Sun et al (The Influence of Ethnicity and Culture on Dementia Caregiving: A Review of Empirical Studies on Chinese Americans) pinpoint the cultural and ethnic influences on dementia caregiving in Chinese American families through a systemic analysis of published works. They found that caregivers’ beliefs concerning dementia and the concept of family harmony are cultural values that impact attitudes toward research and help-seeking behaviors in their population. These cultural beliefs may impinge on the caregiving process. Their findings have potential implications for future research and practice with the Chinese American population.
Llanque and Enriquez (Interventions for Hispanic Caregivers of Patients with Dementia: A Review of the Literature) note that the number of Hispanics/Latinos with dementia in the United States is expected to rise dramatically, paralleling that of other US populations. Their review identified intervention strategies that can help Hispanics/Latinos deal with caregiver burden for adults with dementia. They found that language and communication should be considered when developing interventions for Hispanics/Latino caregivers and those interventions should be culturally tailored, easy to understand, and provide access to resources.
In Palliative Care for Advanced Dementia: A Pilot Project in 2 Nursing Homes, Kuhn and Forrest describe a pilot project involving training, case consultations, and administrative coaching aimed at introducing palliative care in nursing homes for residents with advanced dementia. They found varied improvements in measures for residents, staff members, and family members. Leadership turnover seemed to be an important factor in this. Implications for implementing palliative care programs in nursing homes were discussed.
As a segue to the Bradford et al manuscript, Verma and Anand note that noncognitive symptoms are common in patients with dementia. Their opinion is that although aggression is common, its presence is often impacted by environmental factors. To demonstrate their point, they present a case of Alzheimer’s disease with marked aggressive behavior. Many health care providers would agree with this, and it raises the point that environmental triggers should be sought.
Bradford et al (Managing Pain to Prevent Aggression in People With Dementia: A Nonpharmacologic Intervention) also note that aggression is a common form of behavioral disturbance in dementia and that there is a need for strategies to treat aggression. Modifiable risk factors for aggression include pain management. They review areas of overlap in interventions for pain and for behavioral disturbances and describe an intervention concept that may hold promise for patients with dementia who are at risk of developing aggressive behavior.
In Frailty and Quality of Life for People With Alzheimer’s Dementia and Mild Cognitive Impairment, Ni Mhaolain et al investigated the relationship between frailty and health-related quality of life in cognitively impaired elderly individuals. Frailty and neuropsychiatric symptoms were associated with frailty and health-related quality of life in those with Mini-Mental State Examination scores of at least 21. Functional limitation was associated with frailty and health-related quality of life in those with Mini-Mental State Examination scores less than 21. They concluded that frailty may represent a novel modifiable target in patients with early dementia.
Laditka et al (Use of Dietary Supplements for Cognitive Health: Results of a National Survey of Adults in the United States) studied the use of vitamins, minerals, herbs, and other supplements for cognitive health using the 2007 National Health Interview Survey. They found that fish oil, ginkgo biloba, and vitamins were commonly used for cognitive health. Adults reporting cognitive problems were more likely than normal individuals to use supplements for cognitive health. Among supplement users, over one third did not tell their health care providers. They concluded that we are more likely to use supplements as a treatment of cognitive difficulties than for prevention.
In Development of a Questionnaire on Everyday Navigational Ability to Assess Topographical Disorientation in Alzheimer’s disease, Pai et al developed a questionnaire on everyday navigational ability to detect topographical disorientation in people with Alzheimer’s disease. They found that the caregiver version of their questionnaire fits the proposed topographical disorientation model well but their patient version did not. A discrepancy existed between the appraisal of navigational abilities by Alzheimer’s patients and caregivers, and it was correlated with the number of getting lost events. They concluded that the caregiver version of the questionnaire on everyday navigational ability is a valid instrument to assess topographical disorientation. It may be able to discriminate Alzheimer's disease individuals who get lost and those who do not.