Author Interviews, Cognitive Issues, End of Life Care, Gender Differences, JAMA / 16.08.2019
Men With Dementia More Likely to Receive Aggressive Care at End of Life
MedicalResearch.com Interview with: [caption id="attachment_50851" align="alignleft" width="142"]
Dr. Stall[/caption] Dr. Nathan Stall, MD Geriatrician and Research fellow
Women’s College Research Institute [caption id="attachment_50852" align="alignleft" width="133"] Dr. Rochon[/caption] Dr. Paula Rochon, MD, MPH, FRCPC Periatrician and Vice-President of Research
Women’s College Hospital MedicalResearch.com: What is the background for this study? Response: The advanced stages of the dementia are characterized by profound memory impairment, an inability to recognize family, minimal verbal communication, loss of ambulatory abilities, and an inability to perform basic activities of daily living. Nursing homes become a common site of care for people living with advanced dementia, who have a median survival of 1.3 years. In the advanced stages of the disease, the focus of care should generally be on maximizing quality of life. Our study examined the frequency and sex-based differences in burdensome interventions received by nursing home residents with advanced dementia at the very end of life. Burdensome interventions include a variety of treatment and procedures that are often avoidable, may not improve comfort, and are frequently distressing to residents and their families. We found that in the last 30 days of life, nearly one in 10 nursing home residents visited an emergency department, more than one in five were hospitalized, and one in seven died in an acute care setting. In addition, almost one in 10 residents received life-threatening critical care; more than one in four were physically restrained; and more than one in three received antibiotics.
Dr. Stall[/caption] Dr. Nathan Stall, MD Geriatrician and Research fellow
Women’s College Research Institute [caption id="attachment_50852" align="alignleft" width="133"] Dr. Rochon[/caption] Dr. Paula Rochon, MD, MPH, FRCPC Periatrician and Vice-President of Research
Women’s College Hospital MedicalResearch.com: What is the background for this study? Response: The advanced stages of the dementia are characterized by profound memory impairment, an inability to recognize family, minimal verbal communication, loss of ambulatory abilities, and an inability to perform basic activities of daily living. Nursing homes become a common site of care for people living with advanced dementia, who have a median survival of 1.3 years. In the advanced stages of the disease, the focus of care should generally be on maximizing quality of life. Our study examined the frequency and sex-based differences in burdensome interventions received by nursing home residents with advanced dementia at the very end of life. Burdensome interventions include a variety of treatment and procedures that are often avoidable, may not improve comfort, and are frequently distressing to residents and their families. We found that in the last 30 days of life, nearly one in 10 nursing home residents visited an emergency department, more than one in five were hospitalized, and one in seven died in an acute care setting. In addition, almost one in 10 residents received life-threatening critical care; more than one in four were physically restrained; and more than one in three received antibiotics.
Dr. Dunn[/caption] Dr. Amy Dunn, PhD Kaczorowski lab
The Jackson Laboratory MedicalResearch.com: What is the background for this study? What are the main findings? Response: Environmental factors, such as a poor diet, are known risk factors for Alzheimer’s disease. But the mechanisms are complex, and it is not known how such environmental perturbations interact with individual genetic variation to confer disease risk. Previous studies have not adequately addressed how the combination of genetic variant and environmental factors combine to alter cognitive response to a poor diet. To investigate gene-by-environment interactions, we fed either a normal diet or a high-fat diet to a genetically diverse Alzheimer’s disease mouse model population starting at six months of age and monitored metabolic and cognitive function. We observed accelerated working memory decline in the mice on the high-fat diet after eight weeks, with substantial gene-by diet effects on both cognitive and metabolic traits. Metabolic dysfunction was more closely related to cognitive function in mice carrying Alzheimer’s mutations than in those without. Interestingly, the high-fat diet affected metabolic function differently in female versus male mice. 
![MedicalResearch.com Interview with: Regis Goulart Rosa, MD, PhD Responsabilidade Social - PROADI Hospital Moinhos de Vento MedicalResearch.com: What is the background for this study? Response: The debate about visiting policies in adult ICUs is of broad and current interest in critical care, with strong advocacy in favour of flexible family visitation models in order to promote patient- and family-centred care. However, the proportion of adult ICUs with unrestricted visiting hours is very low. Data from the literature show that 80% of hospitals in the United Kingdom and USA adopt restrictive ICU visiting policies. Among ICUs with restrictive visiting hours, published studies show that the daily visiting time ranges from a median of 1 hour in Italy to a mean of 4.7 hours in France. In agreement with this scenario, most adult ICUs in Brazil follow a restrictive visitation model, in which family members are allowed to visit the critically ill patient from 30 minutes to 1 hour, once or twice a day. These restrictive visitation models have been justified by the theoretical risks associated with unrestricted visiting hours, mainly infectious complications, disorganization of care, and burnout. Controversially, these risks have not been consistently confirmed by the scarce literature on the subject, and flexible ICU visiting hours have been proposed as a means to prevent delirium among patients and improve family satisfaction. MedicalResearch.com: What are the main findings? Response: Disappointingly, studies evaluating the effectiveness and safety of flexible ICU visiting hours are scarce. To date, no large randomized trials have assessed the impact of a flexible visiting model on patients, family members, and ICU staff, and this evidence gap may constitute a barrier to the understanding of the best way to implement and improve ICU visiting policies. In the present pragmatic cluster-randomized crossover trial (The ICU Visits Study), we engaged 1,685 patients, 1,295 family members, and 826 ICU professionals from 36 adult ICUs in Brazil to compare a flexible visitation model (12 hours/day plus family education) vs. the standard restricted visitation model (median 90 minutes per day). We found that the flexible visitation did not significantly reduce the incidence of delirium among patients, but was associated with fewer symptoms of anxiety and depression and higher satisfaction with care among family members in comparison to the usual restricted visitation. Also, the flexible visitation did not increase the incidence of ICU-acquired infections and ICU staff burnout, which are major concerns when adopting this intervention. MedicalResearch.com: What should readers take away from your report? Response: Considering the evidence suggesting that most adult ICUs restrict the presence of family members, our results provide useful and relevant information that may influence the debate about current ICU visitation policies around the world. First, a flexible visitation policy that permits flexible family visitation in ICU (up to 12 hour per day) is feasible, given the high adherence of participant ICUs to implementation in The ICU Visits Study. Second, the flexible family supported by family education is safe regarding the occurrence of infections, disorganization of care or staff burnout. Third, family members - a commonly missing piece of the critical care puzzle - seem to benefit from the flexible visitation model through higher satisfaction with care and less symptoms of anxiety and depression. MedicalResearch.com: What recommendations do you have for future research as a result of this work? Response: Future research might focus on the following topics: 1) methods of implementation of flexible visiting models in ICUs; 2) Family support interventions in the context of flexible ICU visiting hours (e.g.: psychological and social support, support for shared decision making, peer support, and comfort); and 3) How flexible ICU visiting hours affects patient, family member and staff outcome at long-term. Disclosures: The ICU Visits study was funded by the Brazilian Ministry of Health through the Brazilian Unified Health System Institutional Development Program (PROADI-SUS). Citation: Effect of Flexible Family Visitation on Delirium Among Patients in the Intensive Care Unit [wysija_form id="3"] [last-modified] The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.](https://medicalresearch.com/wp-content/uploads/hospital-ICU-intensive-care.jpg)
Dr. Nandi[/caption] Arindam Nandi PhD Center for Disease Dynamics, Economics & Policy MedicalResearch.com: What is the background for this study? Response: The motivation for this study comes from a small but growing body of evidence on the potential long-term benefits of vaccines. The recent resurgence of measles outbreaks in several countries which had previously eliminated the virus makes our study additionally relevant. There have been over 1,000 measles cases reported across 28 states in the US so far in 2019, which is the largest number of cases the country has seen in almost 3 decades. Similarly high number of cases have been reported in several European countries in recent years. This study reiterates the importance of vaccination and proves the long-term benefits of the measles vaccine in low- and middle-income countries, which account for a large proportion of global measles cases.
