Effects of Self‐Management Groups for People with Dementia and Their Spouses—Randomized Controlled Trial

Laakkonen, Marja‐Liisa; Kautiainen, Hannu; Hölttä, Erkki; Savikko, Niina; Tilvis, Reijo S.; Strandberg, Timo; Pitkälä, Kaisu H.

doi:10.1111/jgs.14055

Cited by 86 publications

(92 citation statements)

References 46 publications

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“…We found 10 studies 37,59,62,106,109,110,115,121,132,136 looking at SM interventions for people living with dementia or cognitive impairment, only one of which included people with dementia and diabetes. 59 This controlled study evaluated the impact of personalised education sessions on people with diabetes and cognitive impairment.…”

Section: Stigma and Barriers To Care For People Living With Dementiamentioning

confidence: 99%

“…A larger RCT involving 136 people living with dementia-spouse dyads found that a group-based intervention to promote SM in people newly diagnosed with dementia led to improvements in health-related quality of life in spouses and in cognition in people living with dementia, although quality-of-life improvements in spouses were not maintained at longer-term (9-month) follow-up. 106 Further details of these studies can be seen in Appendix 7 and an overview of some key potential aspects of context, mechanism and outcomes can be seen in Figure 6.…”

Section: Stigma and Barriers To Care For People Living With Dementiamentioning

confidence: 99%

“…Potentially important components of such programmes include the need to focus on the abilities and strengths of people with dementia rather than their disabilities, 109,110 on emotions rather than problems, 109 on building confidence 62,121 and on respecting participant autonomy and enhancing empowerment. 106 Social interaction may also be important. 106,110,143 A small feasibility study 121 suggested that SM interventions may foster independence and reciprocity, and promote social and clinical support.…”

Section: Stigma and Barriers To Care For People Living With Dementiamentioning

confidence: 99%

“…106 Social interaction may also be important. 106,110,143 A small feasibility study 121 suggested that SM interventions may foster independence and reciprocity, and promote social and clinical support. A larger RCT involving 136 people living with dementia-spouse dyads found that a group-based intervention to promote SM in people newly diagnosed with dementia led to improvements in health-related quality of life in spouses and in cognition in people living with dementia, although quality-of-life improvements in spouses were not maintained at longer-term (9-month) follow-up.…”

Section: Stigma and Barriers To Care For People Living With Dementiamentioning

confidence: 99%

“…Of the 57 papers reporting primary research, the majority were from the UK (n = 29 106,113,114,122,124 ). As there was limited literature directly relevant to our target group, which we had anticipated, we included studies that offered opportunities for transferable learning, for example SM strategies for people living with dementia or diabetes care for older people.…”

Section: Description Of Studiesmentioning

confidence: 99%

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Managing diabetes in people with dementia: a realist review

Bunn

Goodman

Jones

et al. 2017

Health Technol Assess

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BackgroundDementia and diabetes mellitus are common long-term conditions that coexist in a large number of older people. People living with dementia and diabetes may be at increased risk of complications such as hypoglycaemic episodes because they are less able to manage their diabetes.ObjectivesTo identify the key features or mechanisms of programmes that aim to improve the management of diabetes in people with dementia and to identify areas needing further research.DesignRealist review, using an iterative, stakeholder-driven, four-stage approach. This involved scoping the literature and conducting stakeholder interviews to develop initial programme theories, systematic searches of the evidence to test and develop the theories, and the validation of programme theories with a purposive sample of stakeholders.ParticipantsTwenty-six stakeholders (user/patient representatives, dementia care providers, clinicians specialising in dementia or diabetes and researchers) took part in interviews and 24 participated in a consensus conference.Data sourcesThe following databases were searched from 1990 to March 2016: MEDLINE (PubMed), Cumulative Index to Nursing and Allied Health Literature, Scopus, The Cochrane Library (including the Cochrane Database of Systematic Reviews), Database of Abstracts of Reviews of Effects, the Health Technology Assessment (HTA) database, NHS Economic Evaluation Database, AgeInfo (Centre for Policy on Ageing – UK), Social Care Online, the National Institute for Health Research (NIHR) portfolio database, NHS Evidence, Google (Google Inc., Mountain View, CA, USA) and Google Scholar (Google Inc., Mountain View, CA, USA).ResultsWe included 89 papers. Ten papers focused directly on people living with dementia and diabetes, and the rest related to people with dementia or diabetes or other long-term conditions. We identified six context–mechanism–outcome (CMO) configurations that provide an explanatory account of how interventions might work to improve the management of diabetes in people living with dementia. This includes embedding positive attitudes towards people living with dementia, person-centred approaches to care planning, developing skills to provide tailored and flexible care, regular contact, family engagement and usability of assistive devices. A general metamechanism that emerges concerns the synergy between an intervention strategy, the dementia trajectory and social and environmental factors, especially family involvement. A flexible service model for people with dementia and diabetes would enable this synergy in a way that would lead to the improved management of diabetes in people living with dementia.LimitationsThere is little evidence relating to the management of diabetes in people living with dementia, although including a wider literature provided opportunities for transferable learning. The outcomes in our CMOs are largely experiential rather than clinical. This reflects the evidence available. Outcomes such as increased engagement in self-management are potential surrogates for better clinical management of diabetes, but this is not proven.ConclusionsThis review suggests that there is a need to prioritise quality of life, independence and patient and carer priorities over a more biomedical, target-driven approach. Much current research, particularly that specific to people living with dementia and diabetes, identifies deficiencies in, and problems with, current systems. Although we have highlighted the need for personalised care, continuity and family-centred approaches, there is much evidence to suggest that this is not currently happening. Future research on the management of diabetes in older people with complex health needs, including those with dementia, needs to look at how organisational structures and workforce development can be better aligned to the needs of people living with dementia and diabetes.Study registrationThis study is registered as PROSPERO CRD42015020625.FundingThe NIHR HTA programme.

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Section: Stigma and Barriers To Care For People Living With Dementiamentioning

confidence: 99%

Section: Stigma and Barriers To Care For People Living With Dementiamentioning

confidence: 99%

Section: Stigma and Barriers To Care For People Living With Dementiamentioning

confidence: 99%

Section: Stigma and Barriers To Care For People Living With Dementiamentioning

confidence: 99%

Section: Description Of Studiesmentioning

confidence: 99%

See 3 more Smart Citations

Managing diabetes in people with dementia: a realist review

Bunn

Goodman

Jones

et al. 2017

Health Technol Assess

View full text Add to dashboard Cite

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Screening for Cognitive Impairment in Older Adults

Patnode

Perdue

Rossom

et al. 2020

JAMA

185

120

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Diagnosis and Management of Dementia: Review

Arvanitakis

Shah

Bennett

2019

JAMA

750

604

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ementia is a common public health problem. 1 Worldwide, approximately 47 million people have dementia, and this number is expected to increase to 131 million by 2050. 1 Reductions in age-adjusted incidence of dementia have occurred in the United States and other developed countries over the last 20 years, perhaps associated with increasing formal educational attainment. However, without improved treatments or preventive therapy, the adverse consequences of dementia will continue to increase. 2 In the United States, the prevalence of dementia is 15% in people older than 68 years. 3 Alzheimer disease (AD) affects 5.8 million people, and 13.8 million are projected to have the diagno-sis of AD by the year 2050. 4 AD is the sixth leading cause of death and the fifth leading cause among people older than 65 years. 5,6 This review summarizes diagnosis and management of dementia, defined as significant cognitive impairment in 2 or more cognitive domains. MethodsWe conducted a literature search in PubMed, using the search terms "dementia and (diagnosis or management)" in the title field. The following inclusion criteria were applied: publication date from IMPORTANCE Worldwide, 47 million people live with dementia and, by 2050, the number is expected to increase to 131 million.OBSERVATIONS Dementia is an acquired loss of cognition in multiple cognitive domains sufficiently severe to affect social or occupational function. In the United States, Alzheimer disease, one cause of dementia, affects 5.8 million people. Dementia is commonly associated with more than 1 neuropathology, usually Alzheimer disease with cerebrovascular pathology. Diagnosing dementia requires a history evaluating for cognitive decline and impairment in daily activities, with corroboration from a close friend or family member, in addition to a thorough mental status examination by a clinician to delineate impairments in memory, language, attention, visuospatial cognition such as spatial orientation, executive function, and mood. Brief cognitive impairment screening questionnaires can assist in initiating and organizing the cognitive assessment. However, if the assessment is inconclusive (eg, symptoms present, but normal examination findings), neuropsychological testing can help determine whether dementia is present. Physical examination may help identify the etiology of dementia. For example, focal neurologic abnormalities suggest stroke. Brain neuroimaging may demonstrate structural changes including, but not limited to, focal atrophy, infarcts, and tumor, that may not be identified on physical examination. Additional evaluation with cerebrospinal fluid assays or genetic testing may be considered in atypical dementia cases, such as age of onset younger than 65 years, rapid symptom onset, and/or impairment in multiple cognitive domains but not episodic memory. For treatment, patients may benefit from nonpharmacologic approaches, including cognitively engaging activities such as reading, physical exercise such as walking, and socialization such as fa...

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Effects of Self‐Management Groups for People with Dementia and Their Spouses—Randomized Controlled Trial

Abstract: anzctr.org.au Identifier: ACTRN12611001173987.

Cited by 86 publications

References 46 publications

Managing diabetes in people with dementia: a realist review

Managing diabetes in people with dementia: a realist review

Screening for Cognitive Impairment in Older Adults

Diagnosis and Management of Dementia: Review

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