Background: The diagnosis of depression in dementia patients leads to an increase in the burden of the disease. To treat depression in this patient group, antidepressants are frequently used; however, there is not any proof of their therapeutic effectiveness, and their use may be potentially harmful. This narrative review aims to summarize the existing evidence regarding the role of antidepressants in treating depression in dementia patients. Main text: A search was conducted in the PubMed, Excerpta Medica database (EMBASE), and Cochrane databases for randomized controlled trials and meta-analyses wherein antidepressants were given to dementia sufferers to address depression. Fifteen randomized controlled trials and seven meta-analyses were identified. Most well-designed blinded placebo-controlled trials reported a lack of effectiveness of antidepressants in treating depression in dementia patients. Among the seven metanalyses, two reported good efficacy of Selective serotonin reuptake inhibitors (SSRIs). However, two major Cochrane reviews reported little or no effectiveness and increased side effects of antidepressants in dementia patients. Conclusion: There is robust evidence regarding the lack of efficacy of antidepressants in treating depression in dementia patients. However, further well-designed Randomized controlled trials (RCTs,) using scales with good validity and reliability to diagnose depression in dementia patients, sufficient sample sizes, and detailed adverse effect profiles may help determine the rationale for their use.

Background: In Canada, more than 60% of persons living with dementia reside in their own homes, and over 25% rely heavilyon their care partners (ie, family members or friends) for assistance with daily activities such as personal hygiene, eating, andwalking. Assistive technology (AT) is a key dementia management strategy, helping to maintain health and social support inhome and community settings. AT comprises assistive products and services required for safe and effective use. Persons livingwith dementia and their care partners often require multiple types of AT to maintain their needs, dignity, and autonomy. AT fordementia management is rapidly developing with abundant scientific literature, which can present a challenge to efficientlynavigate and extract insightsfor policy and personal decision-making. Objective: This scoping review aims to synthesize review-level evidence from published scientific literature on AT to supportdementia management for persons living with dementia and their care partners in their homes and communities. Research gapsin knowledge and areas for further investigation into the use and access of AT will be identified. This review will provide anoverview of AT types and characteristics and chart the outcomes and conclusions in review-level evidence. Methods: This review will follow the Joanna Briggs Institute's framework for conducting scoping reviews and the PRISMA-ScR(Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. In total, 6electronic databases will be searched. Articles will be screened according to the Population-Concept-Context (PCC) frameworkfor eligible studies. Population includes persons living with dementia, their care partners, and health care professionals (eg,therapists or others who recommend AT). Concept includes AT and self-help devices of many types. Context includes homesand communities. A data charting template will guide data extraction, charting, and summarization. A descriptive numerical summary and an overview of the findings will be presented. Data, such as (1) article information (eg, author and year), (2) articlecharacteristics (eg, review type), (3) AT types and characteristics, (4) setting and population characteristics, and (5) key reviewoutcomes and conclusions, will be extracted. Results: A total of 10,978 unique citations were identified across the 6 electronic databases. This review is in the full-textscreening stage, which is expected to be completed by October 2024. Conclusions: This review will provide a comprehensive understanding and documentation of the published scientific literatureon AT to support dementia management. Findings from this review are expected to provide evidence-based insights on thecomplexities of AT types, uses, availability, and access. The author group's diverse national and international perspectives maycontribute to knowledge exchange and influence standards to improve the daily function, safety, and well-being of persons livingwith dementia. Trial Registration: Open Science Framework DKSM9; https://osf.io/dksm9 International Registered Report Identifier (IRRID): PRR1-10.2196/57036

Aims and objectives: Synthesising evidence for effects of dyadic psychoeducational support programs on both people with dementia and their caregivers' health and well-being. Background: There is an increasing need for psychoeducational support programs for people with dementia and their caregivers; therefore, it is important to identify the benefits and practical implications of the programs on the dyads. Methods: Guided by Joanna Briggs Institute (JBI) methodology, and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework, a systematic search of literature was conducted on dyadic psychoeducational programs published in English between January 2012 and January 2021 from four electronic databases. Results: Twenty-four studies evaluating 27 psychoeducational programmes were included in this review. Programs varied in activity types, intensity and duration. Outcome effects on people with dementia were grouped into seven categories: quality of life, cognitive function, psychological and mental health, physical health, changed behaviours, communication and relationship, institutionalisation or mortality. Outcome effects on caregivers were grouped into six: psychological and mental health, quality of life, impact of caregiving, communication and relationship, physical health, and competency. Dyadic psychoeducational programs which were goal oriented and tailored to address individual needs had consistent benefits on various aspects of health and quality of life for the dyads. Conclusions: Multicomponent psychoeducational support programs combined with addressing individual needs, identifying goals and providing support to attain specific outcomes are recommended. Given the progressive deterioration of people with dementia, and the increased needs for homecare by family members, delivering long-term, support programs are recommended to maintain the positive effects on the dyads. Relevance to clinical practice: The findings contribute to dementia-care provision and policy making and inform the development of person-centred interventions and governance. Patient or public contribution: This systematic review was a part of a larger service evaluation project which involved a dementia consumer advisory group.

The use of touchscreen tablets, such as the iPad, offers potential to support the person with dementia staying in a care setting, ranging from a long-term care home to an adult day programme. Although electronic devices are used among people with dementia, a comprehensive review of studies focusing on their impact and how they may be used effectively in care settings is lacking. We conducted a scoping review to summarize existing knowledge about the impact of touchscreen tablets in supporting social connections and reducing responsive behaviours of people with dementia in care settings. Our research team consists of patient partners and family partners, physicians, nurses, a medical student and an academic professor. A total of 17 articles were included in the review. Our analysis identified three ways in which touchscreen tablets support dementia care: (1) increased the person's engagement, (2) decreased responsive behaviours and (3) positive effect on enjoyment/quality of life for people with dementia. Lessons learned and barriers to the use of touchscreen tablets in the care of people with dementia are described. Overall, only a few studies delineated strategies that helped to overcome barriers to technology adoption in care settings. Knowledge translation studies are needed to identify effective processes and practical tips to overcome barriers and realize the potential of assistive technology in dementia care.

Background Mild cognitive impairment (MCI) is a cognitive state falling between normal aging and dementia. The relation between alcohol intake and risk of MCI as well as progression to dementia in people with MCI (PDM) remained unclear. Objective To synthesize available evidence and clarify the relation between alcohol intake and risk of MCI as well as PDM. Method We searched electronic databases consisting of PubMed, EMBASE, Cochrane Library, and China Biology Medicine disc (CBM) from inception to October 1, 2019. Prospective studies reporting at least three levels of alcohol exposure were included. Categorical meta-analysis was used for quantitative synthesis of the relation between light, moderate and heavy alcohol intake with risk of MCI and PDM. Restricted cubic spline and fixed-effects dose-response models were used for dose-response analysis. Result Six cohort studies including 4244 individuals were finally included. We observed an unstable linear relation between alcohol intake (drinks/week) and risk of MCI (P linear = 0.0396). It suggested that a one-drink increment per week of alcohol intake was associated with an increased risk of 3.8% for MCI (RR, 1.038; 95% CI 1.002-1.075). Heavy alcohol intake (> 14 drinks/week) was associated with higher risk of PDM (RR = 1.76; 95% CI 1.10-2.82). And we found a nonlinear relation between alcohol intake and risk of PDM. Drinking more than 16 drinks/week (P nonlinear = 0.0038, HR = 1.42; 95% CI 1.00-2.02), or 27.5 g/day (P nonlinear = 0.0047, HR = 1.46; 95% CI 1.00-2.11) would elevate the risk of PDM. Conclusion There was a nonlinear dose-response relation between alcohol intake and risk of PDM. Excessive alcohol intake would elevate the risk of PDM.

The purpose of this article is to analyse the available literature describing the economic burden of dementia and to compare costs between studies examining cost drivers. To shed light on this field, a systematic review is performed using PubMed, the Cochrane Library and Web of Science. An eight-year retrospective horizon was considered until 25 May 2018. Several papers were obtained from the database search (n = 23), being others (n = 3) identified through other sources (hand-searching) because we did not detect it through the three databases. The cost estimates were compared between three perspectives: state/publicly funded health services, third-party/private sector/not-for-profit organisations and patient and family and/or societal. The estimated total annual cost per person with dementia in Europe is on average €32,506.73 (n = 10), whereas for the United States, it gets €42,898.65 (n = 2). Furthermore, differences are appreciated by type of costs. Besides, differences by severity groups are also considered. Overall, the higher the severity the higher the associated costs. Dementia imposes a huge economic burden. The figures here presented provide a good framework to quantify these costs for both, economic experts and researchers, and policy decision makers.

BACKGROUND: The annual prevalence of falls in people with dementia ranges from 47 to 90%. Falls are a common reason for hospital admission in people with dementia, and there is limited research evidence regarding the care pathways experienced by this population. In addition to immediate management of an injury, prevention of further falls is likely to be an important part of any successful intervention. This review aims to assess the effectiveness of interventions for improving the physical and psychological wellbeing of people with dementia who have sustained a fall-related injury. METHODS: Systematic review methodologies were employed utilising searches across multiple databases (MEDLINE, CENTRAL, Health Management Information Consortium, EMBASE, CINAHL, Web of Science, Allied and Complementary Medicine Database, and Physiotherapy Evidence Database (PEDro)) and citation chaining. Studies including people with a known diagnosis of dementia living in the community and who present at health services with a fall, with or without injury, were included. Outcomes of interest included mobility, recurrent falls, activities of daily living, length of hospital stay, and post-discharge residence. Results were independently reviewed and quality assessed by two researchers, and data extracted using a customised form. A narrative synthesis was performed due to heterogeneity of the included studies. RESULTS: Seven studies were included. Interventions clustered into three broad categories: multidisciplinary in-hospital post-surgical geriatric assessment; pharmaceuticals; and multifactorial assessment. Multidisciplinary care and early mobilisation showed short-term improvements for some outcomes. Only an annual administration of zoledronic acid showed long-term reduction in recurrent falls. CONCLUSIONS: Due to high heterogeneity across the studies, definitive conclusions could not be reached. Most post-fall interventions were not aimed at patients with dementia and have shown little efficacy regardless of cognitive status. Minor improvements to some quality of life indicators were shown, but these were generally not statistically significant. Conclusions were also limited due to most studies addressing hip fracture; the interventions provided for this type of injury may not be suitable for other types of fractures or soft tissue injuries, or for use in primary care.

Background: Evidence-based care for people with dementia is a priority for patients, carers and clinicians and a policy priority. There is evidence that people with dementia do not always receive such care. Audit and feedback, also known as clinical audit, is an extensively-used intervention to improve care. However, there is uncertainty about the best way to use it. Objectives: To investigate whether audit and feedback is effective for improving health professionals' care of people with dementia. To investigate whether the content and delivery of audit and feedback affects its effectiveness in the context of health professionals' care for people with dementia. Design: Systematic review DATA SOURCES: The Cochrane Central Register of Controlled Trials, Prospero, Medline (1946-December week 1 2016), PsycInfo (1967-January 2017), Cinahl (1982-January 2017), HMIC (1979-January 2017), Embase (1974-2017 week 1) databases and the Science Citation Index and Social Science Citation Index were searched combining terms for audit and feedback, health personnel, and dementia. Review methods: Following screening, the data were extracted using the Template for Intervention Description and Replication (TIDieR), and synthesised graphically using harvest plots and narratively. Results: Thirteen studies met the inclusion criteria. Published studies of audit and feedback in dementia rarely described more than one cycle. None of the included studies had a comparison group: 12 were before and after designs and one was an interrupted time series without a comparison group. The median absolute improvement was greater than in studies beyond dementia which have used stronger designs with fewer risks of bias. Included studies demonstrated large variation in the effectiveness of audit and feedback. Conclusions: Whilst methodological and reporting limitations in the included studies hinder the ability to draw strong conclusions on the effectiveness of audit and feedback in dementia care, the large interquartile range indicates further work is needed to understand the factors which affect the effectiveness of this much-used intervention.

OBJECTIVE: Caring for people with dementia can be emotionally challenging and is often linked to low job satisfaction and burnout in care staff. Staff training within care settings is potentially valuable in improving well-being and quality of care. This review aimed to (i) establish the impact of training on staff outcomes; (ii) compare the impact of different training approaches; (iii) explore the influence of training intensity; and (iv) explore potential barriers to success. METHOD: A database search of staff training interventions revealed 207 papers, 188 of which were excluded based on prespecified criteria. Nineteen studies were included and appraised using a quality rating tool. RESULTS: Overall, the studies were found to be of variable quality; however, 16 studies found a significant change following training in at least one staff domain, with knowledge improving most frequently. Approaches focusing on managing challenging behaviours appeared to be the most effective. CONCLUSION: Training staff can be an effective method of improving well-being, and programmes helping staff to manage challenging behaviour appear to be the most beneficial. There is no clear relationship between training intensity and outcome. Most studies point to the importance of addressing organisational factors as a barrier to change.

BACKGROUND: Informal caregivers who perform at-home care of older people with dementia might have feelings of a meaningless existence, burden, anxiety, stress and fatigue. Support groups are considered an especially effective and economical way to relieve informal caregivers' stress and burden, although it is unclear if participating in group meetings produces a meaningful outcome for the informal caregiver. OBJECTIVES: To identify the meaningfulness of participating in support groups for informal caregivers of older adults with dementia living in their own home. INCLUSION CRITERIA: TYPES OF PARTICIPANTS: Informal caregivers of older adults aged 65 years and over with dementia. The informal caregiver was a family member, and care was performed at home. PHENOMENA OF INTEREST: How the informal caregivers perceived the meaningfulness of participating in support groups. The setting was all locations where support groups for informal caregivers were held and studied. Types of studies: Studies that focused on qualitative data including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research and feminist research. Types of outcomes: Subjective accounts of the informal caregivers' perceptions of the meaningfulness associated with participating in support groups. Beliefs, benefits, rewards and attitudes related to a caregiver's experiences as a participant in support groups and in the role as caregiver. The perception by informal caregivers of participating in support groups as a way to release stress. SEARCH STRATEGY: The search aimed at finding published and unpublished studies in English, German, Danish, Swedish and Norwegian, and was unrestricted by time. Eleven electronic databases and eleven websites were searched. METHODOLOGICAL QUALITY: Methodological quality of the qualitative papers was assessed independently by two reviewers using standardized critical appraisal instruments from the Joanna Briggs Institute Qualitative Assessment and Review Instrument. DATA EXTRACTION: Qualitative data were extracted from papers included in the review using the standardized data extraction tool from the Joanna Briggs Institute Qualitative Assessment and Review Instrument. DATA SYNTHESIS: Qualitative research findings were synthesized using the Joanna Briggs Institute Qualitative Assessment and Review Instrument. RESULTS: A total of 59 findings from five studies were aggregated into five categories. Three synthesized findings were generated based on the meta-aggregation of the categories: 1) emotional benefits of peer-based support; 2) facing the challenges of caregiving; and 3) embracing the future through virtual configuration of group meetings. CONCLUSIONS: The five studies provided useful and credible findings from caregivers' voices that are not often heard in regard to the meaning of participating in support groups. Peer support is beneficial for caregivers, and it provides a source of positive emotional support and a means of venting negative feeling and gaining help to address issues in the everyday life of caring for older adults with dementia

Purpose of the study: Falls prevention evidence is strong, but little is known about uptake of strategies for people living with dementia (PLWD). This mixed-method systematic review aimed to integrate evidence of falls prevention efficacy with views/experiences of PLWD. Design and methods: Eight electronic databases were searched. Inclusion criteria included quantitative or qualitative studies examining knowledge translation of falls prevention strategies in community-dwelling PLWD and/or their caregiver. Study quality was assessed, and findings are narratively described. Results: Six quantitative and five qualitative studies were included. Study quality was mixed. Quantitative studies showed limited evidence of effectiveness on reduction in falls risk, falls and hospitalization rates, nursing home admission, decline in activities of daily living, and adherence to strategies. Qualitative themes showed inclusion of caregiver and health professionals as key to program success, but many factors influence participation. Implications: Synthesizing the findings generated a new understanding of falls prevention for this high-risk group. A focus upon health professional and caregiver involvement and accommodation of individual preferences may result in increased engagement with falls prevention strategies.

OBJECTIVE: The overall objective is to determine the availability of person-centred intervention and training manuals for dementia care staff with clinical trial evidence of efficacy. DESIGN: Interventions were identified using a search of electronic databases, augmented by mainstream search engines, reference lists, hand searching for resources and consultation with an expert panel. The specific search for published manuals was complemented by a search for randomised control trials focussing on training and activity-based interventions for people with dementia in care homes. Manuals were screened for eligibility and rated to assess their quality, relevance and feasibility. RESULTS: A meta-analysis of randomised control trials indicated that person-centred training interventions conferred significant benefit in improving agitation and reducing the use of antipsychotics. Each of the efficacious packages included a sustained period of joint working and supervision with a trained mental health professional in addition to an educational element. However, of the 170 manuals that were identified, 30 met the quality criteria and only four had been evaluated in clinical trials. CONCLUSIONS: Despite the availability of a small number of evidence-based training manuals, there is a widespread use of person-centred intervention and training manuals that are not evidence-based. Clearer guidance is needed to ensure that commissioned training and interventions are based on robust evidence.

This systematic overview summarizes the published literature reflecting the effectiveness of services or models of care for persons with dementia living in their homes, in specialized institutional care or assisted living centres/congregate homes. A detailed search for literature found studies evaluating respite care, day programs, counselling, congregate living, and special care units in institutions and there is some evidence of the effectiveness of these programs. No scientifically rigorous effectiveness studies, specific for persons with dementia, were found for hospice care, case management or psychogeriatric outreach mental health programs. First and foremost, more research is needed that examines the effectiveness of different programs for specific persons and their caregivers with different characteristics and the measurement of family expenditures as well as costs of programs

BACKGROUND: Most people with dementia transition into nursing homes as their disease progresses. Their family caregivers often continue to be involved in their relative's care and experience high level of strain at the end of life. AIM: To gather and synthesize information on interventions to support family caregivers of people with advanced dementia at the end of life in nursing homes and provide a set of recommendations for practice. DESIGN: Mixed-Methods Systematic Review (PROSPERO no. CRD42020217854) with convergent integrated approach. DATA SOURCES: Five electronic databases were searched from inception in November 2020. Published qualitative, quantitative, and mixed-method studies of interventions to support family caregivers of people with advanced dementia at the end of life in nursing home were included. No language or temporal limits were applied. RESULTS: In all, 11 studies met the inclusion criteria. Data synthesis resulted in three integrated findings: (i) healthcare professionals should engage family caregivers in ongoing dialog and provide adequate time and space for sensitive discussions; (ii) end-of-life discussions should be face-to-face and supported by written information whose timing of supply may vary according to family caregivers' preferences and the organizational policies and cultural context; and (iii) family caregivers should be provided structured psychoeducational programs tailored to their specific needs and/or regular family meetings about dementia care at the end of life. CONCLUSION: The findings provide useful information on which interventions may benefit family caregivers of people with advanced dementia at the end of life and where, when, and how they should be provided.