Day 3 :
- Geriatrics and Cognitive Disorder, Care Practice and Awareness
Location: Hall 4
Wroclaw Medical University, Poland
Saltmarche Health & Associates Inc., Canada
Saltmarche Health & Associates Inc., Canada
Title: Impact of Physical and Mental Insults on Dementia: Clinical Observations following a Transcranial- Intranasal Photobiomodulation Therapy Study
Time : 10:00-10:20
Anita Saltmarche completed her Masters of Health Sciences from McMaster Univeristy, Hamilton, ON, Canada. She was a geriatric clinical nurse specialists for over a decade at Sunnybrook Health Science in Toronto as well as other leadership positions across the healthcare system. Anita manitains a clinical practice and provides research and other consulting services to a broad group of clients ranging from the Ontario Ministry of Health & Long Term Care to a number of private sector companies and non-profit health organizations. As principal and co-investigator on peer-reviewed research projects, she has published numerous papers in well-respected journals.
Observations reported here range from 1 week to 1 year following a randomized, single-blind placebo-controlled pilot study to assess the effect of near infrared transcranial and intranasal photobiomodulation therapy (PBMT) on cognition in 19 participants over 12 weeks with a 4-week no-treatment follow-up. Randomization included 13 into active and 6 into sham treatments. Participants were assessed with MMSE and ADAS-cog scales. Participants with moderate to severe impairment (MMSE baseline of 5-24) who received active treatment showed significant improvements on each test (p<0.03) after 12 weeks. They also reported better sleep, fewer angry outbursts, decreased anxiety, and less wandering. Declines were noted during the final 4 weeks without treatments. No related adverse events were reported. After the 16-week study all participants were given active PBMT devices for home treatment. We continued to monitor the participants every 6 to 8 weeks, and observed that those with physical and mental insults suffered negative impact on their cognition, whereas those who did not, retained or continued with improvements. Physical insults included foot ulcer, chronic pain, influenza, major surgery, and pneumonia. Mental insults included grief from a family loss, property fire, work-related and emotional stress. In conclusion, we observed that improvements from PBMT were maintained when those with dementia did not experience physical trauma and mental stress. Although these observations relate to a PBMT study, they suggest that the effects of additional diseases, accidents, and mental/emotional stress factors need to be incorporated into data analysis that could develop into long-term treatment protocols for dementia.
StavroHedi LLC, USA
Time : 10:20-10:40
Sophia Stavron, Gerontologist and Energy Healing expert, successfully stopped the progression and reversed her father’s Vascular Dementia and Alzheimer’s with simple tools that anyone can use. For twenty-five years, Sophia has combined her passion for helping others with her lifetime of learning to use energy to help others heal their bodies and minds. Her upcoming book shares her story of curing her sister’s Stage 2 Hodgkin’s Lymphoma with alternative energy healing modalities. Sophia has a Bachelor’s degree in Sociology from the University of Nebraska at Omaha and is a candidate for a Master’s degree in Gerontology.
Sophia Stavron, Gerontologist and Energy Healing expert, successfully stopped the progression and reversed her father’s Vascular Dementia and Alzheimer’s with simple tools that anyone can use. Doctors have been stunned to review the test results over the past 7 years, which show improvement in brain function instead of the typical progression of the disease. Believing all disease stems from blocked energy and stress, Sophia prescribed a solid regimen of mindfulness and stress-management practices and energy healing modalities that produced these stunning results.
In this presentation, Sophia shares the tools and strategies she used, the explicit steps to utilize these strategies, the scientific explanations for why these strategies were successful for her father and how these strategies can prevent the onset of the disease in the first place.
University of Leeds, UK
Time : 10:40-11:00
Gary Morris is a PhD student at the University of Huddersfield as well as being a mental health lecturer working at the University of Leeds. He leads the mental health nursing programme and runs modules which include “Lived experience in mental health” and “Media depictions of mental health.” He is the author of a number of articles and textbooks concerned with dementia care, media narratives and lived mental health experience.
Having problems in communicating does not mean that individuals with dementia are unable to express themselves. Instead, we need to find ways to ‘listen’ more to what is being related. This presentation explores the learning potential of engaging mental health nurses with lived dementia experience through the accessing of media narratives. The narrative accounts are selected from a wide selection of media sources utilizing visual, textual and auditory modes of communication. These include internet blogs/discussion forums, autobiographical texts, art work, poetry, feature films and television documentaries. Subsequent learning was evaluated through focus group discussion and module assignments. The preliminary findings from these learning activities demonstrate a greater appreciation of lived dementia experience, including a person’s thoughts and feelings. There was also a sense of attitudinal change reported with students more mindful of the internal world of those with dementia. This importantly helped participants to reframe behaviours which otherwise could be perceived as “challenging”, recognizing internal drivers such as frustration, pain or helplessness. The work illustrated here highlights the need to facilitate expression of lived experience amongst those with dementia and for health care workers/learners to explore means of tuning in to and ‘hearing’ their narratives. The result of this is the promotion of attitudinal change, empathic learning and person centred care approaches as advocated by notable researchers such as Tom Kitwood and the Bradford Dementia Group. This also reflects care approaches to care highlighted in the National Dementia Strategy (DOH 2009).
Western University of Health Sciences, USA
Time : 11:20-11:40
Hoffman has completed her Pharm.D. from the University of Southern California, School of Pharmacy in Los Angeles, CA, USA and postdoctoral studies from University of Maryland at Baltimore Mental Health System. She is the director of PGY-1 pharmacy residency in Geriatrics at the los Angeles Jewish Home for the Aginig, and an Associate Professor at Western University of Health Sciences where she is the expert in nuerology. She has published more than 25 papers in reputed journals and has been serving as an Associate Editor of the California Pharmacist Journal.
Skin reactions are one reason for termination of rivastigmine patch. The study goal was to identify factors associated with skin reactions from rivastigmine patch in older adults. A retrospective chart review with prospective skin assessment observational study was performed on all outpatients with Alzheimer’s dementia at a specialized ambulatory geriatric evaluation clinic.
Demographic, clinical, and outcome variables were compared between the two groups (i.e., those with versus without skin reactions) using χ2 or Fisher’s exact test for cross-tabulations of nominal variables and independent samples and Student t-test, for continuous variables. Statistical differences between groups were considered significant when p-values were ≤ 0.05.
A total of 33 patients were included with 24.2% males, 75.8% females and a mean age of 83 years. Race included Caucasian (90.9%) and Hispanic (9.09%). Patients lived at home with a spouse (39.39%), home with caregiver (24.24%) or in an assisted-living facility (6.06%).
A statistically significant finding was MMSE score of 17 (p<0.01) and a skin reaction. Comorbidities included, 15.2% had diabetes and 66.7% had hypertension. On average sodium plus potassium values were 139 mEq/L and 4 mEq/L respectively. Bathing was on average 3 baths weekly. Concomitant medications included: memantine (39.4%), antidepressant (51.5%), antipsychotic (12.1%) with 24.2% not taking any medications.
Two statistically significant skin reactions seen were erythema where the patch was applied and pruritis (p<0.01). There were no significant skin reactions resulting in rivastigmine patch discontinuation.
This small cohort showed one statistically significant trend: the lower MMSE score the increase risk of a skin reaction.
Shanghai Medical Information Center, China
Title: The Relationship between the Number of Chronic Diseases and Living Environment among Dementia Patients
Time : 11:40-12:00
Aim: To understand the Relationship Between the Number of Chronic Diseases and Living Environment Among Dementia Patients.
Methods: The study use the Aged Care Service Demand Questionnaire to obtain the subjects’ information on activities of daily living, physical health, mental health, and social resources and economic conditions et al.. The current research use Chi-square independence testfor analysis.
Results: In the current study, 64.95%of the dementia patients suffer from at least one chronic disease, but for those who live at home, only 14.54%of the dementia patients suffer from one and more chronic diseases. There are statistically difference between living at home and institutions in terms of the number of chronic diseases (P<0.0001).
Conclusion: There are closely relationship between chronic diseases and living environment, the public should realize the dementia patients could combine many chronic diseases at the same time due to their living environment.
Middlesex University, UK
Time : 12:00-12:20
Tiwalola Kolapo has completed a Master’s degree in Social Policy in Social Policy from the Middlesex University and worked as a commissioner of health services for the NHS for over 15years. She is currently studying for a doctorate in mental health at Middlesex University looking at the challenges and opportunities for commissioning culturally competent Dementia services.
We welcomed the National Service Framework with great enthusiasm as response to improving the less than optimal quality of services experienced by older people and a step in the right direction for increasing the capacity of services. Furthermore, it represented a significant consideration by the government to embrace compassionate care in the NHS in the face of the numbers growing older less healthy. It is now time to move the goal post given the need to be more responsive to the diverse multicultural demographics of the UK and the significant numbers of those living with dementia.
Health commissioners and professionals are finally recognizing now more than ever the importance and timely need to reconfigure older people services away from services previously and suitably set in mono-cultural population settings. This is about providing culturally competent services/care (globalised care) that fits and underpins the challenge to ensure that the Human Rights of all citizens to equal access to good health care is met as enshrined in legislation. Cultural competence is the vehicle that can ensure the commissioning and delivery of health and social care services is done in a manner that meets the complete complement of assessed needs of a locality based on its demographics and those of the individual based on their specific cultural background. This is not about race. It is about ensuring that those affected by Alzheimer’s and dementia have access to care which they or their carers agree will help them maintain ‘self ’.
The question to answer is how do we make the National Dementia Strategy and the Older Peoples Service Framework culturally competent enough to ensure that not only are the inconsistencies in services addressed but those who are affected by these diseases live well, are supported well and die well no matter what their cultural affiliations are?.
University College London, UK
Title: Systematic review of positive psychology outcome measures for family carers of people with dementia
Time : 12:20-12:40
Jacki Stansfeld is currently completing her PhD at University College London in the Division of Psychiatry. She works as a Research Assistant on the Valuing Active Life in Dementia (VALID) research programme.
Introduction: The importance of positive psychology in understanding the wellbeing and experiences of family carers of people with dementia is increasingly being recognised. Despite this, outcome measures used in research with family carers of those with dementia are often centered on concepts such as burden and depression. There is a scarcity of positive psychology measures developed for or validated in this population
Aim: By employing standardised criteria, this review aimed to assess the quality of positive psychology measures developed for or already in use with family carers of people with dementia and to determine their potential utility in future interventional studies.
Methods: We performed a systematic review of positive psychology measures for family carers of people with dementia. The databases searched were PsychINFO, CINHAL, MEDLINE, EMBASE and PubMed. Two reviewers independently assessed full-texts for inclusion and performed a quality assessment of each of the scale development studies identified to examine the psychometric properties reported.
Results: This review identified 10 positive psychology outcome measures (and 6 validation papers of these scales) within the constructs of self-efficacy, spirituality, resilience, gain, and meaning.
Conclusion: Several outcome measures were identified that may have potential utility for future interventional studies, but it is clear that there is still work to be done to develop and refine more positive psychology measures for this population. A lack of reporting of the psychometric properties by development authors limited the conclusions that could be drawn. It is recommended that authors aim to report this in the future.
University of Surrey, UK
Title: The development of an online information and support program for informal carers of people living with YOD: The RHAPSODY study
Time : 12:40-13:00
RHAPSODY (Research to Assess Policies and Strategies for Dementia in the Young) is an EU Joint Programme - Neurodegenerative Disease Research (JPND) initiative that aims to improve information and support for families living with young onset dementia (YOD). Defined by symptom presentation before the age of 65 years, YOD is relatively rare and associated with diagnosis difficulties. Extensive family impact includes carer burden and stress, relationship disruptions and financial decline, all of which are exacerbated by a lack of age-appropriate services, support and information. This multi-disciplinary collaboration across six European countries developed an internet-based e-learning program for families living with YOD. Information and policies related to YOD were analysed from on-line reviews completed in all countries. Carer perspectives on needs and experiences were explored using in-depth interviews in the Netherlands, followed by focus groups in England, France, Germany, Portugal and Sweden. An intervention based on an on-line support program was considered appropriate due to relatively low prevalence of YOD, georgraphical spread and mobility restrictions resulting from the condition. Findings from early research stages informed the design and content of the 7-Part program, which explained clinical background, psychosocial perspectives, family issues, legal aspects and the importance of carer support. Produced in English, German and French, the intervention was tested by volunteer family carers in England, Germany and France.
Emek Yezreel College, Israel
Time : 13:40-14:00
This paper discusses the unique characteristics of communication with people with dementia. While most of the literature on dementia identifies it as a non-communicative state, and focuses on the clinical aspects of dementia and the resulting communication deficiencies, this current paper approaches the communication with people with dementia as a mutual "eye to eye", meaningful and fruitful communication, both for the person with dementia as well as for the "healthy" partner to the conversation. On the basis of the analysis of concrete situations and conversations I held with a relative who was hospitalized at an institution for people with dementia, I point at four patterns of this unique communication: 1. A mutual attempt to understand the experience of dementia; 2. The search for sequence and its absence; 3. Sliding between reality and illusion; 4. Creating mutual space in/against the institutional space. The discussion of these communication patterns has the potential of offering some tools to people that are coping with the challenge of maintaining the relationship with their relatives who were diagnosed with dementia.
University of Baghdad, Iraq
Title: A case report of delirium superimposed on dementia, in an elderly female patient with venous thrombosis of the leg
Time : 14:00-14:20
Ahmed Al-Imam, is a 32-years old medical doctor and a Dermatologist from Iraq. He finished his MSc (Dermatology) in the UK. Currently, he works as a lecturer at the faculty of Medicine, University of Baghdad. He has teaching experience in the fields of Human Anatomy, Surgical Pathology, and tissue processing. His research interests include Novel Psychoactive Substances, skin and hair disorders, and biomedical applications. His doctorate thesis (PhD in Medicine) at the University of Hertfordshire, will deploy comprehensive mapping of the Dark Web, in relation to the Performance and Image Enhancing Drugs (PIEDs). His latest invention patency, was on Intermittent Pneumatic Compression (IPC) devices, for management of bed-ridden and elderly patients, with chronic venous insufficiency.
This is a challenging case of an elderly female patient, 86 years old, that has been diagnosed with delirium superimposed on depression (DSD). This frustrated patient developed DSD in parallel with venous thrombosis (VT) of her right leg. Venous thrombosis was initially superficial, affecting the Great Saphenous Vein (GSV), that later progressed into Deep Venous Thrombosis (DVT), which was confirmed by radiology (Doppler study) and laboratory investigations (D-dimer level assessment).
The therapeutic approach for such patient, was literally a dilemma, and the situation was distressing to the patient, medical and paramedical staff, and the caregivers. The patient had stopped accepting food, and she had a refractory insomnia. Additionally, the patient became frequently hyperactive throughout the day in association with frequent delirium attacks. Her hyperactivity was difficult to control, despite her leg condition (DVT), that requires immobilization to prevent a superimposed catastrophic thromboembolic episode(s). Luckily, a pulmonary embolism did not happen.
The patient refused/resisted diagnostic and therapeutic interventions, and third party consultations. However, a multidisciplinary approach was mandatory, and the core issue was the DSD. Eventually, the DSD was eventually successfully corrected with an adjusted dose of Haloperidol, a high potency first generation antipsychotic. After few days on Haloperidol, the patient became cooperative with caregivers, acceptant to therapeutic interventions, and hospitalization. Her medical and surgical complications were successfully managed. Finally, the patient was scheduled later, for reconstructive surgery, using mesh skin grafting under regional anesthesia, to cure her subsequent refractory venous leg ulcer.
The Chinese University of Hong Kong, Hong Kong
Title: Decision on mode of feeding in advanced dementia: Experience of caregivers in the discussion with medical profession
Time : 14:20-14:40
Connie has completed her BSc in Speech and Hearing Sciences from the University of Hong Kong and MA in Family Counseling and Family Education from the Chinese University of Hong Kong. She works as speech therapist in Hospital Authority in Hong Kong, involving in a variety of projects for rehabilitation and care for the aged population. She had been the committee members of the Hong Kong Association of Speech Therapists since 2012. She has published journals regarding stroke rehabilitation services.
Dysphagia and behavioural feeding problem has long been a prevalent issue in advanced stage of dementia (Easterling & Robbins, 2008). Instead of prescribing tube-feeding to tackle the impairment (Carmel, 1999), comfort feeding (or namely careful hand feeding) is an alternative to the dementia patient and caregivers in view of its comparable mortality rate to tube feeding (Sanders et al., 2000) and the patient’s quality of life (Sampson, Candy, & Jones, 2009). Therefore, it has always been a struggle for medical profession, as predictably as the patient’s caregiver, to choose between an adequate and safe nutritive support and quality end-of-life care on feeding. In this study, caregivers of advanced dementia patients of four different feeding and swallowing scenario were interviewed about their choice of feeding. The four scenarios include family choosing: (1) comfort feeding for patient diagnosed with severe dysphagia despite aspiration risk; (2) tube-feeding for patients with severe dysphagia; (3) comfort feeding for patient with feeding problem despite malnutrition; and (4) tube-feeding due to poor oral intake of the patient.
Narrative analysis (Labov & Waletzky, 1997) was used for analyzing the four interviews about caregiver's experience during discussion with medical profession on mode of feeding. The study then compares and contrasts the four narratives. Implications for stakeholers in relating and working with families and patients are explored, suggesting a framework for a family-centered decision making model on mode of feeding issue for families with patients of advanced dementia. Also, by self-reflexivity of the author (Burck, 2005), the importance of listening and acknowledging each family are important to identify family’s strength and resilience.