Delaying cognitive and physical decline through multidomain interventions for residents with mild‐to‐moderate dementia in dementia care units in Taiwan: A prospective cohort study

Abstract

Aim: To develop experimental multi-domain interventions for older people with mild-to-moderate dementia, and to evaluate the effect of delaying cognitive and physical decline, and improvement or prevention of geriatric syndromes during 1-year follow up.Methods: Participants aged 65 years and older with mild-to-moderate dementia (clinical dementia rating [CDR] 1 or 2) were grouped as intervention in Jia-Li Veterans Home and usual care model in the community (Memory clinic). All residents in Jia-Li Veterans Home received comprehensive intervention, including Multi-disciplinary team consultation and intervention, Multi-component non-pharmacological management, geriatric syndromes survey and intervention by CGA, and a dementia friendly medical Green channel Approach (2MCGA). The decline of cognitive and physical function are determined by the change of Mini-Mental State Examination score, CDR and the sum of CDR box, as well as activities of daily living based on the Barthel Index. We also screened geriatric syndromes at baseline and 1 year later.Results: Participants in the intervention group were older and had a lower educational level, lower body mass index, poor baseline activities of daily living function, lower visual impairment, and higher rates of hearing impairment, polypharmacy and risk of malnutrition. The residents receiving 2MCGA had lower baseline Mini-Mental State Examination scores, and higher CDR. For residents in Jia-Li Veterans Home, all cognitive measurements except Mini-Mental State Examination were significantly associated with delaying the decline of cognition after analyzing by multiple linear regression, and multivariate logistic regression also showed that patients living in the community was independently associated with a higher odds ratio for activities of daily living decline (3.180, 95% CI 1.384-7.308, P = 0.006). There are also more improvement in their baseline geriatric syndromes and suffered less from new geriatric syndromes, including falls, urinary incontinence, and risk of malnutrition.Conclusions: The 2MCGA intervention shows strong delays in the decline of cognition and physical function for older residents with mild-to-moderate dementia. Furthermore, this strategy can also improve or prevent the onset of new geriatric syndromes, especially fall episodes, urinary incontinence and risk of malnutrition.

Health Professionals’ Recommendations for a Dementia Plan for China

“…To support family caregivers, participants emphasized an urgent need to develop specialized nursing homes and specialized dementia care units in hospitals. However, other ways of doing this (e.g., dementia care units in nursing homes) are helpful (Kok et al, 2013; Liang et al, 2017). Compared with people with dementia receiving traditional care, those residing in dementia care units in nursing homes have shown a delay in the decline of cognitive and physical function and better psychosocial functioning as well as a better quality of life (Kok et al, 2013; Liang et al, 2017).…”

Medication Reviews and Clinical Outcomes in Persons with Dementia: A Scoping Review

“…The study designs included observational pre-post studies (n = 4) [14,[35][36][37], retrospective studies (n = 7) [20,[38][39][40][41][42][43], prospective studies (n = 5) [44][45][46][47][48], an audit (n = 1) [49], feasibility studies (n = 2) [50,51], and randomized controlled trials (n = 3) [26,31,33]. Detailed descriptions of the included studies are summarized in Table S3.…”

“…Of the included 22 studies, 1 study each was conducted in Canada [36], the Netherlands [33], Slovenia [35], France [41], Taiwan [46], Australia [51], northern Sweden [17], Germany [43], Denmark [47], and Hong Kong [48], 5 studies were conducted in the USA [20,[38][39][40]44], 3 studies were conducted in the UK [31,49,50], and 4 studies were conducted in Spain [14,37,42,45]. All the studies were published within the previous ten years.…”

“…Nine studies were conducted in long-term care facilities [31,33,36,37,42,44,45,47,50], six studies in community settings [35,[38][39][40]43,51], five studies in hospital settings [14,17,37,41,48,49], and one study in all three settings and one study in both a long-term care facility and community setting [20,46]. Of the studies included, Ballard et al, 2016 [31,32], and Smeets et al, 2021 [33][34][35], published data on the same population.…”

“…Table S4 provides a summary of the interventions and their reported outcomes for each study included in the review. In terms of cognitive pharmacy services and specif-ically for clinical assessment (see Table S2), medication reviews were conducted by the pharmacists independently in 15 studies [17,21,[36][37][38][39][40][41][42]44,[47][48][49][50][51] and in collaboration with multidisciplinary teams in 6 studies [14,33,43,45,46]. One study reported a medication review conducted by a therapist [31].…”