Dementia-friendly public toilets

Many older adults avoid travelling and social interaction because of the scarcity of public toilets or their inaccessibility. Furthermore, where public toilets are provided, poor design and signage can preclude independent use, particularly for people living with dementia | The Lancet

8443350049_ce3efa67f0_z

Image source: Martin Sotirov – Flickr // CC BY 2.0

In general, there is a gap between current public toilet provision and toilet design appropriate for individuals living with dementia, who might have behavioural change, poor level of motivation, loss of mobility and manual dexterity, or abnormalities in visual information processing. In response to research and anecdotal evidence, many guidelines are available to inform and improve the design and independent usability of toilet facilities for people living with dementia. Examples include the use of familiar or automatic flush systems, non-reflective surfaces, good lighting, contrast between doors and surroundings and between the toilet and toilet seat, sinks that do not resemble urinals, well labelled taps and soap dispensers, and the careful placing of mirrors.

However, as highlighted by a substantial amount of anecdotal evidence, the absence of simple and clear way-out signs negates any positive influence of a well designed toilet facility. Such an omission can result in distress, anxiety, embarrassment, and reluctance to use the toilet in the future. Common examples reported to investigators include instances of people having to enter opposite sex toilet facilities to guide their partners out, or going through the wrong door and into undesired or incorrect locations. A fire exit sign showing someone running with a directional arrow is also easily misunderstood as an exit sign, which can result in misdirection with people ending up outside the building and, in some cases, wandering on to a road. Similarly, doors that are both a fire exit and the route back to a public area can cause confusion, and might elicit a reluctance to open them, primarily because of the fear of setting off a fire alarm.

Full reference: Tales, A. et al. (2017) Dementia-friendly public toilets. The Lancet Vol. 390 (no. 10094) pp. 552–553

Advertisements

Effectiveness of dementia risk reduction messaging in NHS health checks.

NHS health check 40-64 dementia pilot research findings | Alzheimer’s Society

10774-2

The NHS Health Check programme is a statutory public health intervention commissioned by all local authorities in England. It aims to improve the health and wellbeing of adults aged 40-74 years through the promotion of earlier awareness, assessment, and management of the major risks factors and conditions driving premature death, disability and health inequalities in England.

The overall aim of the research was to evaluate the pilot and assess the feasibility of extending the NHS Health Check for 40-64 year olds to include a dementia risk reduction component. Specific objectives of the research included first, to understand the impact of the NHS Health Check on an individual’s knowledge and awareness of dementia risk reduction and the impact of the intervention on individuals’ intention to change behaviour.

The second objective was to identify (where sample sizes allowed) whether any differences in the delivery of the intervention between pilot sites had any effect on individual’s awareness and understanding of dementia risk reduction.

The third objective was to understand professional awareness and confidence in promoting dementia risk reduction messages and to identify further training requirements, resources and support.

The final objective was to assess any implications for services and commissioners and provide PHE with advice on any further longer-term evaluation that will be required.

Full report here

Is use of the internet in midlife associated with lower dementia incidence?

Study suggests that use of internet by individuals aged 50 years or older is associated with a reduced risk of dementia

student-849825_1920

Objectives: Dementia is expected to affect one million individuals in the United Kingdom by 2025; its prodromal phase may start decades before its clinical onset. The aim of this study is to investigate whether use of internet from 50 years of age is associated with a lower incidence of dementia over a ten-year follow-up.

Methods: We analysed data based on 8,238 dementia free (at baseline in 2002–2004) core participants from the English Longitudinal Study of Ageing. Information on baseline use of internet was obtained through questionnaires; dementia casesness was based on participant (or informant) reported physician diagnosed dementia or overall score on the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Cox proportional hazards regression analysis was used for examining the relationship between internet use and incident dementia.

Results: There were 301 (5.01%) incident dementia cases during the follow-up. After full multivariable adjustment for potential confounding factors, baseline internet use was associated with a 40% reduction in dementia risk assessed between 2006–2012 (HR = 0.60 CI: 0.42–0.85; p < 0.05).

Conclusion: This study suggests that use of internet by individuals aged 50 years or older is associated with a reduced risk of dementia. Additional studies are needed to better understand the potential causal mechanisms underlying this association.

Full reference: Eleonora d’Orsi, et al.  Is use of the internet in midlife associated with lower dementia incidence? Results from the English Longitudinal Study of Ageing
Aging and Mental Health |Published online: 10 Aug 2017

A comprehensive approach to reablement in dementia

As society grapples with an aging population and increasing prevalence of disability, “reablement” as a means of maximizing functional ability in older people is emerging as a potential strategy to help promote independence | Alzheimer’s & Dementia

This article presents a comprehensive reablement approach across seven domains for the person living with mild-to-moderate dementia. Domains include assessment and medical management, cognitive disability, physical function, acute injury or illness, assistive technology, supportive care, and caregiver support.

In the absence of a cure or ability to significantly modify the course of the disease, the message for policy makers, practitioners, families, and persons with dementia needs to be “living well with dementia”, with a focus on maintaining function for as long as possible, regaining lost function when there is the potential to do so, and adapting to lost function that cannot be regained. Service delivery and care of persons with dementia must be reoriented such that evidence-based reablement approaches are integrated into routine care across all sectors.

Full reference: Poulos, C.J. et al. (2017) A comprehensive approach to reablement in dementia. Alzheimer’s & Dementia. Published online: 28 July 2017

 

Dementia in older age: barriers to primary prevention and factors

Evidence review showing that changing some behaviours in midlife can reduce the chances of getting dementia in older age | PHE

watercolour-2053269_960_720.jpg

These documents help commissioners and researchers make decisions about prioritisation of primary prevention measures relevant to dementia.

This review, by the Personal Social Services Research Unit (PSSRU) at the London School of Economics and Political Science (2016), shows that there is evidence that the risk of dementia is increased by:

  • physical inactivity
  • current smoking
  • diabetes
  • hypertension in mid-life
  • obesity in mid-life and depression

It also shows that mental activity can reduce the risk of dementia.

To promote primary prevention of dementia, it is important to understand both the barriers to primary prevention and factors which facilitate primary prevention.

Read the full overview here

Mild Cognitive Impairment and Driving Cessation

Driving cessation is associated with significant morbidity in older people. People with mild cognitive impairment (MCI) may be at particular risk of this | Dementia and Geriatric Cognitive Disorders

stop-634941_960_720.jpg

Very little research has examined driving in this population. Given this, we sought to identify predictors of driving cessation in people with MCI.

One hundred and eighty-five people with MCI were recruited from 9 memory clinics around Australia. People with MCI and their carers reported their driving status and completed measures of cognition, function, neuropsychiatric symptoms, and medication use at regular intervals over a 3-year period.

Of the 144 people still driving at baseline, 50 (27.0%) stopped driving during the study. Older age, greater cognitive and functional impairment, and greater decline in cognition and function at 6 months predicted subsequent driving cessation. Twenty-nine of the 50 people (58%) who stopped driving were diagnosed with dementia during the study; all except one of whom ceased driving after their dementia diagnosis.

A significant proportion of people diagnosed with MCI stop driving over the following 3 years. This cannot be entirely attributed to developing dementia. Easily assessable characteristics – such as age, cognition, and function – and changes in these measures over 6 months predict driving cessation.

Full reference: Connors, M.H. et al. (2017) Mild Cognitive Impairment and Driving Cessation: A 3-Year Longitudinal Study. Dementia and Geriatric Cognitive Disorders. Vol. 44 (no. 1-2) pp. 63-70

Dementia numbers set to rise to 1.2 million by 2040 in England & Wales

Experts are predicting that there will be 1.2 million people in England and Wales living with dementia by 2040 – a rise of 57% from 2016 – due to increased life expectancy.

upwards.png

A study  published in The BMJ  says that although the number of newly diagnosed cases of dementia is falling, the overall prevalence will increase substantially as people live longer and deaths from other causes, such as heart disease, continue to decline.

The team of researchers  based at University College London (UCL) and the University of Liverpool, set out to predict the future burden of dementia with more certainty by developing a mathematical model that takes account of disease trends and death rates alongside the effects of increasing life expectancy.  They calculated that there were currently 767,000 people living with dementia in England and Wales and the number would increase to more than 1.2 million by 2040.

Full story at OnMedica

Full reference: Ahmadi-Abhari, S et al.  Temporal trend in dementia incidence since 2002 and projections for prevalence in England and Wales to 2040: modelling study BMJ Published 05 July 2017