Challenges in dementia care: Comparing key issues from Brazil and the United Kingdom

The United Kingdom-Brazil Dementia Workshop took place in July 2019 in the city of Belo Horizonte, MG, Brazil, with an interdisciplinary group of health and care professionals from the United Kingdom and from Brazil to address challenges in diagnosis, public perception and care of dementia. The aim of this article is to present the results identified in relation to challenges in the care of dementia, including recommendations that could potentially guide local and State/Municipal authorities and care services for people with dementia in the future. Four key issues were prioritised to identify challenges and generate possible solutions in Brazil and the United Kingdom: I) limitations of current health systems; II) continuous and long-term support for family carers (pre-diagnosis, mourning); III) support for people with advanced dementia and end-of-life care; IV) support for people with young-onset dementia. In both countries, carers feel left without post-diagnostic support; information on the progression of dementia is lacking and some people do not even have a specific diagnosis; encouraging and providing training for carers best manage some of the symptoms is imperative; preparation for end of life care and support carers after the death of their loved ones remains highly needed; strengthening services and qualification of health professionals, also creating protocols to guide dementia-related services represent a common challenge to overcome. The authors outline recommendations according to the issues identified to assist future formulation of adequate policies and services for people with dementia and carers

Cognitive profile of older adults with diabetes study of FIBRA póle UNICAMP

Orientador: Mônica Sanches YassudaDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências MédicasResumo: O envelhecimento normal pode gerar declínio cognitivo significativo na memória, atenção e nas funções executivas. Diabetes Mellitus (DM) é uma desordem metabólica de múltiplas etiologias. Pesquisas sugerem que há conexão entre o DM e comprometimento cognitivo. O objetivo deste estudo foi descrever o perfil cognitivo de idosos com DM auto-referido, avaliados por meio do Mini Exame do Estado Mental (MEEM), comparados com idosos sem diabetes ou outras doenças, que eram participantes do estudo FIBRA Pólo UNICAMP, de base populacional realizado em sete localidades brasileiras. 741 participantes sem déficit cognitivo e sem hipertensão foram divididos em dois grupos: 1) idosos que relataram ser diabéticos (n=78) e 2) idosos que relataram não ter DM (n=663). Dentre os 78 idosos que relataram ser diabéticos, 67 relataram fazer tratamento farmacológico para DM e 11 relataram não fazer tratamento para DM. Os 741 participantes foram divididos ainda em faixas de escolaridade (0 anos, 1 a 4 anos e 5 ou mais anos de escolaridade) para análises de regressão. Os resultados das análises comparativas para a amostra total mostraram que os idosos com DM apresentaram pior desempenho na pontuação total do MEEM e no subdomínio Linguagem. Entre os idosos que possuíam entre 1 a 4 anos de escolaridade, os que tinham DM apresentaram pior escore nos subdomínios Linguagem e Atenção no MEEM. Não houve diferença significativa entre os idosos que fazem ou não fazem tratamento para DM. Na análise de regressão multivariada, no grupo com 1 a 4 anos de escolaridade, houve associação significativa entre ter DM e pior desempenho no subdomínio Linguagem. Idosos com DM apresentaram pior desempenho cognitivo no MEEM, em especial no subdomínio LinguagemAbstract: Normal aging can cause significant cognitive decline in memory, attention and executive functions. Diabetes Mellitus (DM) is a metabolic disorder of multiple etiologies. Research suggests there is a link between diabetes and cognitive impairment. The aim of this study was to describe the cognitive profile of seniors with self-reported DM, assessed by the Mini Mental State Examination (MMSE), compared with older adults without diabetes or other diseases, who were participants in the UNICAMP FIBRA study, a population-based survey conducted in seven Brazilian localities. 741 participants without cognitive impairment and without hypertension were divided into two groups: 1) seniors who reported being diabetic (n = 78) and 2) those who reported not having DM (n = 663). Among the 78 seniors who reported being diabetic, 67 reported using pharmacological treatment for DM and 11 reported not using treatment for DM. The 741 participants were further divided into bands of education (0 years, 1-4 years and 5 or more years of schooling) for the regression analyses. The results of the comparative analyses showed that seniors with DM had worse scores on the MMSE total score and in the Language sub-domain. Among participants who had between 1-4 years of schooling, those with DM had worse scores in the Language and Attention subdomains of the MMSE. There was no significant difference between senior with DM who do or do not use treatment for DM. In multivariate regression analyses, among those with 1-4 years of education, having DM was associated with worse scores in the MMSE Language sub-domain. Seniors with DM had worse cognitive performance in MMSE, especially in the Language sub-domainMestradoGerontologiaMestra em Gerontologi

Elderly Individuals with Diabetes: Adding Cognitive Training to Psychoeducational Intervention

The present research examined the effects of a cognitive training program combined with psychoeducational intervention for diabetic elderly patients. Specifically, it aimed at assessing the effects of an eight-session cognitive training and educational program in diabetic elderly individuals and investigating changes in their awareness about specific aspects of diabetes. The final sample consisted of 34 individuals-19 in the experimental group (EG) and 15 in the control group (CG), all residing in the eastern region of the city of Sao Paulo. The protocol included clinical and sociodemographic questions; the Diabetes Attitudes Questionnaire (ATT-19); Diabetes Knowledge Scale (DKN-A); Mini Mental State Examination (MMSE); Verbal Fluency-animal category (VF); Geriatric Depression Scale (GDS); Short Cognitive Performance Test (SKT); and the Rivermead Behavioral Memory Test (RBMT). Results pointed to a significant difference between the two groups for the ATT-19, DKN, and SKT-memory and SKT-total, and a marginally significant difference for the RBMT history in the posttest. As for the remaining cognitive variables, no changes were observed. Retest effects were not observed in the CG. We concluded that cognitive training combined with psychoeducational intervention in diabetic elderly individuals may be effective in producing cognitive gains as well as attitude and knowledge improvement concerning diabetes mellitus (DM)

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially