- Email: [email protected]
PREVENTING LOSS OF INDEPENDENCE THROUGH EXERCISE IN PERSONS WITH DEMENTIA IN THE VA (PLIÉ-VA)
P498
Poster Presentations: Sunday, July 16, 2017
specific needs for this population. Methods: In this descriptive study there were 14 participants, 11 females and three males with mean age of 62.9(SD6.6) years. Data were collected through a semi-structured interview guide and structured questionnaires that incorporate the Life’s Ups & Downs Scale(LUDS), the Single Item Quality of life Scale (katsuno, 2005), the Zarit Burden Interview (Zarit et al., 1980), and Zung SelfRating Depression Scale (Zung, 1965). The LUDS measured the subjective evaluation of the caregiver’s life quality over time. Vertical axis represents the life quality and horizontal axis represents the time, ‘+10(10cm)’ means best possible time in one’s life and ‘-10(10cm)’ means worst possible time. The participants were asked to draw the line from the left to the right. Four points were indicated to help to evaluate their life quality; before Dx(T1), Dx(T2), Present(T3), Future(T4). All interviews were tape recorded and transcribed. Data were analyzed quantitatively and qualitatively. Results: The LUDS revealed that the participants experienced ups and downs in their life living with spouses. The mean LUDS score at T1 was 3.21(SD5.1; Range -7w10) and it decreased to -4.5(SD3.6; range 0w-10 at T2(p¼0.001). Five participants continued to rate their life quality negatively over time. Three showed mild depression and seven showed moderate to severe burden at T3. Qualitative data analysis revealed six categories to enhance the participant’s life quality; stability of symptoms, economic & social stability, confidence in caregiving, having support, one’s own health, and connectedness of family. Conclusions: Health care professionals need to foresee the impacts of dementia on family caregiver’s life over time, to monitor their risks, and to provide the integrated care for this population, especially at the time of dementia diagnosis. P1-536
WEIGHT CHANGE IN ALZHEIMER’S PATIENTS
Yutaka Kishi, Yutaka Clinic, Wakayama, Japan. Contact e-mail: [email protected] Background: Weight loss is a frequent clinical finding in Alzheimer’s patients. Although it is obvious that in the final stage Alzheimer’s patients lose weight, in the early stage of disease there are several hypotheses why Alzheimer’s patients lose weight. The resting metabolic rate was not higher in Alzheimer’s patients than in healthy elderly subjects. Methods: We investigated the weight changes in 28 patients from an early stage of Alzheimer’s disease and compared with healthy control subjects for more than 3 years up to 12 years. Results: Mean weight changes are similar (Alz-
Age(y.o.) Initial body weight (kg) Observation period (year) Weight changes (kg)
Control subjects (n¼28)
Alzheimer’s patients(n¼28)
72.0 6 6.4 51.8 6 5.5 6.5 6 2.5 0.8 6 3.4
72.0 6 7.8 49.5 6 8.5 7.1 6 2.7 0.7 6 8.2
heimer’s patients -0.768.2 kg vs Control subjects -0.863.4kg). However Alzheimer’s patients showed much exaggerated weight changes individually (Alzheimer’s patients 75% vs Control subjects 43%), which was statistically significant. Another finding is that 32 % of Alzheimer’s patients showed weight gain, which is greater than 14% of control subjects. Conclusions: Alzheimer’s patients are liable to fluctuate in body weights. Caregivers should take a careful attention in body weight changes of Alzheimer’s patients.
P1-537
PREVENTING LOSS OF INDEPENDENCE THROUGH EXERCISE IN PERSONS WITH DEMENTIA IN THE VA (PLIE-VA)
Deborah E. Barnes, Margaret A. Chesney, Kristine Yaffe, Gary Abrams, Wolf Mehling, University of California San Francisco / San Francisco VA Medical Center, San Francisco, CA, USA. Contact e-mail: [email protected] Background: There is growing evidence that behavioral interven-
tions can improve physical function, cognitive function and mood in people with dementia, but most programs are single-domain. ProThe Preventing Loss of Independence through Exercise (PLIE) gram integrates physical, mental and social activities into a single multi-modal, group movement program for people with mild-tomoderate dementia. Movements focus on improving physical function by building procedural memory for basic daily activities such as transitioning safely between sitting and standing; improving cognitive function by bringing mindful awareness and attention to in-the-moment bodily sensations and breathing; and improving social/emotional connection through shared movement and music. Methods: We are performing a randomized, controlled trial to deter improves function and quality of life in people mine whether PLIE with mild-to-moderate dementia. Study sites are adult day centers that contract with the VA, although study participants do not have to be Veterans. Study participants are randomly assigned to Group 1 or Group 2 in blocks (20/site, 6 sites). Group 1 participates in for 4 months (1 hour, 2-3 days/week; monthly home visits; PLIE monthly check-in calls) while Group 2 is placed on a waitlist (monthly check-in calls). Then Group 1 transitions to a maintenance phase (monthly check-in calls) while Group 2 participates for 4 months (1 hour, 2-3 days/week; monthly home visits; in PLIE monthly check-in calls). Assessments are performed at baseline, 4 months and 8 months in both groups. Ongoing qualitative data include exercise instructor notes following all classes and home visits as well as written feedback from caregivers. Results: To date, we have completed 1 site (19 enrolled: 13 completed, 6 withdrawn) and are half-way through the second site (20 enrolled: 15 active, 5 withdrawn). Withdrawals have been due to declining health (n¼6) or personal issues (n¼5). Qualitative data suggest that study participants who complete the program are experiencing physical benefits (improved ability to stand from sitting and balance while standing), cognitive benefits
Poster Presentations: Sunday, July 16, 2017
(improved ability to communicate with other class members) and social/emotional benefits (reduced anxiety). Conclusions: Although withdrawal rates are higher than expected, study participants who complete the program appear to be experiencing beneficial effects across multiple domains. P1-538
PHYSICAL ACTIVITY BARRIERS IN ELDERLY WITH ALZHEIMER’S DISEASE: PERCEPTIONS OF CAREGIVERS AND PATIENTS
Jessica Rodrigues Pereira1, Angelica Miki Stein1, Jose Luiz Riani Costa1, Florindo Stella2,3, 1UNESP - Universidade Estadual Paulista, Biosciences Institute, Rio Claro, Brazil; 2Laboratory of Neurosciences, Institute of Psychiatry, Faculty of Medicine, University of S~ao Paulo, S~ao Paulo, Brazil; 3 UNESP - Universidade Estadual Paulista, Biosciences Institute, Rio Claro, Brazil. Contact e-mail: [email protected] Background: Recently, there was an expressive increase in the interest to the practice of physical activity as a non-pharmacological intervention in the prevention and treatment of dementias. Especially in Alzheimer’s disease (AD), there is a significant drop in the level of physical activity, when these patients are compared to elderly people of similar age and cognitively preserve. The aim of this study is to identify the barriers that impede these seniors to practice physical activities, comparing his view to the caregiver’s perspective. Methods: 78 patient and caregiver participated in the study. Elderly at all stages of the disease were included. These fit the criteria for AD according to the Hachisnki Scale, and had independent walking. The caregivers answered a questionnaire for the collection of socio-demographic data. To assess the level of physical activity, the caregivers also answered the Baecke Questionnaire Modified for Elderly (BQME), Reporting to the activities performed by the patient. The global cognitive functions of the elderly with AD were evaluated by the Mini Mental State Examination (MMSE); In addition, both answered the Questionnaire on Barriers to Practice of Physical Activity in the Elderly (QBPPAE), being the patient in relation to himself and the caregiver in relation to the patient. Results: Sample characterization, level of physical activity and cognitive status are shown in Table 1. Table 2 shows the main barriers identified by the caregiver and the patient. Conclusions: In addition to having a very low level of physical activity, patients and caregivers have different views on the barriers that can prevent or hinder the practice of physical activity. The results indicate an excess of zeal on the part of the caregivers, probably due to the lack of knowledge
Caregivers
Pacientes
Age (years)* Gender Kind of Care Family Caregivers Time of care (years)* Physical activity practice Age (years)* Gender Schooling (years)* AD diagnosis time (years)* Physical activity practice BQME (points)* MMSE (points)* Hachinski (points)*
*mean6SD.
63,2 6 14,7 66% female 44% male 90% family 10% formal 55,5% spouse 44,5% son 3,2 6 2,6 38,9% yes 61,1% no 77,1 6 7,4 50% female 50% male 9,4 6 5,5 2,2 6 1,4 33.3% yes 66,7% no 1,3 6 0,9 16,2 6 6,6 2,8 6 0,5
P499
Perceived barriers by the caregiver in relation to the patient
Perceived barriers by the patient with AD
1. I have an illness, injury or disability that hinders or prevents me 2. I’m very unmotivated 3. I need to rest and relax in my free time
1. I don’t have enough free time
2. I’m already active enough 3. I feel insecure in the environment (fear of violence)
of the benefits of physical activity for this population, mainly because they consider the disease the main barrier. As for patients, these may have distorted vision of their own condition. It professionals aware them of the benefits of physical activity to patients. As for patients, these should be constantly stimulated, since physical activity is an important tool in altering the course of the disease.
P1-539
BEHAVIORAL ACTIVATION FOR DEPRESSION FOR OLDER PEOPLE WITH OR WITHOUT COGNITIVE IMPAIRMENT: A SYSTEMATIC REVIEW AND METAANALYSIS OF RANDOMISED CONTROLLED TRIALS
Vasiliki Orgeta1, Janina Brede1, Gill Livingston2, 1University College London, London, United Kingdom; 2Camden and Islington NHS Foundation Trust, London, United Kingdom. Contact e-mail: [email protected] Background: Behavioral activation (BA) is an effective treatment for depression in the general adult population but evidence of effectiveness for older people in general and for those with cognitive impairment is lacking. The aim of this study was to systematically review existing evidence of randomised controlled trials (RCTs) of BA for depression in older people with or without cognitive impairment (all participants aged 55 years old). Methods: We included RCTs comparing BA with a control condition. Primary outcomes were treatment response either by change in symptoms or remission of depression. Secondary outcomes were measures of functional disability and quality of life. Twenty eight RCTs met the pre-determined inclusion criteria, and seventeen were included in meta-analyses. We separated analyses by treatment setting (community, inpatient or long-term care), and type of intervention (stand-alone BA or BA as part of a multicomponent intervention). Results: BA reduced mean depression scores for older people living in the community as a stand-alone treatment (5 studies, 96 participants receiving BA, 79 receiving treatment as usual, standardised mean difference (SMD) -0.72; 95% confidence interval (CI) -1.04 to -0.41) and as part of a multicomponent intervention (3 studies, 983 participants receiving multicomponent BA, 954 receiving treatment as usual, SMD -0.50; 95% CI -0.70 to -0.30). It was ineffective in inpatient and care home settings. RCTs testing BA for older people with dementia were not well-defined in terms of approaches and were therefore not entered in meta-analysis. We found no evidence that additional components such as collaborative care add to efficacy of BA. Overall the quality of the evidence was moderate, due to methodological limitations and the small number of trials. Conclusions: Although we found evidence that BA significantly reduced depressive symptoms in older people most of the studies are small so results should be considered with caution. This review highlights the need for high quality multicentre trials of BA including cost-effectiveness analyses and applying these
Poster Presentations: Sunday, July 16, 2017
specific needs for this population. Methods: In this descriptive study there were 14 participants, 11 females and three males with mean age of 62.9(SD6.6) years. Data were collected through a semi-structured interview guide and structured questionnaires that incorporate the Life’s Ups & Downs Scale(LUDS), the Single Item Quality of life Scale (katsuno, 2005), the Zarit Burden Interview (Zarit et al., 1980), and Zung SelfRating Depression Scale (Zung, 1965). The LUDS measured the subjective evaluation of the caregiver’s life quality over time. Vertical axis represents the life quality and horizontal axis represents the time, ‘+10(10cm)’ means best possible time in one’s life and ‘-10(10cm)’ means worst possible time. The participants were asked to draw the line from the left to the right. Four points were indicated to help to evaluate their life quality; before Dx(T1), Dx(T2), Present(T3), Future(T4). All interviews were tape recorded and transcribed. Data were analyzed quantitatively and qualitatively. Results: The LUDS revealed that the participants experienced ups and downs in their life living with spouses. The mean LUDS score at T1 was 3.21(SD5.1; Range -7w10) and it decreased to -4.5(SD3.6; range 0w-10 at T2(p¼0.001). Five participants continued to rate their life quality negatively over time. Three showed mild depression and seven showed moderate to severe burden at T3. Qualitative data analysis revealed six categories to enhance the participant’s life quality; stability of symptoms, economic & social stability, confidence in caregiving, having support, one’s own health, and connectedness of family. Conclusions: Health care professionals need to foresee the impacts of dementia on family caregiver’s life over time, to monitor their risks, and to provide the integrated care for this population, especially at the time of dementia diagnosis. P1-536
WEIGHT CHANGE IN ALZHEIMER’S PATIENTS
Yutaka Kishi, Yutaka Clinic, Wakayama, Japan. Contact e-mail: [email protected] Background: Weight loss is a frequent clinical finding in Alzheimer’s patients. Although it is obvious that in the final stage Alzheimer’s patients lose weight, in the early stage of disease there are several hypotheses why Alzheimer’s patients lose weight. The resting metabolic rate was not higher in Alzheimer’s patients than in healthy elderly subjects. Methods: We investigated the weight changes in 28 patients from an early stage of Alzheimer’s disease and compared with healthy control subjects for more than 3 years up to 12 years. Results: Mean weight changes are similar (Alz-
Age(y.o.) Initial body weight (kg) Observation period (year) Weight changes (kg)
Control subjects (n¼28)
Alzheimer’s patients(n¼28)
72.0 6 6.4 51.8 6 5.5 6.5 6 2.5 0.8 6 3.4
72.0 6 7.8 49.5 6 8.5 7.1 6 2.7 0.7 6 8.2
heimer’s patients -0.768.2 kg vs Control subjects -0.863.4kg). However Alzheimer’s patients showed much exaggerated weight changes individually (Alzheimer’s patients 75% vs Control subjects 43%), which was statistically significant. Another finding is that 32 % of Alzheimer’s patients showed weight gain, which is greater than 14% of control subjects. Conclusions: Alzheimer’s patients are liable to fluctuate in body weights. Caregivers should take a careful attention in body weight changes of Alzheimer’s patients.
P1-537
PREVENTING LOSS OF INDEPENDENCE THROUGH EXERCISE IN PERSONS WITH DEMENTIA IN THE VA (PLIE-VA)
Deborah E. Barnes, Margaret A. Chesney, Kristine Yaffe, Gary Abrams, Wolf Mehling, University of California San Francisco / San Francisco VA Medical Center, San Francisco, CA, USA. Contact e-mail: [email protected] Background: There is growing evidence that behavioral interven-
tions can improve physical function, cognitive function and mood in people with dementia, but most programs are single-domain. ProThe Preventing Loss of Independence through Exercise (PLIE) gram integrates physical, mental and social activities into a single multi-modal, group movement program for people with mild-tomoderate dementia. Movements focus on improving physical function by building procedural memory for basic daily activities such as transitioning safely between sitting and standing; improving cognitive function by bringing mindful awareness and attention to in-the-moment bodily sensations and breathing; and improving social/emotional connection through shared movement and music. Methods: We are performing a randomized, controlled trial to deter improves function and quality of life in people mine whether PLIE with mild-to-moderate dementia. Study sites are adult day centers that contract with the VA, although study participants do not have to be Veterans. Study participants are randomly assigned to Group 1 or Group 2 in blocks (20/site, 6 sites). Group 1 participates in for 4 months (1 hour, 2-3 days/week; monthly home visits; PLIE monthly check-in calls) while Group 2 is placed on a waitlist (monthly check-in calls). Then Group 1 transitions to a maintenance phase (monthly check-in calls) while Group 2 participates for 4 months (1 hour, 2-3 days/week; monthly home visits; in PLIE monthly check-in calls). Assessments are performed at baseline, 4 months and 8 months in both groups. Ongoing qualitative data include exercise instructor notes following all classes and home visits as well as written feedback from caregivers. Results: To date, we have completed 1 site (19 enrolled: 13 completed, 6 withdrawn) and are half-way through the second site (20 enrolled: 15 active, 5 withdrawn). Withdrawals have been due to declining health (n¼6) or personal issues (n¼5). Qualitative data suggest that study participants who complete the program are experiencing physical benefits (improved ability to stand from sitting and balance while standing), cognitive benefits
Poster Presentations: Sunday, July 16, 2017
(improved ability to communicate with other class members) and social/emotional benefits (reduced anxiety). Conclusions: Although withdrawal rates are higher than expected, study participants who complete the program appear to be experiencing beneficial effects across multiple domains. P1-538
PHYSICAL ACTIVITY BARRIERS IN ELDERLY WITH ALZHEIMER’S DISEASE: PERCEPTIONS OF CAREGIVERS AND PATIENTS
Jessica Rodrigues Pereira1, Angelica Miki Stein1, Jose Luiz Riani Costa1, Florindo Stella2,3, 1UNESP - Universidade Estadual Paulista, Biosciences Institute, Rio Claro, Brazil; 2Laboratory of Neurosciences, Institute of Psychiatry, Faculty of Medicine, University of S~ao Paulo, S~ao Paulo, Brazil; 3 UNESP - Universidade Estadual Paulista, Biosciences Institute, Rio Claro, Brazil. Contact e-mail: [email protected] Background: Recently, there was an expressive increase in the interest to the practice of physical activity as a non-pharmacological intervention in the prevention and treatment of dementias. Especially in Alzheimer’s disease (AD), there is a significant drop in the level of physical activity, when these patients are compared to elderly people of similar age and cognitively preserve. The aim of this study is to identify the barriers that impede these seniors to practice physical activities, comparing his view to the caregiver’s perspective. Methods: 78 patient and caregiver participated in the study. Elderly at all stages of the disease were included. These fit the criteria for AD according to the Hachisnki Scale, and had independent walking. The caregivers answered a questionnaire for the collection of socio-demographic data. To assess the level of physical activity, the caregivers also answered the Baecke Questionnaire Modified for Elderly (BQME), Reporting to the activities performed by the patient. The global cognitive functions of the elderly with AD were evaluated by the Mini Mental State Examination (MMSE); In addition, both answered the Questionnaire on Barriers to Practice of Physical Activity in the Elderly (QBPPAE), being the patient in relation to himself and the caregiver in relation to the patient. Results: Sample characterization, level of physical activity and cognitive status are shown in Table 1. Table 2 shows the main barriers identified by the caregiver and the patient. Conclusions: In addition to having a very low level of physical activity, patients and caregivers have different views on the barriers that can prevent or hinder the practice of physical activity. The results indicate an excess of zeal on the part of the caregivers, probably due to the lack of knowledge
Caregivers
Pacientes
Age (years)* Gender Kind of Care Family Caregivers Time of care (years)* Physical activity practice Age (years)* Gender Schooling (years)* AD diagnosis time (years)* Physical activity practice BQME (points)* MMSE (points)* Hachinski (points)*
*mean6SD.
63,2 6 14,7 66% female 44% male 90% family 10% formal 55,5% spouse 44,5% son 3,2 6 2,6 38,9% yes 61,1% no 77,1 6 7,4 50% female 50% male 9,4 6 5,5 2,2 6 1,4 33.3% yes 66,7% no 1,3 6 0,9 16,2 6 6,6 2,8 6 0,5
P499
Perceived barriers by the caregiver in relation to the patient
Perceived barriers by the patient with AD
1. I have an illness, injury or disability that hinders or prevents me 2. I’m very unmotivated 3. I need to rest and relax in my free time
1. I don’t have enough free time
2. I’m already active enough 3. I feel insecure in the environment (fear of violence)
of the benefits of physical activity for this population, mainly because they consider the disease the main barrier. As for patients, these may have distorted vision of their own condition. It professionals aware them of the benefits of physical activity to patients. As for patients, these should be constantly stimulated, since physical activity is an important tool in altering the course of the disease.
P1-539
BEHAVIORAL ACTIVATION FOR DEPRESSION FOR OLDER PEOPLE WITH OR WITHOUT COGNITIVE IMPAIRMENT: A SYSTEMATIC REVIEW AND METAANALYSIS OF RANDOMISED CONTROLLED TRIALS
Vasiliki Orgeta1, Janina Brede1, Gill Livingston2, 1University College London, London, United Kingdom; 2Camden and Islington NHS Foundation Trust, London, United Kingdom. Contact e-mail: [email protected] Background: Behavioral activation (BA) is an effective treatment for depression in the general adult population but evidence of effectiveness for older people in general and for those with cognitive impairment is lacking. The aim of this study was to systematically review existing evidence of randomised controlled trials (RCTs) of BA for depression in older people with or without cognitive impairment (all participants aged 55 years old). Methods: We included RCTs comparing BA with a control condition. Primary outcomes were treatment response either by change in symptoms or remission of depression. Secondary outcomes were measures of functional disability and quality of life. Twenty eight RCTs met the pre-determined inclusion criteria, and seventeen were included in meta-analyses. We separated analyses by treatment setting (community, inpatient or long-term care), and type of intervention (stand-alone BA or BA as part of a multicomponent intervention). Results: BA reduced mean depression scores for older people living in the community as a stand-alone treatment (5 studies, 96 participants receiving BA, 79 receiving treatment as usual, standardised mean difference (SMD) -0.72; 95% confidence interval (CI) -1.04 to -0.41) and as part of a multicomponent intervention (3 studies, 983 participants receiving multicomponent BA, 954 receiving treatment as usual, SMD -0.50; 95% CI -0.70 to -0.30). It was ineffective in inpatient and care home settings. RCTs testing BA for older people with dementia were not well-defined in terms of approaches and were therefore not entered in meta-analysis. We found no evidence that additional components such as collaborative care add to efficacy of BA. Overall the quality of the evidence was moderate, due to methodological limitations and the small number of trials. Conclusions: Although we found evidence that BA significantly reduced depressive symptoms in older people most of the studies are small so results should be considered with caution. This review highlights the need for high quality multicentre trials of BA including cost-effectiveness analyses and applying these