- Email: [email protected]
Frequency and type of medication errors by dementia caregivers
Poster Presentations: P3 compared to drivers without cognitive impairment. Results: This study provides information on the extent to which insight into driving competence impacts upon the use of self regulatory driving strategies for drivers with cognitive impairment compared to those without. Conclusions: The findings have important implications for understanding selfimposed driving practices of older adults with cognitive decline. The identification of the most frequently used driving strategies could assist policy makers and licensing authorities with promoting safe driving behaviours to enable older drivers with cognitive impairment to maintain safe driving.
P3-283
THE EFFECT OF SYSTEMIC AGMATINE ADMINISTRATION ON WATER MAZE MEMORY ACQUISITION, CONSOLIDATION AND RETRIEVAL
Golnaz Yadollahi Khales, Atefeh Khajeh, Maryam Moosavi, Shiraz University of Medical Sciences, Shiraz, Iran. Background: Agmatine is an endogenous polyamine derived from enzymatic decarboxylation of L-arginine. It is present in brain and other mammal’s tissues. In the brain, agmatine exists in hypothalamus, hippocampus, cortex, locus ceruleus, red nucleus and forebrain. The presence of agmatine in the hippocampus suggests that agmatine may be involved in water maze learning and memory. Previous reports about the effects of exogenously administered agmatine on hippocampal function were controversial; some of them have reported that agmatine can improve memory; some have suggested that agmatine can deteriorate memory and the others have reported that agamatine does not interfere with learning and memory. In the present study the effect of systemic agmatine injection on acquisition, consolidation and retrieval of water maze reference memory is examined. Methods: Adult male SpragueDawely rats weighing 250-350 were trained in a single session consisting of 8 trials. The probe test was done 24 hours later to assess memory retention. To assess the effect of agmatine on acquisition, it (40mg/kg/ ip) was administered 30 minutes before training; to assess its effect on consolidation phase, it was injected immediately after training and to assess its effect on retrieval, it was injected 30 minutes before probe trial. Results: The results showed that post-training administration of agmatine improves learning. Post-training and pre-probe administration of agmatine have not any effects on animal’s performance in probe trial. Conclusions: It seems that agmatine is involved in memory consolidation.
P3-284
LONG-TERM PRACTICE OF SALAT PREVENTS ALZHEIMER’S DISEASE IN HUMANS: ORIGINAL STUDY
Shafi Shaafi1, Harish Kulkarni2, 1Kannur Medical College and Superspecialty Hospital, Anjarakandy, Kannur, India; 2Mandya Institute of Medical Sciences, Mandya, Karnataka, India. Background: In the absence of a proven therapy, physical-mental exercises are considered as alternate tools for preventing Alzheimer’s disease (AD). Salat is a physical-mental activity model, performed throughout lifetime by over a billion people at exact prescribed 5-times daily from dusk to dawn. On an average a person who practices Salat performs 70 pro-gravity postures (prostrations)/day or 2.0 million prostrations /year. Salat involves repetitive body movements simultaneously requiring recitation/speech, memory recall, hearing, attention, judgment to start and end the task, calculation, concentration, sense of time, location, direction, hygiene, self-discipline and other executive functions such as washing and dressing, the very abilities destroyed during AD. This is an Indo-American study, sponsored by Human Service International-USA and Kannur Medical College Superspecialty Hospital, India, Methods: Volunteers aged 60-8065 were randomly selected.
P559
Mini-Mental-State-Exam (MMSE) and Mini-cog/Clock Draw Test (CDT) was administered. Demented volunteers were further tested to rule out causes of dementia other than AD. Three groups were formed from the final pool, namely: Salat Group (SG: n¼2500, with a history of Salat practice for at least 5 years prior to study); Non-Salat Group (NSG: n¼2800 with no history of Salat).NSG-volunteers with MMSE score lower than 5 were put to 3-years Salat test (NSG-s n¼1500). MMSE, CDT scores and serum lipids data collected before, during (6-month intervals) and at the end of 3-years) Results: At baseline SG scored 2961.0 on MMSE and 3.0 on Mini-cog with normal CDT. Serum Lipid profile was within the normal reference range. In contrast, NSG scored 1162 or lower on MMSE and serum total lipids were 20-25% higher than the maximum reference range (p<0.001). Data collected at 6 months intervals showed no change in SG till the end of 3-years. The NSG condition deteriorated over time reflected by lower MMSE and elevation in serum lipid profile. Interestingly, NSG-s showed a steady increase in MMSE and Mini-cog scores with time and significant decreases (p<0.001) in serum total lipids, cholesterol, LDL and VLDL. Conclusions: Long-term practice of Salat may improve cognition, lower blood lipids and may prevent Alzheimer’s disease. Further investigations are needed to understand the exact mechanism of Salat on mental health.
P3-285
FREQUENCY AND TYPE OF MEDICATION ERRORS BY DEMENTIA CAREGIVERS
Jennifer Lingler, Lisa Tamres, Melissa Knox, Janet Arida, Carolyn Amspaugh, Judith Erlen, University of Pittsburgh, Pittsburgh, Pennsylvania, United States. Background: Reducing medication errors is a high priority patient safety issue in formal health care settings, yet medication errors in the community setting have received considerably less attention. Prior research has shown that dementia family caregivers are slow to assume responsibility for administering patients’ medications, often waiting until safety issues are overt. The objective of this study was to characterize the scope and nature of errors made, and problems encountered, by dementia caregivers who assume involvement in patients’ medication management. Methods: We examined baseline data from the first 50 patient-caregiver dyads to be screened for participation in a randomized controlled trial of a problem-solving intervention to promote safe medication management practices on the part of dementia family caregivers. In-home assessments of medication management practices were performed using direct observation [Medication Management Instrument for Deficiencies in the Elderly (MedMaIDE)] and caregiver self-report [a 15-item medication deficiencies checklist (MDC)]. Measures of patient and caregiver sociodemographic and clinical characteristics were used to identify potential correlates of unsafe or otherwise problematic medication management practices. Results: Over half of the dyads screened (62%) exhibited multiple problematic medication practices (MDC range 0-8; mean ¼ 2.7, s.d. 1.86). The most commonly reported problematic practices were administering medications at the wrong time (47.3%), losing or dropping pills during administration (27.3%), and forgetting to administer medications (26.6%). Having at least one problematic practice was positively associated with the total number of daily medications taken by the patient (F ¼ 4.30 (1, 47), P <.05). Rates of problematic practices did not differ by the degree of patient cognitive impairment, severity of caregiver burden, or in association with patient or caregiver sociodemographic characteristics. Rather, higher levels of depressive symptoms among patients (r ¼ .365, P ¼ .01), and greater medical comorbidity among patients (r ¼ .395; P < .01) and caregivers (r ¼ .357; P ¼ .01) were associated with more problematic practices. Conclusions: Medication errors and related problems occur frequently in dementia care dyads, particularly those with multiple medical comorbidities. Longitudinal investigations are needed to determine how these problems impact
P560
Poster Presentations: P3
quality of life and health resource utilization, and to assess their amenability to intervention.
P3-286
DESIGNING AND VALIDATING A QUESTIONNAIRE TO ASSESS THE IMPACT OF CAREGIVING ON PATIENTS WITH DEMENTIA IN COLOMBIA
Juan Vargas1, Mario Munoz-Collazos1, Eugenia Solano1, Gabriel Torres2, Javier Triana3, Blanca Janneth Hernandez4, 1Clinica Marly, Bogota, Colombia; 2Hospital Santa Clara, Bogota, Colombia; 3 Hospital el Tunal, Bogota, Colombia; 4Universidad del Rosario, Bogota, Colombia. Background: Information on the psychosocial burden experienced by Colombia caregivers, as a result of the patient’s symptoms, is scarce. Our goal was to design and validate a questionnaire to evaluate the impact of caregiving on caregivers due to of patient’s symptoms. Methods: We gathered a group of professionals with experience in dementia. This group proposed which domains could affect the caregivers and elaborated the questions. Then using caregivers of patients with dementia, from four neurology services in Bogota-Colombia, we conducted focus groups; they discussed which aspects affect their lives, and then scored each proposed questions. Questions with higher scores were retained, maintaining 2-3 questions per domain. Questions that were not understood by caregivers were rewritten until all were understood. Chronbach alpha was determined for internal consistency. The validity was determined by a convergent construct between the results of our questionnaire and the presence of symptoms of anxiety, depression and impaired quality of life measured by validated Colombian Spanish versions of Hospital Anxiety and Depression scale (HADS) and SF36v2. These scales were applied to 100 caregivers. Nonparametric correlation tests were used. The test-retest reproducibility was assessed on 50 caregivers after 45 days and determined by Intraclass Correlation Coefficient (ICC) between the results of both applications. Results: Caregivers and professionals found that an instrument should include the domains of mood, functionality, caregiver symptoms, cognition and behavioral alterations. The internal consistency yielded a Cronbach alpha of 0.93. We obtained a moderate correlation between our scale and the domain of depression and a low correlation with the domain of anxiety. We found a significantly higher median score in our questionnaire in patients with symptoms of depression (112vs87, p¼0.001) and anxiety symptoms (114.5vs.78.5, p<0.001). The correlation between our scale and
Table 1 Internal consistency of the scale of caregivers’ assessment in dementia; Chronbach alpha 0.9364. Average inter-item correlation 0.4239.
Item/a
N
Sign
Item-test correlation
1/0.9366 2/0.9316 3/0.9318 4/0.9348 5/0.9314 6/0.9340 7/0.9349 8/0.9344 9/0.9333 10/0.9314 11/0.9350 12/0.9366 13/0.9317 14/0.9324 15/0.9341 16/0.9309 17/0.9327 18/0.9294 19/0.9341 20/0.9327
60 114 95 85 107 100 92 88 77 94 84 63 103 103 85 105 79 112 61 98
+ + + + + + + + + + + + + + + + + + + +
0.4529 0.7432 0.7340 0.5813 0.7596 0.6452 0.6124 0.5962 0.6710 0.7571 0.5770 0.4504 0.7276 0.7073 0.6250 0.7698 0.6696 0.8136 0.5679 0.7180
Item-rest correlation
Average inter-item covariance
0.3834 0.6910 0.6824 0.5199 0.7125 0.5808 0.5518 0.5330 0.6179 0.7153 0.5119 0.3735 0.6776 0.6516 0.5648 0.7239 0.6116 0.7723 0.5093 0.6625
0.4373 0.4176 0.4183 0.4302 0.4170 0.4269 0.4304 0.4283 0.4239 0.4167 0.4310 0.4375 0.4181 0.4207 0.4272 0.4148 0.4220 0.4095 0.4274 0.4219
SF36v2 physical health domain was significant; in mental health domain, only the emotional function correlated. The reproducibility between applications was high for the total score and moderate for most of the individual domains (ICC¼0.74). Conclusions: We design and validate an instrument to assess the impact of dementia patients’ symptoms on Colombia caregivers.
P3-287
WHEN DEMENTIA IS IN THE HOUSE 1
Tiffany Chow , Katherine Nichols2, Cheryl Cook3, Gail Elliot4, Michelle Pearce5, Sylvia Baago6, Kenneth Rockwood3, 1Baycrest Rotman Research Institute, Toronto, Ontario, Canada; 2Honolulu, Hawaii, United States; 3Dalhousie University, Halifax, Nova Scotia, Canada; 4McMaster University, Hamilton, Ontario, Canada; 5Young Carers Initiative, Thorold,
Table 2 Correlation between the total questionnaire score with the SF-36v2 and HADS Domains Total Physical Health Physical Functioning (PF) Role-Physical (RP) Bodily Pain (BP) General Health (GH) Mental Health Vitality (VT) Social Functioning (SF) Role-Emotional (RE)) Mental Health (MH) HADS-D HADS-A
Mood
Functionality
Caregiver Symptoms
Cognition
Behavioral Alterations
-0.32 -0.461 0.491 0.351
-0.312 -0.411 0.431 0.292
-0.263 -0.441 0.381 0.292
-0.322 -0.481 0.471 0.421
-0.32 -0.361 0.481 0.371
-0.223 -0.411 0.381 0.242
-0.174 -0.054 -0.361 <-0.014 0.421 0.233
-0.094 -0.124 -0.272 <-0.014 0.421 0.23
-0.134 -0.084 -0.381 0.084 0.421 0.312
-0.074 -0.124 -0.471 0.054 0.322 0.253
-0.213 0.034 -0.41 -0.054 0.361 0.164
-0.194 -0.014 -0.233 -0.034 0.282 0.14
1: P<0.001, 2: P<0.01, 3: P<0.05, 4: NS
P3-283
THE EFFECT OF SYSTEMIC AGMATINE ADMINISTRATION ON WATER MAZE MEMORY ACQUISITION, CONSOLIDATION AND RETRIEVAL
Golnaz Yadollahi Khales, Atefeh Khajeh, Maryam Moosavi, Shiraz University of Medical Sciences, Shiraz, Iran. Background: Agmatine is an endogenous polyamine derived from enzymatic decarboxylation of L-arginine. It is present in brain and other mammal’s tissues. In the brain, agmatine exists in hypothalamus, hippocampus, cortex, locus ceruleus, red nucleus and forebrain. The presence of agmatine in the hippocampus suggests that agmatine may be involved in water maze learning and memory. Previous reports about the effects of exogenously administered agmatine on hippocampal function were controversial; some of them have reported that agmatine can improve memory; some have suggested that agmatine can deteriorate memory and the others have reported that agamatine does not interfere with learning and memory. In the present study the effect of systemic agmatine injection on acquisition, consolidation and retrieval of water maze reference memory is examined. Methods: Adult male SpragueDawely rats weighing 250-350 were trained in a single session consisting of 8 trials. The probe test was done 24 hours later to assess memory retention. To assess the effect of agmatine on acquisition, it (40mg/kg/ ip) was administered 30 minutes before training; to assess its effect on consolidation phase, it was injected immediately after training and to assess its effect on retrieval, it was injected 30 minutes before probe trial. Results: The results showed that post-training administration of agmatine improves learning. Post-training and pre-probe administration of agmatine have not any effects on animal’s performance in probe trial. Conclusions: It seems that agmatine is involved in memory consolidation.
P3-284
LONG-TERM PRACTICE OF SALAT PREVENTS ALZHEIMER’S DISEASE IN HUMANS: ORIGINAL STUDY
Shafi Shaafi1, Harish Kulkarni2, 1Kannur Medical College and Superspecialty Hospital, Anjarakandy, Kannur, India; 2Mandya Institute of Medical Sciences, Mandya, Karnataka, India. Background: In the absence of a proven therapy, physical-mental exercises are considered as alternate tools for preventing Alzheimer’s disease (AD). Salat is a physical-mental activity model, performed throughout lifetime by over a billion people at exact prescribed 5-times daily from dusk to dawn. On an average a person who practices Salat performs 70 pro-gravity postures (prostrations)/day or 2.0 million prostrations /year. Salat involves repetitive body movements simultaneously requiring recitation/speech, memory recall, hearing, attention, judgment to start and end the task, calculation, concentration, sense of time, location, direction, hygiene, self-discipline and other executive functions such as washing and dressing, the very abilities destroyed during AD. This is an Indo-American study, sponsored by Human Service International-USA and Kannur Medical College Superspecialty Hospital, India, Methods: Volunteers aged 60-8065 were randomly selected.
P559
Mini-Mental-State-Exam (MMSE) and Mini-cog/Clock Draw Test (CDT) was administered. Demented volunteers were further tested to rule out causes of dementia other than AD. Three groups were formed from the final pool, namely: Salat Group (SG: n¼2500, with a history of Salat practice for at least 5 years prior to study); Non-Salat Group (NSG: n¼2800 with no history of Salat).NSG-volunteers with MMSE score lower than 5 were put to 3-years Salat test (NSG-s n¼1500). MMSE, CDT scores and serum lipids data collected before, during (6-month intervals) and at the end of 3-years) Results: At baseline SG scored 2961.0 on MMSE and 3.0 on Mini-cog with normal CDT. Serum Lipid profile was within the normal reference range. In contrast, NSG scored 1162 or lower on MMSE and serum total lipids were 20-25% higher than the maximum reference range (p<0.001). Data collected at 6 months intervals showed no change in SG till the end of 3-years. The NSG condition deteriorated over time reflected by lower MMSE and elevation in serum lipid profile. Interestingly, NSG-s showed a steady increase in MMSE and Mini-cog scores with time and significant decreases (p<0.001) in serum total lipids, cholesterol, LDL and VLDL. Conclusions: Long-term practice of Salat may improve cognition, lower blood lipids and may prevent Alzheimer’s disease. Further investigations are needed to understand the exact mechanism of Salat on mental health.
P3-285
FREQUENCY AND TYPE OF MEDICATION ERRORS BY DEMENTIA CAREGIVERS
Jennifer Lingler, Lisa Tamres, Melissa Knox, Janet Arida, Carolyn Amspaugh, Judith Erlen, University of Pittsburgh, Pittsburgh, Pennsylvania, United States. Background: Reducing medication errors is a high priority patient safety issue in formal health care settings, yet medication errors in the community setting have received considerably less attention. Prior research has shown that dementia family caregivers are slow to assume responsibility for administering patients’ medications, often waiting until safety issues are overt. The objective of this study was to characterize the scope and nature of errors made, and problems encountered, by dementia caregivers who assume involvement in patients’ medication management. Methods: We examined baseline data from the first 50 patient-caregiver dyads to be screened for participation in a randomized controlled trial of a problem-solving intervention to promote safe medication management practices on the part of dementia family caregivers. In-home assessments of medication management practices were performed using direct observation [Medication Management Instrument for Deficiencies in the Elderly (MedMaIDE)] and caregiver self-report [a 15-item medication deficiencies checklist (MDC)]. Measures of patient and caregiver sociodemographic and clinical characteristics were used to identify potential correlates of unsafe or otherwise problematic medication management practices. Results: Over half of the dyads screened (62%) exhibited multiple problematic medication practices (MDC range 0-8; mean ¼ 2.7, s.d. 1.86). The most commonly reported problematic practices were administering medications at the wrong time (47.3%), losing or dropping pills during administration (27.3%), and forgetting to administer medications (26.6%). Having at least one problematic practice was positively associated with the total number of daily medications taken by the patient (F ¼ 4.30 (1, 47), P <.05). Rates of problematic practices did not differ by the degree of patient cognitive impairment, severity of caregiver burden, or in association with patient or caregiver sociodemographic characteristics. Rather, higher levels of depressive symptoms among patients (r ¼ .365, P ¼ .01), and greater medical comorbidity among patients (r ¼ .395; P < .01) and caregivers (r ¼ .357; P ¼ .01) were associated with more problematic practices. Conclusions: Medication errors and related problems occur frequently in dementia care dyads, particularly those with multiple medical comorbidities. Longitudinal investigations are needed to determine how these problems impact
P560
Poster Presentations: P3
quality of life and health resource utilization, and to assess their amenability to intervention.
P3-286
DESIGNING AND VALIDATING A QUESTIONNAIRE TO ASSESS THE IMPACT OF CAREGIVING ON PATIENTS WITH DEMENTIA IN COLOMBIA
Juan Vargas1, Mario Munoz-Collazos1, Eugenia Solano1, Gabriel Torres2, Javier Triana3, Blanca Janneth Hernandez4, 1Clinica Marly, Bogota, Colombia; 2Hospital Santa Clara, Bogota, Colombia; 3 Hospital el Tunal, Bogota, Colombia; 4Universidad del Rosario, Bogota, Colombia. Background: Information on the psychosocial burden experienced by Colombia caregivers, as a result of the patient’s symptoms, is scarce. Our goal was to design and validate a questionnaire to evaluate the impact of caregiving on caregivers due to of patient’s symptoms. Methods: We gathered a group of professionals with experience in dementia. This group proposed which domains could affect the caregivers and elaborated the questions. Then using caregivers of patients with dementia, from four neurology services in Bogota-Colombia, we conducted focus groups; they discussed which aspects affect their lives, and then scored each proposed questions. Questions with higher scores were retained, maintaining 2-3 questions per domain. Questions that were not understood by caregivers were rewritten until all were understood. Chronbach alpha was determined for internal consistency. The validity was determined by a convergent construct between the results of our questionnaire and the presence of symptoms of anxiety, depression and impaired quality of life measured by validated Colombian Spanish versions of Hospital Anxiety and Depression scale (HADS) and SF36v2. These scales were applied to 100 caregivers. Nonparametric correlation tests were used. The test-retest reproducibility was assessed on 50 caregivers after 45 days and determined by Intraclass Correlation Coefficient (ICC) between the results of both applications. Results: Caregivers and professionals found that an instrument should include the domains of mood, functionality, caregiver symptoms, cognition and behavioral alterations. The internal consistency yielded a Cronbach alpha of 0.93. We obtained a moderate correlation between our scale and the domain of depression and a low correlation with the domain of anxiety. We found a significantly higher median score in our questionnaire in patients with symptoms of depression (112vs87, p¼0.001) and anxiety symptoms (114.5vs.78.5, p<0.001). The correlation between our scale and
Table 1 Internal consistency of the scale of caregivers’ assessment in dementia; Chronbach alpha 0.9364. Average inter-item correlation 0.4239.
Item/a
N
Sign
Item-test correlation
1/0.9366 2/0.9316 3/0.9318 4/0.9348 5/0.9314 6/0.9340 7/0.9349 8/0.9344 9/0.9333 10/0.9314 11/0.9350 12/0.9366 13/0.9317 14/0.9324 15/0.9341 16/0.9309 17/0.9327 18/0.9294 19/0.9341 20/0.9327
60 114 95 85 107 100 92 88 77 94 84 63 103 103 85 105 79 112 61 98
+ + + + + + + + + + + + + + + + + + + +
0.4529 0.7432 0.7340 0.5813 0.7596 0.6452 0.6124 0.5962 0.6710 0.7571 0.5770 0.4504 0.7276 0.7073 0.6250 0.7698 0.6696 0.8136 0.5679 0.7180
Item-rest correlation
Average inter-item covariance
0.3834 0.6910 0.6824 0.5199 0.7125 0.5808 0.5518 0.5330 0.6179 0.7153 0.5119 0.3735 0.6776 0.6516 0.5648 0.7239 0.6116 0.7723 0.5093 0.6625
0.4373 0.4176 0.4183 0.4302 0.4170 0.4269 0.4304 0.4283 0.4239 0.4167 0.4310 0.4375 0.4181 0.4207 0.4272 0.4148 0.4220 0.4095 0.4274 0.4219
SF36v2 physical health domain was significant; in mental health domain, only the emotional function correlated. The reproducibility between applications was high for the total score and moderate for most of the individual domains (ICC¼0.74). Conclusions: We design and validate an instrument to assess the impact of dementia patients’ symptoms on Colombia caregivers.
P3-287
WHEN DEMENTIA IS IN THE HOUSE 1
Tiffany Chow , Katherine Nichols2, Cheryl Cook3, Gail Elliot4, Michelle Pearce5, Sylvia Baago6, Kenneth Rockwood3, 1Baycrest Rotman Research Institute, Toronto, Ontario, Canada; 2Honolulu, Hawaii, United States; 3Dalhousie University, Halifax, Nova Scotia, Canada; 4McMaster University, Hamilton, Ontario, Canada; 5Young Carers Initiative, Thorold,
Table 2 Correlation between the total questionnaire score with the SF-36v2 and HADS Domains Total Physical Health Physical Functioning (PF) Role-Physical (RP) Bodily Pain (BP) General Health (GH) Mental Health Vitality (VT) Social Functioning (SF) Role-Emotional (RE)) Mental Health (MH) HADS-D HADS-A
Mood
Functionality
Caregiver Symptoms
Cognition
Behavioral Alterations
-0.32 -0.461 0.491 0.351
-0.312 -0.411 0.431 0.292
-0.263 -0.441 0.381 0.292
-0.322 -0.481 0.471 0.421
-0.32 -0.361 0.481 0.371
-0.223 -0.411 0.381 0.242
-0.174 -0.054 -0.361 <-0.014 0.421 0.233
-0.094 -0.124 -0.272 <-0.014 0.421 0.23
-0.134 -0.084 -0.381 0.084 0.421 0.312
-0.074 -0.124 -0.471 0.054 0.322 0.253
-0.213 0.034 -0.41 -0.054 0.361 0.164
-0.194 -0.014 -0.233 -0.034 0.282 0.14
1: P<0.001, 2: P<0.01, 3: P<0.05, 4: NS