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In the early stage of dementia, persons living with dementia (PLwD) can identify their values and wishes for future care with a high degree of accuracy and reliability. However, there is a paucity of research to guide best practices on how best to incorporate advance care planning (ACP) in older adults diagnosed with mild dementia and therefore only a minority of these individuals participate in any ACP discussions. We developed an intervention called Voice Your Values (VYV) that healthcare professionals can implement to identify and document the values of PLwD and their trusted individuals such as friends or family.
This single-group pre-test and post-test design aimed to determine the feasibility, acceptability, and preliminary efficacy of the VYV intervention.
A convenience sample of 21 dyads of PLwD and their trusted individuals were recruited from five outpatient geriatric clinics. The tailored VYV intervention was delivered to the dyads over two sessions using videoconferencing.
In terms of feasibility, the recruitment rate was lower (52%) than the expected 60%; the retention rate was high at 94%, and the intervention fidelity was high based on the audit of 20% of the sessions. In terms of preliminary efficacy, PLwD demonstrated improvement in ACP engagement (p = <0.01); trusted individuals showed improvements in decision-making confidence (p = 0.01) and psychological distress (p = 0.02); whereas a minimal change was noted in their dementia knowledge (p = 0.22).
Most of the feasibility parameters were met. A larger sample along with a control group, as well as a longitudinal study, are requisite to rigorously evaluate the efficacy of the promising VYV intervention. There is emerging evidence that people living with mild dementia can effectively participate in identifying and expressing their values and wishes for future care.
A palliative approach to care aims to meet the needs of patients and caregivers throughout a chronic disease trajectory and can be delivered by non-palliative specialists. There is an important gap in understanding the perspectives and experiences of primary care providers on an integrated palliative approach in dementia care and the impact of existing programs and models to this end. To address these, we undertook a scoping review. We searched five databases; and used descriptive numerical summary and narrative synthesizing approaches for data analysis. We found that: (1) difficulty with prognostication and a lack of interdisciplinary and intersectoral collaboration are obstacles to using a palliative approach in primary care; and (2) a palliative approach results in statistically and clinically significant impacts on community-dwelling individuals, specifically those with later stages of dementia. There is a need for high-quality research studies examining the integrated palliative approach models and initiation of these models sooner in the care trajectory for persons living with mild and moderate stages of dementia in the community.
People working in long-term care homes (LTCH) face ethical dilemmas about how to minimize the risk of spread of COVID-19, while also minimizing psychological hardship and other harms of infection control measures on residents. The Dementia Isolation Toolkit (www.dementiaisolationtoolkit.com; DIT) was developed to address the gap in ethical guidance for LTCH on how to safely and effectively isolate people with dementia while supporting the personhood and well-being of residents. In this presentation, we will present the DIT and report on the results of a survey of LTCH staff in Ontario, Canada on their experiences isolating residents in LTCH and the use of the DIT in supporting person-centred isolation care.
A link to an online survey was distributed to LTCH staff through provincial organizations and agencies as well as through social media and the DIT website. Inclusion criteria were LTCH staff working on-site at a LTCH since March 1, 2020, who had direct or indirect experience with the isolation/quarantine of LTCH residents. Results were summarized descriptively.
A broad sample of LTCH staff (n=207) participated in the survey, most of whom had experienced an outbreak in their LTCH. Dementia (96%) was the most important barrier to implementation of infection control measures in LTCH, followed by staff distress about the effects of isolation on residents (61%). Important facilitators for isolation included delivery of 1:1 activities in the resident’s room (81%) and designating essential caregivers to provide support (67%), while inadequate staffing levels were reported as a barrier (55%). 65% of respondents indicated some familiarity with the DIT, and of those who had used the toolkit, 62% found it helpful in supporting isolation care, particularly in developing care plans and making and communicating decisions. Of those who had used the DIT, 48% found it fairly or very helpful at reducing their level of distress.
Isolation as an infection control and prevention (ICP) measure in LTCH environments can be harmful to residents and create moral distress in staff. ICP guidance and support of LTCH needs to address how to minimize these harms by providing dementia-specific guidance such as in the DIT.
With the rise of wearable sensors, advancement in comprehensible artificial intelligence (AI) algorithms, and growing acceptance of AI in medicine, AI has great potential to more reliably diagnose, prognose, and treat mental illnesses. The rapidly rising number of older adults worldwide presents a unique challenge for clinicians due to increased mental health needs in the setting of a dwindling clinical workforce. AI has enabled researchers to better understand mental illnesses by taking advantage of ‘big data.’
This symposium will present an overview of novel research leveraging AI (machine learning, natural language processing) to better track, understand, and support mental health and cognitive functioning in older adults.
Helmet Karim, PhD will present on prediction of treatment response in late-life major depressive disorder and the implications of those models.
Ellen Lee, MD will present on using natural language processing to understand psychosocial functioning in older adults.
Ipsit Vahia, MD will present on radio-based sensors to phenotype changes in behavior patterns that may correlate with a range of geropsychiatric symptoms.
Andrea Iaboni, MD DPhil FRCPC will present on multimodal wearable and vision-based sensors for the detection and categorization of behavioural symptoms of dementia.
The symposium includes three physician-scientists (Iaboni, Lee, Vahia), two women (Iaboni, Lee), and two early career faculty (Lee, Karim – co-chairs). The symposium represents four different institutions across the country (McLean/Harvard, Toronto Rehabilitation Institute/University of Toronto, UC San Diego, University of Pittsburgh) and four very different approaches using AI technology to improve understanding and outcomes in the field of geriatric mental health.
The symposium seeks to address the underutilization of AI in psychiatric research, especially in the field of aging research. The increased individual-level heterogeneity associated with aging; complex trajectories of decline in cognitive, mental, and physical health; and lack and slow adoption of older adult-centered technologies present great challenges to advancing the field. However, advances in the field of explainable AI and transdisciplinary development of AI approaches can address the unique challenges of aging research.
This chapter describes both the impact of medical diseases and their treatments on sleep, and how disordered sleep can contribute to medical illnesses. Airway function has a normal circadian variation, with peak airflow in the afternoon and the lowest in the early morning. In people with asthma, this morning trough is associated with worsening of asthma symptoms and sleep disturbance. In individuals with heartburn at least once weekly, three-quarters complain of heartburn affecting their sleep. Polysomnography helps to clarify the nature and severity of the primary sleep disorder and aid in the management of end-stage renal disease (ESRD). Disruption of sleep is common in people with arthritic or muscular pain. Pain, sleep disturbance, and low mood are all believed to contribute to fatigue, a common complaint of those with rheumatic disorders. Circadian sleep/wakefulness is intricately linked to neuroendocrine and neuroimmune functions.
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