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Journal Highlights From the November and December Issues of JAMDA

        Dementia Care

        Despite research showing the benefits of nonpharmacologic treatment for behavioral expressions of dementia, clinicians often opt for using psychotropic medications such as antipsychotics, even though these agents are associated with adverse events and new behavioral expressions. For that reason, the Alzheimer’s Association devoted its in-person inaugural April 2019 meeting of the Dementia Care Provider Roundtable, an ongoing consortium of thought leaders in long-term and community-based care, to the challenges underlying the wider implementation of behavioral support and person-centered approaches.
        “Many nonpharmacological practices, such as bright light therapy, music therapy, and reminiscence therapy, have shown positive outcomes for individuals living with dementia, including increasing quality of life and decreasing agitation,” said Sam Fazio, PhD, of the Alzheimer’s Association Home Office in Chicago, in an email. “At the same time, it’s important to understand the physical and social triggers that might lead to dementia-related behaviors and make appropriate changes to care approaches and practices.”
        The panel recommends that nursing homes instead adopt a person-centered culture. “Person-centered care is all about knowing who the person is and using that knowledge to influence care and interactions,” Dr. Fazio said. “Although it can be challenging with staff shortages, it still is possible but may take some extra effort.”
        Specifically, the panel recommends that nursing home employees, especially new staff, get to know the individuals they will be caring for. This includes those individuals’ likes, dislikes, needs, and interests. “Staff should find out all that information, not only from assessments and care plans but also from talking with other staff, families, and the individuals themselves,” Dr. Fazio said.
        The panel also recommends that nursing home staff:
        • Think of behaviors as coping and/or communication strategies rather than clinical symptoms of a disease, and offer behavioral support accordingly.
        • Identify and modify components of the physical or social environment that elicit behavioral expressions, such as increased activity or sounds.
        • When training employees, use a curriculum in which providers can experience activities from the perspective of the person living with dementia.
        • Avoid a one-size-fits-all approach. Instead, provide individuals who have late-stage dementia with their favorite soothers, such as favorite pillow, blanket, aroma, or music, and be aware of each individual’s sensory and physical capabilities.
        If nonpharmacologic practices are not effective despite consistent use, medications may then be appropriate, particularly when individuals living with dementia have severe symptoms or have the potential to harm themselves or others. “Continued need for pharmacological treatment should be reassessed as required by the medication regimen or upon a change in the person’s condition,” Dr. Fazio said.
        The Roundtable, which meets quarterly, recently published COVID-19 guidance for long-term and community-based care settings. This includes tips for preventing illness, monitoring walking and unsafe wandering, providing person-centered care, and responding to dementia-related behaviors. The guidelines, available at https://bit.ly/37rTSLg, also include links to COVID-19 resources from the Centers for Disease Control and Prevention.
        Source: Fazio S, et al. What Is Really Needed to Provide Effective, Person-Centered Care for Behavioral Expressions of Dementia? Guidance from The Alzheimer’s Association Dementia Care Provider Roundtable [published online ahead of print July 25, 2020]. J Am Med Dir Assoc. DOI: https://doi.org/10.1016/j.jamda.2020.05.017.

        Sleep Disorders

        A high prevalence of sleep disturbance or sleep disorders exists among older individuals in inpatient rehabilitation, possibly resulting in poorer rehabilitation outcomes, researchers found from a systematic literature review.
        Led by Kate E. Laver, PhD, of Flinders University in Adelaide, South Australia, researchers searched three electronic databases and gray literature, ultimately selecting 16 studies that addressed the prevalence of sleep disturbances and three that investigated treatments. In 12 studies with individuals recovering from stroke, they found the prevalence of obstructive sleep apnea ranged from 12% to 92%, with a median of 56%. Four studies that looked at individuals with stroke and other conditions found that 55% of individuals had mild to moderate sleepiness, 24% had severe sleepiness, 39% had excessive daytime sleeping, and 48% were identified as having sleep disorders. Three additional studies showed mixed results at improving functional outlook, cognitive ability, and depression symptoms when using continuous positive airway pressure (CPAP), regardless of whether the patient had sleep apnea.
        “Research shows that several factors contribute to sleep disturbance and developing a tailored plan to address these factors is likely beneficial,” the authors said. These factors include room sharing, light, noise, temperature, and poor sleep hygiene practices.
        Source: Laver KE, et al. Sleep Disturbance and Disorders Within Adult Inpatient Rehabilitation Settings: A Systematic Review to Identify Both the Prevalence of Disorders and the Efficacy of Existing Interventions [published online ahead of print April 17, 2020]. J Am Med Dir Assoc. DOI: https://doi.org/10.1016/j.jamda.2020.03.002.

        Slowness Measurement

        Although research has suggested that walking speed may be used as a single tool to assess frailty, individuals may not always be able to perform the test, particularly in instances such as having a fracture. However, the Moberg Picking-Up Test (MPUT), a timed functional test that measures motor activity of the hands, may be a useful alternative, according to a cross-sectional study in Switzerland.
        Led by Brigitte Santos-Eggimann, MD, DrPH, MPH, of the University of Lausanne, the researchers examined data from individuals in the Lausanne Cohort 65+, an ongoing study of frailty. The participants in their analysis performed both the Walking Speed Test and the MPUT.
        Among 2,748 individuals aged 66 to 83, the researchers found a positive correlation between the MPUT and walking times, with a correlation coefficient of 0.38 in both men and women. They also found a statistically significant negative correlation between grip strength and a combination of grip strength and MPUT, with a correlation coefficient of −0.25 in men and −0.28 in women. An additional finding was that higher scores on the Mini-Mental State Examination were statistically significantly associated with faster execution of both the MPUT and the Walking Speed Test.
        Source: Santos-Eggimann B, et al. Measuring Slowness in Old Age: Times to Perform Moberg Picking-Up and Walking Speed Tests [published online ahead of print May 11, 2020]. J Am Med Dir Assoc. DOI: https://doi.org/10.1016/j.jamda.2020.03.020.