- Email: [email protected]
CULTURAL BELIEFS ABOUT ALZHEIMER’S DISEASE IN MEXICAN AND MEXICAN-AMERICAN FAMILIES WITH AUTOSOMAL DOMINANT ALZHEIMER’S DISEASE
P500
Poster Presentations: Sunday, July 16, 2017
interventions to prevent and treat depressive symptoms in people living with dementia.
P1-540
COGNITIVE IMPAIRMENT AS AN ASSOCIATED FACTOR OF DYNAPENIA IN ELDERLY PEOPLE LIVING IN A RURAL AREA OF BRAZIL
Danilo Henrique Trevisan Carvalho, Roberta Oliveira Maximo, Tiago Silva Alexandre, Sofia Cristina Iost Pavarini, Allan Gustavo Brigola, Federal University of S~ ao Carlos, S~ao Carlos, Brazil. Contact e-mail: [email protected] Background: Cognitive impairment (CI) is wisely associated with greater muscle strength decline in ageing. However, there is a lack of studies about this association in rural areas in developing countries. The aim of this study was to investigate the prevalence and association between dynapenia and CI in elderly people living in rural area. Methods: Cross-sectional study with 166 elderly people ( 60 years) dementia free living in a medium-sized town in Sao Paulo state, Brazil. We used logistic regression to analyse the association between dynapenia, according Laurentani et al. (1) criteria, and CI, controlled by sex, age, schooling and weight loss (the loss of at least 4.5 kg or more than 5% of body weight in the previous 12 months unrelated to dieting). Grip strength was measured using a dynamometer (Jamar, Seahan SH5001, Korea). The Mini-Mental State Examination was used to evaluate the cognitive function, according Brazilian suggested points by schooling level (2). Results: Mean age was 70.54 (67.52), 52.90% of the sample were female, 92.35% had conjugal life and 72.35% had low education (until 4 years of schooling). The prevalence rates were 39.88% (95% CI: 32.40-47.36) for dynapenic, 31.35% (95% CI: 22.86-39.85) for dynapenic without CI and 60.41% (95% CI: 46.06-74.76) for dynapenic with CI. The adjusted model showed that poor cognitive function increased odds of dynapenia independently of any other factors (odds ratio [OR] 3.37; 95% CI: 1.61-7.05). Conclusions: Cognitive impairment increased the prevalence and risk of dynapenia in elderly people living in rural areas. The changes in cognitive function may indicate lower muscle strength, that later may be confirmed by a specific physical exam. References: (1) Lauretani F, Russo CR, Bandinelli S, Bartali B, Cavazzini C, Di Iorio A, Corsi AM, Rantanen T, Guralnik JM, Caramelli P, Bertolucci PHF, Okamoto IH. Suggestions for utilization of the mini- Ferrucci L. Age-associated changes in skeletal muscles and their effect on mobility: an operational diagnosis of sarcopenia. J Appl Physiol (1985). 2003 Nov;95(5):1851-60. (2) Brucki SMD, Nitrini R, mental state examination in Brazil. Arq Neuropsiquiatr 2003; 61(3B):777-781.
P1-541
ENHANCING PERSON-CENTRED NUTRITIONAL CARE IN NURSING HOMES: THE DESIGN OF AN EVIDENCEBASED MODEL
Jane Louise Murphy, Joanne Holmes, Cindy Brooks, Bournemouth University, Bournemouth, United Kingdom. Contact e-mail: jmurphy@ bournemouth.ac.uk Background: Eating and drinking difficulties are a major factor
contributing to ill-health, frailty and reduced quality of life for people living with dementia. Consequently, there are complex challenges for the caregiver in ensuring nutritional needs are met. Whilst a number of interventions have been identified to sup-
port food and drink intake, there have been no systematic studies to understand the factors that improve nutritional care from the perspectives of all those responsible for delivering care in nursing homes. The aim of this study was to develop a conceptual model to understand eating and drinking for people with dementia from a range of providers, thus supporting credibility from the perspective of the end-user. Methods: An exploratory qualitative design using purposive sampling was used. A series of nine focus groups and five semi-structured interviews were conducted with 50 participants who were involved or who have a level of responsibility for providing food and drink and nutritional care in nursing homes (care home staff including nurses, care assistants, managers, food service providers n¼30, family carers n¼8, dietitians n¼3, speech and language therapists n¼9). Discussions followed an agreed structure, were tape recorded, transcribed and analysed using thematic analysis. Results: The core themes that emerged were person-centred nutritional care; availability of food and drink; tools, resources and environment; relationship to others when eating and drinking; participation in activities; consistency of care and provision of information. Conclusions: The findings have informed the development of a collaboratively developed, person-centred model for quality improvements in nutritional care to design new education and training tools that can be readily translated into existing programmes. Further research has started to evaluate whether these evidence-informed approaches can be implemented successfully and adopted into practice and policy contexts and demonstrate effectiveness for people living with dementia.
P1-542
CULTURAL BELIEFS ABOUT ALZHEIMER’S DISEASE IN MEXICAN AND MEXICAN-AMERICAN FAMILIES WITH AUTOSOMAL DOMINANT ALZHEIMER’S DISEASE
Chizoba Mosieri1, Lucy Montoya2, Philip Sayegh3, Yaneth Rodriguez Agudelo4, Angelica Zuno Reyes5, Esmeralda Matute5, John M. Ringman6, Mellissa Withers7, 1USC Keck School of Medicine, Institute for Global Health, Los Angeles, CA, USA; 2University of Southern California, Los Angeles, CA, USA; 3University of California, Los Angeles, Los Angeles, CA, USA; 4National Institute of Neurology and Neurosurgery, Mexico City, Mexico; 5Instituto de Neurociencias, CUCBA, Universidad de Guadalajara, Guadalajara, Mexico; 6Keck School of Medicine of USC, Los Angeles, CA, USA; 7USC Keck School of Medicine, Institute for Global Health, Los Angeles, CA, USA. Contact e-mail: [email protected] Background: In order to improve the delivery of care and enhance
participation in Alzheimer’s disease (AD) research, it is critical to understand existing beliefs about the disease among families harboring mutations causing autosomal dominant AD (ADAD). Conducting prevention trials among at-risk populations could provide critical insights. However, their involvement necessitates their understanding of the biological nature of the illness. The objective of this study is to explore cultural beliefs about AD among Mexican and Mexican-American families harboring ADAD mutations, exploring differences between persons living in rural versus urban environments. Methods: The Cultural Beliefs about AD (CBAD) questionnaire was administered to 83 Mexicans and 27 Mexican-Americans who were members of families identified as having ADAD mutations and who participated in a larger study. The CBAD is a validated 26-item questionnaire using a Likert scale to rate whether or not they agreed with statements such as “Alzheimer’s disease is a form
Poster Presentations: Sunday, July 16, 2017
of insanity” and “Alzheimer’s disease results from a curse”. We compared responses between persons living in rural and urban settings in Mexico and the U.S. settings using chi-square tests. Results: Urban participants (n ¼ 31) had higher levels of education (14.7 vs. 10.6 years, p<0.05), and a higher mean age (41.5 vs. 35.6, p<0.05) relative to rural participants (n ¼ 79). Rural participants were significantly more likely to endorse that AD can result from a curse (23.5% vs. 0%, p<.0.01), is a form of insanity (45.6% vs 3.8%, p<0.01), can be caused by traumatic life experiences (19.2% vs. 0%, p<0.01), and that AD can arise as “God’s will” (21.4% vs. 4.2%, p<0.05). Conclusions: In order to ethically conduct ADAD prevention studies, it is critical that potential participants are educated regarding the biological nature of the disease and the potential options for medical interventions. However, our study shows that misconceptions and myths about AD are prevalent, particularly in rural Mexico. Families at-risk for AD need additional education regarding AD in order to understand the potential impact of AD on their lives and inform decisions regarding research participation.
P1-543
WHAT ARE THE PERCEPTIONS OF DEMENTIA CAREGIVING AND HELPSEEKING AMONG PROSPECTIVE KOREAN CAREGIVERS?
Eunyoung Lee, McGill University, Montreal, QC, Canada. Contact e-mail: [email protected] Background: Providing care to a family member with dementia is associated with many physical and emotional issues, which include social isolation and financial burdens. Immigrant caregivers, especially in the Korean community, are not an exception in this matter. Despite the increasing number of Korean immigrants and Korean Canadians with family caregivers in Canada, little research has been done to explore how people with multior cross-cultural values, specifically Koreans, understand dementia caregiving, and what their help-seeking patterns are in Canada. The purpose of this research is to examine: 1) How do Koreans living in Montreal conceive the role of family and other social supports in the provision of care to people living with dementia? 2) What are the commonalities and differences in providing care to family members with dementia among prospective Koreans caregivers? Methods: This study used phenomenological approaches and purposeful sampling for data collection. In depth semi-structured interviews were conducted with eight prospective Korean caregivers (both immigrants and Canadian-born people Korean of ethnic origin). All interviews were tape recorded transcribed and analyzed. Several methods were used to ensure the trustworthiness of the study, including transferability, dependability, credibility, and confirmability. Results: Analysis of these interviews found three emerging themes which related to prospective Korean caregivers’ perceptions of dementia caregiving and social support. Three emerging themes were following: 1) the importance of family care; 2) the roles of the Korean church as a support system; 3) ability to find resources and help from outside of the family. Conclusions: Findings from this study suggest that service providers are crucial to the provision of services to primary caregivers as well as their family members. Service providers who have different cultural backgrounds should first attempt to understand their clients’ family values and then offer information to family members regarding how to engage in caregiving. In doing
P501
so, caregivers and their family members can not only reduce their levels of care burden but also provide better care to their loved ones with dementia. P1-544
THE JOURNEY WITH DEMENTIA FROM THE PERSPECTIVE OF BANGLADESHI FAMILY CAREGIVERS IN ENGLAND
Muhammad Zakir Hossain1, Ann Dewey1, John Crossland1, Rebecca Stores1, Shipa Ahmed Khan2, 1University of Portsmouth, Portsmouth, United Kingdom; 2Portsmouth City Council, Portsmouth, United Kingdom. Contact e-mail: muhammad. [email protected] Background: While Bangladeshis are three times more likely to care for dependent family members than White British (Carers UK, 2011), yet little is known about the experiences of family caregivers of people with dementia. There is a paucity of research, within the Bangladeshi community, on experiences and concerns of Bangladeshi individuals providing care for their relatives with dementia. This qualitative study explores immigrant Bangladeshi family carers’ knowledge and day-to-day experiences living in England. Methods: Semi-structured, audiorecorded interviews were conducted with six Bangladeshi family carers living in London and Portsmouth. Five interviews were conducted in English, one in Bengali later translated and transcribed to English. Data were analysed using thematic analysis. NVivo 10 software was utilised to simplify thematic analysis, including transcribing, coding, and documenting emergent themes. Results: Three major themes emerged from the carers’ interview transcripts. These were: (1) Caregiving journey into dementia; (2) Impact of dementia on family caregivers; and (3) Caregiving support and help. The current study reveals that most carers have a lack of knowledge and awareness of the symptoms of dementia. Caregivers exhibited a strong sense of familism, religious beliefs, and values which appear to increase interpersonal motive, or obligation, to provide care for their relatives with dementia at home. Family carers appeared to accept and take for granted, expectations to fulfil often-considerable caregiving roles. A scarcity of cultural and religious sensitive resources for the needs of Muslim patients saw Bangladeshi caregivers more likely to provide direct care themselves rather than receiving care from service providers. Sending a relative with dementia to a residential care home was seen as unacceptable. Conclusions: Unlike previous studies, where South Asian carers viewed dementia as demons or God’s punishments, this study found carers believed dementia was a medical condition. While previous studies reported that many South Asians were explicit in associating stigmas with dementia, all respondents in this study believed there was no stigma attached to dementia. More research is needed to further examine religious beliefs, familism, and interpersonal motives as theoretical perspectives to explain how Bangladeshi caregivers negotiate and construct their caregiving roles for their relatives with dementia. Reference: Carers UK. (2011). Half a million voices: Improving support for BAME carers. Carers UK London. P1-545
SF-DEM: A NEW INSTRUMENT FOR ASSESSING SOCIAL FUNCTIONING IN DEMENTIA
Andrew Sommerlad1, David Singleton1, Rebecca Jones1, Sube Banerjee2, Gill Livingston11University College London,
Poster Presentations: Sunday, July 16, 2017
interventions to prevent and treat depressive symptoms in people living with dementia.
P1-540
COGNITIVE IMPAIRMENT AS AN ASSOCIATED FACTOR OF DYNAPENIA IN ELDERLY PEOPLE LIVING IN A RURAL AREA OF BRAZIL
Danilo Henrique Trevisan Carvalho, Roberta Oliveira Maximo, Tiago Silva Alexandre, Sofia Cristina Iost Pavarini, Allan Gustavo Brigola, Federal University of S~ ao Carlos, S~ao Carlos, Brazil. Contact e-mail: [email protected] Background: Cognitive impairment (CI) is wisely associated with greater muscle strength decline in ageing. However, there is a lack of studies about this association in rural areas in developing countries. The aim of this study was to investigate the prevalence and association between dynapenia and CI in elderly people living in rural area. Methods: Cross-sectional study with 166 elderly people ( 60 years) dementia free living in a medium-sized town in Sao Paulo state, Brazil. We used logistic regression to analyse the association between dynapenia, according Laurentani et al. (1) criteria, and CI, controlled by sex, age, schooling and weight loss (the loss of at least 4.5 kg or more than 5% of body weight in the previous 12 months unrelated to dieting). Grip strength was measured using a dynamometer (Jamar, Seahan SH5001, Korea). The Mini-Mental State Examination was used to evaluate the cognitive function, according Brazilian suggested points by schooling level (2). Results: Mean age was 70.54 (67.52), 52.90% of the sample were female, 92.35% had conjugal life and 72.35% had low education (until 4 years of schooling). The prevalence rates were 39.88% (95% CI: 32.40-47.36) for dynapenic, 31.35% (95% CI: 22.86-39.85) for dynapenic without CI and 60.41% (95% CI: 46.06-74.76) for dynapenic with CI. The adjusted model showed that poor cognitive function increased odds of dynapenia independently of any other factors (odds ratio [OR] 3.37; 95% CI: 1.61-7.05). Conclusions: Cognitive impairment increased the prevalence and risk of dynapenia in elderly people living in rural areas. The changes in cognitive function may indicate lower muscle strength, that later may be confirmed by a specific physical exam. References: (1) Lauretani F, Russo CR, Bandinelli S, Bartali B, Cavazzini C, Di Iorio A, Corsi AM, Rantanen T, Guralnik JM, Caramelli P, Bertolucci PHF, Okamoto IH. Suggestions for utilization of the mini- Ferrucci L. Age-associated changes in skeletal muscles and their effect on mobility: an operational diagnosis of sarcopenia. J Appl Physiol (1985). 2003 Nov;95(5):1851-60. (2) Brucki SMD, Nitrini R, mental state examination in Brazil. Arq Neuropsiquiatr 2003; 61(3B):777-781.
P1-541
ENHANCING PERSON-CENTRED NUTRITIONAL CARE IN NURSING HOMES: THE DESIGN OF AN EVIDENCEBASED MODEL
Jane Louise Murphy, Joanne Holmes, Cindy Brooks, Bournemouth University, Bournemouth, United Kingdom. Contact e-mail: jmurphy@ bournemouth.ac.uk Background: Eating and drinking difficulties are a major factor
contributing to ill-health, frailty and reduced quality of life for people living with dementia. Consequently, there are complex challenges for the caregiver in ensuring nutritional needs are met. Whilst a number of interventions have been identified to sup-
port food and drink intake, there have been no systematic studies to understand the factors that improve nutritional care from the perspectives of all those responsible for delivering care in nursing homes. The aim of this study was to develop a conceptual model to understand eating and drinking for people with dementia from a range of providers, thus supporting credibility from the perspective of the end-user. Methods: An exploratory qualitative design using purposive sampling was used. A series of nine focus groups and five semi-structured interviews were conducted with 50 participants who were involved or who have a level of responsibility for providing food and drink and nutritional care in nursing homes (care home staff including nurses, care assistants, managers, food service providers n¼30, family carers n¼8, dietitians n¼3, speech and language therapists n¼9). Discussions followed an agreed structure, were tape recorded, transcribed and analysed using thematic analysis. Results: The core themes that emerged were person-centred nutritional care; availability of food and drink; tools, resources and environment; relationship to others when eating and drinking; participation in activities; consistency of care and provision of information. Conclusions: The findings have informed the development of a collaboratively developed, person-centred model for quality improvements in nutritional care to design new education and training tools that can be readily translated into existing programmes. Further research has started to evaluate whether these evidence-informed approaches can be implemented successfully and adopted into practice and policy contexts and demonstrate effectiveness for people living with dementia.
P1-542
CULTURAL BELIEFS ABOUT ALZHEIMER’S DISEASE IN MEXICAN AND MEXICAN-AMERICAN FAMILIES WITH AUTOSOMAL DOMINANT ALZHEIMER’S DISEASE
Chizoba Mosieri1, Lucy Montoya2, Philip Sayegh3, Yaneth Rodriguez Agudelo4, Angelica Zuno Reyes5, Esmeralda Matute5, John M. Ringman6, Mellissa Withers7, 1USC Keck School of Medicine, Institute for Global Health, Los Angeles, CA, USA; 2University of Southern California, Los Angeles, CA, USA; 3University of California, Los Angeles, Los Angeles, CA, USA; 4National Institute of Neurology and Neurosurgery, Mexico City, Mexico; 5Instituto de Neurociencias, CUCBA, Universidad de Guadalajara, Guadalajara, Mexico; 6Keck School of Medicine of USC, Los Angeles, CA, USA; 7USC Keck School of Medicine, Institute for Global Health, Los Angeles, CA, USA. Contact e-mail: [email protected] Background: In order to improve the delivery of care and enhance
participation in Alzheimer’s disease (AD) research, it is critical to understand existing beliefs about the disease among families harboring mutations causing autosomal dominant AD (ADAD). Conducting prevention trials among at-risk populations could provide critical insights. However, their involvement necessitates their understanding of the biological nature of the illness. The objective of this study is to explore cultural beliefs about AD among Mexican and Mexican-American families harboring ADAD mutations, exploring differences between persons living in rural versus urban environments. Methods: The Cultural Beliefs about AD (CBAD) questionnaire was administered to 83 Mexicans and 27 Mexican-Americans who were members of families identified as having ADAD mutations and who participated in a larger study. The CBAD is a validated 26-item questionnaire using a Likert scale to rate whether or not they agreed with statements such as “Alzheimer’s disease is a form
Poster Presentations: Sunday, July 16, 2017
of insanity” and “Alzheimer’s disease results from a curse”. We compared responses between persons living in rural and urban settings in Mexico and the U.S. settings using chi-square tests. Results: Urban participants (n ¼ 31) had higher levels of education (14.7 vs. 10.6 years, p<0.05), and a higher mean age (41.5 vs. 35.6, p<0.05) relative to rural participants (n ¼ 79). Rural participants were significantly more likely to endorse that AD can result from a curse (23.5% vs. 0%, p<.0.01), is a form of insanity (45.6% vs 3.8%, p<0.01), can be caused by traumatic life experiences (19.2% vs. 0%, p<0.01), and that AD can arise as “God’s will” (21.4% vs. 4.2%, p<0.05). Conclusions: In order to ethically conduct ADAD prevention studies, it is critical that potential participants are educated regarding the biological nature of the disease and the potential options for medical interventions. However, our study shows that misconceptions and myths about AD are prevalent, particularly in rural Mexico. Families at-risk for AD need additional education regarding AD in order to understand the potential impact of AD on their lives and inform decisions regarding research participation.
P1-543
WHAT ARE THE PERCEPTIONS OF DEMENTIA CAREGIVING AND HELPSEEKING AMONG PROSPECTIVE KOREAN CAREGIVERS?
Eunyoung Lee, McGill University, Montreal, QC, Canada. Contact e-mail: [email protected] Background: Providing care to a family member with dementia is associated with many physical and emotional issues, which include social isolation and financial burdens. Immigrant caregivers, especially in the Korean community, are not an exception in this matter. Despite the increasing number of Korean immigrants and Korean Canadians with family caregivers in Canada, little research has been done to explore how people with multior cross-cultural values, specifically Koreans, understand dementia caregiving, and what their help-seeking patterns are in Canada. The purpose of this research is to examine: 1) How do Koreans living in Montreal conceive the role of family and other social supports in the provision of care to people living with dementia? 2) What are the commonalities and differences in providing care to family members with dementia among prospective Koreans caregivers? Methods: This study used phenomenological approaches and purposeful sampling for data collection. In depth semi-structured interviews were conducted with eight prospective Korean caregivers (both immigrants and Canadian-born people Korean of ethnic origin). All interviews were tape recorded transcribed and analyzed. Several methods were used to ensure the trustworthiness of the study, including transferability, dependability, credibility, and confirmability. Results: Analysis of these interviews found three emerging themes which related to prospective Korean caregivers’ perceptions of dementia caregiving and social support. Three emerging themes were following: 1) the importance of family care; 2) the roles of the Korean church as a support system; 3) ability to find resources and help from outside of the family. Conclusions: Findings from this study suggest that service providers are crucial to the provision of services to primary caregivers as well as their family members. Service providers who have different cultural backgrounds should first attempt to understand their clients’ family values and then offer information to family members regarding how to engage in caregiving. In doing
P501
so, caregivers and their family members can not only reduce their levels of care burden but also provide better care to their loved ones with dementia. P1-544
THE JOURNEY WITH DEMENTIA FROM THE PERSPECTIVE OF BANGLADESHI FAMILY CAREGIVERS IN ENGLAND
Muhammad Zakir Hossain1, Ann Dewey1, John Crossland1, Rebecca Stores1, Shipa Ahmed Khan2, 1University of Portsmouth, Portsmouth, United Kingdom; 2Portsmouth City Council, Portsmouth, United Kingdom. Contact e-mail: muhammad. [email protected] Background: While Bangladeshis are three times more likely to care for dependent family members than White British (Carers UK, 2011), yet little is known about the experiences of family caregivers of people with dementia. There is a paucity of research, within the Bangladeshi community, on experiences and concerns of Bangladeshi individuals providing care for their relatives with dementia. This qualitative study explores immigrant Bangladeshi family carers’ knowledge and day-to-day experiences living in England. Methods: Semi-structured, audiorecorded interviews were conducted with six Bangladeshi family carers living in London and Portsmouth. Five interviews were conducted in English, one in Bengali later translated and transcribed to English. Data were analysed using thematic analysis. NVivo 10 software was utilised to simplify thematic analysis, including transcribing, coding, and documenting emergent themes. Results: Three major themes emerged from the carers’ interview transcripts. These were: (1) Caregiving journey into dementia; (2) Impact of dementia on family caregivers; and (3) Caregiving support and help. The current study reveals that most carers have a lack of knowledge and awareness of the symptoms of dementia. Caregivers exhibited a strong sense of familism, religious beliefs, and values which appear to increase interpersonal motive, or obligation, to provide care for their relatives with dementia at home. Family carers appeared to accept and take for granted, expectations to fulfil often-considerable caregiving roles. A scarcity of cultural and religious sensitive resources for the needs of Muslim patients saw Bangladeshi caregivers more likely to provide direct care themselves rather than receiving care from service providers. Sending a relative with dementia to a residential care home was seen as unacceptable. Conclusions: Unlike previous studies, where South Asian carers viewed dementia as demons or God’s punishments, this study found carers believed dementia was a medical condition. While previous studies reported that many South Asians were explicit in associating stigmas with dementia, all respondents in this study believed there was no stigma attached to dementia. More research is needed to further examine religious beliefs, familism, and interpersonal motives as theoretical perspectives to explain how Bangladeshi caregivers negotiate and construct their caregiving roles for their relatives with dementia. Reference: Carers UK. (2011). Half a million voices: Improving support for BAME carers. Carers UK London. P1-545
SF-DEM: A NEW INSTRUMENT FOR ASSESSING SOCIAL FUNCTIONING IN DEMENTIA
Andrew Sommerlad1, David Singleton1, Rebecca Jones1, Sube Banerjee2, Gill Livingston11University College London,