Residential aged care staff perceptions and responses towards neuropsychiatric symptoms: a mixed methods analysis of electronic healthcare records

Objectives: To investigate electronic care notes to better understand reporting and management of neuropsychiatric symptoms (NPS) by residential aged care (RAC) staff. Methods: We examined semi-structured care notes from electronic healthcare notes of 77 residents (67% female; aged 67-101; 79% with formal dementia diagnosis) across three RAC facilities. As part of standard clinical practice, staff documented the NPS presentation and subsequent management amongst residents. Using a mixed-method approach, we analyzed the type of NPS reported and explored care staff responses to NPS using inductive thematic analysis. Results: 465 electronic care notes were recorded during the 18-month period. Agitation-related behaviors were most frequently reported across residents (48.1%), while psychosis (15.6%), affective symptoms (14.3%), and apathy (1.3%) were less often reported. Only 27.5% of the notes contained information on potential causes underlying NPS. When faced with NPS, care staff responded by either providing emotional support, meeting resident’s needs, removing identified triggers, or distracting. Conclusion: Results suggest that RAC staff primarily detected and responded to those NPS they perceived as distressing. Findings highlight a potential under-recognition of specific NPS types, and lack of routine examination of NPS causes or systematic assessment and management of NPS. These observations are needed to inform the development and implementation of non-pharmacological interventions and care programs targeting NPS in RAC. Supplemental data for this article is available online at https://doi.org/10.1080/13607863.2022.2032597

High-normal blood glucose levels may be associated with decreased spatial perception in young healthy adults.

The negative effects of high normal glucose on cognitive function were previously reported in euglycemic individuals of middle age and the elderly population. This study aimed at examining the effect of baseline blood glucose levels on spatial ability, specifically verticality perception on the computerized rod and frame test (CRFT) in young healthy adults. 63 healthy male medical students (age range from 18-23 years), of whom 30 were non-fasting outside the month of Ramadan and 33 fasting during Ramadan of the year 2016, were recruited in order to create varying degrees of glycemia during which verticality perception was carried out. Baseline blood glucose reading was obtained prior to commencing the CRFT test. Blood glucose levels at the time of testing decreased as the duration between the last meal and testing increased. A blood glucose range of 62-117 mg/dl was achieved among participants for this study. Linear regression analysis showed that blood glucose level at testing correlated positively with all alignment spatial error parameters, indicating a probable reduction of spatial perception ability with higher blood glucose levels. These results are consistent with other cognitive studies in older healthy humans and emphasize the critical impact of early glucose dys-homeostasis on cognitive function. They also indicate that elevated blood glucose may affect cognitive functioning outside of the usual complications of diabetes

The Impact of Personality Traits Towards the Intention to Adopt Mobile Learning

Mobile devices have become increasingly more common in the digitally connected world. Mobile learning as a model of e-learning refers to the acquisition of knowledge & skills utilizing mobile technologies. The aim of this study is to identify the extrinsic influential factors for the adoption of mobile learning. This study proposes the use of an extended technology acceptance model (TAM) theory that includes variables of personality traits such as perceived enjoyment and computer self-efficiency. The participants of this study were 351 students at University Technology Malaysia who had experiences in e-learning. The study found that perceived usefulness as an extrinsic factor has the highest influence on students’ intention to adopt mobile learning through an investigation of technology acceptance toward mobile learning. Personality traits such as perceived enjoyment and self-efficacy have impact on behavior intention to adopt mobile learning

Prevalence estimates of mild behavioral impairment in a population-based sample of pre-dementia states and cognitively healthy older adults

Background: A dearth of population-based epidemiological research examines neuropsychiatric symptom (NPS) in sub-clinical populations across the spectrum from normal aging to mild cognitive impairment (MCI). The construct of mild behavioral impairment (MBI) describes the emergence of sustained and impactful NPS in advance of or in combination with MCI. This is the first epidemiological study to operationalize the recently published diagnostic criteria for MBI and determine prevalence estimates across the spectrum from cognitively normal to MCI. Methods: MBI was assessed in 1,377 older (age range 72-79 years; 52% male; MCI ;= 133; cognitively normal, but-at-risk = 397; cognitively healthy = 847). MBI was assessed in accordance with the ISTAART-AA diagnostic criteria for MBI using the neuropsychiatric inventory. Results: 34.1% of participants met the criteria for MBI. High prevalence of MBI across the cognitive spectrum was reported (48.9% vs. 43.1% vs. 27.6%). Irrespective of level of cognitive impairment, impulse dyscontrol (33.8% vs. 28.7% vs. 17.2%) and decreased motivation (32.3% vs. 26.2% vs. 16.3%) were the most frequently met MBI domains. MBI was more prevalent in men (χ2 = 4.98, p = 0.026), especially the domains of decreased motivation and impulse dyscontrol. Conclusions: This study presents the first population-based prevalence estimates for MBI using the recently published ISTAART-AA diagnostic criteria. Findings indicate relatively high prevalence of MBI in pre-dementia clinical states and amongst cognitively healthy older adults. Findings were gender-specific, with MBI affecting more men than women. Knowing the estimates of these symptoms in the population is essential for understanding and differentiating the very early development of clinical disorders

Who displays dementia-related stigma and what does the general public know about dementia? Findings from a nationally representative survey

Objectives: To identify the characteristics of those who tend to hold stigmatising beliefs and behaviours towards people living with dementia to inform dementia education and the targeting of interventions to reduce dementia-related stigma. Methods: A nationally representative telephone survey of 1000 Australians aged 18–93 years was conducted to assess general knowledge of dementia and dementia-related stigma. A single open-ended question was used to assess participants’ general knowledge of dementia. Modified items from the Lay Public Dimension of the Family Stigma in Alzheimer’s Disease Scale were used to assess dementia-related stigma. Results: Only 26% of participants demonstrated good dementia knowledge while almost half of the participants had a mixed understanding of dementia. Dementia-related negative cognitive attributions were found to be higher in (1) the older age cohorts, (2) amongst individuals who know someone with dementia, (3) speak a language other than English at home, and (4) have a better understanding of dementia. Older age cohorts, men, those who do not know someone with dementia, and those who speak a non-English language at home also reported significantly higher discriminatory behavioural reactions compared to the younger age cohorts, females, those who know someone with dementia, and those who speak English only at home. Conclusions: This study identifies a need for improved public education about dementia. A structured approach to the development of strategies that is specifically tailored to different age, gender and cultural groups may provide a beneficial approach to help improve dementia knowledge and reduce dementia-related stigma in the population

Differential associations between sensory loss and neuropsychiatric symptoms in adults with and without a neurocognitive disorder

Background: To investigate the differential associations between sensory loss and neuropsychiatric symptoms among older adults with and without diagnosed neurocognitive disorder. Methods: The sample comprised 1,393 adults (52.3% men) aged between 72 and 79 years from a community-based cohort study. There were 213 cases of mild and 64 cases of major neurocognitive disorders. The main outcome was number of informant reported symptoms on the Neuropsychiatric Inventory (NPI). Sensory loss was defined by visual acuity worse the 0.3 logMAR (6/12 or 20/40) and self-reported hearing problems. Results: Clinically relevant NPI symptoms were reported in 182 (13.1%) participants, but no individual symptom occurred in more than 5% of the total sample. Among participants diagnosed with a major neurocognitive disorder, those with any sensory loss had over three times (95%CI: 1.72-11.78) greater rates of NPI symptoms than those with unimpaired levels of sensory functioning. There were no differences in the number of neuropsychiatric symptoms by type of sensory loss, and no additional risk associated with a dual sensory loss compared to a single sensory loss. There was no evidence of an association between sensory loss and number of neuropsychiatric symptoms among cognitively healthy adults. Conclusions: The extent to which this association is the result of underlying neuropathology, unmet need, or interpersonal factors is unclear. These findings have significant implications for dementia care settings, including hospitals and respite care, as patients with sensory loss are at increased risk of neuropsychiatric symptoms and may require additional psychosocial support. Interventions to manage sensory loss and reduce the impact of sensory limitations on neuropsychiatric symptoms are needed

Third-party impact of dual sensory loss on neuropsychiatric symptom-related distress among friends and family

Background: Vision loss and hearing loss are common in later life and are associated with cognitive impairment and neuropsychiatric symptoms. There is a need to better understand how individual characteristics, such as poor sensory functioning, are linked with familial well-being. Objectives: The aim of this study was to investigate whether, among persons with neuropsychiatric symptoms, age-related sensory loss is related to increased emotional distress reported by their family and friends. Methods: The sample comprised 537 participant-informant dyads from the Personality and Total Health through Life (PATH) study, a community-based cohort. Participants were aged between 72 and 79 years (56% men), and all were reported to exhibit at least 1 neuropsychiatric symptom. Informants were participants' spouse (50%), child (35%), friend (7%), or other relatives (7%). Neuropsychiatric symptom-related distress of friends and family was assessed with the distress subscale of the Neuropsychiatric Inventory (NPI). Sensory functioning in participants was assessed by visual acuity and self-reported hearing difficulties. Ordinal logistic regression analyses estimated the association between sensory problems and NPI distress. Results: In models adjusted for informant dyadic relationship and socio-demographics, both lower visual acuity (B = 0.23, SE = 0.10) and self-reported hearing difficulty (B = 0.15, SE = 0.06) were associated with increased levels of distress. The increased informant distress associated with poor visual acuity was attenuated after adjusting for neurocognitive disorder and health conditions (p = 0.069). A significant interaction between vision and hearing remained after multivariable adjustment (χ2(1) = 6.73, p = 0.010). Conclusions: Friends and family of persons with poor visual acuity and perceived hearing difficulties report elevated levels of neuropsychiatric symptom-related distress relative to friends and family of persons with poor sensory functioning in only 1 sensory domain or unimpaired levels of vision and hearing. These findings provide evidence of the third-party effects of sensory loss in the context of neuropsychiatric symptoms, and in particular show how dual sensory loss can confer additional challenges over and above the effects of a single sensory loss