Poster Presentations at the 9th Canadian Conference on Dementia (CCD) Toronto, November 2017
Canadian Geriatrics Journal
Background/Objectives: Comprehensive mapping of evidence-based interventions for the health and supportive service needs of individuals with dementia is an important first step in capacity planning. A scoping review was undertaken to generate potential candidates for simulation and scenario modelling. We achieved these aims by identifying the most promising interventions for improving outcomes for persons living with dementia, care partners and the health system. Methods: We investigated
... ntions representing eleven topics relating to the care and management of communitydwelling persons living with dementia. Primary outcomes of interest were: timing and rate of long-term care transition, hospitalization, economic evaluation, and quality of life and patient-centred measures. Scholarly articles were identified using electronic databases (e.g. MEDLINE and PsycINFO) and grey literature from relevant websites and expert consultation. Two reviewers independently screened results and abstracted data; a third adjudicated final inclusion. GRADE and Oxford Levels of Evidence were applied to assess strength of the evidence and evaluate recommendations for use. Results: We screened 468 titles and abstracts and 152 full-text articles. Sixty-one studies published between 1985 and 2016, ranging from meta-analyses, systematic reviews, randomized clinical trials and cohort studies were included for synthesis. Four effective interventions were assigned a strong recommendation for use based on evidence of high-moderate quality and favourable effects in at least two or more outcomes relevant to our scoping review questions. Interventions achieved between 4.5 to 10 months of delayed time to admission to long-term care and approximately 20-40% reduced rate of transition. Positive benefits of interventions were consistently reported for mental health and quality of life of persons living with dementia and care partners, though their economic benefit and impact on hospitalization or emergency room department use were often mixed or unreported. Conclusion: Our review identified that among the eleven community-based intervention types, only four: adult day programs; caregiver or care partner education programs; comprehensive community-based care; and, dementia case management or care coordination reported sufficient evidence to consider including in scenario modelling for dementia capacity planning. Background: Oxidative stress and subcortical white matter hyperintensities (WMH) presumed to represent subcortical ischemic vascular disease (SIVD) of the small vessels, are commonly detected in older people with and without Alzheimer's disease (AD), but the relationship between SIVD and peripheral oxidative stress markers has not been assessed in patients with or without AD. Objective: To study the relationships between serum oxidative stress markers and SIVD and/or AD, and to explore relationships between oxidative stress, vascular risk factors and WMH. Methods: Patients with varying degrees of WMH were recruited from memory and stroke prevention clinics into 4 groups: minimal SIVD (n=20), extensive SIVD (n=28), AD with minimal SIVD (n=13), and AD with extensive SIVD (n=12). Volumes of deep and periventricular WMH were delineated using PD/T2 and fluid-attenuated inversion recovery MRI at 3.0 T. Serum was collected and assayed for lipid hydroperoxides (LPH), 8-isoprostane (8-iso) and 4-hydroxynonenal. Results : In a multivariate model, SIVD was associated with higher peripheral blood 8-iso (F1,72=13.03, p=0.001) and LPH (F1,72=6.08, p=0.016) concentrations while AD was not (8-iso F1,72=0.04, p=0.851; LPH F1,72<0.001, p=0.990). LPH concentrations were related to hypertension (F1,72=7.30, p=0.009), and LPH mediated the effect of hypertension on deep (indirect effect=249.96, 95% bootstrap confidence interval [79.91, 557.69]) but not periventricular WMH CCD POSTER PRESENTATIONS 72 volumes. 4-hydroxynonenal was associated with hyperlipidemia (F1,72=4.47, p=0.038), but not SIVD or AD. Conclusions: Peripheral oxidative stress markers were related to subcortical small vessel disease and vascular risk factors but not to Alzheimer's disease. Lipid peroxidation mediated the impact of hypertension on damage to the deep subcortical white matter. Background: Nearly 12% of Canadians are caregivers for a person who has dementia. Up to 90% of people with dementia (PWD) experience significant behavioural and psychological symptoms (BPSD) that challenge and upset caregivers. Currently, there is no easy way for caregivers to manage and track behaviour-related symptoms in the care recipient, making it difficult to improve care and share information across the circle of care. Objectives: This presentation will discuss the development of a mobile application called the Dementia Talk App, an award winning App, designed to empower caregivers to manage and track behaviours in the person with dementia as well as enhance communication among care providers. The presentation will showcase key features of the App and share highlights from caregiver focus groups to demonstrate the importance of caregiver driven development process in creating meaningful and accessible digital solutions for clients and their caregivers. Method: The study involves 15-20 participants, who have reviewed and trialed the app for a period of three weeks. The participants attended focus groups to discuss their experience and provide feedback about the app. The feedback was recorded through audio recordings and written notes. The transcripts were analyzed using the "framework analysis" approach, which is a standard method of qualitative data analysis. Conclusion: This study will provide information that guides the modification and further development of the Dementia Talk App. The goal of the study is to refine the app in order to optimize its effectiveness in helping caregivers to track and manage behaviour-related challenges with the PWD.