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Background: Advance care planning in dementia includes supporting the person and their family to consider important goals of care. International research reports the importance of psycho-social-spiritual aspects towards end of life. Aim: To develop a multidimensional international palliative care goals model in dementia for use in practice. Design: International Delphi study integrating consensus and evidence from a meta-qualitative study. The Delphi panel rated statements about the model on a 5-point agreement scale. The criteria for consensus were pre-specified. Setting/participants: Seventeen researchers from eight countries developed an initial model, and 169 candidate panellists were invited to the international online Delphi study. Results: Panellists (107; response 63.3%) resided in 33 countries. The model comprised four main care goals: (1) Comfort ensured; (2) Control over function maintained; (3) Identity protected and personhood respected and (4) Coping with grief and loss−person and caregiver supported. The model reflects how needs and care goals change over time with the progression of dementia, concluding with bereavement support. The first version of the model achieved a consensus after which it was slightly refined based on feedback. We did not achieve a consensus on adding a goal of life prolongation, and on use of the model by people with dementia and family themselves. Conclusion: A new palliative care goals model for people with dementia and their families includes relationship aspects for use by professionals and achieved a consensus among a panel with diverse cultural background. The position of life prolongation in relation to palliative care goals needs further research. [ABSTRACT FROM AUTHOR]

Objectives: Physical activity (PA) can reduce depressive symptoms but has not been tested amongst depressed older caregivers and their care‐recipients. The aim of this single‐blind randomized controlled trial was to investigate the effect of a 6‐month tailored PA program on depressive symptoms in older caregivers. Method: Caregivers were included if they had scores of ≥5 on the 15‐item geriatric depression scale (GDS‐15). Care‐recipients could have any type of physical, mental or cognitive condition requiring support. The PA intervention group completed an individualized program based on the Otago‐Plus Exercise Program. The primary outcome was improvement in depressive symptoms in caregivers measured at six and 12 months. Results: Two hundred and twelve participants (91 dyads and 30 caregivers only) were randomized using a 3:3:1 ratio to PA intervention, social‐control, and usual‐care control groups. There were no significant differences in depressive symptoms of the caregivers between the three groups at 6 months or 12 months. However, more than 50% of caregivers in all three groups no longer had a GDS‐15 score ≥5 at 6 months. Further analysis revealed that caregivers in the PA group caring for someone with a standardised mini‐mental state examination (SMMSE) score ≥24 had significantly less depressive symptoms than those caring for someone with a SMMSE score <24 compared with social‐control (p < 0.02) and usual‐care groups (p < 0.02). Conclusions: A PA intervention may be beneficial for some caregivers in reducing symptoms of depression but may not be as beneficial to caregivers of people living with cognitive impairment. Key points: Physical activity (PA) may help to reduce depression, stress and burden in caregivers.This study investigated the effects of an individually tailored, home‐based PA intervention for both caregivers and care‐recipients, of 6 months' duration, on improving depressive symptoms in older caregivers.A PA intervention may be beneficial for caregivers in reducing symptoms of depression but may not be as beneficial to caregivers of people living with cognitive impairment. [ABSTRACT FROM AUTHOR]