Centre for Gerontology and Rehabilitation - Journal Articles
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Item Specialist palliative care professionals’ views on access to their services for people with dementia(Taylor & Francis, 2024-04-25) Cronin, Lisa; O’Shea, Emma; Fox, SiobhánBackground: In Ireland and around the world populations are ageing, contributing to an increase in the number of people living with dementia. Dementia is a life-limiting condition and evidence suggests that people with dementia would benefit from specialist palliative care (SPC) input. There is ongoing investigation into how people with dementia access the services they need at the right time. Aim: The aim of this study was to explore how people with dementia access SPC services in a region in the Mid-West of Ireland, from the perspectives of key healthcare workers linked to the service. Methods: Semi-structured qualitative interviews (n=10) were conducted with healthcare professionals involved in the referral process of accessing SPC input, including consultants, specialist registrars, clinical nurse managers and an assistant director of nursing. The data was analysed using thematic analysis. Results: Overall four main themes were identified from the data: Capacity for providing SPC services to people with dementia; Appropriate Referrals and Recognising Need; Inadequate volume and inequitable geographical distribution of dementia services; Service integration and inter-professional collaboration. The underlying premise was the disease trajectory of dementia and a changing model of care. Conclusion: A needs assessment rather than a diagnosis is the referral process that underpins access to SPC for people with dementia. However, there is little consensus on ‘grey’ areas within this process and some SPC professionals may be less comfortable with treating patients with dementia. A different model of care is needed.Item Design of a multi-sensors wearable system for continuous home monitoring of people with Parkinson's(IEEE, 2024-03-11) Sica, Marco; Varnosfaderani, Omid Talebi; Crowe, Colum; Kenny, Lorna; Bocchino, Andrea; O'Flynn, Brendan; Mueller, David Scott; Tedesco, Salvatore; Timmons, Suzanne; Barton, John; Enterprise Ireland; AbbVie; Science Foundation Ireland; European Regional Development FundParkinson’s disease is a degenerative neurological disorder that impairs motor functions and is accompanied by a wide range of non-motor symptoms, such as sleep problems. Parkinsonism is assessed during clinical evaluations and via self-administered diaries and, based on these, the required medication therapies are provided to lessen symptoms. Tri-axial accelerometers and gyroscopes have the potential utility to objectively assess the patient’s condition and aid clinicians in their decision-making. People with Parkinson’s often have significant abnormalities in blood pressure due to comorbid age-related cardiovascular disease and orthostatic hypotension, which result in blurred vision, dizziness, and falls. Frequent blood pressure monitoring may aid in the evaluation of such events and differentiate Parkinson’s disease symptoms from those originated by hypotension. In the present paper, a novel technology for the remote monitoring of Parkinsonian symptoms is presented: the WESAA system. It consists of two devices, worn on the wrist and ankle; its main function is to record accelerations and angular velocities from these body parts, together with photoplethysmograph and electrocardiogram data. This information can be elaborated offline to measure common Parkinson’s disease motor symptoms (e.g., tremor, bradykinesia, and dyskinesia), as well as gait speed, sleep-wake cycles, and cuff-less blood pressure measurements. The overall system requirements, market overview, industrial design and ergonomics, system development, user experience, early results of the gathered inertial raw data, and validation of the photoplethysmograph and electrocardiogram signal waveforms are all thoroughly discussed. The developed technology satisfies all system requirements, and the sensors adopted provided outcomes comparable with gold standard techniques.Item Factors Influencing Continued Wearable Device Use in Older Adult Populations: Quantitative Study.(JMIR Publications, 2023-01-19) Muñoz Esquivel, Karla; Gillespie, James; Kelly, Daniel; Condell, Joan,; Davies, Richard; McHugh, Catherine; Duffy, William; Nevala, Elina; Alamäki, Antti; Jalovaara, Juha; Tedesco, Salvatore; Barton, John; Timmons, Suzanne; Nordström, Anna; InterregThe increased use of wearable sensor technology has highlighted the potential for remote telehealth services such as rehabilitation. Telehealth services incorporating wearable sensors are most likely to appeal to the older adult population in remote and rural areas, who may struggle with long commutes to clinics. However, the usability of such systems often discourages patients from adopting these services. This study aimed to understand the usability factors that most influence whether an older adult will decide to continue using a wearable device. Older adults across 4 different regions (Northern Ireland, Ireland, Sweden, and Finland) wore an activity tracker for 7 days under a free-living environment protocol. In total, 4 surveys were administered, and biometrics were measured by the researchers before the trial began. At the end of the trial period, the researchers administered 2 further surveys to gain insights into the perceived usability of the wearable device. These were the standardized System Usability Scale (SUS) and a custom usability questionnaire designed by the research team. Statistical analyses were performed to identify the key factors that affect participants' intention to continue using the wearable device in the future. Machine learning classifiers were used to provide an early prediction of the intention to continue using the wearable device. The study was conducted with older adult volunteers (N=65; mean age 70.52, SD 5.65 years) wearing a Xiaomi Mi Band 3 activity tracker for 7 days in a free-living environment. The results from the SUS survey showed no notable difference in perceived system usability regardless of region, sex, or age, eliminating the notion that usability perception differs based on geographical location, sex, or deviation in participants' age. There was also no statistically significant difference in SUS score between participants who had previously owned a wearable device and those who wore 1 or 2 devices during the trial. The bespoke usability questionnaire determined that the 2 most important factors that influenced an intention to continue device use in an older adult cohort were device comfort (t=0.34) and whether the device was fit for purpose (t=0.34). A computational model providing an early identifier of intention to continue device use was developed using these 2 features. Random forest classifiers were shown to provide the highest predictive performance (80% accuracy). After including the top 8 ranked questions from the bespoke questionnaire as features of our model, the accuracy increased to 88%. This study concludes that comfort and accuracy are the 2 main influencing factors in sustaining wearable device use. This study suggests that the reported factors influencing usability are transferable to other wearable sensor systems. Future work will aim to test this hypothesis using the same methodology on a cohort using other wearable technologies.Item Education and training interventions for physiotherapists working in dementia care: a scoping review(Elsevier Inc., 2022-11-10) O'Sullivan, Trish; McVeigh, Joseph G.; Timmons, Suzanne; Foley, TonyObjectives: Physiotherapy plays a key role in many aspects of dementia care, most notably in maintaining mobility. However, there is a lack of dementia care training at undergraduate and postgraduate level, and more importantly, a paucity of evidence as to what constitutes effective dementia education and training for physiotherapists. The aim of this scoping review was to explore and map the evidence, both quantitative and qualitative, relating to education and training for physiotherapists. Design: This scoping review followed the Joanna Briggs Institute methodology for scoping reviews. A chronological narrative synthesis of the data outlined how the results relate to the objectives of this study. Setting: All studies, both quantitative and qualitative on dementia education and training conducted in any setting, including acute, community care, residential or any educational setting in any geographical area were included. Participants: Studies that included dementia education and training for both qualified and student physiotherapists were considered. Results: A total of 11 papers were included in this review. The principal learning outcomes evaluated were knowledge, confidence, and attitudes. Immediate post- intervention scores showed an improvement in all three outcomes. The Kirkpatrick four level model was used to evaluate the level of outcome achieved. Most educational interventions reached Kirkpatrick level 2, which evaluates learning. A multi-modal approach, with active participation and direct patient involvement seems to enhance learning. Conclusions: Allowing for the heterogeneity of intervention design and evaluation, some common components of educational interventions were identified that led to positive outcomes. This review highlights the need for more robust studies in this area. Further research is needed to develop bespoke dementia curricula specific to physiotherapy.Item Gait speed, cognition and falls in people living with mild-to-moderate Alzheimer disease: Data from NILVAD(BioMed Central Ltd, 2020) Dyer, A. H.; Murphy, C.; Lawlor, B.; Kennelly, S. P.; Segurado, R.; Olde Rikkert, M. G. M.; Howard, R.; Pasquier, F.; Börjesson-Hanson, A.; Tsolaki, M.; Lucca, U.; Molloy, D. William; Coen, R.; Riepe, M. W.; Kálmán, J.; Kenny, R. A.; Cregg, F.; O'Dwyer, S.; Walsh, C.; Adams, J.; Banzi, R.; Breuilh, L.; Daly, L.; Hendrix, S.; Aisen, P.; Gaynor, S.; Sheikhi, A.; Taekema, D. G.; Verhey, F. R.; Nemni, R.; Nobili, F.; Franceschi, M.; Frisoni, G.; Zanetti, O.; Konsta, A.; Anastasios, O.; Nenopoulou, S.; Tsolaki-Tagaraki, F.; Pakaski, M.; Dereeper, O.; Sayette, V. D. L.; Sénéchal, O.; Lavenu, I.; Devendeville, A.; Calais, G.; Crawford, F.; Mullan, M.; Aalten, P.; Berglund, M. A.; Claassen, J. A.; De Heus, R. A.; De Jong, D. L. K.; Godefroy, O.; Hutchinson, S.; Ioannou, A.; Jonsson, M.; Kent, A.; Kern, J.; Nemtsas, P.; Panidou, M.-K.; Abdullah, L.; Paris, D.; Santoso, A. M.; van Spijker, G. J.; Spiliotou, M.; Thomoglou, G.; Wallin, A.; NILVAD Study Group; Seventh Framework ProgrammeBackground: Previous evidence suggests that slower gait speed is longitudinally associated with cognitive impairment, dementia and falls in older adults. Despite this, the longitudinal relationship between gait speed, cognition and falls in those with a diagnosis of dementia remains poorly explored. We sought to assess this longitudinal relationship in a cohort of older adults with mild to-moderate Alzheimer Disease (AD). Methods: Analysis of data from NILVAD, an 18-month randomised-controlled trial of Nilvadipine in mild to moderate AD. We examined: (i) the cross-sectional (baseline) association between slow gait speed and cognitive function, (ii) the relationship between baseline slow gait speed and cognitive function at 18 months (Alzheimer Disease Assessment Scale, Cognitive Subsection: ADAS-Cog), (iii) the relationship between baseline cognitive function and incident slow gait speed at 18 months and finally (iv) the relationship of baseline slow gait speed and incident falls over the study period. Results: Overall, one-tenth (10.03%, N = 37/369) of participants with mild-to-moderate AD met criteria for slow gait speed at baseline and a further 14.09% (N = 52/369) developed incident slow gait speed at 18 months. At baseline, there was a significant association between poorer cognition and slow gait speed (OR 1.05, 95% CI 1.01-1.09, p = 0.025). Whilst there was no association between baseline slow gait speed and change in ADAS-Cog score at 18 months, a greater cognitive severity at baseline predicted incident slow gait speed over 18 months (OR 1.04, 1.01-1.08, p = 0.011). Further, slow gait speed at baseline was associated with a significant risk of incident falls over the study period, which persisted after covariate adjustment (IRR 3.48, 2.05-5.92, p < 0.001). Conclusions: Poorer baseline cognition was associated with both baseline and incident slow gait speed. Slow gait speed was associated with a significantly increased risk of falls over the study period. Our study adds further evidence to the complex relationship between gait and cognition in this vulnerable group and highlights increased falls risk in older adults with AD and slow gait speed. Trial registration: Secondary analysis of the NILVAD trial (Clincaltrials.gov NCT02017340; EudraCT number 2012-002764-27). First registered: 20/12/2013.