Mild cognitive impairment, Alzheimer’s diagnoses trigger lower self-ratings of quality of life

Researchers at Penn Medicine have discovered that a patient’s awareness of a diagnosis of cognitive impairment may diminish their self-assessment of quality of life. In a study published this month in the Journal of Gerontology: Psychological Sciences the researchers report that older adults who were aware of their diagnosis — either Mild Cognitive Impairment or mild stage Alzheimer’s disease dementia — reported greater depression, higher stress, and lower quality of life than those who were unaware. They also found that older adults who had an expectation that their disease would worsen over time reported lower overall satisfaction with daily life.

“These findings suggest that a patient’s quality of life could be impacted by a diagnostic label and their expectations for the prognosis. So, when a clinician discloses the diagnosis and prognosis of Mild Cognitive Impairment or mild stage Alzheimer’s disease, a patient may experience additional symptoms, like anxiety or depression,” said the study’s lead author, Shana Stites, PsyD, MA, MS, a clinical psychologist in the Penn Memory Center, senior research investigator for the Penn Project on Precision Medicine for the Brain (P3MB).

Full story at Science Daily

New low-cost workforce extends primary care to homes of older adults

A new study from the Indiana University School of Medicine and the Regenstrief Institute has found that person-centered dementia care, which involves both patients and their caregivers, can be effectively provided by an engaged low-cost workforce — care coordinator assistants.

Under the close supervision of clinical professionals, the care coordinator assistants, known as CCAs, work as integral health care team members conducting home and phone visits with dementia patients and family caregivers. CCAs, who typically have at most two years of post-high school education, are selected through a rigorous and innovative screening process. Once hired and trained, CCAs are assigned tasks focused on patient engagement and caregiver support that require less training and expertise than that of nurses or social workers.

As the number of older adults increases and health care resources cannot keep pace, the question of how to provide good care for this growing population has become increasingly pressing.

Full story of low-cost workforce and primary care at Science Daily

Dementia care at home: Raising knowledge, confidence to improve quality, decrease costs

Over two thirds or the home health care population consists of adults over the age of 65, approximately 36% have some form of cognitive impairment, including dementia. According to the Institute of Medicine, the number of home health care (HHC) providers qualified to properly care for the older adults, including those with dementia, is inadequate.

Seeing the need to fill the knowledge gap, Abraham Brody, PhD, RN, GNP-BC, an assistant professor at the New York University College of Nursing (NYUCN) and associate director, Hartford Institute for Geriatric Nursing (HIGN), recently developed the Dementia Symptom Management at Home (DSM-H). The intent of the program is to help home healthcare agencies to improve the quality of care they provide to patients living with dementia (PLWD) and reduce caregiver stress and burnout.

The DSM-H is a synergistic combination of elements from several interprofessional training programs utilizing both online education, off-line mentoring, and evidence-based assessment tools and care plans to provide a structured way for HHC agencies to assess and manage pain and behavioral symptoms such as agitation, verbal and physical aggression, delusions, hallucinations, and sleep problems in PLWD and to also decrease their caregivers’ stress, burnout, and burden of care.

Full story of dementia care at home at Science Daily

Patient self-reporting version of ‘blood pressure cuff’ for dementia is reliable, valid

The patient self-reporting version of the Healthy Aging Brain Care Monitor — a primary-care tool to measure cognitive, functional and psychological symptoms — is user-friendly, reliable and valid, including being sensitive to symptom change, according to a new Regenstrief Institute and Indiana University Center for Aging Research study.

Similar to the way the blood pressure cuff measures blood pressure levels during (systolic) and between (diastolic) heart beats, the Healthy Aging Brain Center Monitor measures 27 items on a four-point scale to assess cognitive, functional, and psychological symptoms. The health care team can track scores over time to note declines or improvements.

“Depression, anxiety and inability to cope with demands of daily living are common in older adults. The patient self-reporting version of the HABC Monitor helps busy physicians accurately measure and monitor the severity of symptoms, providing valuable information that the patient’s entire care team needs,” said Regenstrief Institute investigator Malaz Boustani, M.D., MPH, Richard M. Fairbanks Professor in Aging Research at the IU School of Medicine and associate director of the IU Center for Aging Research.

Full story of blood pressure cuff for dementia at Science Daily

Less than half of UK prescriptions for antipsychotics issued for main licensed conditions

Less than half of UK prescriptions for antipsychotic drugs are being issued to treat the serious mental illnesses for which they are mainly licensed, reveals research published in the online journal BMJ Open.

Instead, they may often be prescribed ‘off label’ to older people with other conditions, such as anxiety and dementia, despite the greater risk of potentially serious side effects in this age group, the findings indicate.

The researchers analysed family doctors’ prescribing patterns for first and second generation antipsychotic drugs across the UK between 2007 and 2011, using data submitted to The Health Improvement Network (THIN) database.

Full story of UK anti-psychotics at Science Daily

Most misdiagnosed form of dementia leaves patients, doctors unprepared

Lewy body dementia (LBD) is the most misdiagnosed form of dementia, taking on average more than 18 months and three doctors to receive a correct diagnosis. Even though it is second only to Alzheimer’s disease as the most common cause of progressive dementia, affecting 1.3 million Americans, the symptoms of LBD are not well recognized by many physicians, especially primary care physicians and other general practitioners. Unfortunately, then, most people are not diagnosed until they are at moderate or severe states, leaving their caregivers unprepared and the patient vulnerable to potentially deadly medication side effects.

“Recognizing LBD at its earliest stage is critical not only for an accurate diagnosis by the appropriate specialist but also because it is important for a patient with LBD to be managed by an expert familiar with dementia in general and LBD in particular,” says Howard I. Hurtig, M.D., Chair Emeritus, Department of Neurology, Pennsylvania Hospital, and Elliott Professor of Neurology, Perelman School of Medicine, University of Pennsylvania. “A primary care physician with the best intentions may not be well informed about LBD, so it becomes the duty of the patient and caregiver to know about resources, such as the Lewy Body Dementia Association (LBDA), for help when needed.”