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Introduction: This study aimed to provide insight into the merits of DementiaNet, a network-based primary care innovation for community-dwelling dementia patients. Methods: Longitudinal mixed methods multiple case study including 13 networks of primary care professionals as cases. Data collection comprised continuously-kept logs; yearly network maturity score (range 0–24), yearly quality of care assessment (quality indicators, 0–100), and in-depth interviews. Results: Networks consisted of median nine professionals (range 5–22) covering medical, care and welfare disciplines. Their follow-up was 1–2 years. Average yearly increase was 2.03 (95%-CI:1.20–2.96) on network maturity and 8.45 (95%-CI:2.80–14.69) on quality indicator score. High primary care practice involvement and strong leadership proved essential in the transition towards more mature networks with better quality of care. Discussion: Progress towards more mature networks favored quality of care improvements. DementiaNet appeared to be effective to realize transition towards network-based care, enhance multidisciplinary collaboration, and improve quality of dementia care. [ABSTRACT FROM AUTHOR]

Oral tetrahydrocannabinol (THC) is currently studied for its possible efficacy on dementia-related neuropsychiatric symptoms (NPS), but might lead to increased risk of falling. This was a randomised, double-blind, crossover study to evaluate the effects of THC on mobility in dementia patients. Eighteen community-dwelling patients ( Mage=77 years) received 1.5 mg of oral THC twice daily and placebo, in random order, for three days, separated by a four-day washout. Balance and gait were assessed using SwayStarTM and GAITRiteTM within two hours after administration, in two consecutive intervention periods, under the following conditions: standing with eyes open (EO) and eyes closed (EC), preferred speed walking with and without a cognitive dual task. THC significantly increased sway during standing EC (roll angle 0.32[±0.6]°, p=0.05; pitch angle 1.04[±1.5]°, p=0.009; pitch velocity 1.96[±3.3]°/s, p=0.02), but not during standing EO. During preferred speed walking, THC increased stride length (4.3[±5.4] cm, p=0.005) and trunk sway (pitch angle 1.18[±1.6]°, p=0.005). No effects were observed during dual task walking. No differences in the number and type of adverse events were found, and no falls occurred after administration of THC. This study showed that 3 mg of THC per day has a benign adverse event profile regarding mobility and was well tolerated by community-dwelling dementia patients. [ABSTRACT FROM AUTHOR]

Unintended weight loss frequently complicates the course of many neurodegenerative disorders and can contribute substantially to both morbidity and mortality. This will be illustrated here by reviewing the characteristics of unintended weight loss in the three major neurodegenerative disorders: Alzheimer’s disease, Parkinson’s disease and Huntington’s disease. A common denominator of weight loss in these neurodegenerative disorders is its typically complex pathophysiology. Timely recognition of the underlying pathophysiological process is of crucial importance, since a tailored treatment of weight loss can considerably improve the quality of life. This treatment is, primarily, comprised of a number of methods of increasing energy intake. Moreover, there are indications for defects in the systemic energy homeostasis and gastrointestinal function, which may also serve as therapeutic targets. However, the clinical merits of such interventions have yet to be demonstrated. [ABSTRACT FROM AUTHOR]

New models of care seek to reorganize healthcare to meet the challenges of a growing number of persons with chronic conditions, to optimize the use of the available workforce, and to improve the quality of care. Increasingly, these models also seek to organize care in a manner that addresses cost and efficiency in addition to quality of care. This chapter first revisits the history of chronic care models and then provides a description of successful and sustainable examples of integrated, multidisciplinary approaches for persons with dementia, persons with Parkinson's disease, and the frail elderly. We focus on models for neurodegenerative diseases and draw from the perspectives of research, clinical practice, and informal caregiving. Although focused on neurodegenerative disease, the principles of these approaches reflect the hallmarks of good primary, geriatric, and collaborative care. Many of the current models of care emanate from a medical approach led by physicians and other professional providers within the formal healthcare setting. Innovative approaches, however, now seek to incorporate these medical models within social and community services. We conclude this chapter by describing several international examples of community-based efforts that have been implemented to improve the care and lives of patients with dementia and their informal caregivers, which is at present one of the top priorities in many countries., (Copyright © 2019 Elsevier B.V. All rights reserved.)

This paper describes the development of a guideline on medical research with older subjects. Although our society is aging, evidence on health care for older persons is lacking on many topics, because these subjects are underrepresented in most drug and non-drug trials, while these services are used many older persons, and result in many adverse reactions and unplanned hospitalisation. Part of the reasons for this underrepresentation is the multimorbidity, often leading to exclusion, but also the lack of appropriate research methods plays a major role. Therefore, this paper describes the methods and results of the development of a multidisciplinary, evidence based guideline on how to conduct medical research in older persons. The recent changes in European and Dutch legislation on medical research were another reason to start this guideline project. We conducted two systematic reviews (on informed consent and recruitment) and conducted surveys and focus groups on the other four topics covered by the paper: proportionality, resistance, drop out, and societal relevance. In total we formulated 45 recommendations, all agreed on in consensus meetings, in which older persons' representatives played a major role. This Guideline on medical research in older persons, will be implemented via the ethical review boards, the medical scientific committees, and the Ministry of Health in the Netherlands, who commissioned the guideline work. We hope the guideline stimulates quality and quantity of research on older adults to answer the increasing number of societal and scientific questions with regard to this populations.

Older persons represent a growing proportion of the population. However, few of them participate in medical research. Moreover, amendments have been proposed to the Medical Research Involving Human Subjects Act (WMO) concerning the participation of vulnerable subjects such as older persons. In light of these changes, the Dutch Ministry of Health, Welfare and Sport sought to develop a guideline to improve the quality of research involving older persons. This guideline will also be a tool for researchers to enhance the inclusion of older persons in their medical research. It focuses on six aspects to consider when setting up a research project: recruitment, informed consent, attrition, reluctance to participate, proportionality between the burden for participants and the benefits for the investigator, and societal relevance.