- Email: [email protected]
Does the management of people with dementia differ in rural general practice compared to urban general practice?
Poster Presentations P1 complex ethical, legal, and social issues due to their progressive incapacity to provide valid consent for participation in research. Researchers in aging and Institutional Review Boards (IRB) should be knowledgeable of the rules enacted in their jurisdiction to protect this vulnerable population. Using a pre-tested postal questionnaire, we surveyed all French researchers in aging and IRB members to 1) assess their knowledge of the legislation governing proxy consent for research in decisionally-incapacitated subjects, and 2) elicit their opinions regarding the person best suited to provide proxy consent for research purposes. Methods: Knowledge and opinions were measured with vignettes describing hypothetical research situations involving Alzheimer’s disease patients. For each vignette, respondents were asked to either identify the person legally authorized to consent or choose the substitute decision-maker whom they considered best suited to consent. Results: The sample comprised 122 researchers and 332 IRB members, for an overall response rate of 31.4%. Knowledge was worse for vignettes describing incompetent adults who had not been appointed a legal representative. In these situations, the correct answer rates ranged from 15.4% to 41.6%. In hypothetical studies presumed to carry little risk for the subjects, 59% of researchers and 55% of IRB members favored consent from close relatives. As the postulated risks became serious, the proportions gradually decreased (p<0.001) to 18% and 13%, respectively. In such instances, one out of three respondents preferred excluding cognitively impaired older adults, regardless of their legal status. Conclusions: The observed lack of knowledge strongly argues for better educating French researchers in aging and IRB members about legal provisions that may limit the participation of Alzheimer’s disease patients in clinical research. Survey findings also provide some support for recent changes to the French legislation which now allows close relatives to consent on behalf on incapable subjects for low-risk studies. P1-198
COMPARATIVE EFFICACY OF RISPERIDONE VERSUS YI-GAN SAN ON BEHAVIOURAL AND PSYCHOLOGICAL SYMPTOMS OF DEMENTIA
P1-199
P235 DOES THE MANAGEMENT OF PEOPLE WITH DEMENTIA DIFFER IN RURAL GENERAL PRACTICE COMPARED TO URBAN GENERAL PRACTICE?
Angela M. Greenway-Crombie1, Sam Davis1, Peter Disler1, Dimity Pond2, Jessica Swain2, 1Monash University, Bendigo, Australia; 2University of Newcastle, Callaghan, Australia. Contact e-mail: acrombie@ bendigohealth.org.au Background: The substantial ageing of the Australian population has provoked a ‘dementia epidemic’ which has far-reaching consequences for people with dementia, their carers and for the health system in meeting increasing demand for services. The health status of the rural elderly is poorer than that of their urban counterparts. A study is currently being undertaken in Australia examining the detection and management of dementia in general practice. This presentation will explore some of the differences in the management of people with dementia in rural compared to urban general practice. Methods: General Practitioners (GPs) participating in the study were asked to complete an audit form for patients whom they had diagnosed with definite, probable or possible dementia. The audit form asks GPs to indicate what pathology, radiology or pencil and paper tests they ordered in relation to memory problems and whether they have referred the patient to any services in relation to the memory problems. GPs from four urban centres in three different Australian States and one regional centre (that includes three rural towns) are participating in the study. Results: Results from the preliminary analysis of the audit data will highlight differences in tests and referrals for patients with dementia by rural and urban GPs. Conclusions: The relevance of results will be discussed in relation to Australian evidence based management guidelines for dementia. The discussion will consider these issues from a rural versus urban perspective. P1-200
HOW CAREGIVERS PROVIDE FOR THE HEALTH CARE OF RESIDENTS WITH DEMENTIA IN ASSISTED LIVING FACILITIES
Yuko Furuhashi1, Kouichi Shin2, Hisatomo Oshima2, Shusuke Furuhashi3, 1 Shisuoka University, Shizuoka-city, Japan; 2Asahi Hospital, Sayama-city, Japan; 3National Printing Bureau, Tokyo, Japan. Contact e-mail: [email protected]
Tara J. Sharpp, Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, CA, USA. Contact e-mail: tara.sharpp@ucdmc. ucdavis.edu
Background: Behavioral and psychological symptoms are common and distressing symptoms in patients with Alzheimer’s disease (AD). Management of behavioral and psychological symptoms of dementia (BPSD) has not been standardized. Typical antipsychotic drugs are only modestly effective and have potentially serious adverse effects that limit their usefulness in older adults. Compared with typical antipsychotic agents, atypical antipsychotics are thought to be less likely to cause extrapyramidal symptoms such as parkinsonism and tardive dyskinesia. Recently, traditional herbal medicines have been reported to be effective for BPSD. Controlled trials have demonstrated the safety and efficacy of the traditional herbal medicine Yi-Gan San (YGS, yokukansan in Japanese) monotherapy for patients with AD. This study is aimed to compare the efficacy and safety of YGS and risperidone in the treatment of BPSD in institutionalized elderly Japanese patients with AD. Methods: Twenty five in-patients with AD were investigated. Patients were randomly assigned to the YGS group (N¼12) or the risperidone group (N¼13) and treated for 4 weeks. BPSD were evaluated using the Neuropsychiatric Inventory (NPI) and the Cohen-Mansfield Agitation Inventory (CMAI). Cognitive functions were evaluated using the Mini-Mental State Examination (MMSE). Activities of daily living (ADL) were evaluated using the Barthel Index. These measurement scales were administered at baseline and the end of the treatment. The frequency of extrapyramidal symptoms (EPS) and other adverse events were recorded. Results: All participants in both groups completed the trial. Both YGS and risperidone were efficacious in alleviating BPSD. The MMSE and the Barthel Index did not significantly change either in the YGS group or the risperidone group. No adverse effects were observed in the YGS group, while one somnolence was noted in the risperidone group. Conclusions: In this 4-week trial, Yi-Gan San was as effective as risperidone in treating BPSD in patients with Alzheimer’s disease. The present study suggests that YGS is effective and well-tolerated for patients with BPSD.
Background: Assisted living facilities (ALFs) are growing worldwide as a housing option for older adults with Alzheimer’s disease or related dementias. It is estimated that over 50% of the residents in ALFs in the United States have some form of cognitive impairment. The only requirements for caregivers in ALFs in California are to have a criminal background check and to receive ten hours of training at the facility. Registered nurses (RNs) or other health care personnel are not required to be employed in ALFs in California. The purpose of this presentation is to describe and analyze how paid caregivers provide for the health care of residents with dementia in ALFs. Methods: An ethnographic study was conducted in an ALF that specializes in dementia care. Over 100 hours of participant observation were conducted over a period of six months. Chart reviews were completed on all residents (n¼35) and formal, semi-structured interviews were completed with all employees (n¼20). In addition, formal or informal interviews were completed with available family members (n¼5) and four focus groups were conducted with the caregivers. The data were transcribed and analyzed for themes regarding how caregivers in ALFs provide for residents’ health care. Results: The residents in this facility had numerous medical, physical, and functional needs similar to residents in skilled nursing facilities. The residents needed help with an average of 4.6 activities of daily living and all of the residents needed their medications administered by the staff. Numerous problems in the delivery of health care were observed, including how residents were monitored and assessed for changes in conditions, how medications were administered, and the use of universal precautions. 40% of the residents were admitted to the hospital over six months, many for preventable conditions such as infectious diseases or improper use of medications. Conclusions: The problems in the provision of health care observed in this facility demonstrate the need for improved supervision and education of the caregivers. The employment of RNs or other health care professionals may improve care.
COMPARATIVE EFFICACY OF RISPERIDONE VERSUS YI-GAN SAN ON BEHAVIOURAL AND PSYCHOLOGICAL SYMPTOMS OF DEMENTIA
P1-199
P235 DOES THE MANAGEMENT OF PEOPLE WITH DEMENTIA DIFFER IN RURAL GENERAL PRACTICE COMPARED TO URBAN GENERAL PRACTICE?
Angela M. Greenway-Crombie1, Sam Davis1, Peter Disler1, Dimity Pond2, Jessica Swain2, 1Monash University, Bendigo, Australia; 2University of Newcastle, Callaghan, Australia. Contact e-mail: acrombie@ bendigohealth.org.au Background: The substantial ageing of the Australian population has provoked a ‘dementia epidemic’ which has far-reaching consequences for people with dementia, their carers and for the health system in meeting increasing demand for services. The health status of the rural elderly is poorer than that of their urban counterparts. A study is currently being undertaken in Australia examining the detection and management of dementia in general practice. This presentation will explore some of the differences in the management of people with dementia in rural compared to urban general practice. Methods: General Practitioners (GPs) participating in the study were asked to complete an audit form for patients whom they had diagnosed with definite, probable or possible dementia. The audit form asks GPs to indicate what pathology, radiology or pencil and paper tests they ordered in relation to memory problems and whether they have referred the patient to any services in relation to the memory problems. GPs from four urban centres in three different Australian States and one regional centre (that includes three rural towns) are participating in the study. Results: Results from the preliminary analysis of the audit data will highlight differences in tests and referrals for patients with dementia by rural and urban GPs. Conclusions: The relevance of results will be discussed in relation to Australian evidence based management guidelines for dementia. The discussion will consider these issues from a rural versus urban perspective. P1-200
HOW CAREGIVERS PROVIDE FOR THE HEALTH CARE OF RESIDENTS WITH DEMENTIA IN ASSISTED LIVING FACILITIES
Yuko Furuhashi1, Kouichi Shin2, Hisatomo Oshima2, Shusuke Furuhashi3, 1 Shisuoka University, Shizuoka-city, Japan; 2Asahi Hospital, Sayama-city, Japan; 3National Printing Bureau, Tokyo, Japan. Contact e-mail: [email protected]
Tara J. Sharpp, Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, CA, USA. Contact e-mail: tara.sharpp@ucdmc. ucdavis.edu
Background: Behavioral and psychological symptoms are common and distressing symptoms in patients with Alzheimer’s disease (AD). Management of behavioral and psychological symptoms of dementia (BPSD) has not been standardized. Typical antipsychotic drugs are only modestly effective and have potentially serious adverse effects that limit their usefulness in older adults. Compared with typical antipsychotic agents, atypical antipsychotics are thought to be less likely to cause extrapyramidal symptoms such as parkinsonism and tardive dyskinesia. Recently, traditional herbal medicines have been reported to be effective for BPSD. Controlled trials have demonstrated the safety and efficacy of the traditional herbal medicine Yi-Gan San (YGS, yokukansan in Japanese) monotherapy for patients with AD. This study is aimed to compare the efficacy and safety of YGS and risperidone in the treatment of BPSD in institutionalized elderly Japanese patients with AD. Methods: Twenty five in-patients with AD were investigated. Patients were randomly assigned to the YGS group (N¼12) or the risperidone group (N¼13) and treated for 4 weeks. BPSD were evaluated using the Neuropsychiatric Inventory (NPI) and the Cohen-Mansfield Agitation Inventory (CMAI). Cognitive functions were evaluated using the Mini-Mental State Examination (MMSE). Activities of daily living (ADL) were evaluated using the Barthel Index. These measurement scales were administered at baseline and the end of the treatment. The frequency of extrapyramidal symptoms (EPS) and other adverse events were recorded. Results: All participants in both groups completed the trial. Both YGS and risperidone were efficacious in alleviating BPSD. The MMSE and the Barthel Index did not significantly change either in the YGS group or the risperidone group. No adverse effects were observed in the YGS group, while one somnolence was noted in the risperidone group. Conclusions: In this 4-week trial, Yi-Gan San was as effective as risperidone in treating BPSD in patients with Alzheimer’s disease. The present study suggests that YGS is effective and well-tolerated for patients with BPSD.
Background: Assisted living facilities (ALFs) are growing worldwide as a housing option for older adults with Alzheimer’s disease or related dementias. It is estimated that over 50% of the residents in ALFs in the United States have some form of cognitive impairment. The only requirements for caregivers in ALFs in California are to have a criminal background check and to receive ten hours of training at the facility. Registered nurses (RNs) or other health care personnel are not required to be employed in ALFs in California. The purpose of this presentation is to describe and analyze how paid caregivers provide for the health care of residents with dementia in ALFs. Methods: An ethnographic study was conducted in an ALF that specializes in dementia care. Over 100 hours of participant observation were conducted over a period of six months. Chart reviews were completed on all residents (n¼35) and formal, semi-structured interviews were completed with all employees (n¼20). In addition, formal or informal interviews were completed with available family members (n¼5) and four focus groups were conducted with the caregivers. The data were transcribed and analyzed for themes regarding how caregivers in ALFs provide for residents’ health care. Results: The residents in this facility had numerous medical, physical, and functional needs similar to residents in skilled nursing facilities. The residents needed help with an average of 4.6 activities of daily living and all of the residents needed their medications administered by the staff. Numerous problems in the delivery of health care were observed, including how residents were monitored and assessed for changes in conditions, how medications were administered, and the use of universal precautions. 40% of the residents were admitted to the hospital over six months, many for preventable conditions such as infectious diseases or improper use of medications. Conclusions: The problems in the provision of health care observed in this facility demonstrate the need for improved supervision and education of the caregivers. The employment of RNs or other health care professionals may improve care.