatively inaccurate in determining the preferences of patients. Results may have implications for developing more effective care plans and improving quality of life for persons with dementia residing in long-term care facilities.     

The Benefits of Individualized Leisure and Social Activity Interventions for People with Dementia: A Systematic Review

This systematic review describes the benefits of individualized leisure and social activity interventions for people with dementia (aim 1), how these interventions were individually tailored (aim 2), and what recommendations or suggestions can be made for these interventions and further studies (aim 3). Thirty-two included studies were organized into four categories based on how the intervention was individually tailored. These categories include: (1) performance factors; (2) self-identity; (3) music preference; and (4) life experiences and past memories. The authors discuss suggestions and benefits by synthesizing the finding of the included studies in each category.