Non-genetic risk and protective factors for sporadic degenerative and vascular young onset dementia

Young onset dementia (with symptom onset before age 65, YOD) has a significant personal and public health impact. Despite this, little is known about its cause and non-genetic factors have been sparsely investigated. Existing studies have not considered the timing or severity of exposure, which is important in late onset dementia (LOD). They have also failed to exclude directly-inherited cases and those occurring secondarily to another disease. This thesis examined the risk for sporadic degenerative and vascular YOD associated with six selected non-genetic factors: cognitive reserve enhancing factors, cardiovascular risk factors, smoking, depression, alcohol use, and traumatic brain injury (TBI). It established the role of exposure timing and severity, as well as interrelationships existing between factors. Data were taken from two epidemiological studies conducted in Sydney, Australia, one of which exclusively included Aboriginal and Torres Strait Islander participants. Dementia diagnosis was confirmed via clinical consensus and risk exposure was retrospectively self- and/or informant-reported. Participants were 96 people with YOD (58.4% with Alzheimer’s disease) and 179 age-group and sex matched control participants. Poor educational attainment, low lifetime participation in cognitive leisure activity, stroke or TIA, smoking, and heavy alcohol use were significantly related to risk for primary degenerative and vascular YOD. Some compensation for low educational attainment was possible via a complex occupation later in life. The effect of hypertension and depression varied depending on when they occurred relative to dementia onset. There was no effect of mild-moderate alcohol use, hypercholesterolemia, diabetes, or TBI of any kind. Cumulative risk exposure was detrimental, particularly where lack of access to or participation in cognitive-reserve enhancing factors clustered with cardiovascular risk factors. The results of this thesis suggest that non-genetic factors have a role in YOD as they do in LOD. Compared with their same-age peers, people with YOD experience a lifetime of disadvantage starting from early in life. The timing and severity of exposure, as well as the potential for compensation with later protective exposures, are important considerations. Efforts to address early life disadvantage and facilitate upward social mobility will be beneficial in delaying dementia to later in life

Single- and double-scattering production of four muons in ultraperipheral PbPb collisions at the Large Hadron Collider

We discuss production of two $\mu^+\mu^-$ pairs in ultraperipheral ultrarelativistic heavy ion collisions at the LHC. We take into account electromagnetic (two-photon) double-scattering production and for a first time direct $\gamma\gamma$ production of four muons in one scattering. We study the unexplored process $\gamma \gamma \to \mu^+\mu^-\mu^+\mu^-$. We present predictions for total and differential cross sections. Measurable nuclear cross sections are obtained and corresponding differential distributions and counting rates are presented.Comment: 13 pages, 11 figures, 1 tabl

Neuropsychiatric symptoms of dementia in those with and without a recorded history of psychological trauma: A comparative study from an Australian dementia support service

Objective: To compare the number and severity of neuropsychiatric symptoms (NPS) and associated caregiver distress between those with and without a noted history of psychological trauma among those referred to a specialised national dementia NPS support service. Methods: This was a 5-year retrospective observational study of records from the Dementia Support Australia NPS support service. NPS were reported by formal or informal caregivers at service entry using the Neuropsychiatric Inventory Nursing Home version or Questionnaire version. A history of psychological trauma was recorded in the person\u27s social or medical history and/or endorsed as a contributor to NPS by a trained dementia consultant after a comprehensive clinical review. Regression was used to examine the impact of a recorded history of psychological trauma on NPS severity and associated caregiver distress, controlling for age and sex. Results: Among 41,876 eligible referrals with dementia, 6% (n = 2529) had some reference in their records to a history of psychological trauma. Referrals with a recorded history of psychological trauma were rated with a higher rate of both NPS severity (mean = 12.0) and associated caregiver distress (mean = 16.5) at service entry than those without a recorded history of psychological trauma (means = 10.7 and 14.5, respectively). A recorded history of psychological trauma was associated with higher odds of psychotic symptoms, agitation/aggression, irritability, disinhibition, affective symptoms and night-time behaviours. Conclusions: Traumatic stress symptoms may represent a neglected target for intervention to reduce the impact of NPS in people with dementia

Is there still a need for abortion-specific laws? the capacity of the health framework to regulate abortion care

After prolonged periods of criminalisation, 20th and 21st century law reform has now moved abortion care closer to being regulated as health care in all Australian jurisdictions. However, no jurisdiction has yet tested the proposition that specific laws for abortion care are unnecessary. This article analyses the capability of health law, policy and ethics to regulate abortion comprehensively, without the need for either stand-alone laws or special provisions within health law. We examined this question in the South Australian context and concluded that the health framework provides the basis for equitable, safe and accountable abortion care that is also acceptable to the community

Rehabilitation in dementia care

The Accepted Manuscript (AM) is the final draft author manuscript, as accepted for publication by a journal, including modifications based on referees’ suggestions, before it has undergone copyediting, typesetting and proof correction. This is sometimes referred to as the post-print version. © The Author 2017. Published by Oxford University Press on behalf of the British Geriatrics Society.All rights reserved. For permissions, please email: [email protected] rehabilitation is increasingly accepted as valuable in the management of chronic disease. Whereas traditional rehabilitation models focussed on recovery, maintaining independence and delaying functional decline are now considered worthwhile aims even where full recovery is not feasible. Despite this, rehabilitation is notably absent from dementia care literature and practice. People with dementia report frustration with the lack of availability of structured post-diagnosis pathways like those offered for other conditions. Alternative terms such as ‘re-ablement’ are used to refer to rehabilitation-like services, but lack an evidence-base to guide care. This commentary will discuss possible reasons for the resistance to accept multidisciplinary rehabilitation as part of dementia care, and identifies the value of doing so for people with dementia, their families, and for health professionals

A cross-country comparison of family carers experiences with residential aged care facilities during the COVID-19 pandemic

Background:The number of research projects into residential aged care (RAC) during the COVID-19 pandemic is increasing, however there are limited data on the cross-country comparison of experiences residents living with dementia and their families. Our study aimed to 1) give an overview of the RAC restrictions and changes (visiting policy, governmental & health authorities' advice, service delivery) implemented during the pandemic in Australia, Italy and the UK and 2) and their impact on people with dementia in RAC facilities and their families.Methods:A total of 56 informal family carers of people with dementia residing in RAC took part in semi- structured interviews over the telephone or via Skype in Australia (n=6), Italy (n=25) and the UK (n=26) between July 2020 and March 2021. The interviews were recorded and translated verbatim. Transcripts were analysed by researchers in each country using thematic analysis, then combined across sites.Results:Inductive thematic analysis identified four overarching themes: 1) Adaptations implemented in RAC facilities due to the COVID-19 pandemic in Australia, Italy and the UK; 2) means of communication between RAC facility personnel, people with dementia living in RAC and family members; 3) impact of the implemented restrictions and changes in care provision due to the COVID-19 pandemic on people with dementia in RAC facilities and 4) impact of the implemented restrictions and changes in care provision due to the COVID-19 pandemic on families of people with dementia in RAC facilities. While differences between countries and facilities were identified, the restrictions and changes within the residential care system impacted families' well-being, increased their worries about care quality and safety of people with dementia. The consequences of a lack or modified services for people with dementia included noticeable physical and mental health changes. Although the majority of the facilities implemented some form of video-communication between families and residents, those solutions were unable to replace face-to-face contact.Conclusions:These findings demonstrate the need for implementing safe solutions which might facilitate more frequent in-person contact between families and residents with dementia preventing consequences in mental and physical health in both groups

Delivering Trauma-Informed Care in a Hospital Ward for Older Adults With Dementia: An Illustrative Case Series

IntroductionUp to 70% of older adults have experienced a psychologically traumatic event in their life. Traumatic events can have lifelong effects on functioning and emotion regulation and can affect behavior and experiences in care settings. Common healthcare practices and environments can be re-traumatizing for trauma survivors. These features may trigger behavior change (e.g., aggression and agitation) particularly after the onset of dementia. However, very little research exists to understand how the effects of traumatic events manifest in aged care settings. Trauma-informed care is a framework in which the potential impact of trauma is acknowledged, and practices and procedures are adapted to maximize feelings of control and safety for the patient. Trauma-informed care is an innovative approach with little published evidence in acute geriatric settings.MethodsWe present a series of cases to demonstrate how psychological trauma can affect the experience of inpatient care for older people. The cases detail the patients' relevant background, triggers and behaviors followed by the steps taken by staff to support the patient and respond to their trauma-related needs. These cases describe how the principles of trauma-informed care can be applied to recognize when past psychologically traumatic events are impacting the older adult in hospital. The outcomes of these interventions are reported on in terms of their impact on challenging behavior, patient experiences and satisfaction with care, and/or staff confidence and skill.FindingsA range of past events negatively impacted the patients during their time in hospital, including childhood abuse, military service, and domestic violence. Staff implemented strategies to accommodate trauma-related needs while providing care that improved safety and reduced patient distress. Principles of trauma-informed care were applied where able, including providing choices and enabling autonomy. However, organizational and environmental features of inpatient wards continued to pose risks for re-traumatisation.ConclusionsTrauma-informed care is an under-utilized yet potentially beneficial approach to care for older adults in the hospital setting. The cases detailed here demonstrated that the impact of psychological trauma requires an individualized response from staff which when effectively implemented can promote staff and patient safety, reduce the risk of re-traumatisation, and minimize adverse events

Social health of people with dementia during the SARS-CoV-2 pandemic

Background:Limited access to medical and social services during the coronavirus outbreak has contributed to the exclusion of vulnerable populations, such as people with dementia and older adults. These limitations and the resulting social isolation have highlighted the importance of social relationships and their relationship to the mental health of these people. In the context of dementia, 'social health' (SH) can be defined as the role of social abilities for achieving a dynamic balance between opportunities and limitations. The concept encompasses the capacity and independency of an individual to participate in social activities alongside the influences of the surrounding social network.Methods:Using a qualitative and quantitative approach, we will present social health and its determinants of people with dementia related to social care service closures and self-isolation during the SARS-CoV-2 pandemic. We present an analysis of the survey data from the cross-country population- based study and the semi-structured telephone interviews with people with and without dementia from Poland, UK, Australia and Italy aged 65 and over.Results:Measuring the Social Health Index in relation to experiencing self-isolation and changes in the use of services before and during the pandemic among the people with dementia, allow us to identify the level of SH and its determinants. Also, the qualitative results revealed the indirect consequences of the pandemic-related restrictions in the access to social care service and social isolation. Reduction of social support was significantly related to deficits in social health and well-being.Conclusions:Our results highlight the emerging impact of health the current global epidemiological situation upon social health, with a particular focus on those affected by social disadvantage and isolation

Health Professional Perspectives on Rehabilitation for People With Dementia

© The Author(s) 2019. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. This author accepted manuscript is made available following 12 month embargo from date of publication (February 2019) in accordance with the publisher’s archiving policyMultidisciplinary rehabilitation is not incorporated into the usual care pathway for dementia despite increasing demand from key advocates. Clinician views regarding the relevance of rehabilitation in dementia care are not well known. This qualitative study explored the perspectives of health professionals regarding barriers to provision of multidisciplinary rehabilitation programs for people with dementia