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Dementia care and treatment issues
  1. Roberta Heale
  1. School of Nursing, Laurentian University, Sudbury, Ontario, Canada
  1. Correspondence to Dr Roberta Heale, School of Nursing, Laurentian University, Sudbury, ON P3E 2C6, Canada; rheale{at}laurentian.ca

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This perspectives article expands on the one published in EBN July 2019, Vol 22-3 about Care of the Older Person by focusing on commentaries specifically related to research with dementia. Dementia rates are growing internationally and along with this are the complexities of caring for this growing cohort of people.1 It is helpful to explore the literature related specifically to this issue. Commentaries related to dementia and cognitive decline were found from January 2017 to January 2020. Key themes were identified followed by a summary and discussion.

Key themes

The 13 commentaries are grouped into three themes (see box 1).

  • Pain management and dementia.

  • Carers of those with dementia.

  • Treatment issues for those with dementia.

Box 1

Evidence-based nursing commentaries on dementia and cognitive decline (2017–2020)

Theme 1: Pain management and dementia

Evidence that active pain treatment improves sleep quality and quantity in people with depression and dementia https://ebn.bmj.com/content/22/2/49

Pain-related palliative care challenges in people with advanced dementia call for education and practice development in all care settings https://ebn.bmj.com/content/20/4/118

Assessment and treatment of persistent pain in nursing home residents should be implemented systematically to prevent suffering https://ebn.bmj.com/content/20/3/91

Theme 2: Carers of those with dementia

Help seeking increases stress among caregivers of partners with young-onset dementia https://ebn.bmj.com/content/23/1/28

Better support and education is imperative to bolster informal at-home carers of people with cognitive impairment and reduce incidences of involuntary treatment of older adults in their homes https://ebn.bmj.com/content/22/2/51

Spouses with partners with dementia living in institutional care develop visiting routines that help to maintain the spousal relationship https://ebn.bmj.com/content/20/2/58

Theme 3: Treatment issues for those with dementia

International study reveals aged patients with dementia frequently receive ‘inappropriate prescriptions’ https://ebn.bmj.com/content/22/2/50

Deprescribing in nursing homes is safe and should be pursued https://ebn.bmj.com/content/21/2/53

Effective dietary recommendations could help to prevent age-related cognitive decline https://ebn.bmj.com/content/21/1/26

Cognitively impaired patients with heart failure may not perceive weight gain as a risk for decompensation https://ebn.bmj.com/content/20/4/115

Risk of injury higher in older adults with dementia than in those without https://ebn.bmj.com/content/20/4/117

More research needed on animal-assisted interventions in dementia (Olsen) https://ebn.bmj.com/content/20/2/60

Nursing home residents prefer fewer interventions and the nursing home instead of hospital for place of death https://ebn.bmj.com/content/20/1/24

Theme 1: Pain management and dementia

Literature demonstrates that there is very poor pain management for those with dementia. There is a lack of understanding about the signs of pain for people with dementia and there are some alarming findings, such as one where the majority of healthcare staff in a study thought that people with dementia had reduced pain sensation.2 Three commentaries from the past 3 years reflected various aspects of pain management for people with dementia. The first was based on a study by Blytt et al,3 a double-blinded, placebo-controlled trial of 106 long-term patients with depression and dementia. The research group studied the effects of pain treatment versus non-treatment and found that treatment for pain was significantly associated with better sleep.3

The second commentary reviewed qualitative research by De Witt Jansen et al 4 where 24 nurses practising in long-term care were interviewed about their experiences in caring for patients dying of advanced dementia. Three themes were identified including patient-related challenges, such as the patient’s refusal to take medication; the nurse–physician relationship, where if a difficult relationship with physicians was identified, nurses gave examples such as waiting for prescriptions and physician refusal to assess complex cases; and interactive learning and practice development, where some nurses were not able to access appropriate professional development activities. The overall message was that achieving pain management for people dying of advanced dementia is extremely challenging.4

The final commentary in this theme was a cross-sectional study by Fain et al 5 of 18 536 nursing home residents with persistent pain living in the USA. The findings showed that pain in nursing homes is undertreated, especially for those with dementia and cognitive decline.5

Theme 2: Carers of those with dementia

The second theme explores the experiences and challenges of carers for those with dementia and cognitive decline. The first commentary about research by Kobiske et al 6 describes the outcomes of a cross-sectional, correlational study that investigated the experiences of caregivers for people with young-onset dementia. The survey design reflected the theoretical framework of Resilience Theory and examined the effects of personal and social relationships, pre-death grief and stress of this caregiving role. There was a large positive correlation between pre-death, grief and caregiver perceived stress, which was positively impacted by social resourcefulness.6

The outcomes of caregiver stress are examined in research by Moermans et al. 7 In this cross-sectional study, older adults who were receiving care in their home were randomly selected for the study. The district nurses caring for this group were asked to complete an online questionnaire that identified the use of involuntary treatment. The findings demonstrated that non-consensual care, psychotropic drugs and physical restraints were often used, in part, to address informal caregiver burden.7

The final commentary in this theme reflects research by Førsund et al 8, a qualitative, grounded theory design consisting of 15 interviews with the spouses of nursing home residents with dementia. The findings demonstrate that it is important for the spouses to remain involved with the resident and they did so by establishing visiting routines.8

Theme 3: Treatment issues for those with dementia

The final theme includes a variety of commentaries, all with a focus on a treatment issue related to the care of people with dementia. The first two commentaries are of studies related to prescription medication for those with dementia. In the first, Renom-Guiteras et al 9 conducted a survey of people with dementia from across the EU to explore a variety of issues. The findings showed that 60% of the participants had at least one inappropriately prescribed medication.9 The next study, by Wouters et al,10 included a randomised controlled trial of the discontinuation of one mediation for nursing home residents in the Netherlands. Results showed that the 3MR process of multidisciplinary, multistep medication review was significantly better than usual care for successful discontinuation of one medication.10

Next, McEvoy et al conducted a population-based cross-sectional study that showed an association between neuroprotective diets, such as the Mediterranean Diet, and better cognitive health.11 In the next research, also related to diet, Dolansky et al 12 conducted an observational study which demonstrated that adults with cognitive decline may be at risk for gaining significant amounts of weight, thus negatively impacting their heart failure status.12

The final cluster of commentaries gives an overview of three different topics. Meuleners et al 13 analysed 29 671 hospital admissions and identified that older adults with dementia are at greater risk for admission to hospital with an injury.13 Next, Olsen et al found in their randomised trial that when a dog was added to activities of those with severe dementia in nursing homes, there was a significant decrease in the levels of depression and a positive impact on quality of life of the residents.14 Finally, Ng et al 15 conducted a cross-sectional study of nursing home residents in Singapore to determine their wishes at end of life. Their findings determined that the majority would prefer to die at home.15

Conclusions

There is a wealth of research related to dementia. Commentaries about dementia research give nurses efficient summaries, which may be of benefit to them in expanding knowledge and improving practice that includes those with dementia.

References

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Footnotes

  • Twitter @robertaheale

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.

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