Literature Review

Risk of dementia diagnosis after injurious falls in older adultsJAMA Network Open; Alexander J. Ordoobadi, MD; Hiba Dhanani, MD, ScM; Samir R. Tulebaev, MD; Ali Salim, MD; Zara Cooper, MD, MSc; Molly P. Jarman, PhD, MPH; 9/24In this cohort study, new ADRD [Alzheimer disease and related dementias] diagnoses were more common after falls compared with other mechanisms of injury, with 10.6% of older adults being diagnosed with ADRD in the first year after a fall. To improve the early identification of ADRD, this study’s findings suggest support for the implementation of cognitive screening in older adults who experience an injurious fall that results in an ED visit or hospital admission.

Is end-of-life care consistent with wishes of patients with dementia? Oklahoma University News, Oklahoma City, OK; by April Wilkerson; 10/8/24 Soon after a dementia diagnosis, many people document their preferences for medical care near the end of their lives, often stipulating that they want to avoid hospitalizations and aggressive interventions. A new University of Oklahoma study aims to discover whether the actual care they receive aligns with their preferences. Lee Jennings, M.D., a geriatrician and associate professor in the OU College of Medicine, recently received a $2.3 million grant from the National Institutes of Health to analyze the end-of-life experiences of about 550 people with dementia, as well as their caregivers. The findings will advance medical knowledge of how best to care for people with an incurable disease that often robs them of their cognition, causes swallowing disorders, and leads to immobility and falls. An estimated 5 million Americans are affected by Alzheimer’s disease and related dementias, a number that is expected to increase to 10.5 million over the next 25 years. 

One Senior Place: What legal steps should be taken after dementia diagnosis? Florida Today; by Brenda Lyle; 10/1/24 After a dementia diagnosis, preparing key legal documents early helps families focus on the quality of life for their loved one. ... Dementia is a term for many progressive neurodegenerative disorders that affect memory, thinking, and behavior. Alzheimer accounts for about 60% of all dementias. As the disease advances, individuals may lose the ability to make informed decisions about their health care, finances and other important aspects of life. Legal planning is absolutely crucial for ensuring that the wishes of the person with dementia are honored and that their affairs are managed appropriately. This planning also helps reduce stress for family members and caregivers. [Click on the title's link to continue reading for basics about Durable power of attorney, Heath care surrogate, Living will, Last will and testament, and Guardianship.]

Alzheimer dementia among individuals with down syndromeJAMA Network Open; Eric Rubenstein, PhD; Salina Tewolde, ScM; Amy Michals, MPH; Jennifer Weuve, ScD; Juan Fortea, MD; Matthew P. Fox, ScD; Marcia Pescador Jimenez, PhD; Ashley Scott, MPH; Yorghos Tripodis, PhD; Brian G. Skotko, MD; 9/24In this cohort study of  ... adults with Down syndrome enrolled in Medicaid or Medicare between 2011 to 2019, 23.3% of adults had Alzheimer dementia diagnoses, and the mean age of death was 59.2 years. These findings suggest that Alzheimer dementia is almost universal among people with Down syndrome, and administrative claims data may offer valuable insights into improving care for this diverse population.

Improv for Caregivers receives a grant from the New Hampshire State Council on the Arts EINPressWire; by A. A. Cristi; 9/23/24 The New London Barn Playhouse received an arts in health grant from the New Hampshire State Council on the Arts to continue and expand their Improv for Caregivers program through a larger umbrella program titled “Improv for a Cause.” “Improv for a Cause” will encompass two communication programs that use a similar process to reach different communities. The first, Improv for Caregivers, in partnership with Lake Sunapee Region VNA & Hospice, is an ongoing communication workshop series for those who care for loved ones with dementia and Alzheimer's. ... Each improv workshop session combines insight from healthcare professionals with improvisational theatre techniques, with a goal of developing new communication skills, strategies to cope with stress, flexibility in relationships, and an understanding of loved ones' changing perspectives. With guidance from the VNA and caregivers in the community, the team of actors prepare short scenarios that portray situations caregivers commonly face, such as sundowning, taking away car keys, collaborating with care staff, and hallucinations. ...

The persistent stigma attached to dementia encourages denial InForum; by Carol Bradley Bursack; 9/14/24 Dear Carol: ... At age 70, I was diagnosed with mild cognitive impairment (MCI). Theoretically, that diagnosis means that I have a few more memory glitches than normal for my age. A percentage of people with MCI will develop Alzheimer’s disease, but not all. Yet, some family members treat me like I shouldn’t make decisions beyond what I want for dinner. ...Dear Al: The stigma attached to mental illness, cognitive decline, and even aging, illustrates widespread ignorance of facts. The more people like you speak up the better the future will be for others. ... For now, work on educating your family about MCI.  ... Here's a start: 

Adoption of artificial intelligence-enabled robots in long-term care homes by health care providers: Scoping reviewJournal of Medical Internet Research; Karen Lok Yi Wong, Lillian Hung, Joey Wong, Juyoung Park, Hadil Alfares, Yong Zhao, Abdolhossein Mousavinejad, Albin Soni, Hui Zhao; 8/24Long-term care (LTC) homes face the challenges of increasing care needs of residents and a shortage of health care providers. Literature suggests that artificial intelligence (AI)-enabled robots may solve such challenges and support person-centered care. We identified three barriers to AI-enabled robot adoption: (1) perceived technical complexity and limitation; (2) negative impact, doubted usefulness, and ethical concerns; and (3) resource limitations. Yet, our findings show that health care providers might not use robots because of different considerations. The implication is that the voices of health care providers need to be included in using robots.

Long-term dementia risk in Parkinson DiseaseNeurology; Julia Gallagher, Caroline Gochanour, Chelsea Caspell-Garcia, Roseanne D Dobkin, Dag Aarsland, Roy N Alcalay, Matthew J Barrett, Lana Chahine, Alice S Chen-Plotkin, Christopher S Coffey, Nabila Dahodwala, Jamie L Eberling, Alberto J Espay, James B Leverenz, Irene Litvan, Eugenia Mamikonyan, James Morley, Irene H Richard, Liana Rosenthal, Andrew D Siderowf, Tatyana Simuni, Michele K York, Allison W Willis, Sharon X Xie, Daniel Weintraub, Parkinson's Progression Markers Initiative; 9/24It is widely cited that dementia occurs in up to 80% of patients with Parkinson disease (PD), but studies reporting such high rates were published over two decades ago, had relatively small samples, and had other limitations. We aimed to determine long-term dementia risk in PD using data from two large, ongoing, prospective, observational studies. Participants from the Parkinson's Progression Markers Initiative (PPMI), a multisite international study, and a long-standing PD research cohort at the University of Pennsylvania (Penn), a single site study at a tertiary movement disorders center, were recruited. Results from two large, prospective studies suggest that dementia in PD occurs less frequently, or later in the disease course, than previous research studies have reported.

World Alzheimer's Month: September 2024 Alzheimer's Disease International, London, UK and Lincolnshire, IL, USA; retrieved from the internet 8/26/24Each September, people unite from all corners of the world to raise awareness and to challenge the stigma that persists around Alzheimer's disease and all types of dementia.  ... The 2024 World Alzheimer's Month will centre around the taglines 'Time to act on dementia, Time to act on Alzheimer's.' ...  Editor's Note: Click here for Alzheimer's Disease Internationals' 2024 campaign theme materials. Click here for the Alzheimer's Association in your USA location.

Palliative care is a viable option for frail elderly patients with neurocognitive disorders admitted for hip fractures BMC Musculoskeletal Disorders; by Justine Boulet, Etienne L Belzile, Norbert Dion, Chantal Morency, Mélanie Bérubé, Alexandra Tremblay, Stéphane Pelet; 8/10/24 Most patients presenting with a hip fracture regardless of their comorbidities are surgically treated. A growing body of research states that a certain type of elderly patient could benefit more from a palliative approach. ... The presence of [a nuerocognitive disorder] NCD and diminished prefracture autonomy strongly support counseling for palliative care. The high rate of complications when surgery is proposed for frail patients with multiple comorbidities suggests that the concept of palliative surgery needs to be revisited. 

Cognitive impairment in the workplace Alzheimer's Association; email 8/14/24, webpage posted 8/8/24 Due to the aging of the U.S. population, rates of cognitive impairment and dementia in the workplace are on the rise. This creates challenges for employers, many of whom may not know how to best support employees who are experiencing symptoms of cognitive impairment. Conversely, employees may be hesitant to share with their employer the challenges that they’re experiencing. ... Recommendations Regarding Dementia in the Workplace ... [Click on the title's link for this excellent HR information.]

Commentary: Prognostication in Alzheimer's disease and related dementias Journal of the American Geriatrics Society / Early View; by Natalie C. Ernecoff PhD, MPH, Kathryn L. Wessell MPH, Laura C. Hanson MD, MPH; 8/8/24  ... Hospice provides comfort-oriented care, emphasizing patient-tailored elements of quality of life, including time with family, access to nature, and music. In late-stage ADRD, studies show that a majority of families prioritize comfort-oriented treatment, and understanding prognosis may help them align treatments accordingly. Yet, only 15% of people enrolled in hospice with a primary diagnosis of ADRD. This is due to difficulty estimating 6-month prognosis required for hospice eligibility—ADRD carries a prognosis of 12–18 months in the latest stage. While low rates of live discharges from hospice are a regulatory requirement for hospices, people who are increasingly experiencing ADRD progression lose access to those beneficial hospice services. ...

CMS unveils services available to patients in the GUIDE Model, integrates palliative care principles Hospice News; by Jim Parker; 8/12/24 The U.S. Centers for Medicare & Medicaid Services (CMS) has outlined the range of services that will be available to patients aligned with the agency’s Guiding an Improved Dementia Experience (GUIDE) payment model. The payment model is designed to improve quality of life for dementia patients and their caregivers by addressing care coordination, behavioral health and functional needs. While the model does not use the term “palliative care,” it does incorporate principles and practices traditionally associated with those services, such as interdisciplinary care and caregiver support, among others. ... Nearly 400 health care organizations are developing Dementia Care Programs (DCPs) to potentially serve hundreds of thousands of Medicare beneficiaries nationwide, the CMS stated in a fact sheet.