CWPT Dementia/Alzheimer's Disease

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Dementia And Physical Activity (DAPA) trial of moderate to high intensity exercise training for people with dementia: randomised controlled trial
(BMJ, 2018-05-16) Lamb, Sarah E; Sheehan, Bartholomew; Atherton, Nicky; Nichols, Vivien; Collins, Helen; Mistry, Dipesh; Dosanjh, Sukhdeep; Slowther, Anne-Marie; Khan, Iftekhar; Petrou, Stavros; Lall, Ranjit; Investigators, DAPA Trial; University of Oxford; University of Warwick; Coventry and Warwickshire Partnership NHS Trust; Oxford University Hospitals NHS Foundation Trust; Old Age Psychiatry; Research; Admin and Clerical; Medical and Dental; Atherton, Nicky; Sheehan, Bart
Objective: To estimate the effect of a moderate to high intensity aerobic and strength exercise training programme on cognitive impairment and other outcomes in people with mild to moderate dementia. Design: Multicentre, pragmatic, investigator masked, randomised controlled trial. Setting: National Health Service primary care, community and memory services, dementia research registers, and voluntary sector providers in 15 English regions. Participants: 494 people with dementia: 329 were assigned to an aerobic and strength exercise programme and 165 were assigned to usual care. Random allocation was 2:1 in favour of the exercise arm. Interventions: Usual care plus four months of supervised exercise and support for ongoing physical activity, or usual care only. Interventions were delivered in community gym facilities and NHS premises. Main outcome measures: The primary outcome was score on the Alzheimer's disease assessment scale-cognitive subscale (ADAS-cog) at 12 months. Secondary outcomes included activities of daily living, neuropsychiatric symptoms, health related quality of life, and carer quality of life and burden. Physical fitness (including the six minute walk test) was measured in the exercise arm during the intervention. Results: The average age of participants was 77 (SD 7.9) years and 301/494 (61%) were men. By 12 months the mean ADAS-cog score had increased to 25.2 (SD 12.3) in the exercise arm and 23.8 (SD 10.4) in the usual care arm (adjusted between group difference -1.4, 95% confidence interval -2.6 to -0.2, P=0.03). This indicates greater cognitive impairment in the exercise group, although the average difference is small and clinical relevance uncertain. No differences were found in secondary outcomes or preplanned subgroup analyses by dementia type (Alzheimer's disease or other), severity of cognitive impairment, sex, and mobility. Compliance with exercise was good. Over 65% of participants (214/329) attended more than three quarters of scheduled sessions. Six minute walking distance improved over six weeks (mean change 18.1 m, 95% confidence interval 11.6 m to 24.6 m). Conclusion: A moderate to high intensity aerobic and strength exercise training programme does not slow cognitive impairment in people with mild to moderate dementia. The exercise training programme improved physical fitness, but there were no noticeable improvements in other clinical outcomes.
The effectiveness of music as an intervention for dementia patients in acute settings
(PKP Publishing Services, 2021-10-25) Hack, Kate; Martin, Kate; Atkinson, Chris; University of Warwick; Coventry and Warwickshire Partnership NHS Trust; Acute Psychological Services; Learning Disability Services - Community Health; Additional Professional Scientific and Technical Field; Allied Health Professional; Martin, Kate; Atkinson, Chris
In 2019 there were an estimated 50 million people living with dementia globally [1]. There is a strong need for therapies and interventions that ameliorate symptoms and improve quality of life for individuals living with dementia. Whilst there is evidence for the effectiveness of music interventions in long-term care settings, such as nursing homes, less research has been conducted into their effectiveness in acute settings. It is important to build up an evidence base of effective interventions in acute settings specifically, which often see the most challenging cases of symptoms associated with dementia. This systematic review represents a novel examination of the literature on music as an intervention for dementia patients in acute settings. A database search identified 204 papers, of which 10 studies satisfied criteria and were reviewed. A quality assessment framework was applied, with the majority of studies scoring highly (above 80%). The review identified 4 areas where music interventions have been utilized to improve outcomes for dementia patients in acute settings: mood and wellbeing, behavioral and psychological symptoms of dementia, and use of inpatient resources. The most reliable evidence is currently within mood and behavior domains reflecting positive change following music intervention for inpatients. Limitations, clinical implications and recommendations for future research are discussed.
How people with dementia and their carers adapt their homes : a qualitative study
(Sage Journals, 2017-06-08) Allen, Frances; Cain, Rebecca; Meyer, Caroline; University of Warwick; Coventry and Warwickshire Partnership NHS Trust; Psychology; Additional Professional Scientific and Technical Field; Meyer, Caroline
The objective was to explore the ways in which people with dementia and their carers adapt their homes, including the barriers and use of available information. Semi-structured interviews were conducted with 10 people with dementia and their informal carer. The collected data were analysed using thematic analysis. Three core themes emerged: Maintaining familiarity and coping with change, Having knowledge and finding knowledge and Meeting challenges through home adaptation. The most significant barriers to making home adaptations were lack of knowledge and maintaining familiarity. Having more information and making home modifications earlier might enable individuals with dementia to adjust to their adapted environment.
Oral health in Dementia: Clinical Update
(Hamad Medical Corporation for Educational Purposes, 2024-10) Girgis, Eriny; Mishriky, Raafat; Antoun Reyad, Ayman; Coventry and Warwickshire Partnership Trust; Hamad Medical Corporation, Qatar; University of Wolverhampton; Dental Department; Medical and Dental; Girgis, Eriny
Dementia is a progressive and debilitating neurodegenerative condition leading to a negative impact on older people’s quality of life and daily activities. Recently, there is interest in the bidirectional association between dementia and poor oral health. Research suggests higher incidence of gingivitis, plaque, periodontitis, mucosal lesions, reduced salivary flow and tooth loss in patients with dementia. Maintaining good oral health is visionary with disease progression and challenging behaviors. Good oral health could be achieved through appropriate oral care advice and education to carers/families with regular professional dental care. Standards of living are improving with increased life expectancy leading to an ageing population (1) which constitutes a risk factor for dementia, with a huge economic and social burden. Family members are negatively impacted, especially with disease progression and behavioral changes (2). Dementia is characterized by progressive cognitive impairment. Patients suffering from dementia usually present with dental conditions influenced by their impaired self-care, polypharmacy, co-existing morbidity, malnutrition, xerostomia, dysphasia, and dysphagia (2). Recent research suggested that dementia patients have higher incidence of caries, retained roots, and orofacial pain (3). There is increased risk of plaque, gingival bleeding, periodontal pockets, xerostomia, reduced salivary flow, stomatitis and oral lesions (3).
QI 1214 Improving Staff Confidence and Competence in Delivering End of Life Care on Acute Dementia Wards (Stanley and Pembleton)
(Coventry and Warwickshire Partnership NHS Trust, 2024) Martin, Kate; Supported by the Quality Improvement Team, Coventry and Warwickshire Partnership Trust; Coventry and Warwickshire Partnership NHS Trust; Older Adult Acute Psychology Service; Morgan, Jane; Evans, Kirby; Gordon-Brown, Alexandra; Bond, Judith; Sawyer, Laura; Additional Professional Scientific and Technical Field; Martin, Kate
Aim: Improve staff's confidence and abilities to care for patients on end-of-life (EOL) pathways. This project ran across Stanley and Pembleton the acute dementia wards. During reflective meetings, staff identified a need around improving confidence in working with people at end of life (EOL). Staff voiced wanting to feel they had done the right thing, despite not being a specialist EOL ward. Staff’s views regarding what they needed to help improve their confidence in working with people at end of life were used to develop training, information and support around the following topics: -Increasing Knowledge and Skills around EOL -MDT Working and a ‘joined up approach’. Providing an appropriate environment and tools to guide interventions (i.e. SOP, pain identification). Tools Used: Staff discussions and feedback. Questionnaires with quantitative and qualitative responses. QI Driver Diagram - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-driver-diagrams.pdf. Staff report feeling more confident in their abilities to care for patients at end of life (EOL). Service level agreement in place: Mary Ann Evans hospice to offer rapid response to support ward with EOL concerns. Staff report feeling better able to access support from services during/following identifying a patient as approaching EOL. Importance of the need for a SOP identified and development has begun.
Quality improvement project: delirium awareness and training in Coventry memory services
(Cambridge University Press, 2021-06-18) Yahya, Nurul; Saad, Karim; Coventry and Warwickshire Partnership Trust; Older Adult Psychiatry; Medical and Dental; Yahya, Nurul; Saad, Karim
Aims By way of Quality Improvement, this project aims to identify awareness levels, deliver a brief training and thus increasing the confidence of Memory Assessment Clinicians in detecting delirium. Background People with dementia are at greater risk of delirium, and the acute confusion associated with delirium may be mistaken as part of their dementia. Despite having an estimated prevalence in care homes of 14.2% in the UK, delirium is under-recognised. Memory Assessment Clinicians may have low confidence in identifying and have low awareness of delirium despite being tasked with a triage and diagnostic role in dementia assessment. NICE has recently updated the guidelines on Delirium in March 2019 with recommendations on prevention and treatment of Delirium. Method We delivered a survey pertaining: Awareness of Delirium NICE Guidelines Confidence in spotting Delirium We used convenience sample of Memory Assessment Clinicians in Coventry. Overall, this survey was uptake by 17 clinicians. The pre training survey was done in early October 2019 and the post training survey was done shortly after the training, at the end of October 2019. A brief training comprising NICE Guidelines and using Confusion Assessment Method (CAM) was delivered. The survey is repeated post training and differences in result of level of confidence is done to measure changes. The survey assessed knowledge, beliefs, practices and confidence level regarding delirium detection. Result Pre training: 17 clinicians took part in the survey. 59% was aware that there is a delirium NICE guidelines. 12% felt strongly agree, 41% agree and 47% felt neutral in their confidence of detecting delirium. Post training: 10 clinicians took part in the survey. 50% felt strongly agree and 50% agree that they are confident in detecting delirium. Overall, the mean difference is 2 and the p value is 0.92034. we used Mann- Whitney Test to measure the difference in pre and post training which showed not significant at p < 0.05. Participants felt that the training was useful and relevant to practice. Conclusion This study showed our clinicians have a good basic knowledge in detecting delirium. As a result of this study, we have created ‘Delirium checklist’ and Confusion Assessment Method (CAM) to be used during duty work. We also feel that the majority of delirium cases referred to us comes from the community base, thus our next step of the project will be to involve educational work with the community care home.
Reducing Falls in Dementia Inpatients Using Vision-Based Technology
(Lippincott, Williams & Wilkins, 2022-04) Wright, Kay; Singh, Swaran P; Coventry and Warwickshire Partnership Trust; Research and Development; Psychiatry; Additional Professional Scientific and Technical Field; Wright, Kay; Singh, Swaran, P.
Objectives Falls have a significant negative impact on the health and well-being of people with dementia and increase service costs related to staff time, paramedic visits, and accident and emergency (A&E) admissions. We examined whether a remote digital vision-based monitoring and management system had an impact on the prevention of falls. Methods Our study was conducted within the Manor dementia inpatient wards at the Coventry and Warwickshire Partnership Trust. Data were retrieved from incident reports before and 22 months after installation of the system. We examined number of night time falls, severity of fall, number of paramedic visits and A&E admissions, and the number of enhanced observations during both time periods. Results There was a significant 48% reduction in the number of nighttime falls (P < 0.01), a 49% reduction in visits from paramedics (P < 0.2), and a 68% reduction in A&E admissions (P < 0.02). In addition, the data indicated an 82% reduction in the number of moderate severity falls and that enhanced one-to-one observation hours were reduced by 71%. Conclusions The study demonstrated that a contact-free, remote digital vision-based monitoring and management system reduced falls, fall-related injuries, emergency services time, clinician time, and disruptive night time observations. This benefits the clinicians by allowing them to undertake other clinical duties and promotes the health and safety of patients who might normally experience injury-related stress and disruption to sleep.

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