Letters to the Editor epidermis of Japanese individuals with familial acanthosis nigricans and hyperpigmentation caused by the K650Q mutation in FGFR3 is reported to be 22-25/mm, being approximately one-third of the value observed herein. 4 The biggest concern in the present case was the diffuse facial hyperpigmentation, although her entire body was equally hyperpigmented. The hyperpigmentation was very strong and apparently beyond the normal range of skin coloration of Japanese individuals. As serine/threonine-protein kinase B-Raf (BRAF) and MAPK/ERK kinase (MEK) are located downstream of FGFR3, novel treatment modalities may include the topical application of BRAF and/or MEK inhibitors. 5 Inhibitors designed against FGFR3 would evidently be effective in controlling this condition in the future.
Objectives
To examine the circumstances and needs of older adults who were “kinless,” defined as having no living spouse or children, when they developed dementia.
Methods
We conducted a secondary analysis of information from the Adult Changes in Thought (ACT) Study. Among 848 participants diagnosed with dementia between 1992 and 2016, we identified 64 who had no living spouse or child at dementia onset. We then conducted a qualitative analysis of administrative documents pertaining to these participants: handwritten comments recorded after each study visit, and medical history documents containing clinical chart notes from participants’ medical records.
Results
In this community dwelling cohort of older adults diagnosed with dementia, 8.4% were kinless at dementia onset. Participants in this sample had an average age of 87 years old, half lived alone, and one-third lived with unrelated persons. Through inductive content analysis we identified four themes that describe their circumstances and needs: 1) life trajectories, 2) caregiving resources, 3) care needs and gaps, and 4) turning points in caregiving arrangements.
Discussion
Our qualitative analysis reveals that the life trajectories that led members of the analytic cohort to be kinless at dementia onset were quite varied. This research highlights the importance of non-family caregivers, and participants’ own roles as caregivers. Our findings suggest that providers and health systems may need to work with other parties to directly provide dementia caregiving support rather than rely on family, and address factors such as neighborhood affordability that particularly affect older adults who have limited family support.
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