Mental illnesses are common in individuals with dementia.
A new study has shown that talk therapy can be helpful in improving the mental health of individuals with dementia. The results of the study could be helpful to long-term care leaders looking to support the care of these patients.
Depression and anxiety are common mental illnesses that individuals with dementia may experience. The study, led by researchers from University College London, looked at whether talk therapy helped relieve symptoms of these illnesses. The team examined data from over two million people with clinical anxiety or depression and completed a course of talk therapy treatment through England's Improving Access to Psychological Therapies (IAPT) service.
To evaluate outcomes for individuals with dementia, researchers looked at 1,549 participants who had a dementia diagnosis prior to beginning the IAPT treatment, comparing it to a control group of 1,329 participants with the same age, gender, and severity of mental illness.
"Anxiety and depression are very common in people with dementia," Georgia Bell, PhD candidate and the study's lead author, said in a statement. "They are extremely debilitating and associated with worse outcomes for both the person with dementia and their [caregivers]."
"Our findings suggest that while people with dementia are less likely to improve or recover than those without dementia, psychological therapies offered in primary care mental health services can be beneficial for them," she said.
Of the participants with dementia, 63% saw a reduction in symptoms after IAPT, and approximately 40% recovered completely from their symptoms. In comparison, 70% of participants in the control group saw a reduction in their symptoms and 47% recovered completely.
In an October 2022 article by University College London, it states that "previously, there was limited evidence that talking therapies were adequately effective for people with dementia."
Dr. Richard Oakley, associate director of research of the Alzheimer's Society, said it's vital that mental health support be consistent and accessible for individuals after being diagnosed. The Alzheimer's Society and Wellcome funded the study.
"This Alzheimer's Society-funded research is the first study looking at the effectiveness of therapy for people living with dementia in a real-world setting," Oakley said. "It showed that people living with dementia showed a significant improvement in symptoms of anxiety and depression when treated with therapy, even though their response wasn't as strong as that shown in the general population."
He added, "Though this study didn't compare the types of therapy, types of dementia, or if there were adaptations made for people living with the disease, it still highlights the urgent need to improve real-world therapy for those living with dementia—with adaptations to improve its effectiveness and accessibility."
New research explains why women are more likely to develop Alzheimer's.
Research has identified the reason women seem to be more vulnerable to Alzheimer's disease, which may help in developing new treatments for the disease.
A group of Case Western Reserve University researchers found that female brain tissue that reflects a higher expression of a specific enzyme, USP11, causes it to accumulate more of the tau protein, compared to that of male brain tissue. The tau protein can build into toxic protein clumps in brain nerve cells.
"When a particular tau protein is no longer needed for its nerve cell's function, it is normally designated for destruction and clearance," David Kang, co-senior author of the study said in a statement. "Sometimes this clearance process is disrupted, which causes tau to pathologically aggregate inside nerve cells. This leads to nerve cell destruction in conditions called tauopathies, the most well-known of which is Alzheimer's disease."
It's known that women are afflicted by Alzheimer's disease around twice as often as men. The university's findings showed that women express higher levels of USP11 naturally, and that women have a higher tau deposition in their brains, but it's still unknown why the increased vulnerability exists.
Kang added that the study's findings could help identify other factors that contribute to tauopathy in women. It also offers a starting point for the development of new neuroprotective medicines.
"We reasoned that if this could be identified, then it could provide a basis for the development of new medicine that could restore the proper balance of tau levels in the brain," he said.
The research also revealed a potential protective measure for women. In a mouse model, once the USP11 enzyme was genetically eliminated, female mice were more likely to be protected from tau pathology and cognitive impairment than male mice.
However, tau pathology in animal models may not reflect the way it functions in humans.
"In terms of implications, the good news is that USP11 is an enzyme, and enzymes can traditionally be inhibited pharmacologically," Kang said. "Our hope is to develop a medicine that works in this way, in order to protect women from the higher risk of developing Alzheimer's disease."
The acquisition marks Jet Health's eighth acquisition in the last four years as part of its growth strategy.
Home health provider Jet Health announced its acquisition of Trio Home Health and Hospice, based in Denton, Texas, earlier this week. The terms of the transaction were not disclosed.
Jet Health has acquired eight providers over the last four years, as part of its growth strategy to become the leading home health and hospice provider in the west and southwest regions of the U.S.
"With each of the acquisitions Jet Health has completed of late, we have always remained focused on broadening both our offering while extending our reach," Stacie Bratcher, CEO of Jet Health, said in a statement. "Texas marks the state with the most Jet Health-branded enterprises and is also home to our corporate headquarters. Now, with our 10 locations statewide, coupled with a strong, solid network of caregiving professionals throughout all our service areas, we are well positioned to meet the home healthcare and hospice needs of Texans."
While Trio Home Health and Hospice will remain a separate brand, it will operate under Jet Health's companies. With the closing of the acquisition, Jet Health will oversee Trio's 10 Texas locations and employ 500 full-time healthcare professionals across the state.
"This latest acquisition fills our quest to expand our geographic footprint within our primary service areas. We will now extend services beyond the Central Texas area where we currently have established our reputation to include North Texas and the Dallas/Fort Worth metropolitan area," Bratcher said.
Trio Home Health and Hospice services the Denton and northern Texas region with skilled nursing care; physical, occupational and speech therapy; and cardiac and pulmonary care.
"Trio Home Health and Hospice and Jet Health share similar missions, values, patient care approaches and corporate cultures," Becky Mize, CFO of Trio Home Care, said in a statement. "By combining our organizations, the company will significantly bolster its growth trajectory as we now care for more patients in need of the quality services we provide."
The testing will measure the effect of the app on caregivers of patients with dementia.
Researchers from the University of Indiana's School of Public Health-Bloomington and School of Medicine were recently awarded $3.96 million by the National Institutes of Health's National Institute on Aging. The award will fund a five-year clinical trial of a telehealth application for Alzheimer's and related dementias (ADRD).
Specifically, the I-CARE 2 trial will be measuring the effect of the Brain CareNotes telehealth app on caregivers of patients living with ADRD. The new trial is a follow-up of a pilot study on the efficacy of the app, which is designed to help informal and family caregivers manage the behavioral and psychological symptoms of dementia in patients and offer support by connecting caregivers to coaches.
The results of the trial could potentially bring applications like these into the hands of more family caregivers, enabling them to collaborate with providers to ensure quality and precise care for their loved one.
"The I-CARE 2 trial will be nearly three times the size and a much broader study than the first one," co-principal investigator Dr. Richard Holden, a professor at the IU School of Public Health-Bloomington, said in a statement. "This will be the definitive trial to tell us whether the app improves informal caregiver and patient health outcomes."
Participants for the trial will come from Indiana, with Holden adding that researchers intend to have a diverse sample set. The previous trial, I-CARE, had a sample group that was over 40% African American, and in the I-CARE 2 trial, they hope to enroll a larger portion of Hispanic participants.
"We are trying to change the current trend that clinical trials in ADRD underrepresent racial and ethnic minority groups. Our interventions should work for everyone," Holden said.
Endpoints the I-CARE 2 trial will explore are caregiver burden and depressive symptoms, patient symptoms, and the rate of hospital visits and emergency admissions for both parties. The starting hypothesis, Holden explained, is the likelihood of those outcomes being lower after 12 months of using the Brain CareNotes app.
"Our Brain CareNotes solution is built entirely for the purpose of scaling the evidence-based, collaborative care model for dementia," Dr. Malaz Boustani , co-principal investigator for the study and professor at IU School of Medicine, said in a statement.
"It's the most evidence-based model that is actually right now helping people living with dementia to reduce their behavioral/psychological symptoms and reduce—and even prevent—the stress and the burden of their informal caregivers."
Shelly Necke, RN, speaks with HealthLeaders about the benefits of the post-acute provider being part of a larger health system.
PIH Health Home Health was recently acknowledged as an honoree for the Best Homecare program by the Los Angeles Business Journal. The post-acute care service provider is part of the larger PIH Health system, which serves over 3.7 million residents in the greater Los Angeles area with three hospitals, 35 outpatient medical offices, a medical specialty group, and a full spectrum of post-acute care services.
According to Shelly Necke, RN, PIH Health's vice president of post acute services, it was the expansion of the home health branch's service area that made them stand out for the honor. In addition to the greater Los Angeles area, over the last year PIH Health Home Health has expanded its reach to downtown Los Angeles and San Bernardino County.
HealthLeaders spoke with Necke about PIH Health Home Health's patient-first vision and the benefits of being part of a larger health system as a post-acute service provider.
This transcript has been edited for clarity and brevity.
HealthLeaders: Being in the Los Angeles area, what is the importance of having a full spectrum of post-acute services available to the community?
Shelly Necke, RN: Our vision is patients first, and as a nonprofit organization serving our community, it affords us the opportunity to take care of our community members and our patients in the best way possible and being able to help them transition through life. We take care of the acute needs in the hospital setting, and in having different levels of service, we can basically help the patient transition to the level they need all the way to their end of life. We also have two beautiful hospice houses, which is rare in the Los Angeles market, so just being able to utilize a setting like that that we could place a patient in and help them transition at the end of their life.
HL: What sets PIH Health Home Health apart from other homecare providers?
Necke: PIH Health Home Health has been providing in-home nursing, therapy, and social services since 1951, so it's something that we know well and know how to do well. Being part of a large health system affords us the opportunity to have the connections and resources that we need to be able to have efficient workflows and systems out in the field. We service approximately 6,000 patients annually. We provide the full spectrum of home health services, including a new program called remote patient monitoring, which is designed to keep patients safe and out of the hospital.
It was key that we aligned all of our post-acute care services under one leadership structure and that we have the full spectrum, because being able to service those 6,000 patients with a home health service line, when that patient needs to transition to palliative care or to hospice or back to the acute care hospital, we have a full spectrum of services we can utilize to take care of that patient to the best of our abilities.
HL:Many systems are beginning to explore remote patient monitoring. What has been PIH Health Home Health's experience with it so far?
Necke: Remote patient monitoring gives us the ability to place a device in the patient's home that they can interact with. There's a tablet that will ask them different questions throughout the day, and they have Bluetooth devices, [for example], they can weigh themselves and the device will send the information to the tablet. They take their pulse, blood pressure, and all those things including the questions they answer, go into a system that is managed by an RN that is monitoring those trends based on a care plan that we established for the patient.
We can quickly identify any trends that may be changing for a patient [where] we may need to intervene, notify their physician, go out and conduct a visit, and it just gives us a better picture of those high-risk patients in the field. It has impacted readmission rates to the hospital because you can take care of their needs as more care is being delivered in the home, and most patient's preference is to receive care within the home, and they do better in their own home environment. We're well positioned to meet those needs within the home and deliver that kind of care in a timely manner.
HL: How did being part of a larger health system enable PIH Health Home Health to perform efficiently over the last few years, especially with the challenges presented by the pandemic?
Necke: Being connected to an integrated delivery system has benefited us greatly. More importantly, we [have] a disaster resource center and are well trained to respond to disasters within the community. Myself, [having been with the system] 25 years, I've been trained each year. We have a significant hospital command center that we deployed, and because I've been involved in that within the acute care hospitals, we deployed that in our post-acute care service line. We were able to efficiently organize a timely response to the events of the pandemic and keep our patients and our staff safe, and we had different types of new workflows that we created to meet the needs as they changed every single day, and we're still doing that.
CMS urged to reissue blanket waiver for temporary nurse aides.
A significant number of temporary nurse aides (TNAs) may lose their jobs Friday if the Center for Medicare and Medicaid Services (CMS) doesn’t reissue a blanket waiver.
The American Health Care Association (AHCA) and National Center for Assisted Living (NCAL) have asked the Center for Medicare and Medicaid Services (CMS) to reissue the blanket waiver originally intended to allow nursing homes to employ temporary nurse aides beginning during the pandemic.
TNAs handle non-clinical tasks, serving as companions for nursing home residents. In June, the section of the 1135 waiver permitting their employment ended, giving them four months to become certified nursing assistants (CNAs), which would allow them to remain at their facilities.
However, there is a backlog of CNA training and testing in multiple states, leaving some TNAs without the training and certification they need by the October 7 deadline and possible job loss, according to a press release from AHCA/NCAL.
"Temporary nurse aides stepped up during the pandemic to serve our nation's seniors in their hour of need, and now they are on pins and needles waiting to hear if they'll have a job come Friday," Mark Parkinson, president and CEO of AHCA/NCAL said in a statement. "It's time to cut the red tape and bring certainty to these caregivers and their residents who have come to rely on them."
Currently, CMS has allowed only short-term exceptions for the employment of TNAs to individual states and facilities that submitted requests and were approved. As of Monday, October 3, four states have had these waiver requests approved, with more than 10 other states still waiting for an answer or further information to apply for the waiver.
"It is evident that the temporary nurse aide role has been pivotal and beneficial to our nursing home residents nationwide, not on a case-by-case basis," Holly Harmon, RN, LNHA, senior vice president of quality, regulatory, and clinical services at AHCA/NCAL said in a statement.
"Federal data clearly shows that quality of care for residents remains high when temporary nurse aides are present. Our residents deserve continuity of care from caregivers they know, and these experienced aides deserve adequate time to build a permanent career in long term care."
As the healthcare industry's nursing crisis presses on, the October 7 deadline may worsen its effect on nursing homes, which have lost more than 220,000 caregivers over the duration of the pandemic—more than any other part of the industry.
Replacing certain foods in an individual's diet can improve its quality and result in better health outcomes.
The quality of popular diets in the U.S. could benefit from substituting different foods for others, resulting in better health outcomes, new research from the College of William and Mary and Ohio State University has determined.
Researchers examined dietary survey data from 34,411 adults over the age of 20, collected between 2005 and 2018, noting that all the popular diet patterns they evaluated were low quality. Using the "Healthy Eating Index-2015," they were able to further evaluate the quality of each diet and model changes to figure out substitutions that would improve quality.
Dietary quality indexes compare the intake of different food groups and nutrients based on an individual's preferred diet, to the recommended intakes, using algorithms to generate a summary score. The higher the score, the better the diet aligns with dietary guidance and results in better health outcomes.
Few studies, the paper stated, have evaluated broader popular diet patterns for their quality; and those that have were limited in their analyses.
Based on the data, the diet quality of popular diet patterns was found to be "far below optimal."
Other notable findings include:
Pescatarian diets—eating fish and seafood, but not meat and poultry—had the highest dietary quality, followed by vegetarian and low-grain diets.
The quality of restricted carb, time-restricted, and high-protein diets were lower than that of the general population.
The modeled replacement of less than three daily servings of foods high in added sugar, sodium, saturated fat, or refined grains resulted in modest improvements in diet quality.
When foods high in added sugar, sodium, saturated fat, and refined grains were replaced, there were some changes in quality noted, though they were "far from optimal."
"[Individuals] may be more likely to initiate and sustain moderate diet and lifestyle changes than more comprehensive modifications, which is known as the 'small changes’ approach," the study said. "One way to implement this approach is to make targeted food replacements rather than adopt an entirely new diet pattern."
By making small dietary changes such as replacing food or drinks with healthier alternatives, the study explained, it will be easier to implement other healthy changes in an individual's lifestyle.
Davis speaks with HealthLeaders about tactics he emphasizes as a consultant for recruitment and retention.
As the healthcare industry struggles with recruitment and retention efforts to bolster the workforce, many are implementing different strategies to differentiate themselves from competitors.
In addition to his role as president of Davis + Delany Home Care Lab, Leigh Davis also offers consulting services in the post-acute, home care sector for organizations wanting to improve their recruitment and retention efforts. One retention technique, the Caregiver Champions Club, allows agencies to find common ground with their caregivers by outlining a path of upward mobility within the organization based on the number of hours they work.
HealthLeaders spoke with Davis about the program's structure, its appeal to caregivers, and its benefits for agencies, along with other recruitment and retention strategies.
This transcript has been edited for clarity and brevity.
HealthLeaders: How does a program like Caregiver Champions Club work?
Leigh Davis: It's a recognition and promotion program by virtue of caregivers; as they work more hours, they're moved up in the club. They'll start out the first 90 days as a base-level caregiver. They're not in the club yet, and what happens is the recruiter explains to them the career path they have for them where they're not just going to be a caregiver all their life. We talk to them in terms of how they're going to be recognized, how they're going to be promoted and move up; not just be a caregiver. After 90 days, they get a raise, a promotion, and become a member of the Caregiver Champions Club. They move from a base-level caregiver to a pearl-level caregiver.
From then on, once you work 1,000 hours, you become a silver-level caregiver and we give you another promotion. Now, I won't say [they] get another raise; that usually comes about every six months thereafter, but we're going to keep giving you promotions.
HL: How does a program like this set an organization apart from others like it?
Davis: It allows companies, the owners, to have a completely different conversation with caregivers. We're telling them about how we're going to move them up the longer they stay with us. We're talking to them about how they're going to ascend. This isn't just recruitment and retention, this is human psychology. Humans want to improve their lot in life, they want to be promoted, they want to be recognized. So we're giving them a clear future path to which they can be promoted and move up the ranks.
HL: How many levels are there to a program like this?
Davis: We've got one [caregiver] who's been with us over 20 years. She’s double titanium. She's got 20,000 hours. You've got to get a little creative the longer they go. We started the Caregiver Champions Club after she had started with us and calculated all her hours and she was already at the gold level. You can create your own levels as you go.
HL: How can implementing a program like this help agencies and health systems impacted by the staffing shortage?
Davis: The Caregiver Champions Club is one of those tools among others that allow you to address more than just pay. We've seen the research now; it's not all about pay as many people still believe. You've got to pay well, but the pandemic has brought this realization that there's more to life than working. This allows you to have this broader appeal; you can address more than just a paycheck. It helps them to feel they're making a difference or impacting the lives of others.
HL: Are there similar methods that agencies can implement?
Davis: Another tactic is what I call the BEAP, which is more of an overarching principal that owners need to remember that they talk to applicants about. B is for broader mission, E is for their education path, A is for advancement, and P is promotion. That's for today's caregivers, Gen Z and Gen Y. They need to know more than just their duties. This allows you to have a broader conversation, and within all of that you can insert the Caregivers Champion Club.
HL: What would you say about agencies and systems reluctant to change their practices, but still struggling find talent?
Davis: They'll just keep getting the same results. There will be a moment of reckoning where they admit they've got to implement something new, and then they commit themselves to it. For most, it almost comes back to the “sea of homecare sameness”: we love our team, we love our caregivers, etc.
Caregivers will think, “Oh, I've heard this before.” You're not just looking for employees, you're not just looking for caregivers; you're looking for partners who can support what you believe in. So, each owner, to a certain degree, can have a unique and distinct culture in which individuals say to themselves, “That's cool. That's different."
We want to show ourselves as unique and what we're passionate about. Owners need to get out from the behind-the-desk mentality and bring people into a team mindset. We're a force, changing the lives of seniors, but we're affecting entire communities in what we're doing. But sharing that drive, the personal vision, whatever you're giving your time and energy to that isn't work-related, people want to know that. They want to know what's real.
The life expectancy of older adults is based more on their capabilities rather and less on a specific diagnosis, Duke Health researchers say.
Factors such as ability to grocery shop, whether and how often they smoked, and the amount of certain cholesterol particles present in their blood can help predict how likely an individual over 70 years old will live two, five, or 10 years into the future, researchers at Duke Health have found.
"This study was designed to determine the proximal causes of longevity—the factors that portend whether someone is likely to live two or more years or 10 more years," researcher Virginia Byers Kraus, MD, PhD, said in a statement. "Properly applied, these measures could help determine the benefits and burdens of screening tests and treatments for older people."
Along with her colleagues from Duke University School of Medicine, Kraus began their study with examining a cache of 1,500 blood samples of older adults, which had been used in a study in the 1980s. The participants were at least 71 years old at the time, and with the samples having been drawn during a time where statins weren't widely used, there was no worry of them providing skewed results.
Those same participants had been followed for years after the fact, filling out questionnaires about their health history and habits, which provided a helpful resource for the university's current study.
With the leadership of researchers from the University of Minnesota, the Duke Health team was able to identify a core set of 17 predictive variables that could impact longevity.
The leading factor for longevity for all older individuals— those who lived two, five, and 10 years after having their blood drawn—was physical function. The longevity of those who lived two years after having their blood drawn was associated with having high quantity of small high-density lipoprotein (HDL) cholesterol particles in their blood.
"This was especially surprising. We hypothesize that these very small HDL particles are the size that is best at scavenging and clearing endotoxin, a potent inflammation-causing molecule from gut microbes, from the circulation," Kraus explained.
For those who lived five years after having their blood drawn, being on the younger side of participants and cognitive function were predictive of their longevity. In the group that lived 10 years after having their blood drawn, the individual's smoking history was the best predictor of their longevity, with non-smokers faring best.
"These measures clarify and enrich our understanding of mechanisms underlying longevity and could point to appropriate tests and potential interventions," Kraus said.
The next stage of their research, Kraus said, would be to use analytical tools to improve the predictivity and identify potential targets for therapies.
The Alden Group, a healthcare provider for older adults, is being accused of intentionally understaffing their facilities.
AARP and other counsel have alleged “chronic and intentional understaffing” in a class action lawsuit against Alden Group, an Illinois-based healthcare provider for older adults.
The complaint, representing residents from Alden Group’s six nursing facilities in the Chicago area, says that the provider attracts large groups of residents, only to understaff their facilities. This has led to neglect, residents suffering from injuries and illnesses that could have been prevented, and dangerous and unsanitary living conditions, according to the lawsuit.
In understaffing their facilities and hiding their practices from regulators, the filed complaint stated, Alden saves "millions of dollars each year." The filed suit also stated that residents were required to sign illegal admission agreements that would prevent them from suing for injuries that occurred due to understaffing.
"The goal with this class action is to finally end the chronic understaffing at Alden facilities. It will also send a strong message to other nursing homes and assisted living facilities that they too will be held accountable for intentional understaffing," Steven Levin, a partner at Levin & Perconti, a Chicago law firm noted for its work on behalf of nursing home residents, said in a statement.
In addition to monetary, declaratory, and injunctive relief, the plaintiffs also seek to hold the provider accountable for its alleged neglect and unfair business practices, which violate the Illinois Nursing Home Care Act and Illinois Consumer Fraud and Deceptive Business Practices Act.
The complaint states that Alden profits from its facilities operating with inadequate numbers of certified nursing assistants, licensed practical nurses, RNs, dietary staff, and therapists. Most of the facilities named in the complaint provided less than 50% of necessary nursing care hours for their residents between 2018 and 2020, the complaint said.
"Nursing facilities have a responsibility to meet the individualized needs of every resident. That is not happening at these Alden facilities," William Alvarado Rivera, senior vice president of litigation at AARP Foundation, said in a statement. "It is imperative that residents can hold them accountable in court through private rights of action for abusive and neglectful practices."
The complaint also states that Alden facilities lied to regulators, with some employees saying the provider falsified documents, going so far as to claim individuals who no longer worked at a facility to still be on staff.
