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      Progressive Support for Activities of Daily Living for Persons Living With Dementia

      1 , 2 , 3
      The Gerontologist
      Oxford University Press (OUP)

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          Abstract

          <div class="section"> <a class="named-anchor" id="s1"> <!-- named anchor --> </a> <h5 class="section-title" id="d1572340e139">Background and Objectives</h5> <p id="d1572340e141">Dementia is accompanied by increasing need for support in activities of daily living (ADLs). This brief report/literature review summarizes the practices to care for early stage, middle stage, and late stage ADL needs (dressing, toileting, and eating/nutrition), and examines commonalities across ADL needs and the extent to which practices are reflected in guidelines and/or evidence. </p> </div><div class="section"> <a class="named-anchor" id="s2"> <!-- named anchor --> </a> <h5 class="section-title" id="d1572340e144">Research Design and Methods</h5> <p id="d1572340e146">A review of the grey and peer-reviewed literature, using some but not all procedures of a systematic review. Key terms were identified for ADLs overall and for each of the 3 ADLs, and a search was conducted using these words in combination with (a) dementia, Alzheimer’s disease, and similar terms, and (b) practices, interventions, guidelines, recommendations, and similar terms. Searches were conducted using databases of peer-reviewed literature as well as the Grey Literature Reports and Google search engine. Sources were included if they provided evidence or recommendations on interventions to address ADL functioning for dressing, toileting, and feeding for persons living with dementia. </p> </div><div class="section"> <a class="named-anchor" id="s3"> <!-- named anchor --> </a> <h5 class="section-title" id="d1572340e149">Results</h5> <p id="d1572340e151">As cognitive and functional impairment increases, the number of care practices and themes that embody care practices increases. The majority of practices are evidence-based, and most evidence is incorporated into guidelines. </p> </div><div class="section"> <a class="named-anchor" id="s4"> <!-- named anchor --> </a> <h5 class="section-title" id="d1572340e154">Discussion and Implications</h5> <p id="d1572340e156">Virtually all practices reflect person-centered care principles. Five recommendations summarize the evidence and recommendations related to providing support to persons living with dementia in relation to dressing, toileting, and eating/nutrition. </p> </div>

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          Most cited references38

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          The Fundamentals of Person-Centered Care for Individuals With Dementia

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            Visual contrast enhances food and liquid intake in advanced Alzheimer's disease.

            Patients with severe Alzheimer's disease (AD) in long-term care have deficient contrast sensitivity and poor food and liquid intake. The present study examined how contrast manipulations affect these intake levels.
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              Improvement of weight and fat-free mass with oral nutritional supplementation in patients with Alzheimer's disease at risk of malnutrition: a prospective randomized study.

              To study the effects of oral nutritional supplements (OS) on body weight, body composition, nutritional status, and cognition in elderly patients with Alzheimer's disease (AD). Prospective, randomized, controlled study. Geriatric wards and day care centers in the Toulouse area, France. Ninety-one subjects with AD aged 65 and older at risk of undernutrition as evaluated using the Mini Nutritional Assessment. After randomization, 46 patients (intervention group) received 3-month OS. The other 45 patients (control group) received usual care. Weight, body composition (evaluated using dual-energy x-ray absorptiometry), cognitive function, activities of daily living, eating behavior, and dietary intakes were evaluated at the beginning of the study and at 3 months and 6 months. Supplement compliance was recorded each day. Between baseline and 3 months, energy and protein intakes significantly improved in the intervention group, resulting in a significant increase in weight and fat-free mass, but no significant changes were found for dependence, cognitive function, or biological markers. The nutritional benefit was maintained in the intervention group after discontinuation of OS at 3 months. Three-month daily OS significantly improves body weight. It is practicable and effective, and the patients accepted it well. The improvement that was observed even in the control group showed that caregiver education is an important factor in maintaining the nutritional status of patients with AD. Moreover, regular courses of OS may help to maintain the increase in fat-free mass and improve the nutritional status of these patients.
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                Author and article information

                Journal
                The Gerontologist
                Oxford University Press (OUP)
                0016-9013
                1758-5341
                February 2018
                January 18 2018
                January 18 2018
                February 2018
                January 18 2018
                January 18 2018
                : 58
                : suppl_1
                : S74-S87
                Affiliations
                [1 ]Division of General Medicine & Geriatrics, Emory University School of Medicine, Atlanta, Georgia
                [2 ]Atlanta VA Medical Center, Veterans Affairs Administration, Decatur, Georgia
                [3 ]Cecil G. Sheps Center for Health Services Research and the School of Social Work, The University of North Carolina at Chapel Hill
                Article
                10.1093/geront/gnx103
                5881654
                29361063
                48626bcb-fbaf-4208-9f1a-f2aa3db32b96
                © 2018
                History

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