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https://www.readbyqxmd.com/read/28813236/ethics-and-intimate-sexual-activity-in-long-term-care
#1
Eran Metzger
A case is presented in which the staff of a long-term care facility discovers that the husband of a resident with dementia is engaged in sexual activity with her. The case illustrates a dilemma for long-term care facilities that create a home-like environment with a goal of maximizing residents' autonomy while ensuring their safety. An approach to assessing capacity to consent to intimate sexual activity is described, followed by guidelines that nursing homes can implement to support residents who wish to engage in sexual activity...
July 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28811048/receipt-of-nephrology-care-and-clinical-outcomes-among-veterans-with-advanced-ckd
#2
Enrica Fung, Tara I Chang, Glenn M Chertow, I-Chun Thomas, Steven M Asch, Manjula Kurella Tamura
BACKGROUND: Clinical practice guidelines recommend referral to nephrology when estimated glomerular filtration rate (eGFR) decreases to <30mL/min/1.73m(2); however, evidence for benefits of nephrology care are mixed. STUDY DESIGN: Observational cohort using landmark analysis. SETTINGS & PARTICIPANTS: A national cohort of veterans with advanced chronic kidney disease, defined as an outpatient eGFR≤30mL/min/1.73m(2) for January 1, 2010, through December 31, 2010, and a prior eGFR<60mL/min/1...
August 12, 2017: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/28807433/influences-on-decision-making-regarding-antipsychotic-prescribing-in-nursing-home-residents-with-dementia-a-systematic-review-and-synthesis-of-qualitative-evidence
#3
REVIEW
Kieran A Walsh, Rebecca Dennehy, Carol Sinnott, John Browne, Stephen Byrne, Jennifer McSharry, Eoin Coughlan, Suzanne Timmons
BACKGROUND: Antipsychotic prescribing is prevalent in nursing homes for the management of behavioral and psychological symptoms of dementia (BPSD), despite the known risks and limited effectiveness. Many studies have attempted to understand this continuing phenomenon, using qualitative research methods, and have generated varied and sometimes conflicting findings. To date, the totality of this qualitative evidence has not been systematically collated and synthesized. AIMS: To synthesize the findings from individual qualitative studies on decision-making and prescribing behaviors for antipsychotics in nursing home residents with dementia, with a view to informing intervention development and quality improvement in this field...
August 11, 2017: Journal of the American Medical Directors Association
https://www.readbyqxmd.com/read/28801443/the-provision-of-medical-assistance-in-dying-protocol-for-a-scoping-review
#4
Simon J W Oczkowski, Ian Ball, Carol Saleh, Gaelen Kalles, Anatoli Chkaroubo, Mike Kekewich, Paul Miller, Marianne Dees, Andrea Frolic
INTRODUCTION: Medical assistance in dying (MAID), a term encompassing both euthanasia and assisted suicide, was decriminalised in Canada in 2015. Although Bill C-14 legislated eligibility criteria under which patients could receive MAID, it did not provide guidance regarding the technical aspects of providing an assisted death. Therefore, we propose a scoping review to map the characteristics of the existing medical literature describing the medications, settings, participants and outcomes of MAID, in order to identify knowledge gaps and areas for future research...
August 11, 2017: BMJ Open
https://www.readbyqxmd.com/read/28793933/can-cognitive-assessment-really-discriminate-early-stages-of-alzheimer-s-and-behavioural-variant-frontotemporal-dementia-at-initial-clinical-presentation
#5
Sophia Reul, Hubertus Lohmann, Heinz Wiendl, Thomas Duning, Andreas Johnen
BACKGROUND: Neuropsychological testing is considered crucial for differential diagnosis of Alzheimer's disease (AD) and behavioural variant frontotemporal dementia (bvFTD). In-depth neuropsychological assessment revealed specific dysfunctions in the two dementia syndromes. However, a significant overlap of cognitive impairments exists in early disease stages. We questioned whether a standard neuropsychological assessment at initial clinical presentation can delineate patients with AD versus bvFTD...
August 9, 2017: Alzheimer's Research & Therapy
https://www.readbyqxmd.com/read/28765285/incidence-of-brain-infarcts-cognitive-change-and-risk-of-dementia-in-the-general-population-the-ages-reykjavik-study-age-gene-environment-susceptibility-reykjavik-study
#6
Sigurdur Sigurdsson, Thor Aspelund, Olafur Kjartansson, Elias F Gudmundsson, Maria K Jonsdottir, Gudny Eiriksdottir, Palmi V Jonsson, Mark A van Buchem, Vilmundur Gudnason, Lenore J Launer
BACKGROUND AND PURPOSE: The differentiation of brain infarcts by region is important because their cause and clinical implications may differ. Information on the incidence of these lesions and association with cognition and dementia from longitudinal population studies is scarce. We investigated the incidence of infarcts in cortical, subcortical, cerebellar, and overall brain regions and how prevalent and incident infarcts associate with cognitive change and incident dementia. METHODS: Participants (n=2612, 41% men, mean age 74...
August 1, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28745420/reasons-for-not-discontinuing-antipsychotics-in-dementia
#7
Sarah I M Janus, Jeannette G van Manen, Sytse U Zuidema, Carina Snijder, Constance H C Drossaert, Maarten J Ijzerman
BACKGROUND: The gap between high antipsychotic prescription rates for patients with dementia and the guidelines' advice to prescribe cautiously indicates that barriers to discontinuation exist. This exploratory study used the theory of planned behaviour to give a first overview of the factors that influence physicians to discontinue antipsychotics in nursing home patients with dementia. METHODS: Forty-one physicians in the Netherlands completed an online survey based on the theory of planned behaviour...
July 26, 2017: Psychogeriatrics: the Official Journal of the Japanese Psychogeriatric Society
https://www.readbyqxmd.com/read/28721544/sleep-in-older-adults-and-in-subjects-with-dementia
#8
REVIEW
Helmut Frohnhofen, Jeanina Schlitzer, Nikolaus Netzer
The neuronal structures for the regulation of sleep and wakefulness are located in the brain. This complex network is vulnerable to numerous factors, most importantly neurodegenerative diseases and drugs. The macrostructure and microstructure of sleep change with age. These changes are more pronounced in subjects with dementia. Sleep disorders in subjects with dementia may be independent of dementia or caused by dementia. Furthermore, epidemiological studies reveal that sleep disorders per se may induce dementia by reduction of cerebral clearance of beta-amyloids...
July 18, 2017: Zeitschrift Für Gerontologie und Geriatrie
https://www.readbyqxmd.com/read/28716614/evaluation-of-a-pain-assessment-procedure-in-long-term-care-residents-with-pain-and-dementia
#9
Janine van Kooten, Martin Smalbrugge, Johannes C van der Wouden, Max L Stek, Cees M P M Hertogh
BACKGROUND: The management of pain in long-term care residents with dementia is complex. A prospective exploratory study was conducted to describe the course of pain and pain management strategies following a guideline-based pain assessment procedure in long-term care (LTC) residents with pain and dementia. MEASURES: Pain observations with the MOBID-2 Pain Scale, review of the medical records and pharmacy files and physical examination of LTC residents with pain and dementia...
July 14, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28715552/large-perivascular-spaces-visible-on-magnetic-resonance-imaging-cerebral-small-vessel-disease-progression-and-risk-of-dementia-the-age-gene-environment-susceptibility-reykjavik-study
#10
Jie Ding, Sigurður Sigurðsson, Pálmi V Jónsson, Gudny Eiriksdottir, Andreas Charidimou, Oscar L Lopez, Mark A van Buchem, Vilmundur Guðnason, Lenore J Launer
Importance: With advancing age, an increased visibility of perivascular spaces (PVSs) on magnetic resonance imaging (MRI) is hypothesized to represent impaired drainage of interstitial fluid from the brain and may reflect underlying cerebral small vessel disease (SVD). However, whether large perivascular spaces (L-PVSs) (>3 mm in diameter) visible on MRI are associated with SVD and cognitive deterioration in older individuals is unknown. Objective: To examine whether L-PVSs are associated with the progression of the established MRI markers of SVD, cognitive decline, and increased risk of dementia...
July 17, 2017: JAMA Neurology
https://www.readbyqxmd.com/read/28705297/the-diagnosis-and-treatment-of-behavioral-disorders-in-dementia
#11
Torsten Kratz
BACKGROUND: Behavioral disorders such as aggressiveness, agitation, delusions, disinhibition, affect lability, and apathy arise in more than 90% of patients with dementia. Behavioral disorders are a major challenge and the greatest stress factor in everyday life for nursing personnel and for family members caring for the patient. METHODS: This review is based on relevant publications retrieved by a selective literature search in the PubMed, Cochrane Library, and German S3 guideline databases with the search terms "behavioral disorders," "non-cognitive disorders," and "challenging behavior," in conjunction with "dementia" and "behavioral and psychological symptoms of dementia...
June 30, 2017: Deutsches Ärzteblatt International
https://www.readbyqxmd.com/read/28697570/adherence-to-clinical-practice-guidelines-during-dementia-work-up-in-a-real-world-setting-a-study-from-the-registry-of-dementias-of-girona
#12
Oriol Turró-Garriga, Laia Calvó-Perxas, Joan Vilalta-Franch, Marta Hernández-Ferrándiz, Margarita Flaqué, Marta Linares, Marta Cullell, Jordi Gich, Isabel Casas, Héctor Perkal, Josep Garre-Olmo
BACKGROUND: There are several position statements and clinical practice guidelines (CPG) for diagnosing dementia. OBJECTIVE: Our aims were to evaluate the adherence to CPG among specialists in the 7 memory clinics included in the Registry of Dementias of Girona (ReDeGi), and to compare the results between 2007-2011 and 2012-2015. We also determined the time and number of visits required to achieve a diagnosis, the supplementary tests ordered, and the drugs prescribed according to dementia subtypes...
2017: Journal of Alzheimer's Disease: JAD
https://www.readbyqxmd.com/read/28697569/relationships-of-dietary-patterns-foods-and-micro-and-macronutrients-with-alzheimer-s-disease-and-late-life-cognitive-disorders-a-systematic-review
#13
Vincenzo Solfrizzi, Carlo Custodero, Madia Lozupone, Bruno P Imbimbo, Vincenzo Valiani, Pasquale Agosti, Andrea Schilardi, Alessia D'Introno, Maddalena La Montagna, Mariapaola Calvani, Vito Guerra, Rodolfo Sardone, Daniela I Abbrescia, Antonello Bellomo, Antonio Greco, Antonio Daniele, Davide Seripa, Giancarlo Logroscino, Carlo Sabbá, Francesco Panza
In the last decade, the association between diet and cognitive function or dementia has been largely investigated. In the present article, we systematically reviewed observational studies published in the last three years (2014-2016) on the relationship among dietary factors and late-life cognitive disorders at different levels of investigation (i.e., dietary patterns, foods and food-groups, and dietary micro- and macronutrients), and possible underlying mechanisms of the proposed associations. From the reviewed evidence, the National Institute on Aging-Alzheimer's Association guidelines for Alzheimer's disease (AD) and cognitive decline due to AD pathology introduced some evidence suggesting a direct relation between diet and changes in the brain structure and activity...
2017: Journal of Alzheimer's Disease: JAD
https://www.readbyqxmd.com/read/28693437/effects-of-computerized-cognitive-training-on-neuroimaging-outcomes-in-older-adults-a-systematic-review
#14
Lisanne F Ten Brinke, Jennifer C Davis, Cindy K Barha, Teresa Liu-Ambrose
BACKGROUND: Worldwide, the population is aging and the number of individuals diagnosed with dementia is rising rapidly. Currently, there are no effective pharmaceutical cures. Hence, identifying lifestyle approaches that may prevent, delay, or treat cognitive impairment and dementia in older adults is becoming increasingly important. Computerized Cognitive Training (CCT) is a promising strategy to combat cognitive decline. Yet, the underlying mechanisms of the effect of CCT on cognition remain poorly understood...
July 10, 2017: BMC Geriatrics
https://www.readbyqxmd.com/read/28688072/-a%C3%A2-qualitative-exploration-of-the-chronic-use-of-psychotropic-drugs-in-nursing-homes
#15
Lukas Leten, Majda Azermai, Maarten Wauters, Jan De Lepeleire
BACKGROUND: Although guidelines put forward non-pharmacological therapies and advise against the chronic use of psychotropic drugs, these are still being prescribed regularly in Belgian nursing homes. GOAL: To explore the reasons for initiation, continuation and cessation of psychotropic drug treatment of elderly with dementia and behavioral problems, residing in the nursing home. METHOD: Twenty-seven interviews from an earlier project were used, in which a semi-structured interview was conducted with the nursing staff, the physicians and the caretakers of eleven randomly selected residents from three nursing homes...
July 7, 2017: Tijdschrift Voor Gerontologie en Geriatrie
https://www.readbyqxmd.com/read/28679818/cms-strategies-to-reduce-antipsychotic-drug-use-in-nursing-home-patients-with-dementia-show-some-progress
#16
Judith A Lucas, John R Bowblis
The Centers for Medicare and Medicaid Services initiated three strategies (in March and July 2012 and in May 2013) to reduce the use of unnecessary antipsychotic medications in nursing homes, especially their widespread use to control behavioral symptoms of dementia. We examined 86,163 state recertification surveys conducted at 15,055 facilities in the period January 1, 2009-March 31, 2015. We found that these strategies were associated with increases in citations for only one of two targeted deficiencies (unnecessary drug use) and only after the third strategy (revisions to the federal guidelines for the citations) was implemented...
July 1, 2017: Health Affairs
https://www.readbyqxmd.com/read/28677230/delirium-in-a-residential-care-facility-an-exploratory-study-of-staff-knowledge
#17
Amy Buettel, Michelle Cleary, Marguerite Bramble
OBJECTIVE: To explore staff knowledge of delirium by eliciting meaning through descriptions of their experiences within a residential aged care facility (RACF). METHODS: Six staff from one RACF in Australia participated in this qualitative study. Semi-structured individual interviews were conducted and analysed using Colaizzi's analytical framework. RESULTS: The analysis revealed four themes: (i) absence of the word delirium; (ii) care based on intuition and automated actions; (iii) reliance on teamwork; and (iv) confusing delirium, depression and dementia...
July 5, 2017: Australasian Journal on Ageing
https://www.readbyqxmd.com/read/28669365/incidence-of-pneumonia-in-nursing-home-residents-with-dementia-in-the-netherlands-an-estimation-based-on-three-differently-designed-studies
#18
T P Zomer, T VAN DER Maaden, A B VAN Gageldonk-Lafeber, S C DE Greeff, J T VAN DER Steen, L Verhoef
Pneumonia leads to considerable morbidity and mortality in nursing home residents with dementia. We assessed pneumonia incidence based on data from three different studies: (1) real-time national surveillance of healthcare-associated infections in nursing home residents in 2009-2015; (2) a randomized controlled trial in 2012-2015 to assess effects of a practical guideline in nursing home residents with dementia and pneumonia; and (3) a study in 2007-2010 to assess quality of dying in newly admitted nursing home residents with dementia...
July 3, 2017: Epidemiology and Infection
https://www.readbyqxmd.com/read/28667059/hypercholesterolaemia-and-vascular-dementia
#19
REVIEW
Jason P Appleton, Polly Scutt, Nikola Sprigg, Philip M Bath
Vascular dementia (VaD) is the second commonest cause of dementia. Stroke is the leading cause of disability in adults in developed countries, the second major cause of dementia and the third commonest cause of death. Traditional vascular risk factors-diabetes, hypercholesterolaemia, hypertension and smoking-are implicated as risk factors for VaD. The associations between cholesterol and small vessel disease (SVD), stroke, cognitive impairment and subsequent dementia are complex and as yet not fully understood...
July 15, 2017: Clinical Science (1979-)
https://www.readbyqxmd.com/read/28666470/the-effects-of-chronic-and-acute-physical-activity-on-working-memory-performance-in-healthy-participants-a-systematic-review-with-meta-analysis-of-randomized-controlled-trials
#20
Azeem Rathore, Barbara Lom
BACKGROUND: Understanding how physical activity (PA) influences cognitive function in populations with cognitive impairments, such as dementia, is an increasingly studied topic yielding numerous published systematic reviews. In contrast, however, there appears to be less interest in examining associations between PA and cognition in cognitively healthy individuals. Therefore, the objective of this review was to evaluate and synthesize randomized controlled trial (RCT) studies that investigated the effects of both chronic and acute PA on working memory performance (WMP) in physically and cognitively healthy individuals...
June 30, 2017: Systematic Reviews
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