Nature as a 'Lifeline': The Power of Photography when Exploring the Experiences of Older Adults living with Memory Loss and Memory Concerns

The visual is an underutilised modality through which to investigate experiences of memory loss in older people. We describe a visual ethnography with older adults experiencing subjective or objective memory loss, receiving a cognitive wellbeing group intervention designed to prevent cognitive decline and dementia (APPLE-Tree programme). We aimed to explore lived experiences of people with memory concerns, how participants engaged with this photography and co-design project, and how collaboration with an artist/photographer enhanced this process. Nineteen participants shared photographs reflecting what they valued in their daily lives, their experiences of memory concerns, and the intervention. Fourteen participated in qualitative photo-elicitation interviews, and thirteen collaborated with a professional artist/photographer to co-create an exhibition, in individual meetings and workshops, during which a researcher took ethnographic field notes. Eight participants were re-interviewed after the exhibition launch. We contextualise images produced by participants in relation to discourses around the visual and ageing and highlight their relationship with themes developed through thematic analysis that interconnects photographic, observational and interview data. We present themes around the use of photographs to: (1) celebrate connections to nature as a lifeline; (2) anchor lives within the context of relationships with family; (3) reflect on self and identity, enduring through ageing, memory concerns, pandemic, and ageing stereotypes. We explore visual research as a powerful tool for eliciting meaningful accounts from older adults experiencing cognitive change and to connect the arts and social sciences within ageing studies

Cost-effectiveness analyses for mirtazapine and sertraline in dementia: randomised controlled trial

BACKGROUND Depression is a common and costly comorbidity in dementia. There are very few data on the cost-effectiveness of antidepressants for depression in dementia and their effects on carer outcomes. AIMS To evaluate the cost-effectiveness of sertraline and mirtazapine compared with placebo for depression in dementia. METHOD A pragmatic, multicentre, randomised placebo-controlled trial with a parallel cost-effectiveness analysis (trial registration: ISRCTN88882979 and EudraCT 2006-000105-38). The primary cost-effectiveness analysis compared differences in treatment costs for patients receiving sertraline, mirtazapine or placebo with differences in effectiveness measured by the primary outcome, total Cornell Scale for Depression in Dementia (CSDD) score, over two time periods: 0-13 weeks and 0-39 weeks. The secondary evaluation was a cost-utility analysis using quality-adjusted life years (QALYs) computed from the Euro-Qual (EQ-5D) and societal weights over those same periods. RESULTS There were 339 participants randomised and 326 with costs data (111 placebo, 107 sertraline, 108 mirtazapine). For the primary outcome, decrease in depression, mirtazapine and sertraline were not cost-effective compared with placebo. However, examining secondary outcomes, the time spent by unpaid carers caring for participants in the mirtazapine group was almost half that for patients receiving placebo (6.74 v. 12.27 hours per week) or sertraline (6.74 v. 12.32 hours per week). Informal care costs over 39 weeks were £1510 and £1522 less for the mirtazapine group compared with placebo and sertraline respectively. CONCLUSIONS In terms of reducing depression, mirtazapine and sertraline were not cost-effective for treating depression in dementia. However, mirtazapine does appear likely to have been cost-effective if costing includes the impact on unpaid carers and with quality of life included in the outcome. Unpaid (family) carer costs were lower with mirtazapine than sertraline or placebo. This may have been mediated via the putative ability of mirtazapine to ameliorate sleep disturbances and anxiety. Given the priority and the potential value of supporting family carers of people with dementia, further research is warranted to investigate the potential of mirtazapine to help with behavioural and psychological symptoms in dementia and in supporting carers

Assessing the societal benefits of river restoration using the ecosystem services approach

This paper is a contribution from the EU seventh framework funded research project REFORM (Grant Agreement 282656).The success of river restoration was estimated using the ecosystem services approach. In eight pairs of restored–unrestored reaches and floodplains across Europe, we quantified provisioning (agricultural products, wood, reed for thatching, infiltrated drinking water), regulating (flooding and drainage, nutrient retention, carbon sequestration) and cultural (recreational hunting and fishing, kayaking, biodiversity conservation, appreciation of scenic landscapes) services for separate habitats within each reach, and summed these to annual economic value normalized per reach area. We used locally available data and literature, did surveys among inhabitants and visitors, and used a range of economic methods (market value, shadow price, replacement cost, avoided damage, willingness-to-pay survey, choice experiment) to provide final monetary service estimates. Total ecosystem service value was significantly increased in the restored reaches (difference 1400 ± 600 € ha−1 year−1; 2500 − 1100, p = 0.03, paired t test). Removal of one extreme case did not affect this outcome. We analysed the relation between services delivered and with floodplain and catchment characteristics after reducing these 23 variables to four principal components explaining 80% of the variance. Cultural and regulating services correlated positively with human population density, cattle density and agricultural N surplus in the catchment, but not with the fraction of arable land or forest, floodplain slope, mean river discharge or GDP. Our interpretation is that landscape appreciation and flood risk alleviation are a function of human population density, but not wealth, in areas where dairy farming is the prime form of agriculture.PostprintPeer reviewe

Hydromorphologische Methodenentwicklungen, Anwendungen und Analysen an den großen österreichischen Flusslandschaften

Ein hoher Anteil europäischer Fließgewässer weist beträchtliche Störungen hinsichtlich Flussmorphologie, Feststoffhaushalt und/oder Abflussregime auf. Damit verbunden sind tiefgreifende Veränderungen der Gewässerfauna und flora. Um gezielte Maßnahmenprogramme entwickeln zu können, bedarf es grundlegender Informationen über die Flusslebensräume. In der vorliegenden Dissertation werden die großen Fließgewässer Österreichs mit einem Einzugsgebiet über 500 km2 ab der Flussordnungszahl 3 untersucht. Im Mittelpunkt der Arbeiten stehen die Flusslandschaften als funktionale Einheit von Fluss und flussgeprägtem Umland. Basis bildet eine naturräumliche Typisierung der großen Fließgewässer Österreichs, die das Naturraumpotential der Flüsse widerspiegelt. Mit Hilfe der flusstypspezifischen Bewertungsmethode wird der Status quo der 53 untersuchten Fließgewässer dokumentiert. Von einer Gesamtlänge von 5265 km sind nur mehr rund 20 % der Gewässerstrecken einem sehr gutem bzw. gutem hydromorphologischem Zustand zugeordnet. Haupteingriffstypen sind Regulierungen des Flussverlaufes, Flächennutzungen im Talraum ebenso wie kraftwerksbedingte Einflüsse durch Rückstau, Wasserausleitung bzw. Schwellbetrieb. Landnutzungsanalysen im potentiellen Fluss-Auen-System zeigen auf unterschiedlichen räumlichen Maßstabsebenen eine hohe Korrelation zu hydromorphologischen Zustandskriterien. Die Ergebnisse der Gefährdungsanalysen der großen Flusslandschaften dokumentieren einen hohen Gefährdungsgrad des Großteils aller Fließgewässer-Lebensräume und zeigen damit den hohen Handlungsbedarf zum Schutz ökologisch sensibler Fließgewässer in Österreich auf. Zur Restauration der nicht mehr flusstypspezifisch erhaltenen Flussabschnitte (etwa 80% der untersuchten Fließgewässerstrecken) ist es notwendig, die Sanierungen schrittweise anhand von Prioritätskriterien umzusetzen. In vorliegender Arbeit wird ein breites hydromorphologisches Maßnahmenspektrum in einem Maßnahmenkatalog hierarchisch gegliedert.A high proportion of European running waters are severely impacted with regard to river morphology, bed load and/or hydrological regime. This fact is reflected in major changes in the aquatic fauna and flora. Management programmes directed to protecting, restoring or using running waters require basic information about riverine habitats. In this thesis all Austrian rivers (catchments exceeding 500 km2) have been investigated with focus on riverine landscapes. The classification of river landscape types according to abiotic criteria provides a basis for this doctoral thesis and reflects the landscape potential of various river types. By means of the rivertype-specific assessment method the current hydromorphological state of 53 Austrian running waters (5265 km) was documented. Approximately only 20% of the river stretches show a high or good hydromorphological status. Channelization, land use, impoundment, water abstraction and hydropeaking have been identified as key pressure components on Austrian rivers. Land use analyses in the potential flood plain area at different spatial extents prove that the intensity of land use is highly correlated to hydromorphological parameters. The results of a Red List of Endangered River Habitat Types in Austria show a high degree of threat and reveal a major need for action to protect river habitats in Austria. It will be essential to protect these valuable ecosystems against further destruction as stated in the relevant European Union directives. 80 % of the evaluated river stretches in Austria have been moderately to heavily impacted by human pressures. Restoration measures have to be set gradually by means of prioritisation criteria. Adequate restoration measures are documented in a comprehensive catalogue of measures.verf. und eingereicht von Michaela PoppeAbweichender Titel laut Übersetzung der Verfasserin/des VerfassersZsfassung in engl. SpracheWien, Univ. für Bodenkultur, Diss., 2010OeBB(VLID)193094

Qualitative evaluation of advanced care planning in early dementia (ACP-ED).

BACKGROUND: End-of-life-care is often poor in individuals with dementia. Advanced care planning (ACP) has the potential to improve end-of-life care in dementia. Commonly ACP is completed in the last six months of life but in dementia there may be problems with this as decision-making capacity and ability to communicate necessarily decrease as the disease progresses. Choosing the right time to discuss ACP with people with dementia may be challenging given the duration of the illness may be up to nine years. AIMS: To explore the acceptability of discussing ACP with people with memory problems and mild dementia shortly after diagnosis. METHODS: In-depth interviews were conducted with 12 patients and eight carers who had participated in ACP discussions and six staff members from a memory clinic and a community mental health team who had either conducted or attended the discussions for training purposes. RESULTS: Patients and carers found ACP a positive intervention that helped them think about the future, enabled people with dementia to make their wishes known, and resulted in their feeling relieved and less worried about the future. The importance of sharing the ACP documentation between health service providers was highlighted. CONCLUSIONS: This qualitative evaluation of ACP in early dementia has encouragingly positive results which support the wider application of the intervention in memory services and community mental health teams. Strategies are suggested to support the implementation of ACP further in clinical practice

Non-clinically trained facilitators’ experiences of remote psychosocial interventions for older adults with memory loss and their family carers

Background Dementia is the seventh leading cause of global mortality, with cases increasing. Psychosocial interventions might help prevent dementia and improve quality of life. Although it is cost-effective for non-clinically trained staff to deliver these, concerns are raised and little is known about the resulting impact on staff, especially for remote interventions.  Aims To explore how non-clinically trained facilitators experienced delivering remote, one-to-one and group-based psychosocial interventions with older adults with memory loss and their family carers, under training and supervision.  Method We conducted a secondary thematic analysis of interviews with non-clinically trained facilitators, employed by universities, the National Health Service and third-sector organisations, who facilitated either of two manualised interventions: the APPLE-Tree group dementia prevention for people with mild memory loss or the NIDUS-Family one-to-one dyadic intervention for people living with dementia and their family carers.  Results The overarching theme of building confidence in developing therapeutic relationships was explained with subthemes that described the roles of positioning expertise (subtheme 1), developing clinical skills (subtheme 2), peer support (subtheme 3) in enabling this process and remote delivery as a potential barrier to it (subtheme 4).  Conclusions Non-clinically trained facilitators can have positive experiences delivering remote psychosocial interventions with older adults. Differences in life experience could compound initial fears of being ‘in at the deep end’ and ‘exposed’ as lacking expertise. Fears were allayed by experiencing positive therapeutic relationships and outcomes, and by growing confidence. For this to happen, appropriate training and supervision is needed, alongside accounting for the challenges of remote delivery.</p