The Use of Wearable Technology to Measure Energy Expenditure, Physical Activity and Sleep Patterns in Dementia.

Project Description Unexplained weight loss is frequently observed in dementia leading to further cognitive decline, frailty and disability. Apparent mechanisms that could lead to weight loss (lower energy intake and/or higher expenditure) remain unresolved and may be different in the various stages and types of dementia. During the progression of the illness, the extent to which altered sleep duration and variable physical activity patterns (intermittent or constant pacing/lying down) could affect weight loss is unknown. We have used an innovative light weight physical activity monitor (Sensewear TM Armband, Body Media, Pittsburgh, PA) to objectively determine total energy expenditure (TEE), sleep duration, physical activity and number of steps in people with dementia living in care homes. The armband was placed around the left upper triceps for up to 7 days. The device measures tri-axial acceleration, skin temperature, galvanic skin response and heat flux and has been shown to be valid in resting, exercise and free-living conditions in older people. The mean age of the residents (n=20) was 78.5 (58-99) years, 50% were women with confirmed diagnosis of a range of dementia types. Body Mass Index (BMI) was 23.0 (range 13.7-30.0) kg/m2 with 40% classified as underweight, 50% normal range, 10% overweight. Duration of sleeping ranged from 0.4-12.5 (mean 5.9) hrs/d and time spent lying down was 1.0-16.0 (8.1) hrs/d. On average residents spent 17.4 (6.0-23.7) hrs/d undertaking sedentary activity. Sleeping duration was inversely related to body weight (r= -0.46, p<0.05) and TEE (r= -0.59, P<0.01). There was an inverse association between time lying down for both body weight (r= -0.45, p<0.05) and TEE (r= -0.62, p<0.01).TEE was positively correlated with number of steps per day (r= 0.45, p<0.05). There was no relationship between TEE or BMI and the amount of physical activity. Variable patterns of physical activity and sleep duration demonstrates the need to recognise the influence of these factors on meeting energy requirements and the challenge of providing appropriate food and nutrition within the care home environment. Thus wearable technology has the potential to offer real-time feedback to support better nutritional management and improve efforts to prevent weight loss in dementia

Understanding the strategies required to meet hydration needs of people living with dementia.

BackgroundDementia can increase the risk of dehydration as cognitive impairment and old age reduce the ability to recognise thirst. Dehydration can cause further deterioration in cognitive function and other health problems. There is no consensus on recommended fluid intakes for dementia but generally 1500 ml per day is regarded as sufficient. However the challenges of meeting appropriate hydration continue to be reported. The aim of this study, using quantitative and qualitative methods was to gain a deeper understanding of the strategies required to understand hydration needs of people living with dementia.MethodsQuantitative measures of fluid intake were recorded over a period of five days in residents (n=18) who were living in care homes. The mean age of the residents was 79 (104-58) years, 50% were women with a diagnosis of a range of dementia types. Qualitative research using a blend of nine focus groups and five semi structured interviews were conducted with all those involved in the care of people with dementia, including nurses, managers, chefs, care workers, family members, dietitians and speech and language therapists. Thematic analysis of transcripts enabled core themes to be explored.ResultsThe daily intake of fluid was 1065 ± 836 ml (mean ± 2 standard deviations). Fifteen (83%) residents did not meet the recommended fluid intake. The qualitative themes highlighted ways to overcome poor fluid intake and included alternative ways to improve hydration; a person centred approach to delivering fluid with a recognition of psychosocial and cultural influences; communication between front-line staff and key healthcare professionals.ConclusionsUsing this combined methodological approach, the results show that new strategies are needed to meet the hydration needs, with a person centred approach to care for people living with dementia. It is important to ensure all staff are well trained and competent to encourage sufficient fluid intake

Are the Adaptogenic Effects of Omega 3 Fatty Acids Mediated via Inhibition of Proinflammatory Cytokines?

The study was undertaken to estimate the size of the impact of n-3 fatty acids in psychological stress and the extent to which it is mediated via proinflammatory cytokines. Structural equation modeling (SEM) was used to analyze data from 194 healthy Australians. Biomarkers used were erythrocyte polyunsaturated fatty acids (docosahexaenoic acid (DHA) and arachidonic acid (AA)), ex-vivo stimulated secretion of proinflammatory cytokines (interleukins (IL-1 and IL-6), and tumor necrosis factor (TNF)). Stress was measured with the perceived stress scale (PSS-10), found to comprise three factors: Coping (items 4, 7, 5), Overwhelm (2, 10, 6 and 8), and Emotional (1, 9 and 3). This modeling demonstrated that the effects of DHA on coping are largely direct effects (0.26, t = 2.05) and were not significantly mediated via the suppression of proinflammatory cytokines. Future modeling should explore whether adding EPA to the model would increase the significance of the mediation pathways

Assessing victim risk in cases of violent crime

Purpose: There is a body of evidence that suggests a range of psychosocial characteristics demarcate certain adults to be at an elevated risk for victimisation. To this end, the aim of the current study was to examine consistency between one police force, and a corresponding victim support service based in England, in their assessment of level of risk faced by victims of violent crime. Methodology: This study explored matched data on 869 adult victims of violent crime gathered from these two key services in Preston, namely Lancashire Constabulary and Victim Support, from which a sub-group of comparable ‘domestic violence’ cases (n=211) were selected for further examination. Findings: Data analyses revealed methodological inconsistencies in the assessment of victimisation resulting in discrepancies for recorded levels of risk in domestic violence cases across these two agencies. Practical implications: These findings provide a compelling argument for developing a more uniformed approach to victim assessment and indicate a significant training need. Value: This paper highlights areas of good practice and forwards several recommendations for improved practice that emphasises the integration of empirical research conducted by psychologists to boost the validity and reliability of risk assessment approaches and tools used

Repeat Victimisation, Retraumatisation and Victim Vulnerability

Abstract: This study explores the contribution that traumatic experiences and psychological post-traumatic stress symptoms make to predicting subsequent revictimisation in a sample of violent crime victims. In addition, the timing of first trauma exposure was also explored. Fifty-four adult victims (27 male and 27 female) of police recorded violent crime were interviewed and their traumatic exposure history, trauma symptomology, age at first trauma exposure as well as psychological and psychosocial functioning were assessed. These victims were followed longitudinally and subsequent revictimisation between six and twelve months post index victimisation measured. A greater number of types of trauma exposure was related lower emotional stability, higher trauma symptomology and revictimisation. Those victims with childhood traumatic exposure reported more trauma symptomology exposure than those without prior exposure. The implications for law enforcement and victim services are discussed

The development and implementation of a ‘one stop’ assessment strategy in Psychology

In this paper we will be outlining the development of an assessment strategy and accompanying online single point of access for all assessment-related processes undertaken by Psychology staff within a higher education setting. We will outline the problem and highlight why the changes were needed. Then we will outline how we created the assessment strategy and single point of access, discuss the preliminary impact, and conclude with next steps

Social networks, work and network-based resources for the management of long-term conditions: a framework and study protocol for developing self-care support

Background: increasing the effective targeting and promotion of self-care support for long-term conditions requires more of a focus on patient contexts and networks. The aim of this paper is to describe how within a programme of research and implementation, social networks are viewed as being centrally involved in the mobilisation and deployment of resources in the management of a chronic condition. This forms the basis of a novel approach to understanding, designing, and implementing new forms of self-management support.Methods: drawing on evidence syntheses about social networks and capital and the role of information in self-management, we build on four conceptual approaches to inform the design of our research on the implementation of self-care support for people with long-term conditions. Our approach takes into consideration the form and content of social networks, notions of chronic illness work, normalisation process theory (NPT), and the whole systems informing self-management engagement (WISE) approach to self-care support.Discussion: the translation and implementation of a self-care agenda in contemporary health and social context needs to acknowledge and incorporate the resources and networks operating in patients' domestic and social environments and everyday lives. The latter compliments the focus on healthcare settings for developing and delivering self-care support by viewing communities and networks, as well as people suffering from long-term conditions, as a key means of support for managing long-term conditions. By focusing on patient work and social-network provision, our aim is to open up a second frontier in implementation research, to translate knowledge into better chronic illness management, and to shift the emphasis towards support that takes place outside formal health services.<br/

Chronic psychological stress was not ameliorated by omega-3 eicosapentaenoic acid (EPA)

Background: Chronic psychological stress and mental health disorders are endemic in Western culture where population dietary insufficiencies of omega-3 fatty acids (n-3FA) from seafood have been observed. Objective: This study was designed to test for a causal relationship between one of the most active components of fish oil, eicosapentaenoic acid (EPA), and chronic psychological stress. Method: A randomized double-blind, placebo-controlled clinical trial with parallel-assignment to two groups was designed (Trial Id: ACTRN12610000404022). The interventions were four EPA-rich fish oil capsules per day, delivering 2.2 g/d EPA (and 0.44 g/d DHA), or identical placebo (low-phenolic olive oil capsules with 5% fish oil to aid blinding). The primary outcome was the between-group difference on the Perceived Stress Scale (PSS-10) after 12 weeks supplementation. An a priori power analysis determined that group sizes of 43 would provide 80% power to detect a significant between-group difference of 12.5%, at α = 0.05. Ninety community members (64 females, 26 males) reporting chronic work stress were recruited via public advertising in northern NSW, Australia. Results: At baseline the omega-3 index (EPA + DHA as % to total fatty acids in red blood cell membranes) was 5.2% in both groups (SD = 1.6% control group; 1.8% active group). After supplementation this remained stable at 5.3% (SD = 1.6%) for the control group but increased to 8.9% (SD = 1.5%) for the active group, demonstrating successful incorporation of EPA into cells. Intention-to-treat (ITT) analysis found no significant between-group differences in PSS outcome scores post-intervention (b = 1.21, p = 0.30) after adjusting for sex (b = 2.36, p = 0.079), baseline PSS (b = 0.42, p = 0.001) and baseline logEPA [b = 1.41, p = 0.185; F(3, 86) = 8.47, p \u3c 0.01, n = 89, R-square = 0.243]. Discussion: Treatment increased cell membrane EPA but, contrary to the hypothesis, there was no effect on perceived stress. Limitations included an imbalance of gender in groups after randomization (68% of the males were in the placebo group). While we found no significant interaction between sex and group on the outcome after adjusting for baseline PSS, larger studies with groups stratified for gender may be required to further confirm these findings. Conclusion: This study demonstrated that 2. 2 g/day of EPA for 12 weeks did not reduce chronic psychological stress