Improving quality of life for people with dementia in care homes: Making psychosocial interventions work

This is the author accepted manuscript. The final version is available from Cambridge University Press via the DOI in this recordPsychosocial interventions can improve behaviour and mood in people with dementia, but it is unclear how to maximise their effectiveness or acceptability in residential settings. Aims To understand what underlies the successful implementation of psychosocial interventions in care homes. Method Systematic review and meta-synthesis of qualitative research. Results The synthesis of 39 qualitative papers revealed that beneficial psychosocial interventions met the needs of people with dementia to connect with others, make a meaningful contribution and reminisce. Successful implementation rested on the active engagement of staff and family and the continuing provision of tailored interventions and support. This necessitated staff time, and raised issues around priorities and risk, but ultimately helped redefine staff attitudes towards residents and the caregiving role. Conclusions The findings from the meta-synthesis can help to inform the development and evaluation of psychosocial interventions in care homes and support their widespread implementation in clinical settings.National Institute for Health Research (NIHR

Students’ Perceptions of Factors that Affect College Funding Decisions

This exploratory study examines the factors that college students perceive are important in helping them make good financial decisions about paying for a college education. The study categorizes and summarizes students\u27 self-reported responses to an openended survey question about recommendations for changes in financial aid counseling practices. The 335 student responses had a recurring theme of better information provided through individual counseling sessions

Canadian Postsecondary Students With Disabilities: Where Are They?

Results of a Canada-wide and a Quebec based study of students with a variety of disabilities in Canadian postsecondary education are presented. Study 1 involved 156 professionals. They represent 80% of the population of professionals who provide on-campus disability support services. Results indicate that (1) 8% of postsecondary institutions reported not having any students with disabilities, (2) overall, 2% of students are registered to receive disability related services from their post- secondary institutions, and (3) this varies from 1/2% to 6% across the country. Junior/community colleges had a higher percentage of students with disabilities registered to receive disability related services (3 3/4%) than universities (1 2/3%). (4) Distance education had 3%. (5) Quebec has a smaller proportion of both college (2/3% vs 6%) and university (1/2%) vs 2 1/2%) students with disabilities than the rest of Canada. A targeted study involving 46 professionals who provide disability related services in Quebec's public junior/community colleges, the CEGEPs, revealed that lack of recognition of learning disabilities for postsecondary funding by the Quebec government is an important contributor to the small percentages, although it cannot explain the huge discrepancies between Quebec and the rest of Canada. Extrapolation suggests that there are over 100,000 students with disabilities currently enrolled in Canadian postsecondary education, although only 1/4 to 1/2 of them register to receive disability related services.Les résultats d'une étude pancanadienne basée au Québec portant sur des étudiants ayant diverses incapacités dans des institutions postsecondaires canadiennes sont présentés. L'étude 1 impliquait 156 professionnels. Ils représentent 80% de la population des intervenants qui fournissent de l'appui, sur les campus, aux étudiants ayant des incapacités. Les résultats révèlent que (1) 8% des institutions postsecondaires rapportent qu'elles n'ont pas d'étudiants ayant des incapacités, (2) globalement, 2 % des étudiants sont inscrits aux services offerts aux étudiants ayant des incapacités de leur institution postsecondaire, et (3) cette donnée varie de 1/2% à 6% à travers le pays. Les collèges communautaires ont un pourcentage plus élevé d'étudiants ayant des incapacités inscrits aux services d'appui (3 3/4%) par rapport aux universités (1 2/3%). (4) La formation à distance a 3% d'étudiants nécessitant des services de cette nature. (5) Le Québec a le pourcentage le plus faible au Canada d'étudiants ayant des incapacités aux niveaux collégial (2/3%) contre 6%) et universitaire (1/2% contre 2 1/2%). Une étude cible impliquant 46 intervenants qui fournissent des services aux étudiants ayant des incapacités dans les collèges au Québec, les CEGEPs, révèle qu'un des facteurs contribuant aux faibles pourcentages est le fait que le gouvernement du Québec ne tient pas compte des difficultés d'apprentissage lors du financement. Cependant, ceci ne peut expliquer les différences énormes entre le Québec et le reste du Canada. Par extrapolation, il est possible d'avancer qu'il y a plus de 100 000 étudiants ayant des incapacités présentement inscrits dans des institutions postsecondaires canadiennes, quoique seulement 25 à 50 % de ceux-ci soient inscrits aux services offerts aux étudiants ayant des incapacités

Practitioners’ understanding of barriers to accessing specialist support by family carers of people with dementia in distress

Distressing symptoms in dementia are hard to manage for many family carers. This article explores practitioners' perceptions of the barriers to accessing skilled behaviour management support encountered by carers. A survey of cases referred to the English National Health Service (n = 5,360) was followed by in-depth group discussions and practitioner interviews. Data revealed that practitioners focused on care home residents or older people with mental health problems other than dementia, rather than community-dwelling people with dementia and families. Barriers to access included misperceptions about the nature of distressing behaviour affecting carers and structural limitations in the capacity of specialist services to respond to carers

Projet ITAC - L'accessibilité au cégep pour tous : informatique et technologies adaptées dans les cégeps pour les étudiants ayant des handicaps /

Bibliogr

Apathy and Its Response to Antipsychotic Review and Nonpharmacological Interventions in People With Dementia Living in Nursing Homes: WHELD, a Factorial Cluster Randomized Controlled Trial

This is the author accepted manuscript. The final version is available from Elsevier via the DOI in this recordObjectives Apathy is common, impactful, and difficult to manage in people with dementia. We evaluated the efficacy of nonpharmacological interventions, exercise, and social interaction, in combination with antipsychotic review, to reduce apathy in people with dementia living in nursing homes in a cluster randomized controlled trial (RCT). Methods Well-being and health for people with dementia (WHELD) program included a 2 × 2 × 2 factorial cluster RCT involving people with dementia living in 16 nursing homes in the United Kingdom. All homes received training in person-centered care, and were randomized to receive antipsychotic review, social interaction, and exercise, either alone or in combinations. Apathy was one of the secondary outcomes of the WHELD trial, and it was measured by the Neuropsychiatric Inventory–nursing home version at baseline and 9 months (n = 273). We used multilevel mixed effects linear regression models to assess the impact of the interventions on apathy. Results Prevalence of apathy was 44.0% (n = 120; 95% confidence interval [CI] 38.1%–49.9%) at baseline. Severity of apathy had significant positive correlations with dementia severity, neuropsychiatric symptoms, depressive symptoms, agitation, and the needs of the people with dementia (P < .001). Antipsychotic review reduced antipsychotic use, but it significantly increased apathy (β = 5.37; SE = 0.91; P < .001). However, antipsychotic review in combination with either social interaction (β = −5.84; SE = 1.15; P < .001) or exercise (β = −7.54; SE = 0.93; P < .001) significantly reduced apathy. Conclusions Antipsychotic review can play a significant role in improving apathy in people with dementia living in nursing homes, when combined with psychosocial interventions such as social interaction and exercise. Guidance must be adapted to reflect this subtlety in care.National Institute for Health Research (NIHR

Line-profile tomography of exoplanet transits -- II. A gas-giant planet transiting a rapidly-rotating A5 star

Most of our knowledge of extrasolar planets rests on precise radial-velocity measurements, either for direct detection or for confirmation of the planetary origin of photometric transit signals. This has limited our exploration of the parameter space of exoplanet hosts to solar- and later-type, sharp-lined stars. Here we extend the realm of stars with known planetary companions to include hot, fast-rotating stars. Planet-like transits have previously been reported in the lightcurve obtained by the SuperWASP survey of the A5 star HD15082 (WASP-33; V=8.3, v sin i = 86 km/sec). Here we report further photometry and time-series spectroscopy through three separate transits, which we use to confirm the existence of a gas giant planet with an orbital period of 1.22d in orbit around HD15082. From the photometry and the properties of the planet signal travelling through the spectral line profiles during the transit we directly derive the size of the planet, the inclination and obliquity of its orbital plane, and its retrograde orbital motion relative to the spin of the star. This kind of analysis opens the way to studying the formation of planets around a whole new class of young, early-type stars, hence under different physical conditions and generally in an earlier stage of formation than in sharp-lined late-type stars. The reflex orbital motion of the star caused by the transiting planet is small, yielding an upper mass limit of 4.1 Jupiter masses on the planet. We also find evidence of a third body of sub-stellar mass in the system, which may explain the unusual orbit of the transiting planet. In HD 15082, the stellar line profiles also show evidence of non-radial pulsations, clearly distinct from the planetary transit signal. This raises the intriguing possibility that tides raised by the close-in planet may excite or amplify the pulsations in such stars.Comment: 9 pages, 6 figures, accepted for publication in MNRA

Epidemiology of Pain in People With Dementia Living in Care Homes: Longitudinal Course, Prevalence, and Treatment Implications

This is the author accepted manuscript. The final version is available from Elsevier via the DOI in this recordIntroduction Knowledge regarding the longitudinal course, impact, or treatment implications of pain in people with dementia living in care homes is very limited. Methods We investigated the people with dementia living in 67 care homes in London and Buckinghamshire, United Kingdom. Pain, dementia severity, neuropsychiatric symptoms, depression, agitation, and quality-of-life were measured using appropriate instruments at baseline (N = 967) and after 9 months (n = 629). Results Baseline prevalence of pain was 35.3% (95% CI 32.3–38.3). Pain severity was significantly correlated with dementia severity, neuropsychiatric symptoms, depression, agitation, and quality of life at both time points. Regular treatment with analgesics significantly reduced pain severity. Pain was significantly associated with more antipsychotic prescriptions. Pain was significantly associated (OR 1.48; 95% CI 1.18–1.85) with all-cause mortality during follow-up. Conclusions Pain is an important determinant of neuropsychiatric symptoms, mortality, quality-of-life, and antipsychotic prescriptions. Improved identification, monitoring, and treatment of pain are urgent priorities to improve the health and quality-of-life for people with dementia.National Institute for Health Research (NIHR

‘You’re just chopped off at the end’: Retired servicemen’s identity work struggles in the military to civilian transition

Promoting positive transition to retirement and cultural adaption for ex-service personnel has been identified as a priority for both social-science research and for public health policy in the UK. The Royal British Legion (RBL) aims to provide support to service and retired service personnel, but to date the transition to retirement experiences of older (60-plus) ex- service personnel remain under-researched. In this article, we employ a symbolic interactionist theoretical framework to examine older servicemen’s experiences and identity challenges post-retirement from the British armed forces. Data were collected primarily through semi-structured, focus-group interviews with 20 former servicemen. Here, we focus specifically upon the challenges encountered by these ex-servicemen in the retirement transition from military to civilian life, a time of identity flux of sociological interest. To navigate this period of identity change and challenge, many participants constructed a ‘modified military self’ through involvement with the RBL as a key social support network. For many retired personnel the RBL offered a form of identification and group identity that resonated strongly with earlier experiences of comradeship in the military