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Iva Holmerová,1 Stefanie R Auer,2,3 Anna Beránková,1 Margit Höfler,2 Paulina Ratajczak,2 Michal Šteffl4 1Centre of Expertise in Longevity and Long-Term Care, Faculty of Humanities, Charles University, Prague, Czech Republic; 2Danube University Krems, 3500 Krems, Austria; 3MAS Alzheimerhilfe, 4820 Bad Ischl, Austria; 4Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic Background: The treatment of pain and treatment of anxiety are two of the most complex issues in nursing homes worldwide, mainly because of the large numbers of people with cognitive impairment who reside in this environment. Aim: The aim of this study was to investigate the administration of analgesics and anxiolytics to people living in nursing homes, taking into account cognitive status. Methods: For this cross-sectional study, we used data from 404 residents who lived in nine randomly selected nursing homes in the Czech Republic and participated in the Czech-Austrian Long-Term Care Research Project called DEMDATA. Information about medication administration was obtained from medical records. Cognitive impairment was evaluated by the Mini-Mental State Examination, and pain was measured by the Pain Assessment in Advanced Dementia. To measure anxiety, we used the Behavioral Pathology in Alzheimer’s Disease Rating Scale in residents with severe-to-moderate dementia and also the standardized questionnaire EuroQol in other residents. Results: In all, 68% (95% CI 62–74) of residents with pain did not receive any analgesic medication and 31% (95% CI 25–38) of residents were administered some analgesics and continued to report pain. The lowest reported occurrence of pain, as well as the lowest prevalence of analgesic administration, was in residents with moderate-to-severe dementia. We found that an alarming percentage of residents in the nursing homes were not treated sufficiently. Conclusion: This study indicates that treatment effects should be better monitored. Keywords: pain, anxiety, dementia, analgesics, anxiolytics

Shima Mehrabian,1 Larissa Schwarzkopf,2 Stefanie Auer,3 Iva Holmerova,4 Milica G Kramberger,5 Marina Boban,6 Elka Stefanova,7 Catalina Tudose,8 Natalia Bachinskaya,9 Tibor Kovács,10 Petr Koranda,11 Todor Kunchev,1 Latchezar Traykov,1 Janine Diehl-Schmid,12 Katrina Milecka,12 Alexander Kurz12On behalf of the Danubian Network for Dementia Education Care (DANDEC) Consortium1UH “Alexandrovska”, Department of Neurology, Medical University Sofia, Sofia, Bulgaria; 2Helmholtz-Centre Munich, Deutsches Forschungszentrum für Gesundheit und Umwelt (GmbH), Munich, Germany; 3Department for Clinical Neurosciences and Preventive Medicine, Danube University Krems, Krems, Austria; 4CELLO Faculty of Humanities, Charles University, Prague, the Czech Republic; 5University of Ljubljana, Department of Neurology, Ljubljana, Slovenia; 6University of Zagreb, Department of Cognitive Neurology, Zagreb, Croatia; 7School of Medicine, University of Belgrade, Neurology Clinic, Belgrade, Serbia; 8University of Medicine and Pharmacy Carol Davila, Department of Clinical Neurosciences, Bucharest, Romania; 9Acacdemy of Medical Sciences Kiev, Department of clinical physiology and pathology of the central nervous system, Kiev, the Ukraine; 10Department of Neurology, Semmelweis University, Budapest, Hungary; 11MEDIWARE corp., Prague, the Czech Republic; 12Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, GermanyCorrespondence: Alexander KurzCentre for Cognitive Disorders at the Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar; Technische Universität München, Ismaninger Strasse 22 Munich 81675, GermanyTel +49 894 140 4285Email a.kurz@tum.deBackground: Dementia is a particularly severe societal challenge in several countries of the Danube Region due to higher-than-average increment in population longevity, disproportionate increase of the old-age dependency ratio, and selective outward migration of health care professionals. A survey was conducted among dementia experts to obtain a deeper understanding of the dementia care structures and services in this geographical area, and to identify the educational needs of health care professionals, and the availability of assistive technology.Subjects and methods: A standardized questionnaire was sent out to 15 leading dementia experts/clinicians in 10 Danube Region countries inquiring about professional groups involved in dementia care, availability and reimbursement of services, inclusion of dementia in professional education and training, acceptability of Internet-based education, and availability of assistive technology. The authors are the survey respondents.Results: The majority of individuals with dementia receive care in the community rather than in institutions. The roles of medical specialties are disparate. General practitioners usually identify dementia symptoms while specialists contribute most to clinical diagnosis and treatment. Health care professionals, particularly those who work closely with patients and carers, have limited access to dementia-specific education and training. The greatest need for dementia-specific education is seen for general practitioners and nurses. An Internet-based education and skill-building program is considered to be equivalent to traditional face-to-face but offer advantages in terms of convenience of access. Assistive technology is available in countries of the Danube Region but is significantly underused.Conclusion: Dementia care in the Danube Region can be improved by an educational and skill-building program for health care professionals who work in the frontline of dementia care. Such a program should also attempt to enhance interdisciplinary and intersectorial collaboration, to intensify the interaction between primary care and specialists, and to promote the implementation of assistive technology.Keywords: dementia, Danube Region, expert survey, dementia care structures, education, assistive technology

We examined whether recognition of facial emotional expression would be affected in amnestic mild cognitive impairment (aMCI). A total of 50 elderly persons met the initial inclusion criteria; 10 were subsequently excluded (Geriatric Depression Score > 5). 22 subjects were classified with aMCI based on published criteria (single domain aMCI [SD-aMCI], n = 10; multiple domain aMCI [MD-aMCI], n = 12); 18 subjects were cognitively normal. All underwent standard neurological and neuropsychological evaluations as well as tests of facial emotion recognition (FER) and famous faces identification (FFI). Among normal controls, FFI was negatively correlated with Mini-Mental Status Examination scores and positively correlated with executive function. Among patients with aMCI, FER was correlated with attention/speed of processing. No other correlations were significant. In a multinomial logistic regression model adjusted for age, gender, and education, a poorer score on FER, but not on FFI, was associated with greater odds of being classified as MD-aMCI (odds ratio [OR], 3.82; 95% confidence interval [CI], 1.05-13.91; p = 0.042). This association was not explained by memory or global cognitive score. There was no association between FER or FFI and SD-aMCI (OR, 1.13; 95% CI, 0.36-3.57; p = 0.836). Therefore, FER, but not FFI, may be impaired in MD-aMCI. This implies that in MD-aMCI, the tasks of FER and FFI may involve segregated neurocognitive networks. [ABSTRACT FROM AUTHOR]

The goal of this pilot study was to assess the validity of the three selected screening tools that assess the risk of falls in hospitalized elderly patients in acute care settings. Validity was assessed using sensitivity, specificity, positive predictive value and negative predictive values. The research sample consisted of 122 hospitalized seniors, whose risk of falling was assessed using the Mors Fall Scale (further MFS), the modified scale patient/client fall risk assessment index by Jurásková (further Jurásková 2006) and Screening test for fall risk assessment to identify patients at high risk of falling (further STRP). Subsequently, it was observed whether the patients fell or not. The research methods used were interviews with patients, the study of written documents and observations. The results identified a sensitivity of 91% of MFS, Jurásková 2006 100%, STRP 100%. Specificity was at MFS 2%, Jurásková 2006 7%, STRP 2%. MFS Positive predictive value 17%, Jurásková 2006 18%, STRP 17%. MFS 50% Negative predictive value, Jurásková 2006 100%, STRP100%. The results suggest that further research is required aimed not only at verifying the functionality of the assessment tools used, but also to assess the risk factors used in all three instruments. Evaluating the risk factors in a specific population of hospitalized elderly could lead to the creation of a new tool, or the modification of an existing index, which would be functional and easily applicable for Czech Geriatric Nursing. [ABSTRACT FROM AUTHOR]

Care for patients with dementia poses multiple challenges to the caretaker, including issues concerning maintaining patient dignity. In this paper, we discuss dignity in the context of patient autonomy, self-respect and appreciation, and explore issues that relate to dignity of patients in dementia care. As patients become incapacitated by the disease, it becomes the caretaker's responsibility to assure that the patient continues to live with dignity. The uniform manifestation of dementia symptoms across individuals allows for implementation of patient-friendly activities to address their special needs and allow them to express the remaining autonomy. In advanced dementia, a beneficial long-term care outcome becomes secondary and should give way to strategies to maintain patient comfort and dignity. Although it may be challenging to stress dignity in a patient with advanced dementia, where multiple serious health problems are likely to co-exist, it remains important to realize that dignity can be, should be and must be supported, maintained and, in some situations, regained. [ABSTRACT FROM AUTHOR]

Michal Steffl,1 Jan Sima,2 Kate Shiells,3 Iva Holmerova3 1Department of Physiology and Biochemistry, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic; 2Department of Sport Management, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic; 3Centre of Expertise in Longevity and Long-term Care, Faculty of Humanities, Charles University, Prague, Czech Republic Abstract: Muscle weakness and associated diseases are likely to place a considerable economic burden on government health care expenditure. Therefore, our aim for this study was to estimate the direct and indirect costs associated with muscle weakness in the Czech Republic. We applied a cost-of-illness approach using data from the Survey of Health, Ageing and Retirement in Europe (SHARE). Six hundred and eighty-nine participants aged 70 years and over and without any long-term illnesses were included in our study. A generalized linear model with gamma distribution was used, and odds ratio (OR) was calculated in order to explore the effect of muscle weakness on direct and indirect costs. For both genders, muscle weakness had a statistically significant impact on direct costs (OR =2.11), but did not have a statistically significant impact on indirect costs (OR =1.08) or on total cost (OR =1.51). Muscle weakness had the greatest statistically significant impact on direct costs in females (OR =2.75). In conclusion, our study has shown that muscle weakness may lead to increased direct costs, and consequently place a burden on health care expenditure. Therefore, the results of this study could lead to greater interest in the prevention of muscle weakness among older people in the Czech Republic. Keywords: direct cost, indirect cost, economic burden, sarcopenia, frailty

Michal Steffl,1 Richard W Bohannon,2 Lenka Sontakova,1 James J Tufano,1 Kate Shiells,3 Iva Holmerova3 1Department of Physiology and Biochemistry, Faculty of Physical Education and Sport, Charles University Prague, Prague, Czech Republic; 2Department of Physical Therapy, College of Pharmacy and Health Sciences, Campbell University, Buies Creek, NC, USA; 3Faculty of Humanities, Centre of Gerontology, Charles University Prague, Prague, Czech Republic Abstract: Physical activity (PA) has been identified as beneficial for many diseases and health disorders, including sarcopenia. The positive influence of PA interventions on sarcopenia has been described previously on many occasions. Current reviews on the topic include studies with varied PA interventions for sarcopenia; nevertheless, no systematic review exploring the effects of PA in general on sarcopenia has been published. The main aim of this study was to explore the relationship between PA and sarcopenia in older people on the basis of cross-sectional and cohort studies. We searched PubMed, Scopus, EBSCOhost, and ScienceDirect for articles addressing the relationship between PA and sarcopenia. Twenty-five articles were ultimately included in the qualitative and quantitative syntheses. A statistically significant association between PA and sarcopenia was documented in most of the studies, as well as the protective role of PA against sarcopenia development. Furthermore, the meta-analysis indicated that PA reduces the odds of acquiring sarcopenia in later life (odds ratio [OR] =0.45; 95% confidence interval [CI] 0.37–0.55). The results of this systematic review and meta-analysis confirm the beneficial influence of PA in general for the prevention of sarcopenia. Keywords: aging, sarcopenia, physical activity

The article summarizes key priorities of European research in the field of ageing both at individual and population levels and reviews the process of preparation of the "road map" for European ageing research under the FuturAge project. The project focused on four key priority themes: 1. Biogerontology, 2. Social and economic resources, 3, Environments of ageing and 4 Healthy ageing Besides recognized experts from academia, professionals and representatives from practice, public administration, civil society, and the private sector participated in the consultation process on priorities for the Road Map [ABSTRACT FROM AUTHOR]

Article on education and training programme of physicians for their practice in long-term care medicine in selected countries and in the Czech Republic, in the context of health care provision for patients of old age. [ABSTRACT FROM AUTHOR]

Abstract Background Frontotemporal lobar degeneration with ubiquitin and TDP-43 positive neuronal inclusions represents a novel entity (FTLD-TDP) that may be associated with motor neuron disease (FTLD-MND); involvement of extrapyramidal and other systems has also been reported. Case presentation We present three cases with similar clinical symptoms, including Parkinsonism, supranuclear gaze palsy, visuospatial impairment and a behavioral variant of frontotemporal dementia, associated with either clinically possible or definite MND. Neuropathological examination revealed hallmarks of FTLD-TDP with major involvement of subcortical and, in particular, mesencephalic structures. These cases differed in onset and progression of clinical manifestations as well as distribution of histopathological changes in the brain and spinal cord. Two cases were sporadic, whereas the third case had a pathological variation in the progranulin gene 102 delC. Conclusions Association of a "progressive supranuclear palsy-like" syndrome with marked visuospatial impairment, motor neuron disease and early behavioral disturbances may represent a clinically distinct phenotype of FTLD-TDP. Our observations further support the concept that TDP-43 proteinopathies represent a spectrum of disorders, where preferential localization of pathogenetic inclusions and neuronal cell loss defines clinical phenotypes ranging from frontotemporal dementia with or without motor neuron disease, to corticobasal syndrome and to a progressive supranuclear palsy-like syndrome.

Background: Loneliness, a major public health concern, could be alleviated through social interventions with nature contact as a primary component. "Friends in Nature" is a complex nature-based social intervention designed to be implemented as part of "Reimagining Environments for Connection and Engagement: Testing Actions for Social Prescribing in Natural Spaces" (RECETAS). This project aims to alleviate loneliness and promote health-related quality of life in six different geographic areas worldwide. Feasibility studies are crucial to assess the viability of complex interventions and study procedures before conducting definitive studies. This paper aims to describe the design, implementation, and evaluation of the six-related feasibility studies on the "Friends in Nature" intervention. These studies specifically evaluate feasibility of recruitment and study procedures, intervention implementation, and data collection and distribution., Methods: We defined a comprehensive set of indicators to assess the feasibility of "Friends in Nature." For the first domain, recruitment procedures were assessed to determine their adequacy, while attrition rates were examined to assess participant retention. For the second domain, the implementation of interventions was evaluated, along with the study design's ability to adapt to unexpected situations and participant adherence to the intervention. Finally, for the third domain, completion rates and the acceptability of the study activities were also analyzed. The feasibility of using specific scales to assess loneliness and well-being was also explored., Results: The feasibility indicators defined for this study were useful to assess the feasibility of "Friends in Nature." Recruitment procedures were generally found to be adequate, and the number of dropouts was low. Interventions were implemented with minor adjustments, and facilitators played a vital role in the well-functioning of the interventions. Although some unexpected situations occurred during the study, adaptations were made, and participants were generally satisfied with the activities proposed. Scales used to assess loneliness and quality of life showed potential for measuring the effects of nature-based social prescribing in the full trial., Conclusion: This paper offers valuable insights into the design and execution of feasibility studies for complex interventions like "Friends in Nature." Findings from these assessments explore the feasibility of "Friends in Nature" and will inform the main RECETAS studies, which are designed to strengthen the evidence base to support the use of nature-based social prescribing to reduce loneliness and promote quality of life., Trial Registration: Barcelona trial: NCT05488496, Prague trial: NCT05522140, and Helsinki trial: NCT05507684., Competing Interests: Declarations. Ethics approval and consent to participate: The study protocols have been reviewed and approved in the six cities. The clinical trial of Barcelona received the approval of Research Ethics Committee (REC) at UVic-UCC with registration number 2014/2022 on 28 June 2022 and Primary Health Care Research Institute of Catalonia with the registration number 22/170-P on 02/08/2022. Moreover, the consortium obtained the approval of the Helsinki University Hospital Ethics Committee (No. HUS/119/2022). They also received approval from Social Services and Health Care of the City of Helsinki on 13 June 2022. The protocol in Prague was approved by the Ethics Committee of the Faculty of Humanities, Charles University, on June 28, 2022. The protocol in Cuenca, Ecuador, was approved by the Committee of Bioethics (Comité de Bioética en Investigación del Área de la Salud (COBIAS)) on June 28, 2022 (2022-001EO-I). The protocol in Melbourne, Australia, was approved by the Human Research Ethics Committee (HREC) Research and Innovation Office NH&MRC Code: EC00237 on October 10, 2022. The protocol in Marseille, France, was approved by the Comité d’éthique de l’université d’Aix-Marseille on January 10, 2023. The three trial protocols have been published at www.clinicaltrials.gov . Protocol numbers are as follows: Barcelona Trial: NCT05488496, Prague Trial: NCT05522140, and Helsinki Trial: NCT05507684. Informed consent was obtained from all study participants before enrollment in the study. Human subjects’ data generated throughout this project was anonymized, and safeguards were in place to ensure protection of human subjects’ data. Consent for publication: Not applicable. Competing interests: The authors declare that they have no competing interests., (© 2024. The Author(s).)

Objectives: Mindfulness-based interventions (MBIs) for persons with dementia (PwD) have yielded mixed results, possibly attributable to the fact that little is known about the validity and reliability of trait mindfulness self-report measures in PwD. This narrative review sought to identify studies involving self-reported trait mindfulness and other clinical measures that may hold information on the convergent validity and reliability of these measures in PwD., Methods: Scientific databases were searched for studies involving PwD and mindfulness assessments., Results: N  = 426 studies from PubMed and N  = 156 from PsychInfo databases were reviewed. Four cross-sectional studies were identified that allowed inferences about the validity of mindfulness measures. A qualitative review indicated that convergent validity with other measures varied with sample heterogeneity and cognitive impairment. Merely one MBI included self-reported trait mindfulness, however without reporting sample-specific validity or reliability., Conclusions: Despite efforts to implement MBIs in PwD, information on basic methodological psychometric issues is minimal. Future studies ought to address the validity and reliability of self-reported mindfulness in detail across different stages of dementia., Clinical Implications: Results of MBIs need to be considered cautiously. Basic information about psychometric properties of mindfulness self-report measures is required and these measures need to be included systematically in MBIs.

Objectives: Mental illness affects approximately 1 in 8 people globally, with approximately 15% of adults aged 60 years and older experiencing a mental disorder. With the aging population, there is a growing demand for long-term care. This scoping review focuses on older adults with non-neurocognitive and non-neurodevelopmental mental illnesses (NNNDMIs) in nursing homes, exploring how the care is provided., Design: A scoping review., Setting and Participants: The review includes studies addressing care for older adults with NNNDMI in nursing homes., Method: The PRISMA-ScR protocol was followed. Four research databases (EBSCO, PubMed, Web of Science, and Scopus) and article bibliographies were used for the literature search. Thematic analysis identified the main themes., Results: From a total of 1948 search results, 13 articles were analyzed to reveal 5 themes: (1) challenges and recommendations in nursing home admission for older adults with mental illness; (2) impact on the quality of the care; (3) need for specialized staff training and competency; (4) contributions to psychiatric and behavioral symptoms; and (5) need for a range of interventions., Conclusion and Implications: Older adults with NNNDMI face barriers during admission to long-term care facilities that highlight concerns about care quality and systemic issues. Behavioral symptoms require specialized mental health support, but access to such services is lacking. Deficiencies in staff education and burnout prevention initiatives further underscore the need for comprehensive reforms to address the unique needs of this overlooked population in long-term care settings., Competing Interests: Disclosure The authors declare no conflicts of interest., (Copyright © 2024 Post-Acute and Long-Term Care Medical Association. Published by Elsevier Inc. All rights reserved.)

Advance care planning (ACP) is increasingly recognised in the global agenda for dementia care. The European Association for Palliative Care (EAPC) Taskforce on ACP in Dementia aimed to provide recommendations for policy initiatives and future research. We conducted a four-round Delphi study with a 33-country panel of 107 experts between September, 2021, and June, 2022, that was approved by the EAPC Board. Consensus was achieved on 11 recommendations concerning the regulation of advance directives, equity of access, and dementia-inclusive approaches and conversations to express patients' values. Identified research gaps included the need for an evidence-based dementia-specific practice model that optimises engagement and communication with people with fluctuating and impaired capacity and their families to support decision making, while also empowering people to adjust their decisions if their goals or preferences change over time. Policy gaps included insufficient health services frameworks for dementia-inclusive practice. The results highlight the need for more evidence and policy development that support inclusive ACP practice models., Competing Interests: Declaration of interests MN received research grants from the Japan Society for the Promotion of Science and the Japan Agency for Medical Research and Development outside of this work. LVdB reports research grants from EU NAVIGATE, PACE, INDUCT, and DISTINCT under European Commission grant agreements and from Fonds Wetenschappelijk Onderzoek Flanders, Flanders Innovation and Entrepreneurship Francqui Foundation, Research Council University at Vrije Universiteit Brussel, Kom Op Tegen Kanker (Flemish Stand Up to Cancer), Foundation for Alzheimer Research, and the King Baudouin Foundation. LVdB has received book royalties from Oxford University Press; payment for lectures from the Flemish Federation of Palliative Care, Katholieke Universiteit Leuven for developing the content of an e-learning module for physicians; and payment from the Vrije Universiteit Brussel for a lecture within the postgraduate course on palliative care for masters and medicine. PJL received contract payment from National Technical University Norway. IH received research grants from the Health Care Research Agency Czech Republic and the Department of Health Social Care in Prague. JTvdS received salary support from a European Research Council personal Consolidator career award and Leiden University Medical Center Department of Public Health and Primary Care. All other authors declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Background: The negative effects of loneliness on population health and wellbeing requires interventions that transcend the medical system and leverage social, cultural, and public health system resources. Group-based social interventions are a potential method to alleviate loneliness. Moreover, nature, as part of our social and health infrastructure, may be an important part of the solutions that are needed to address loneliness. The RECETAS European project H2020 (Re-imagining Environments for Connection and Engagement: Testing Actions for Social Prescribing in Natural Spaces) is an international research project aiming to develop and test the effectiveness of nature-based social interventions to reduce loneliness and increase health-related quality of life., Methods: This article describes the three related randomized controlled trials (RCTs) that will be implemented: the RECETAS-BCN Trial in Barcelona (Spain) is targeting people 18+ from low socio-economic urban areas; the RECETAS-PRG Trial in Prague (Czech Republic) is addressing community-dwelling older adults over 60 years of age, and the RECETAS-HLSNK trial is reaching older people in assisted living facilities. Each trial will recruit 316 adults suffering from loneliness at least sometimes and randomize them to nature-based social interventions called "Friends in Nature" or to the control group. "Friends in Nature" uses modifications of the "Circle of Friends" methodology based on group processes of peer support and empowerment but including activities in nature. Participants will be assessed at baseline, at post-intervention (3 months), and at 6- and 12-month follow-up after baseline. Primary outcomes are the health-related quality-of-life according to 15D measure and The De Jong Gierveld 11-item loneliness scale. Secondary outcomes are health and psychosocial variables tailored to the specific target population. Nature exposure will be collected throughout the intervention period. Process evaluation will explore context, implementation, and mechanism of impact. Additionally, health economic evaluations will be performed., Discussion: The three RECETAS trials will explore the effectiveness of nature-based social interventions among lonely people from various ages, social, economic, and cultural backgrounds. RECETAS meets the growing need of solid evidence for programs addressing loneliness by harnessing the beneficial impact of nature on enhancing wellbeing and social connections., Trial Registration: Barcelona (Spain) trial: ClinicalTrials.gov, ID: NCT05488496. Registered 29 July 2022. Prague (Czech Republic) trial: ClinicalTrials.gov, ID: NCT05522140. Registered August 25, 2022. Helsinki (Finland) trial: ClinicalTrials.gov, ID: NCT05507684. Registered August 12, 2022., (© 2024. The Author(s).)

Background: Due to the rapid ageing of the population, there is increasing demand for long-term care in the people's home environment. Such care aims to allow the people to stay at home and avoid hospitalisation or other institutional care. In home health care, care must be provided at the highest possible quality, with the focus on the people's needs and experiences., Objectives: This study explores the experiences and needs of frail older people receiving home health care., Design and Methods: An exploratory descriptive qualitative approach was chosen. Audio-taped semi-structured interviews were conducted with fifteen older people receiving home health care. A content analysis was used to analyse the data collected., Results: The content analysis identified one main theme, three categories and seven subcategories related to frail older people's needs and experiences of home health care. The main theme was quality of care. The first category, Safe and Secure Care, consisted of three subcategories: Education and Experience of Nurses, Information, and Continuity of Care in terms of personnel continuity and regular care. The second category, Autonomy, contained two subcategories: Decision-making and Self-sufficiency. The last category, Relationship with Professionals, consisted of two subcategories: Personality of Nurse and Partnerships., Conclusion: Older people are able to express their satisfaction or dissatisfaction with home health care. The results of this study revealed that the quality of care is crucial for frail older people., Implication for Practice: The provision of home health care is inherently highly specific; home care nurses should work to provide the highest possible quality of care. In particular, nurses should focus on ensuring that the care they provide is safe, effective, timely, efficient and person-centred., (© 2021 The Authors. International Journal of Older People Nursing published by John Wiley & Sons Ltd.)

Background: Research into care for older patients in the hospital environment has become an increasingly valuable source of information, as it gives feedback on the quality of hospital care provided. The aim of this study is to provide a comprehensive overview of the self-reported needs of older people in hospital care., Methods: The scoping review was conducted by searching the following databases: Medline, Web of Science, ProQuest Central, Scopus, Cinahl, PsycINFO and Summon., Results: The search identified articles focusing on older people in hospital care. The majority of these articles address the system and quality of care for seniors at a somewhat general and theoretical level. Met and unmet needs were assessed by a variety of test methods focusing mainly on medical issues (e.g., Mini-Nutritional Assessment, ADLs-activities of daily living, Abbey Pain Scale) and mostly from the perspective of hospital staff, carers and relatives. Only 15 articles used assessments based on information and opinions obtained from the seniors themseAbstract_Paralves (self-reported needs). A thematic analysis revealed seven main themes: conduct and care in emergency departments, dignity, nutritional care, satisfaction of patients' needs, pain, caring with respect, decision-making and spiritual needs., Conclusion/discussion: The results of this scoping review suggest that more attention should be focused on information acquired from the patients themselves, as it is only the patient, however, old or frail, who can offer an accurate perspective on met or unmet needs and the quality of care provided., (© 2020. Springer Nature Switzerland AG.)

Alzheimer's disease (AD) is the most common type of dementia, but it is very difficult to diagnose with certainty, so many AD studies have attempted to find early and relevant diagnostic markers. Regulated upon activation, normal T cell expressed and secreted (RANTES, also known as C-C chemokine ligand) is a chemokine involved in the migration of T cells and other lymphoid cells. Changes in RANTES levels and its expression in blood or in cerebrospinal fluid have been reported in some neurodegenerative diseases, such as Parkinson's disease and multiple sclerosis, but also in metabolic diseases in which inflammation plays a role. The aim of this observational study was to assess RANTES levels in peripheral blood as clinical indicators of AD. Plasma levels of RANTES were investigated in 85 AD patients in a relatively early phase of AD (median 8.5 months after diagnosis; 39 men and 46 women; average age 75.7 years), and in 78 control subjects (24 men and 54 women; average age 66 years). We found much higher plasma levels of RANTES in AD patients compared to controls. A negative correlation of RANTES levels with age, disease duration, Fazekas scale score, and the medial temporal lobe atrophy (MTA) score (Scheltens's scale) was found in AD patients, i.e., the higher levels corresponded to earlier stages of the disease. Plasma RANTES levels were not correlated with cognitive scores. In AD patients, RANTES levels were positively correlated with the levels of pro-inflammatory cytokines interleukin-6 and tumor necrosis factor-α, which is consistent with the well-known fact that AD is associated with inflammatory processes. RANTES levels were also positively correlated with insulin levels in AD patients, with insulin resistance (HOMA-R) and pancreatic beta cell function (HOMA-F). This study evaluated several clinical and metabolic factors that may affect plasma levels of RANTES, but these factors could not explain the increases in RANTES levels observed in AD patients. Plasma levels of RANTES appear to be an interesting peripheral marker for early stages of AD. The study was approved by the Ethics Committee of Institute of Endocrinology, Prague, Czech Republic on July 22, 2011., Competing Interests: None

There is evidence supporting the use of psychosocial interventions in dementia care. Due to the role of policy in clinical practice, the present study investigates whether and how the issue of psychosocial care and interventions has been addressed in the national dementia plans and strategies across Europe. A total of 26 national documents were found. They were analyzed by content analysis to identify the main pillars associated with the topic of psychosocial care and interventions. Specifically, three categories emerged: (1) Treatment, (2) Education, and (3) Research. The first one was further divided into three subcategories: (1) Person-centred conceptual framework, (2) Psychosocial interventions, and (3) Health and social services networks. Overall, the topic of psychosocial care and interventions has been addressed in all the country policies. However, the amount of information provided differs across the documents, with only the category of 'Treatment' covering all of them. Furthermore, on the basis of the existing policies, how the provision of psychosocial care and interventions would be enabled, and how it would be assessed are not fully apparent yet. Findings highlight the importance of policies based on a comprehensive and well-integrated system of care, where the issue of psychosocial care and interventions is fully embedded.

Background: Most people in a state of illness or reduced self-sufficiency wish to remain in their home environment. Their physiological needs, and their psychological, social, and environmental needs, must be fully met when providing care in their home environment. The aim of this study is to provide an overview of the self-perceived needs of older people living with illness or reduced self-sufficiency and receiving professional home care., Methods: A scoping review of articles published between 2009 and 2018 was conducted by searching six databases and Google Scholar. Inductive thematic analysis was used to analyze data from the articles retrieved., Results: 15 articles were included in the analysis. Inductive thematic analysis identified six themes: coping with illness; autonomy; relationship with professionals; quality, safe and secure care; role in society; environment., Conclusion/discussion: Older home care patients living with chronic illness and reduced self-sufficiency are able to express their needs and wishes. Care must, therefore, be planned in line with recipients' needs and wishes, which requires a holistic approach.

Objectives: With rates of dementia continuing to rise, the impetus on improving care for people with dementia is growing. Unmet needs of people with dementia living in nursing homes have been linked with worsening neuropsychiatric symptoms, higher levels of depression, and reduced quality of life. Furthermore, proxy accounts exploring the needs of people with dementia have frequently been shown to be unreliable. Therefore, this literature review aims to explore the self-reported needs and experiences of people with dementia in nursing homes. Method: A scoping review of the literature was carried out using the databases PubMed and PsycINFO to search for relevant articles according to PRISMA guidelines. Search terms were designed to include both quantitative and qualitative study designs. Thematic synthesis was used to categorise findings into themes related to self-reported needs and experiences. Results: A total of 41 articles met the eligibility criteria. An analysis of study characteristics revealed more than half of studies used a qualitative design. Thematic synthesis resulted in eight themes: activities, maintaining previous roles, reminiscence, freedom and choice, appropriate environment, meaningful relationships, support with grief and loss, end-of-life care. Conclusion: Whilst the voice of people with dementia has previously been neglected in research, this review has shown that people with dementia in nursing homes are able to describe their experiences and communicate their needs. The findings in this review have provided a contribution towards guiding evidence-based practice that is tailored to the needs of nursing home residents with dementia.

The nursing home sector has seen a disproportionately high number of deaths as part of the COVID-19 pandemic. This reflects, in part, the frailty and vulnerability of older people living in care homes but has also, in part, been a consequence of the failure to include care homes in the systematic planning of a response to COVID, as well as a measure of neglect of standards and quality improvement in the sector. In response, the EUGMS published a set of medical standards of care developed in consultation with experts across its member national societies in 2015. The standards consisted of seven core principles of medical care for physicians working in nursing homes as a first step in developing a programme of clinical, academic and policy engagement in improving medical care for older people who are living and frequently also dying as residents in nursing homes. The gravity of the concerns arising for nursing home care from the COVID-19 pandemic, as well as emerging insights on care improvement in nursing homes indicate that an update of these medical standards is timely. This was performed by the writing group from the original 2015 guidelines and is intended as an interim measure pending a more formal review incorporating a systematic review of emerging literature and a Delphi process.

Background: The electronic patient record (EPR) has been introduced into nursing homes in order to facilitate documentation practices such as assessment and care planning, which play an integral role in the provision of dementia care. However, little is known about how the EPR facilitates or hinders these practices from the end-user's perspective. Therefore, the objective of this qualitative study was to explore the usability issues associated with the EPR for assessment and care planning for people with dementia in nursing homes from a staff perspective., Methods: An exploratory, qualitative research design with a multiple case study approach was used. Contextual Inquiry was carried out with a variety of staff members (n = 21) who used the EPR in three nursing homes situated in Belgium, Czech Republic and Spain. Thematic analysis was used to code interview data, with codes then sorted into a priori components of the Health Information Technology Evaluation Framework: device, software functionality, organisational support. Two additional themes, structure and content, were also added., Results: Staff provided numerous examples of the ways in which EPR systems are facilitating and hindering assessment and care planning under each component, particularly for people with dementia, who may have more complex needs in comparison to other residents. The way in which EPR systems were not customisable was a common theme across all three homes. A comparison of organisational policies and practices revealed the importance of training, system support, and access, which may be linked with the successful adoption of the EPR system in nursing homes., Conclusions: EPR systems introduced into the nursing home environment should be customisable and reflect best practice guidelines for dementia care, which may lead to improved outcomes and quality of life for people with dementia living in nursing homes. All levels of nursing home staff should be consulted during the development, implementation and evaluation of EPR systems as part of an iterative, user-centred design process.

Objectives: The aim of this data paper is to provide the data set of a sub-analysis of the DEMDATA study data. In the DEMDATA study, epidemiological data on the prevalence and severity of dementia, as well as functioning, behavioral problems and other health related factors in residents living in Austrian and Czech nursing homes were collected. The DEMDATA project further provides information on relatives' perception of the life Quality of residents, care team burden as well as environmental factors. Participating nursing homes were randomly drawn and stratified. Inclusion criteria for participation were that the resident was living permanently in the institution and that he/she and/or a legal representative (where relevant) had signed an informed consent., Data Description: This paper provides data of cognitive, functional and behavioral assessments as well as other health related information of 1085 residents living in Austrian and Czech nursing homes. For each resident, several measurements on his or her cognitive, functional, and behavioral status are available. Also further health-related factors such as quality of life, pain, numbers of falls and hospital stays are provided.

Case management is generally seen as a way to provide efficient, cost-saving person-centred care for people with dementia by connecting together fragmented services, but the available evidence in favour of its merits is often considered inconclusive, unclear and sketchy. This discussion paper investigates the evidence of the benefit of case management for people with dementia and explores the complexity of the concept and the experiences of its implementation. It offers a comprehensive framework for conceptualising various types of case management and asks the question: who can be a case manager? Building on examples from three European countries it addresses the problem of the expansion and adoption of the case management method. It compares the conventional model of diffusion of innovation with the ideas of interessement and co-constitution and envisions a successful model of case management as a fluid technology that is both friendly and flexible, allowing it to adapt to different settings and systems.

Introduction: Nursing home residents are complex, vulnerable and have been historically neglected. The EuGMS is committed to improving their care, and is currently developing a curriculum of core competencies. Integral to these efforts is identifying the physicians, for whom, education in these competencies needs to be directed., Method: A survey was distributed to European national geriatrics societies, asking members their perceptions of proportions of nursing home medical care delivered by various physician specialties, and the main functions carried out in nursing homes., Results: Responses were received from 22 of 32 national geriatrics societies. The vast majority of care (estimated at 69%), is delivered by general practitioners, rather than geriatricians or specialist nursing home physicians. Nursing homes have acquired important roles in rehabilitation, respite and palliative care., Conclusion: Education and training to achieve the highest standards of care must be designed for general practitioners who do not have specialist training. Education and infrastructure must be developed for the evolving roles of nursing homes.

Objectives: Timely diagnosis of dementia is recommended in national strategies. To what extent is it occurring across Europe, what factors are associated with it, and what is the impact on carers emotions of quality of diagnostic disclosure?, Methods/design: Survey of family carers recruited through 5 Alzheimer's associations (Czech Republic, Finland, Italy, the Netherlands, and Scotland). One thousand four hundred and nine carers participated, 84% completing online. Fifty-two percent were adult children, and 37% were spouses, with median age 57. Most (83%) were female., Results: Nearly half (47%) of carers reported that an earlier diagnosis would have been preferable. Delaying factors included reluctance of the person with dementia, lack of awareness of dementia, the response of professionals, and delays within health systems. Recent diagnoses were no more likely to be considered timely, although professional responses appeared to be improving. Delayed diagnoses were more often reported by adult child carers and where the diagnosis was made in the later stages of dementia, or another condition had been previously diagnosed. In all countries except Italy, the diagnosis was shared with the person with dementia in the majority of cases. Timely diagnoses and higher quality diagnostic disclosure are associated with better adjustment and less negative emotional impact on carers in the short and medium term., Conclusions: Although the study sample were well educated and likely to be in touch with an Alzheimer organisation, many continued to experience the diagnosis of dementia as coming too late, and further work on public awareness, as well as on professional responses, is needed., (© 2018 The Authors. International Journal of Geriatric Psychiatry Published by John Wiley & Sons Ltd.)

Background: This paper provides a first comparative exploratory analysis of our findings from DEMDATA, a collaborative project between Austria and the Czech Republic. Analysed here are data from the residents and the environment assessment protocol., Methods: In a cross sectional study design, residents from randomly drawn and stratified nursing homes were investigated using a common study protocol., Results: From a total resident pool of 1666 persons, 1085 (571 in Austria, 514 in the Czech Republic) persons signed a consent form and participated in the data collection. More than 70% of residents assessed were female and the population was on average 85 years old. A discrepancy between the presence of a medical diagnosis in the charts of the residents and the results of cognitive testing was found. In Austria, 85.2%, in the Czech Republic 53.0% of residents had cognitive impairment. In Austria 80.0%, and in the Czech Republic 56.7% had behavioural problems. With respect to pain, 44.8% in Austria, and 51.5% in the Czech Republic had mild to severe pain. 78.4% of Austrian and 74.5% of the residents had problems with mobility and both populations were in danger of malnutrition., Conclusions: Most of the prevalence rates are comparable with previous studies also using direct resident assessment. Variations in prevalence rates seem to result mainly from the assessment technique (direct cognitive testing vs. medical chart review). The high prevalence rates for dementia, behavioural symptoms, pain and malnutrition indicate an immediate call for attention to further research and practice development.

This study was conducted to examine differences between self- and proxy ratings of activities in daily living (ADL) in nursing home residents and to compare them with actual performance. An impact of cognitive status on these ratings was also determined. Data were obtained from 164 dyads of nursing home residents (self-ratings) and their professional care providers (proxy ratings). Statistical procedures included t tests, intraclass correlations, Pearson's correlations, analysis of variance (ANOVA) and ROC curves. Paired t test provided evidence that residents in general overestimated their abilities for all ADLs ( p  < .01 in all cases), but a substantial subset of 54 residents, with mean MMSE of 18, agreed with their care providers. The mean MMSE score of those who overestimated their abilities was 13 ( N  = 57). The ANOVA revealed that greater rating differences were associated with more severe cognitive impairment (MMSE, F  = 9.93, p  < .001). Proxy ratings of walking were not significantly different from actual performances ( p  = .145), while self-ratings overestimated it ( p  < .001). Although residents in general overestimated their ADL abilities and results of comparison with actual performance indicated that proxies may be closer to the actual status in this population, a considerable number of those with milder cognitive impairment were able to assess their ADLs with reasonable accuracy., Competing Interests: Compliance with ethical standardsThe authors declare that they have no conflict of interest.

Cardiovascular events occur most frequently in patients at higher age groups. The elderly suffer not only more advanced and complex changes of cardiovascular system but, also, other chronic conditions. Moreover, compared to middle-age, different therapeutic response is often observed due to changes of pharmaco-kinetics and -dynamics; these patients use other medications, which may trigger drug interactions. The situation is further complicated by non-adherence related to frequent cognitive impairment. On one hand the elderly enjoy the greatest absolute benefit from adequate cardiovascular treatment while on the other they might be more susceptible to adverse reactions. In spite of the fact statins represent preventative medications, they must be indicated cautiously taken into consideration comorbidities, frailty and disability occurring in advanced age. Frail and disabled patients have greater risk of statin adverse effects, however, even these patients have lower mortality rates while being on statins. In seniors with life expectancy exceeding 5 years statins, when indicated, bring unambiguously proven benefit and should be considered high-priority medications. Key words: atherosclerosis - cardiovascular disease - dyslipidemia - elderly - frailty - management - statins.

Objective: The aim of this study was to estimate the cost of dementia in the Czech Republic., Methods: One hundred and nineteen patient-caregiver dyads participated in our multicenter observational cost-of-illness study. The modified Resource Utilization in Dementia Questionnaire was used as the main tool to collect data from patients and caregivers. Medical specialists provided additional data from medical records. The average costs of dementia were calculated and patients were then divided by the level of cognitive impairment. A generalized linear model was used to determine if differences were present for selected cost variables., Results: The mean (standard deviation) for direct cost per a patient in a month was estimated to be €243.0 (138.0), €1727.1 (1075.6) for the indirect cost, and €1970.0 (1090.3) for the total cost of dementia in the Czech Republic. All of the costs increased as dementia severity increased. Both the indirect and total costs significantly (p < 0.05) increased if patients were living with their primary caregiver, and if the severity of cognitive impairment was increased., Conclusions: The indirect cost, which was represented mainly by informal care, comprised the main part of the total cost of care for patients with dementia in the Czech Republic. Both total and indirect care costs increased significantly the cognition declined.

This paper examines the provision of integrated advanced dementia care within seven European countries and critically reviews the potential contribution of the Prudent Healthcare perspective as a starting point for reform. Progressive efforts to innovate, promote quality and integrate care are tempered with the reality of resource constraints. Some policy makers in Europe and North America have turned their attention to the principles of Prudent Healthcare as a potential mechanism to maximise benefits for patients within available resources. As dementia progresses, living well requires increasing levels of support and care, people living with advanced dementia have complex health and social care needs, are highly dependent on others but are not yet at the terminal end stage of the condition. People with advanced dementia can benefit from a dementia specific palliative approach to care ( Palliare ), that helps them to live the best life possible for the months and often years they live with advanced dementia. It is also highly desirable to align policy innovations with integrated palliative care practice models and the education of the dementia workforce to accelerate informed improvements in advanced dementia care. There may be some coherence, at least superficially between Prudent Healthcare and integrated palliative care models such as Palliare . It is argued that for successful implementation, both require practitioners to be equipped with knowledge and skills and be empowered to deliver high quality care often within impoverished care environments. Adoption of the prudent perspective will however require development of a repertoire of approaches to hear the voice or proxy voice of people living with advanced dementia and to commit to the development and implementation of new evidence for advanced dementia practice. Evidence informing this policy debate draws upon contemporary literature and policy and the findings from research activities undertaken by the Palliare project supported through the Erasmus+ K2 Strategic Partnerships funding programme.