Study Objectives Sleep disturbances are a feature in people living with dementia, including getting up during the night, difficulty falling asleep, and excessive daytime sleepiness and may precipitate a person with dementia moving into residential care. There are varying estimates of the frequency of sleep disturbances, and it is unknown whether they are a problem for the individual. We conducted the first systematic review and meta-analysis on the prevalence and associated factors of sleep disturbances in the care home population with dementia. Methods We searched Embase, MEDLINE, and PsycINFO (29/04/2019) for studies of the prevalence or associated factors of sleep disturbances in people with dementia living in care homes. We computed meta-analytical estimates of the prevalence of sleep disturbances and used meta-regression to investigate the effects of measurement methods, demographics, and study characteristics. Results We included 55 studies of 22,780 participants. The pooled prevalence on validated questionnaires of clinically significant sleep disturbances was 20% (95% confidence interval, CI 16% to 24%) and of any symptom of sleep disturbance was 38% (95% CI 33% to 44%). On actigraphy using a cutoff sleep efficiency of <85% prevalence was 70% (95% CI 55% to 85%). Staff distress, resident agitation, and prescription of psychotropic medications were associated with sleep disturbances. Studies with a higher percentage of males had a higher prevalence of sleep disturbance. Conclusions Clinically significant sleep disturbances are less common than those measured on actigraphy and are associated with residents and staff distress and the increased prescription of psychotropics. Actigraphy appears to offer no benefit over proxy reports in this population.
Balance disorders and falls are common in the elderly population. Regular balance exercises are an evidence-based physical intervention to prevent falls in older adults, while patient motivation and adherence are important factors for intervention outcome. Exergames are a relatively new, alternative intervention for physical rehabilitation as they improve balance and strength in older adults. The aims of this systematic review and meta-analysis were to assess the (1) effect of motivation factors as per the Capability, Opportunity and Motivation model of Behavior change (COM-B) on the effectiveness of exergame interventions in healthy older adults, (2) effectiveness of exergames to improve balance in older healthy adults and, (3) impact of exergames on cognitive outcomes. Results show that motivation and capability components influence the general outcome of the exergame training. Motivational factors should thus be considered when setting-up an exergame intervention. Furthermore, exergame intervention appears to be a promising training method in comparison to traditional exercise training. However, exergame training in itself might not be sufficient to improve fall risk and cognitive performance.
Background: Age-related hearing loss is an independent and potent risk factor for dementia. There is observational evidence that hearing aid use may mitigate deterioration in cognitive performance and could prevent dementia, but experimental evidence is lacking. A trial on whether treating hearing loss reduces the risk of dementia may not be feasible because people often do not access or use hearing aids even when prescribed. We designed the Treating Auditory impairment and Cognition Trial (TACT) as a manual-based preventative intervention, promoting and supporting hearing aid use in those with Mild Cognitive Impairment. We studied the feasibility of a full-scale randomized controlled trial. Method:We conducted a pilot trial of a new intervention designed to increase uptake and adherence to hearing aid treatment. Pre COVID-19, we randomized MCI participants to face-to-face interventions: the active arm is a home-based hearing assessment and hearing aid fitting, with study audiologist and research assistant delivering motivational and practical support in 4 visits over 3 months. Participants in the control arm were referred to standard audiological care through their general practitioner without additional hearing support, and given a healthy ageing educational intervention on dementia risk factors, matched in contact with the study team. Follow-up for both interventions was at 6 months. After the onset of COVID-19, additional MCI participants, who had not received hearing aids, were allocated to active remote hearing support. This did not involve any face-to-face contact with the study team but provided hearing support remotely, with outcomes collected after 1 month.Result: Pre COVID-19, N=36 MCI participants were randomized to the original faceto-face study interventions, with follow-up measures collected at 6 months, also in a face-to-face session. After the onset of COVID-19, a further N=11 received the remote hearing intervention. We will present results from these samples. The pre-specified outcomes of the pilot include recruitment, randomization, retention, and acceptability of the interventions, with secondary outcomes including difference in usage of hearing aids between active and control arms, and cognition, mood, and social function. Conclusion:The results of this study may influence hearing care in all settings as well as dementia prevention.
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