Literature Review

Advance care planning among diverse U.S. older adults with varied cognition levelsAlzheimer's & Dementia; by Zahra Rahemi, Swann Arp Adams; 1/25Older adults from minority groups often experience elevated rates of chronic diseases and cognitive impairment, coupled with lower rates of engagement in advance care planning (ACP) and comfort care as they approach end of life... Our study revealed that individuals facing cognitive impairments exhibited lower rates of engagement in ACP. Notably, among the variables examined, race, ethnicity, rural residence, education, and age emerged as significant predictors of ACP in a national sample of older adults in the U.S. These findings underscore the importance of incorporating these sociodemographic factors into the design of interventional studies aimed at enhancing ACP and mitigating disparities.

“I aim to fulfill my promise”: Dementia caregiving from the perspective of spouses and partnersJournal of Applied Gerontology; Haley M. Shiff, Theresa A. Allison, Madina Halim, Kenneth E. Covinsky, Alexander K. Smith, Deborah E. Barnes, Jennie M. Gubner, Kara Zamora; 1/25In the United States, spouses provide 17% of in-home care for people living with dementia. We found common features underlying the care provided by spouses/partners, including challenges and motivators guided by notions of loyalty and commitment. As cognition and function declined, care partners found the relationship increasingly difficult. They shared the feeling of being stuck as well as the loss of identity and freedom. This finding follows what Westrelin et al. (2024) describe in their study on spousal caregivers of partners living with dementia, in which spouses perceived changes not only in their partner but also in themselves and oscillated between their identity as a caregiver and as a spouse, highlighting the dynamic nature of caregiver identity construction within the context of caring for a partner living with dementia.

United States dementia cases estimated to double by 2060: Anticipated jump especially large for women, Black people & those over age 75NYULangone Health; by David March; 1/13/25A new study shows that the risk of developing dementia at any time after age 55 among Americans is 42 percent, more than double the risk reported by older studies. That dementia risk translates into an estimated half-million cases this year, rising to a million new cases a year by 2060, according to the new work. Dementia involves progressive declines in memory, concentration, and judgment. The increasing number of cases is directly tied to the aging of the U.S. population. Beyond aging, a high risk of dementia is linked to genetic factors, as well as high rates of hypertension and diabetes, obesity, unhealthy diets, lack of exercise, and poor mental health.

Behavioral symptoms and treatment challenges for patients living with dementia: Hospice clinician and caregiver perspectivesJournal of the American Geriatrics Society; Karolina Sadowska BA; Molly Turnwald BA; Thomas O'Neil MD; Donovan T. Maust MD, MS; Lauren B. Gerlach DO, MS; 12/24Dementia affects one in three older adults over age 85 and individuals with dementia constitute the fastest growing population of patients entering hospice care. While cognitive impairment is the hallmark of dementia, behavioral symptoms are reported in nearly all patients with advanced dementia, contributing to both the complexity of end-of-life care and caregiver burden. Behavioral symptoms of dementia are highly prevalent among the US hospice population and are often managed with psychotropic medications prescribed off-label. There are limited treatment guidelines in this population, so the appropriate risk and benefit balance may be highly individual. This qualitative study can help to inform the decision-making of hospice clinicians and caregivers regarding anticipated behavioral changes and limitations of treatment options in dementia end-of-life care. 

Hospice study reveals contrasting views on managing dementia behaviors McKnights Long-Term Care News; by Donna Shryer; 12/20/24 A new study finds that healthcare providers and family caregivers often disagree on how best to manage dementia behaviors during end-of-life care. The research, published in the Journal of the American Geriatrics Society, involved interviews with 23 hospice clinicians and 20 family caregivers. With dementia affecting 33% of adults over age 85 and now ranking as the primary diagnosis for Medicare hospice services, understanding these differing perspectives about managing dementia behaviors has become increasingly important. The study found that while both groups identified agitation as the most concerning behavioral symptom, they approached it from different angles. Clinicians primarily worried about physical safety risks, while family caregivers were more distressed by personality changes in their loved ones.

Taking over affairs for an aging parent in mental decline U.S. News & World Report; by Lisa Esposito and Elaine K. Howley; 12/17/24 ... Taking over affairs for an aging parent is a vast undertaking that must focus on several areas of the individual’s life and health simultaneously. Here is a step-by-step guide to approaching this process:

How innovative designs can help ease ethical tension in good dementia caregiving and decision-makingAMA Journal of Ethics; Emily Roberts, PhD; 12/24The European dementia village is a pioneering health care site: 4 acres of integrated housing and amenities that include large exterior walkways around gardens, restaurants, and shops. A US-based conceptual model is the dementia friendly city center [DFCC], which integrates health care service delivery into adaptive reuse and urban revitalization. Separately and together, we can work to deliver new interventions that can make a difference for those living with dementia and their families. Further exploration of the DFCC model is required to address possible financial and regulatory constraints that accompany the development of necessary public health infrastructure.

[Denmark] Opioids and dementia in the Danish populationJAMA Network Open; Nelsan Pourhadi, MD; Janet Janbek, PhD; Christiane Gasse, Dr rer medic; Thomas Munk Laursen, PhD; Gunhild Waldemar, DMSc; Christina Jensen-Dahm, PhD; 11/24This study found that opioid use of less than 90 TSDs [total standardized doses] was not significantly associated with increased dementia risk. Above 90 TSDs of opioid use was associated with an elevated dementia risk before age 90 years, which persisted in individuals with chronic noncancer pain and in individuals solely exposed to weak opioids. Further research should ascertain whether the findings denote causality between opioids and dementia risk.

This Scottsdale art class helps adults with memory loss 'live in the moment' AZCentral, Scottsdale, AZ; by Alexandra Hardle; 12/1/24 ... Anne Halvorson and her mother, Nancy Halvorson, have been attending Memory Lounge since 2022. Nancy was diagnosed with Alzheimer's the year prior, Anne said. Nancy lives in an assisted living facility, but she spent much of her career as a music therapist working with children with special needs in the public school system, Anne said. Since her mother was already naturally drawn to art, the two became frequent attendees of Memory Lounge after hearing of the program through Hospice of the Valley. "It's been a lifesaver for us. It has given my mother an outlet for all of her creativity, which she has in abundance," Anne said. Memory Lounge also allows Anne's mother the chance to use a different part of her brain and to learn something new. It's also a space for her to simply socialize and talk about something other than her doctor's appointments and where she's living, Anne said.

It gives you a really great feeling, knowing that what you are doing is making somebody's day: Provider perspectives on implementing the individualized positive psychosocial interactionPsychological Services; Cassandra Keiser, Molly Noble, Kimberly VanHaitsma, Katherine M Abbott; 11/24The Individualized Positive Psychosocial Interaction (IPPI) is an evidence-based program that supports engaging people living with dementia and their care partners in the nursing home (NH). IPPIs are brief, one-to-one, preference-based activities to improve well-being and decrease behavioral and psychological symptoms of dementia. Champions voiced that the IPPI program was cost-effective, adaptable to their local contexts, and provided training to staff to support residents experiencing distress. Overall, the IPPI program goals are aligned with nursing home organization goals, supporting staff in providing comfort to residents communicating distress, and can be feasibly implemented.

BREAKING: CMS issues ‘significant’ survey changes for 2025 [long-term care] McKnights Long-Term Care News; by Kimberly Marselas; 11/19/24 The Centers for Medicare & Medicaid Services on Monday issued “significant revisions” to its long-term care surveyor guidance, with changes affecting everything from admission and discharge standards to the use of psychotropic medications and newly adopted infection prevention practices. CMS released an advance copy of the 900-page document online, including new critical element pathways, to give providers and surveyors time to adjust to the new requirements before they go into effect Feb. 24, 2025. A significant portion of the changes is related to chemical restraints and unnecessary psychotropic medication.

There aren't enough dementia providers in Arizona. This unique campus offers training KJZZ Phoenix, AZ; by Kathy Ritchie; 11/15/24 Arizona has the fastest growth rate of Alzheimer’s disease in the country. Yet there are not enough paid caregivers or even geriatricians — only 92 in the entire state — for this population. So how do you educate, even inspire, health care students to care about dementia? As the saying goes, if you build it, they will come. Judy Ward is chatting with three nursing students from Creighton University when a group of preschoolers toddle on by. ... The children attend a care center located at Hospice of the Valley’s Dementia Care and Education Campus in Arcadia. That’s also where Judy’s adult day club for people living with dementia is situated, along with a 12-bed assisted living community and a hospice unit. ...

Alzheimer Disease—What’s in a name?JAMA Neurology; Ronald C. Petersen, PhD, MD; Elizabeth Mormino, PhD; Julie A. Schneider, MD, MS; 11/24Back in 2018, the National Institute on Aging (NIA)–AA [Alzheimer Association] group proposed a biological definition of AD [Alzheimer Disease] stating that if a person had the biomarker evidence of brain amyloid (A) and tau (T), the pathologic hallmarks of the disease, the patient had AD irrespective of the person’s clinical state. In their recent 2024 revision, they maintain a biological definition but have extended it to incorporate more recent biomarkers for AD; ... positivity on core 1 biomarkers that indicate the crossing of a specific amyloid threshold on amyloid positron emission tomography (PET), cerebrospinal fluid, and foreseeably, plasma biomarkers. A major question pertains to the requirement for tau in the definition [as] the AA group argues that the vast majority of individuals who have amyloid-positive PET scans have some tau pathology. Furthermore, the AA group proposes a clinical staging scheme that provides a framework to define the frequent mismatch between AD biomarker positivity (and underlying neuropathology) and the clinical expression of the disease, often an indicator of mixed pathologies or resilience. Importantly, although the AA group does base the AD diagnosis on biomarker positivity, they do not currently advise testing in asymptomatic persons in a clinical setting.