Search Results (52)

People with migration backgrounds (PwM) and their loved ones living with dementia often encounter multiple disparities for appropriate care and support. Simultaneously, care professionals may feel inadequately prepared to address the needs of PwM effectively. As a response to these concerns, research and practice have increasingly emphasized the importance of culturally sensitive care. These efforts center on understanding the cultural norms and beliefs of migrant communities and developing professional strategies tailored to these cultural factors. However, while cultural factors clearly play a role in the care experiences of PwM, the emphasis on culture in research and practice has drawn criticism from various scholars. In our contribution to this debate, we highlight the shortcomings of the concept of culturally sensitive care within the context of dementia and propose a perspective that responds to these shortcomings. We present the following arguments: (1) The prevailing discourse, which treats culture and culturally sensitive care as fixed concepts and relies on separate tools for addressing the needs of PwM, fails to offer comprehensive guidance for inclusive care. (2) Instead of attributing care-related obstacles to cultural differences, we must shift our focus to understanding individual experiences of inequality as well as the systemic structures that perpetuate inequality. (3) To address the diverse needs of PwM and the challenges of ongoing diversity within Western societies, dementia care services should embrace diversity as the norm rather than an exception requiring separate tools. This requires a paradigm shift in which professionals are trained to navigate relationships in ways that minimize reliance on rigid (ethnic and cultural) categorizations. Full article

Background: The aging population is increasing, leading to a greater need for home care for older adults, often provided by informal caregivers (ICs). These caregivers face numerous challenges, requiring adequate training and support. Objectives: This study aimed to map the main interventions performed by the Rehabilitation Nursing Specialist in empowering ICs of older adults at home. Methods: A scoping review was conducted following the Joanna Briggs Institute methodology. The search included seven articles published between 2019 and 2024, in Portuguese, English, and Spanish, available in the PubMed e CINHAL Ultimate databases. The descriptors used were (Rehabilitation Nursing) AND (Informal Caregivers OR Caregivers) AND (Elderly OR Aged) AND (mentoring OR Training. Results: The RNS interventions focused on training caregivers in technical skills (e.g., positioning, transfers, hygiene care, feeding, medication administration), preventing caregiver burden, managing behavioral and psychological symptoms of dementia, promoting self-care, and emotional support. Educational programs and the use of technologies (telehealth) were identified as effective strategies. Conclusions: RNS interventions are crucial for enhancing the skills and well-being of ICs, improving the quality of care provided to older adults at home, and reducing caregiver burden. Person-centered care, continuous support, and recognizing the caregiver’s role are fundamental aspects of these interventions. Full article

The need for person- and relationship-centered care (PCC/RCC) in Alzheimer’s disease and other dementias is well established. Recognizing the limitations of PCC in fully honoring the intricate interdependencies between care partners and persons living with dementia, a new training program called Bravo Zulu was developed. This comprehensive, 12-hour dementia training program aims to enhance personhood beliefs and self-efficacy among care partners, improving the experience of care and support for both people living with dementia and their care partners. Responses from 182 participants who completed the training were analyzed using paired t-tests to assess changes in personhood beliefs and self-efficacy. The Bravo Zulu training produced significant increases in both personhood beliefs and self-efficacy. Notably, healthcare professionals without prior care partner training exhibited the greatest gains in personhood beliefs, while participants who were not direct care partners showed substantial improvements in self-efficacy. Overall, these findings support the concept of tailoring dementia education to ensure care partners and healthcare professionals are able to provide culturally competent care that is aligned with the diverse backgrounds of people living with dementia. Expanding access to high-quality interactive programs such as Bravo Zulu can contribute to strengthening the dementia care workforce and improving care experiences for all involved. Full article

Background/Objectives: We previously demonstrated that nilotinib can sufficiently enter the brain to pharmacologically inhibit discoidin domain receptors (DDR)-1 in patients with Parkinson’s and Alzheimer’s disease. We primarily hypothesized that nilotinib is safe, and may alter disease-related biomarkers to improve, motor, cognitive and/or behavioral features in dementia with Lewy bodies (DLB). Methods: Forty-three participants were randomized 1:1 into nilotinib, 200 mg, or matching placebo in a single-center, phase 2, randomized, double-blind study. Study drug was taken orally once daily for 6 months followed by one-month wash-out. Results: Of 43 individuals enrolled, 14 were women (33%); age (mean ± SD) was 73 ± 8.5 years. Nilotinib was safe and well-tolerated, and more adverse events were noted in the placebo (74) vs. nilotinib (37) groups (p = 0.054). The number of falls were reduced in the nilotinib (six) compared to placebo (21) group (p = 0.006). Cerebrospinal fluid homovanillic acid, a biomarker of dopamine levels, was increased (p = 0.004), while the ratio of pTau181/Aβ42 was reduced (p = 0.034). The Alzheimer’s Disease Assessment Scale—cognition 14 improved by 2.8 pts (p = 0.037), and no differences were observed in Movement Disorders Society–Unified Parkinson’s Disease Rating Scale parts II and III. However, part I (cognition) improved (p = 0.044) in nilotinib compared to placebo. Conclusions: Nilotinib demonstrates favorable safety, biomarkers, and efficacy outcomes in patients with DLB supporting further trials in DLB or advanced Parkinson’s disease with dementia. Full article

Background: The increasing prevalence of dementia and mild cognitive impairment (MCI) among the elderly population is a global health issue. Information and Communication Technology (ICT)-based interventions hold promises for maintaining cognition, but their viability is affected by several challenges. Objectives: This study aimed to significantly assess the effectiveness of ICT-based cognitive and memory aid technology for individuals with MCI or dementia, identify adoption drivers, and develop an implementation model to inform practice. Methods: A PRISMA-based systematic literature review, with the protocol registered in PROSPERO (CRD420251051515), was conducted using seven electronic databases published between January 2015 and January 2025 following the PECOS framework. Random effects models were used for meta-analysis, and risk of bias was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklists. Results: A total of ten forms of ICT interventions that had proved effective to support older adults with MCI and dementia. Barriers to adoption included digital literacy differences, usability issues, privacy concerns, and the lack of caregiver support. Facilitators were individualized design, caregiver involvement, and culturally appropriate implementation. ICT-based interventions showed moderate improvements in cognitive outcomes (pooled Cohen’s d = 0.49, 95% CI: 0.14–1.03). A sensitivity analysis excluding high-risk studies yielded a comparable effect size (Cohen’s d = 0.50), indicating robust findings. However, trim-and-fill analysis suggested a slightly reduced corrected effect (Cohen’s d = 0.39, 95% CI: 0.28–0.49), reflecting potential small-study bias. Heterogeneity was moderate (I² = 46%) and increased to 55% after excluding high-risk studies. Subgroup analysis showed that tablet-based interventions tended to produce higher effect sizes. Conclusions: ICT-based interventions considerably enhance cognition status, autonomy, and social interaction in older adults with MCI and dementia. To ensure long-term scalability, future initiatives must prioritize user-centered design, caregiver education, equitable access to technology, accessible infrastructure and supportive policy frameworks. Full article

Introduction: Hypoglossal nerve stimulation (HNS) “Inspire_© therapy” has garnered popularity among obstructive sleep apnea (OSA) patients seeking an alternative to continuous positive airway pressure (CPAP) therapy. The growth in HNS has been particularly high in older adults living with OSA. Consistent and proper use of HNS in the geriatric population faces unique age-associated barriers: a high rate of multiple chronic conditions (MCC) and polypharmacy (being on five or more drugs). Early recognition and patient-centered management of these barriers will allow older patients to obtain maximum benefits from HNS. HNS has distinct advantages in the geriatric population because it overcomes many concerns related to CPAP therapy adherence, such as mechanical limitations due to manual dexterity, maxillofacial anatomy, dental issues such as usage of dentures, allergy/otolaryngology-related disorders, and pre-existing post-traumatic stress disorder-related claustrophobia. This paper describes how we worked with older patients with OSA and their care partners to overcome these barriers so patients can continue to derive cardiovascular, neurologic, and quality of life benefits resulting from optimal OSA management. These benefits are especially important in the older population because of higher rates of comorbidities (dementia, coronary artery disease, and atrial fibrillation) exacerbated by sub-optimally treated OSA. In this article, we describe our clinical experience with elderly patients on Inspire_© therapy, with a focus on the everyday difficulties faced by these patients and the measures implemented to address and mitigate these barriers. Methods: A retrospective chart review was conducted to identify patients aged 65 and above who underwent hypoglossal nerve stimulator insertion. Experiences of older patients during and after the insertion procedure were documented and compared to a younger population of patients on HNS therapy. We specifically collected information on difficulties encountered during activation or follow-up visits and compared them between the different age groups. Using this information, we identified areas to improve treatment adherence from the patients’ perspectives. Results: We identified 43 geriatric (65 to 86 years old) patients who received the Inspire implant at a tertiary academic medical center and compared them to a younger population of 23 patients. Most common challenges noted—with a potential to impact adherence—included orofacial and lingual neuropraxia (ischemic or demyelination-induced neuropathy) at activation, cognitive dysfunction (memory problems), preexisting anxiety, and insomnia. Other difficulties that are less commonly reported but equally important to consistent and proper use of HNS included headaches, concerns of device malfunction, change in comfort levels after cardiac procedures, and general intolerance of the device. The older patient population had a statistically significant higher incidence of cognitive difficulties (30.2% vs. 4.4%) and a smaller social support system (62.8% vs. 91.3%) affecting device usage compared to the younger population. There were no statistically significant differences in the rates of other more commonly reported adverse effects such as headaches, dry mouth, and anxiety between the two age groups. Conclusion: Despite several challenges faced by geriatric patients, Inspire_© hypoglossal nerve stimulation remains a viable, alternative treatment option for OSA with improved tolerance and adherence compared to CPAP. After identifying less commonly reported barriers such as cognitive decline, sensory deficits, and decreased social support systems, minor adjustments and appropriate education on use allows older patients to correctly use and benefit from Inspire_© device therapy, with subsequent improvement in sleep and overall quality of life. Full article

Introduction: The World Health Organization has identified dementia as a growing global health concern with 10 million new cases diagnosed every year. The growing number of people living with dementia (PLWD) heightens the need for effective interventions that support PLWD and their caregivers. The most effective interventions supporting PLWD and caregivers combine education, care, and services to increase knowledge, decrease stigma, improve care, heighten empathy, and increase engagement of PLWD in their communities. Dementia Friendly America (DFA), administered by USAging, promotes a Dementia Friendly Community (DFC) initiative designed to engage multiple sectors (e.g., business, healthcare, community services) and engage PLWD in a comprehensive community change process. A center for healthy aging and wellness at a midwestern public university developed a network approach in its regional support of eight DFCs, as a part of its Geriatric Workforce Enhancement Program funded by the U.S. Health Resources and Services Administration. Objective: This article documents a mid-size university’s approach to establishing a regional DFC network of urban and rural communities surrounding the university, describing the support the university provided as well as how communities implemented the four-phase DFC process and emulated guiding principles. Results: A retrospective evaluation found engagement with the DFA guiding principles and varying levels of adherence to DFC phases. Discussion: The project team suggests that there are unique roles that universities can play in supporting the DFC movement and that developing a network of communities is a helpful strategy to use in providing this support. Additionally, the authors propose the integration of a community change model to guide future DFC work. Conclusions: This article helps to fill an existing research gap concerning DFC implementation and explores the unique role academic partners can play in cultivating regional hubs of DFC activity. Full article

Background: Person-centered care (PCC) approaches are widely recognized for improving the quality of life of residents living with dementia in long-term care (LTC). However, residents are only one part of the care dyad, and it remains unclear whether PCC also impacts nursing care aides in similarly adventitious ways. Care aides in this context experience significant care strain, which refers to the physical, emotional, and psychological burden experienced by caregivers. While PCC approaches are promoted as the best approach for supporting residents living with dementia, there is limited research on whether their implementation also impacts care aides. This study examined potential associations between organization-level PCC indicators and care strain among nursing care aides who work with residents living with dementia in LTC homes in New Brunswick, Canada. Methods: A cross-sectional survey design was used to explore the relationship between PCC approaches and care strain. Care strain was measured using the strain in dementia care scale, including the daily emotions subscale. A modified version of the Dementia Policy Questionnaire assessed the extent to which PCC approaches were implemented in participants’ workplaces. Descriptive statistics characterized the sample, and multivariable regression analyses examined associations between PCC indicators and care strain, adjusting for demographic factors. Results: Twenty-eight participants completed both measures. Overall, participants reported high levels of care strain but also high levels of positive daily emotions. Findings partially supported the hypothesis that PCC indicators were associated with lower care strain and more positive daily emotions. Certain PCC indicators, such as structured education and ethical support, appeared particularly beneficial. Implications for Practice: Strengthening PCC practices—especially through hands-on training and ethical support—may help reduce care strain and enhance care aides’ emotional well-being. LTC facilities that prioritize these strategies over policy implementation alone may improve both staff well-being and quality of care for residents. Full article

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder characterized by the progressive degeneration of upper and lower motor neurons, leading to muscle atrophy, paralysis, and respiratory failure. This comprehensive review synthesizes the current knowledge on ALS pathophysiology, clinical heterogeneity, diagnostic frameworks, and evolving therapeutic strategies. Mechanistically, ALS arises from complex interactions between genetic mutations (e.g., in C9orf72, SOD1, TARDBP (TDP-43), and FUS) and dysregulated cellular pathways, including impaired RNA metabolism, protein misfolding, nucleocytoplasmic transport defects, and prion-like propagation of toxic aggregates. Phenotypic heterogeneity, manifesting as bulbar-, spinal-, or respiratory-onset variants, complicates its early diagnosis, which thus necessitates the rigorous application of the revised El Escorial criteria and emerging biomarkers such as neurofilament light chain. Clinically, ALS intersects with frontotemporal dementia (FTD) in up to 50% of the cases, driven by shared TDP-43 pathology and C9orf72 hexanucleotide expansions. Epidemiological studies have revealed a lifetime risk of 1:350, with male predominance (1.5:1) and peak onset between 50 and 70 years. Disease progression varies widely, with a median survival of 2–4 years post-diagnosis, underscoring the urgency for early intervention. Approved therapies, including riluzole (glutamate modulation), edaravone (antioxidant), and tofersen (antisense oligonucleotide), offer modest survival benefits, while dextromethorphan/quinidine alleviates the pseudobulbar affect. Non-pharmacological treatment advances, such as non-invasive ventilation (NIV), prolong survival by 13 months and improve quality of life, particularly in bulb-involved patients. Multidisciplinary care—integrating physical therapy, respiratory support, nutritional management, and cognitive assessments—is critical to addressing motor and non-motor symptoms (e.g., dysphagia, spasticity, sleep disturbances). Emerging therapies show promise in preclinical models. However, challenges persist in translating genetic insights into universally effective treatments. Ethical considerations, including euthanasia and end-of-life decision-making, further highlight the need for patient-centered communication and palliative strategies. Full article

As the interest in social and assistive support robots (SASRs) grows, a review of 17 systematic reviews was conducted to assess their use in healthcare, emotional well-being, and therapy for diverse populations, including older adults, children, and individuals with autism and dementia. SASRs have demonstrated potential in alleviating depression, loneliness, anxiety, and stress, while also improving sleep and cognitive function. Despite these promising outcomes, challenges remain in identifying the most effective interventions, refining robot designs, and evaluating long-term impacts. User acceptance hinges on trustworthiness and empathy-driven design. Compared to earlier review studies, recent research emphasizes the ongoing significance of emotional engagement, the refinement of robot functionalities, and the need to address ethical issues such as privacy and autonomy through robust cybersecurity and data privacy measures. The field is gradually shifting towards a user-centered design approach, focusing on robots as tools to augment, rather than replace, human care. While SASRs offer substantial benefits for emotional well-being and therapeutic support, further research is crucial to enhance their effectiveness and address concerns about replacing human care. Algorethics (AI ethics), interdisciplinary collaboration, and standardization and training emerge as key priorities to ensure the responsible and sustainable deployment of SASRs in healthcare settings, reinforcing the importance of rigorous methodologies and ethical safeguards. Full article

Background: Early cognitive training is important to prevent cognitive decline in patients with mild cognitive impairment (MCI) or dementia. Therefore, developing an application that can provide evidence-based cognitive training is necessary for patients with MCI or dementia. Method: This study aimed to develop and evaluate Smart Brain, an evidence-based application that provides comprehensive cognitive training tailored to this population. The application was developed using an ADDIE (analysis, design, development, implementation, and evaluation) model. A systematic review of databases, including Ovid-MEDLINE, Ovid-EMBASE, Cochrane Library, and CINAHL, was conducted up to April 15, 2021, to identify key content areas. Additionally, a survey of 100 participants highlighted the need for features such as cognitive games, health notes, social networking services, and goal achievement. Result: The application was developed with distinct user and administrator interfaces to support engagement and monitoring. Usability testing involved 7 experts and 11 elderly individuals with MCI or dementia from a daycare center. Based on usability feedback, features such as the time limits for cognitive games were refined. The final application integrates cognitive games, physical exercises, emotional support, and health management tools to address user needs comprehensively. Conclusion: Smart Brain holds significant potential to improve the quality of life and cognitive health of elderly individuals with MCI or dementia. Its usability and functionality make it a promising tool for community-based interventions. Full article

Dietary supplements are readily available over the counter in the United States and are used by the majority of older adults to address a variety of concerns and conditions. Many older adults report using dietary supplements for cognitive health—either to address memory loss or dementia or in efforts to prevent cognitive decline. Our objective for this narrative review is to summarize the available efficacy and safety data for several supplements commonly reported in our clinic as being used for symptoms of dementia. Using a validated survey instrument, we conducted a survey of patients in our tertiary referral center memory clinic population to assess for the most commonly reported supplements for cognition. In our review, we compare the strength of published medical and scientific evidence to advertising or other lay press claims made about the nine most reported supplements with the aim of providing a representation of general trends in this industry. We found little or no scientific evidence available to support the use of any of these substances to ameliorate memory loss or other cognitive symptoms. Although most appear safe in the studies conducted to date, several authors have highlighted the lack of Food and Drug Administration oversight in the supplement industry, raising concerns over unknown or undeclared contaminants in these over-the-counter products. This review will better prepare clinicians to discuss these considerations with their patients who are considering the use of dietary supplements. Full article

Doll therapy is a psychosocial intervention that has been commonly used within dementia care for many decades. The practice of doll therapy involves supporting people with dementia to engage with a therapeutic doll and this has been associated with positive changes in a person’s wellbeing and behavior. While there have been several systematic reviews that have focused on behavioral outcomes, limited reviews have explored the broader psychosocial outcomes associated with doll therapy in care home settings. A scoping review of the literature was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews (PRISMA-ScR). Four electronic databases were searched systematically (CINAHL Plus, Medline, PsycINFO, and PubMed). Twelve primary research studies from the past ten years (2013–2023) were included in this review. Primary data were synthesized using a narrative synthesis methodology. The three main themes from this review relate to a reduction in levels of behavioral and psychological symptoms of dementia (BPSD), increased communication skills, and a reduction in caregiver distress. Doll therapy has the potential to be an effective person-centered intervention that can enhance quality of life for people living with dementia in care home settings. Full article

The number of patients hospitalized with dementia is increasing, but one symptom, apathy, tends to be overlooked and unaddressed. Thus, this study determines how nurses certified in dementia nursing engage with older patients with dementia who exhibit apathy during hospitalization. A qualitative study using semi-structured interviews with 10 dementia care nurses in Japan was conducted. Through conventional content analysis, 10 categories were generated. They included (1) initiating patient engagement when their physiological or daily-life problems become more pronounced, (2) assessing and identifying the causes of decreased motivation from multiple perspectives, (3) assessing patients from multiple perspectives to determine the best way to start supporting them, (4) providing reassurance through basic dementia care, (5) incorporating pleasant stimuli into the hospital environment, (6) providing care based on patients’ circumstances and abilities by collaborating with multiple professionals. Nurses initiate involvement with patients when their daily life problems become more pronounced. They conduct comprehensive assessments from multiple perspectives and collaborate with other professionals to ensure patient care and safety. They also extend their support to patients’ families and maintain long-term involvement. Apathetic older patients benefit from basic nursing care practices and a patient-centered approach, which do not require specialization or additional costs and resources. Full article

Family caregivers can be overwhelmed by the care they provide within the family without external support. The development of self-management skills and the associated ability to actively and responsibly manage one’s own health or illness situation therefore plays a vital role in the home care of people living with dementia. As part of an individualized intervention for family caregivers of people of Turkish origin with dementia, existing self-management skills were examined through qualitative interviews to gain insight into health literacy and empowerment in caregiving and in interviewees’ own practices to maintain their health. Ten caregivers of Turkish origin who were responsible for family members living with dementia were interviewed using problem-centered interviews. We found that the target group has very heterogeneous self-management competencies, which are based, on the one hand, on existing supportive resources and, on the other hand, on diverse care-specific, psychosocial and life-world challenges in intrafamily care that have not been overcome. Self-management skills in family caregivers are influenced by a complex interplay of both available resources that support these skills and challenging caregiving situations. This dynamic combination of resources and challenges results in varying levels of self-management ability among family caregivers. Strengthening resources can help caregivers to meet the challenges resulting from caregiving and to expand their self-management competencies. There is great need for action in promoting self-management skills among Turkish caregivers of people living with dementia in home care. Interventions to promote self-management skills must take into account the individual resources of those affected as well as their social and cultural diversity. Full article