Helping carers to care: the 10/66 dementia research group's randomized control trial of a caregiver intervention in Peru

OBJECTIVE There is a need, in the absence of formal services, to design interventions aimed at improving the lives of people with dementia and their families. This study tested the effectiveness of the 10/66 caregiver intervention among people with dementia and their caregivers in Lima, Peru. METHOD Design/participants: a randomized controlled trial was performed involving 58 caregivers of people with dementia that received the intervention in the beginning of the trial (n = 29) or six months later (n = 29). The intervention consisted of three modules: 1) assessment (one session); 2) basic education about dementia (two sessions); and 3) training regarding specific problem behaviors (two sessions). Main outcome measures: Caregivers and patients with dementia were assessed at baseline and after six months. For caregivers, the measures included strain (Zarit Burden Interview), psychological distress (SRQ-20), and quality of life (WHOQOL-BREF). Dementia patients completed scales assessing behavioral and psychological symptoms (NPI-Q) and quality of life (DEMQOL). RESULTS Caregivers in the intervention group reported significantly decreased strain measures six months after the intervention compared to controls. No group differences were found in respect to the caregivers' psychological distress and to quality of life in both caregivers and patients. CONCLUSION The 10/66 intervention seems to be as effective as similar interventions used in more developed countries

Nonprescribed use of tranquilizers and use of other drugs among Brazilian students

Objectives: To describe patterns of nonprescribed use of tranquilizers by students aged 10 to 18 years and assess the sociodemographic characteristics of these adolescents and their use of other substances. Methods: A randomized and stratified sample of 47,979 students from state and private schools of the 27 Brazilian state capitals completed a self-report questionnaire. Poisson regression was used to estimate the associations between tranquilizer use and sociodemographic factors, as well as the use of other psychotropic substances. Results: The lifetime prevalence of nonprescribed use of tranquilizers was 3.9%. Use was most common among girls, wealthier adolescents, and those from private schools. An association was found between use of tranquilizers and lifetime use of alcohol (prevalence ratio [PR] = 3.15; 95% confidence intervals [95%CI] 2.58-3.85), tobacco (PR = 2.61; 95%CI 2.31-2.95), illicit drugs (PR = 3.70; 95%CI 3.19-4.29), and other prescription drugs (PR = 7.03; 95%CI 6.18-7.99). As the number of substances adolescents reported having used increased, so did the nonprescribed use of tranquilizers. Conclusions: Nonprescribed use of tranquilizers by adolescents might indicate the use of other substances, including high-risk combinations such as tranquilizers and alcohol. The risks of this association should be addressed during the early stages of drug prevention programs.Universidade Federal de São Paulo (UNIFESP) Department of PsychobiologyUNIFESP, Department of PsychobiologySciEL

Estimating the number of people living with dementia at different stages of the condition in India: a Delphi process

Introduction: Numerous studies have previously estimated the dementia prevalence in India. However, as these estimates use different methodologies and sampling strategies, generating definitive prevalence estimates can be difficult. Methods: A Delphi process involving eight clinical and academic experts provided prevalence estimates of dementia within India, split by sex and age. The experts were also asked to estimate the number of people potentially living at different stages of the condition. A priori criteria were used to ascertain the point in which consensus was achieved. Results: Our consensus estimates generated a dementia prevalence of 2.8% (95% CI = 1.9 to 3.6) for those aged 60 years and above in India. Consensus was achieved across age and sex prevalence estimates, with the exception of one (females aged 60-64). Our experts estimated that 42.9% of people living with dementia in India had a mild severity. Conclusions: The findings indicate that there could be approximately 3.9 million people living with dementia in India, of which 1.7 million could be living with dementia of mild severity. Such estimates can better help researchers and policy makers to estimate the true cost and impact of dementia in India and can inform resource allocation decisions

Implementação em Portugal de um estudo de prevalência da demência e da depressão geriátrica: a metodologia do 10/66 Dementia Research Group

ResumoIntroduçãoA demência e a depressão têm um impacto social muito significativo. Em Portugal, escasseiam dados epidemiológicos em pessoas idosas na comunidade. Em países em desenvolvimento, o 10/66 Dementia Research Group (DRG) conduziu múltiplos estudos sobre a prevalência e a incidência destes quadros. Os protocolos de avaliação 10/66‐DRG foram validados extensivamente nesses países, havendo vantagens potenciais na aplicação em regiões europeias com populações idosas de baixa escolaridade. Neste estudo, fundamentamos e descrevemos a implementação em Portugal da metodologia 10/66‐DRG para estudo da prevalência da demência e da depressão geriátrica.Materiais e métodosO trabalho de campo desenrola‐se numa fase única, em áreas geográficas definidas, sendo avaliados detalhadamente e de forma sistemática todos os residentes de 65 anos ou mais. A informação é recolhida dos participantes e de informadores próximos (www.alz.co.uk/1066/).ResultadosSelecionámos e mapeámos uma área urbana (em Fernão Ferro) e outra rural (em Mora), definindo amostras finais de 702 e 779 pessoas, respetivamente. Os instrumentos de avaliação foram cuidadosamente traduzidos e adaptados ao contexto português. Teve lugar um treino rigoroso dos entrevistadores, assegurando a fiabilidade de cotação interobservadores.Discussão e conclusãoA aplicação dos protocolos 10/66‐DRG permitirá obter dados robustos de prevalência de demência e de depressão, com amostras comunitárias de pessoas idosas em Portugal. Dada a validade internacional da metodologia utilizada, estes resultados serão comparáveis com os de outros centros 10/66, à escala mundial.AbstractIntroductionDementia and depression have a huge social impact. In Portugal, epidemiological data is scarce regarding community dwelling elderly people with these conditions. In developing countries, the 10/66 Dementia Research Group‐DRG has conducted multiple studies on the corresponding prevalence and incidence. The 10/66‐DRG protocols for population‐based studies were extensively validated in those countries, and there is a rationale to apply them in low literacy elderly populations in Europe. We describe the implementation of the protocols related to the prevalence study (on dementia and geriatric depression) in Portuguese settings.Materials and methodsThis is a one‐phase survey, in which all people 65+ years living in defined catchment areas are comprehensively evaluated. Information is collected directly from participants and from a related informant (www.alz.co.uk/1066/).ResultsWe selected and mapped an urban area (in Fernão Ferro) and a rural one (in Mora). The final samples were n=702 and n=779 respectively. Questionnaires were carefully translated and culturally adapted. Rigorous training procedures took place to ensure inter‐rater reliability.Discussion and conclusionsThe implementation of the 10/66‐DRG protocols will lead to robust data on the prevalence of dementia and depression in community samples of elderly people in Portugal. Given the international validity of our methodology, these results will be comparable with those from other 10/66 centres around the world

Translating science into policy : mental health challenges during the COVID-19 pandemic

Several stressors associated with the coronavirus disease 2019 (COVID-19) are expected to affect the mental health of global populations: the effects of physical distancing, quarantine, and social isolation; the emotional suffering of health and other frontline workers; neuropsychiatric sequelae in those affected by the virus; the impact to families of lives lost to the disease; differential effects for those with severe mental disorders; and the consequences of social and economic deterioration. In this context, we sought: to form a panel of Brazilian experts on child and adolescent health, neurodevelopment, health services, and adult and elderly mental health; and to compile evidencebased interventions to support suggested policy changes in Brazil to mitigate the expected increase in mental health disorders during the pandemic and its mental health consequences. The following actions are recommended: 1) invest in prevention programs for the safe return of students to schools; 2) adopt evidence-based psychosocial interventions to maintain an adequate environment for child and adolescent development; 3) target socially vulnerable populations and those experiencing discrimination; 4) train primary care teams to solve common mental health problems, provide needsbased assessments, and manage long-term, at-home care for older patients; 5) invest in technological advancements (e.g., telemedicine, e-Health, and web-based algorithms) to promote coordinated care; 6) increase access to and literacy in the use of computers and mobile phones, especially among older adults; 7) expand protocols for remote, brief psychotherapy interventions and psychoeducation to manage common mental health problems

Accessing dementia care in Brazil: an analysis of case vignettes

Background and Objectives Despite the rapid increase in the number of people living with dementia in Brazil, dementia care is limited. This study describes how people living with dementia and their carers access care, treatment, and support, and identifies what characteristics are likely to enable or prevent access. Research Design and Methods We created 10 vignettes to illustrate fictitious but realistic scenarios involving people living with dementia in Brazil. The vignettes explore a combination of socioeconomic and demographic variables. They were completed using an in-depth desk review of the dementia care landscape in Brazil; a Strengths, Opportunities, Weaknesses, and Threats (SWOT) analysis of the desk review; and expert knowledge. The analysis focused on identifying common sources of service provision, barriers of access to care and support, and specific issues experienced by some population groups. Findings Access to a dementia diagnosis, care, and support for people living with dementia in Brazil is limited. Demographic and socio-economic circumstances play a role in determining the type of services to which a person might have access. Poor knowledge about dementia, lack of capacity in the health system, and lack of formal long-term care support are among the identified barriers to accessing timely diagnosis, care, and support in the country. Discussion and Implications Understanding the barriers and facilitators of access to diagnosis, treatment, and support for people with dementia and families with different demographic and socioeconomic characteristics is crucial for designing dementia policies that are context-specific and responsive to the care needs of different socioeconomic groups in Brazil

Experiences of stigma and discrimination among people living with dementia and family carers in Brazil: qualitative study

This study aimed to understand stigma in relation to people living with dementia in São Paulo, Brazil. A critical narrative inquiry methodology was used. Home-based semi-structured interviews were conducted between January and March 2020 with six people living with dementia and 15 family carers. Data analysis was conducted using inductive and deductive techniques. The latter was informed by Link and Phelan's sociological theory of stigma. We found that dementia was commonly viewed by people living with dementia as part of ageing and carers reported low levels of knowledge and awareness about the condition. To avoid negative reactions from people, people living with dementia managed the negative views of dementia by minimising and normalising the condition, by expressing their ability to live an active life, and by emphasising the positive impacts of dementia in their lives. Fear of negative reactions appeared to lead to a selective disclosure of their diagnosis. Among carers, stigmatising attitudes coincided with a strong willingness to provide good care, to protect the person cared for, as well as to understand and validate their own caring experiences, rather than to cause any harm. In doing so, however, carers ended up depersonalising and infantilising people living with dementia, underestimating their capacities, demanding ‘obedience’ and restricting the person's freedom. There is a need to increase awareness about dementia and to provide support and training on person-centred and ethical care for carers in Brazil

The dementia severity rating scale: a potential community screening tool for dementia in low- and middle-income countries

Background The Dementia Severity Rating Scale (DSRS) is an informant report, dementia staging tool that is quick to administer and has previous been shown to differentiate between people with dementia and healthy controls. However, it is not clear how accurate the tool is screening against diagnostic criteria in middle-income settings. Methods Embedded within the STRiDE programme, older adults (aged ≥65 years) and their informants were randomly recruited from four sites across Indonesia and South Africa. All informants were asked to complete DSRS. We report the tool’s psychometric properties and accuracy against the 10/66 short diagnostic algorithm. Results Between September and December 2021, data was collected from 2110 older adults in Indonesia and 408 in South Africa. Overall, the DSRS scores significantly differed between those with and without dementia, as identified on the 10/66 short algorithm (p 2 on the DSRS had the greatest agreement with the 10/66 short algorithm and had excellent discriminative properties in both Indonesia (Area Under Curve (AUC) = .75, 95% CIs = .72–.77) and South Africa (AUC = .82, 95% CIs = .76–.88). Conclusions The DSRS has potential as a screening tool for dementia in middle-income countries, with high sensitivity and specificity against a standardized diagnostic algorithm

Socioeconomic Factors and All Cause and Cause-Specific Mortality among Older People in Latin America, India, and China: A Population-Based Cohort Study

Cleusa Ferri and colleagues studied mortality rates in over 12,000 people aged 65 years and over in Latin America, India, and China and showed that chronic diseases are the main causes of death and that education has an important effect on mortality