A systematic review of the relationship between behavioral and psychological symptoms (BPSD) and caregiver well-being

Background: Behavioural and psychological symptoms in dementia (BPSD) are important predictors of institutionalisation as well as caregiver burden and depression. Previous reviews have tended to group BPSD as one category with little focus on the role of the individual symptoms. This review investigates the role of the individual symptoms of BPSD in relation to the impact on different measures of family caregiver wellbeing. Methods: Systematic review and meta-analysis of articles published in English between 1980 and December 2015 reporting which BPSD affect caregiver wellbeing. Article quality was appraised using the Downs and Black Checklist (1998). Results: 40 medium and high quality quantitative articles met the inclusion criteria, 16 were suitable to be included in a meta-analysis of mean distress scores. Depressive behaviours were the most distressing for caregivers followed by agitation/aggression and apathy. Euphoria was the least distressing. Correlation coefficients between mean total behaviour scores and mean distress scores were pooled for 4 studies. Irritability, aberrant motor behaviour and delusions were the most strongly correlated to distress, disinhibition was the least correlated. Conclusion: The evidence is not conclusive as to whether some BPSD impact caregiver wellbeing more than others. Studies which validly examined BPSD individually were limited, and the included studies used numerous measures of BPSD and numerous measures of caregiver wellbeing. Future research may benefit from a consistent measure of BPSD, examining BPSD individually, and by examining the causal mechanisms by which BPSD impact wellbeing by including caregiver variables so that interventions can be designed to target BPSD more effectively

Behavioural and psychological symptoms in dementia and the challenges for family carers: systematic review

Background: Tailored psychosocial interventions can help families to manage behavioural and psychological symptoms in dementia (BPSD), but carer responses to their relative's behaviours contribute to the success of support programmes. Aims: To understand why some family carers have difficulty in dealing with BPSD, in order to improve the quality of personalised care that is offered. Method: A systematic review and meta-ethnographic synthesis was conducted of high-quality quantitative and qualitative studies between 1980 and 2012. Results: We identified 25 high-quality studies and two main reasons for behaviours being reported as challenging by family carers: changes in communication and relationships, resulting in ‘feeling bereft’; and perceptions of transgressions against social norms associated with ‘misunderstandings about behaviour’ in the relative with dementia. The underlying belief that their relative had lost, or would inevitably lose, their identity to dementia was a fundamental reason why family carers experienced behaviour as challenging. Conclusions: Family carers' perceptions of BPSD as challenging are associated with a sense of a declining relationship, transgressions against social norms and underlying beliefs that people with dementia inevitably lose their ‘personhood’. Interventions for the management of challenging behaviour in family settings should acknowledge unmet psychological need in family carers

Self-oriented perfectionism and socially prescribed perfectionism: Differential relationships with intrinsic and extrinsic motivation and test anxiety

Previous studies suggest that self-oriented and socially prescribed perfectionism show differential relationships with intrinsic–extrinsic motivation and test anxiety, but the findings are ambiguous. Moreover, they ignored that test anxiety is multidimensional. Consequently, the present study re-investigated the relationships in 104 university students examining how the two forms of perfectionism are related to intrinsic–extrinsic motivation and multidimensional test anxiety (worry, emotionality, interference, lack of confidence, and total anxiety). Regarding motivation, self-oriented perfectionism showed positive correlations with intrinsic reasons for studying, and socially prescribed perfectionism positive correlations with extrinsic reasons. Regarding test anxiety, only socially prescribed perfectionism showed positive correlations with total anxiety. Moreover, socially prescribed perfectionism showed positive correlations with interference and lack of confidence, whereas self-oriented perfectionism showed positive correlations with worry, but negative correlations with interference and lack of confidence. The findings confirm that socially prescribed perfectionism is a maladaptive form of perfectionism associated with extrinsic motivation for studying and higher anxiety in exams. Self-oriented perfectionism, however, is an ambivalent form associated with intrinsic motivation for studying and with both higher and lower anxiety (higher worry, lower interference, lower lack of confidence) in exams

Using meta-ethnography to synthesize relevant studies: capturing the bigger picture in dementia with challenging behavior within families

In understanding the range and depth of people’s experiences, it is important to include the wide range of approaches which capture the richness within a given knowledge base. However, systematic reviews using quantitative data alone risk missing findings that can contribute to a better understanding of a research question. In response, meta-ethnography has emerged as a potentially useful method to synthesize and integrate both qualitative and quantitative data from different perspectives using qualitative methodology. In this case study, we describe how we have used meta-ethnography to better understand how families experience dementia. We address a particular issue of selecting the highest quality evidence across a range of epistemologies

Spectroscopy and Time Variability of Absorption Lines in the Direction of the Vela Supernova Remnant

We present high resolution (R~75,000), high signal-to-noise (S/N~100) Ca II $\lambda$3933.663 and Na I $\lambda\lambda$5889.951, 5895.924 spectra of 68 stars in the direction of the Vela supernova remnant. The spectra comprise the most complete high resolution, high S/N, optical survey of early type stars in this region of the sky. A subset of the sight lines has been observed at multiple epochs, 1993/1994 and 1996. Of the thirteen stars observed twice, seven have spectra revealing changes in the equivalent width and/or velocity structure of lines, most of which arise from remnant gas. Such time variability has been reported previously for the sight lines towards HD 72089 and HD 72997 by Danks & Sembach (1995) and for HD 72127 by Hobbs et al. (1991). We have confirmed the ongoing time variability of these spectra and present new evidence of variability in the spectra of HD 73658, HD 74455, HD 75309 and HD 75821. We have tabulated Na I and Ca II absorption line information for the sight lines in our sample to serve as a benchmark for further investigations of the dynamics and evolution of the Vela SNR.Comment: 8 pages of text, 4 tables, 16 pages of figures Accepted and to be published in ApJ

Pain and delirium in people with dementia in the acute general hospital setting

YesBackground: Pain and delirium are common in people with dementia admitted to hospitals. These are often under-diagnosed and under-treated. Pain is implicated as a cause of delirium but this association has not been investigated in this setting. Objective: To investigate the relationship between pain and delirium in people with dementia, on admission and throughout a hospital admission. Design: Exploratory secondary analysis of observational prospective longitudinal cohort data. Setting: Two acute hospitals in the UK. Methodology: Two-hundred and thirty participants aged ≥70 years were assessed for dementia severity, delirium ((Confusion Assessment Method (CAM), pain (Pain Assessment in Advanced Dementia (PAINAD)) scale and prescription of analgesics. Logistic and linear regressions explored the relationship between pain and delirium using cross-sectional data. Results: Pain at rest developed in 49%, and pain during activity for 26% of participants during their inpatient stay. Incident delirium developed in 15%, of participants, and 42% remained delirious for at least two assessments. Of the 35% of participants who were delirious and unable to self-report pain, 33% of these participants experienced pain at rest, and 56 experienced pain during activity. The odds of being delirious were 3.26 times higher in participants experiencing pain at rest (95% Confidence Interval 1.03–10.25, P = 0.044). Conclusion: An association between pain at rest and delirium was found, suggesting pain may be a risk factor for delirium. Since pain and delirium were found to persist and develop during an inpatient stay, regular pain and delirium assessments are required to manage pain and delirium effectively.The Impact of Acute Hospitalisation on People with Dementia: The Behaviour and Pain (BepAID Study (jointly funded by the Alzheimer’s Society and BUPA foundation (Grant reference number: 131). Dr Sampson’s, Dr White’s, Dr Kupeli’s and Miss Vickerstaff ’s posts are supported by Marie Curie core funding, grant (MCCC-FCO-16-U)

Passion and motivation for studying: Predicting academic engagement and burnout in university students

Research on the dualistic model of passion (Vallerand et al., 2003) has investigated harmonious and obsessive passion in many domains. However, few studies have investigated passion for studying and the role passion for studying plays in student engagement and well-being. The present study investigated the relationships between harmonious and obsessive passion for studying and academic engagement (vigor, dedication, and absorption) and burnout (exhaustion, cynicism, and inefficacy) in 105 university students, controlling for the effects of autonomous and controlled motivation. Both harmonious and obsessive passion explained variance in academic engagement and burnout beyond autonomous and controlled motivation: harmonious passion predicted higher dedication and lower cynicism, obsessive passion predicted higher absorption, and both harmonious and obsessive passion predicted higher vigor and lower inefficacy. The findings suggest that passion for studying explains individual differences in students’ academic engagement and burnout beyond autonomous and controlled motivation and thus deserves more attention from educational psychology

Development of an implementation science informed “Test Evidence Transition” program to improve cancer outcomes

Introduction: Translation of cancer research into practice takes around 15 years. Programs informed by implementation science methods and frameworks offer potential to improve cancer outcomes by addressing the implementation gap. Methods: We describe the development of a Test Evidence Transition (TET) program which provides funding and support to health system delivery teams and project design and evaluation partners working together to achieve three objectives: Test innovations to support optimal cancer pathways that transform clinical practice; Evidence the process, outcome, and impact of implementation; and work with strategic partners to ensure the Transition of best practice into effective and equitable adoption across UK health systems. Results: Phase 1 launched in April 2023. Teams with the capability and motivation to implement evidence-based pathway innovations were identified and invited to submit expressions of interest. Following peer-review, teams were supported to develop full proposals with input from academics specializing in health services research, evaluation, and implementation science. Projects were selected for funding, providing an opportunity to implement and evaluate innovations with support from academic and health system partners. Conclusions: TET aims to improve cancer outcomes by identifying and addressing local-level barriers to evidence-based practice and translating findings into consistent and equitable adoption across health systems. Phase 1 projects focus on pathway innovations in diagnosis for breast and prostate cancer. We are now launching Phase 2, focusing on colorectal cancer