Publications by authors named "Gill Livingston"

Background: Some individual‐level interventions for dementia risk factors could be cost saving. We aimed to estimate the cost effectiveness of population‐level interventions for tackling dementia risk factors. We found such interventions for tobacco smoking, excess alcohol use, diet modification to decrease hypertension and obesity, air pollution, and head injury.

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Background: Approximately 40% of global dementia cases are associated with 12 modifiable risk factors (less education, hearing loss, hypertension, obesity, smoking, depression, social isolation, physical inactivity, diabetes, alcohol excess, air pollution, and traumatic brain injury). However, the number of people with these risk factors differs between populations. Latin American countries differ in socioeconomic and geographic aspects and, therefore, risk factors prevalence.

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Background: Sleep disturbance is common and distressing for people with dementia, with no known safe, effective treatments. We previously developed and delivered DREAMS‐START (Dementia RElAted Manual for Sleep; STrAtegies for RelaTives), a multimodal non‐pharmacological intervention, and demonstrated feasibility and acceptability. This randomised controlled trial (RCT) aimed to establish whether DREAMS‐START is clinically‐effective in reducing sleep disturbances in people with dementia at home after 8 months compared to usual care.

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Background: The progressive nature of dementia and the complex needs means that people living with dementia require tailored approaches to address their changing care needs over time. These include physical multimorbidity, psychological, behavioural, and cognitive symptoms and possible risks arising from these and helping family caregivers. However, provision of these interventions is highly variable between and within countries, partly due to uncertainty about their efficacy and scarce resources.

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Background: Data from high‐income countries (HICs) suggest a decline in age‐specific incidence rates of dementia. However, this has happened primarily in HICs, with low‐ and middle‐ income countries (LMICs) facing two main challenges: a higher burden of risk factors and, in general, a faster ageing population. Most people with dementia live in LMICs, and this is set to increase, thus requiring urgent and robust action to prevent, treat and support people with dementia and their families.

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Background: Our authors from around the world met to summarise the available knowledge, decide which potentially modifiable risk factors for dementia have compelling evidence and create the most comprehensive analysis to date for potentially modifiable risk factors to inform policy, give individuals the opportunity to control their risks and generate research.

Method: We incorporated all risk factors for which we judged there was strong enough evidence. We used the largest recent worldwide meta‐analyses for risk factor prevalence and relative risk and if not available the best data.

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Background: The Promoting Independence Through quality Care at Home (PITCH) project aimed to improve outcomes for people with dementia and their carers via a co‐designed training intervention for home care workers (HCWs). The results of the primary efficacy analysis of the successful stepped‐wedge cluster RCT (n = 172 HCWs in 18 clusters in 7 Australian service providers) were presented at AAIC 2023.

Method: This presentation goes beyond efficacy and discusses the implementation science (process evaluation and behavioural change) and health economic analysis of the intervention.

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Background: The 2020 Lancet Commission on dementia prevention, intervention and care estimated that up to 40% of dementia cases could be prevented by tackling 12 potentially modifiable risk factors, namely less education, hearing loss, hypertension, physical inactivity, diabetes, social isolation, excessive alcohol consumption, air pollution, smoking, obesity, traumatic brain injury, depression. As more evidence on risk factors emerges, the Lancet standing commission on dementia met to update evidence on established dementia risk factors and to consider the evidence for other risk factors.

Method: We used a lifecourse approach to understand how to reduce risk or prevent dementia, as many risks operate at different timepoints in the lifespan.

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Introduction: While risk factor prevalence of individual risk factors for dementia varies between ethnic groups in New Zealand (NZ), it is not known whether the effect of these risks is the same in each group.

Methods: This retrospective cohort study identified incident cases of dementia. Cox regression models calculated the hazard ratio for dementia for each of the risk factors, after adjustment for age and sex.

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Background And Objective: People with adult-onset hearing loss (AoHL) are at increased dementia risk. In this study, we explore potential aetiological mechanisms by synthesising the evidence on the association between AoHL and neuropathological, cerebrospinal fluid (CSF), blood and imaging biomarkers of dementia.

Methods: We systematically searched electronic databases from inception to 30 April 2024 for cross-sectional and longitudinal studies, including quantitative data on the association between AoHL and dementia biomarkers.

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Background And Objectives: Older people with memory problems living in temporary hostel accommodation have longer stays and higher care needs than those without memory problems. In this ethnographic study, we aimed to elucidate how staff currently support older hostel residents with memory problems, what contextual factors determine support given and, what facilitates positive and meaningful outcomes for staff and residents.

Research Design And Methods: We conducted interviews and participant observations with older people (≥50 years) experiencing memory problems and homelessness (interviews n=17, observations n=13), hostel staff and managers (interviews n=15, observations n=20) from seven residential facilities (six hostels and one care home), and health and social care practitioners (interviews n=17, observations n=7), from September 2021-December 2022 in London, England.

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Article Synopsis
  • - A long-term study in Norway tracked 9,745 individuals for 30 years to explore how midlife depression and anxiety might influence the risk of developing dementia.
  • - The research found that individuals who later developed dementia showed higher rates of anxiety and depression throughout the study, with a notable increase especially in the years leading up to their dementia diagnosis.
  • - The results indicated that mixed anxiety and depressive symptoms were more prevalent in older individuals with dementia, suggesting a significant link between mental health issues in midlife and subsequent dementia risk across various types of dementia.
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Objective: We hypothesise that subclinical myocardial injury during midlife, indexed by increases in cardiac troponin I, is associated with accelerated cognitive decline, smaller structural brain volume, and higher risk of dementia.

Design: Longitudinal cohort study.

Setting: Civil service departments in London (Whitehall II study).

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Background: Depression is common in people with dementia, and negatively affects quality of life.

Aims: This paper aims to evaluate the cost-effectiveness of an intervention for depression in mild and moderate dementia caused by Alzheimer's disease over 12 months (PATHFINDER trial), from both the health and social care and societal perspectives.

Method: A total of 336 participants were randomised to receive the adapted PATH intervention in addition to treatment as usual (TAU) ( = 168) or TAU alone ( = 168).

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Sleep duration's association with future dementia could be a cause or consequence, or both. We searched electronic databases on 14 April 2023 for primary peer-reviewed, longitudinal studies examining the relationship between sleep duration and dementia with any follow-up duration. We meta-analysed studies examining brief (≤6 h/night) and extended sleep duration (≥9 h/night) separately and divided the studies into those with follow-up periods of less or more than 10 years.

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Background: Social connection is a basic human need and is essential to quality of life. It is associated with better mental and physical health outcomes for long-term care (LTC) home residents and is a key aspect of quality of care and person-centred care. There are considerations for LTC homes that may present obstacles to and opportunities for social connection.

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Article Synopsis
  • Communication difficulties in dementia can harm both patients and their caregivers, making effective communication strategies essential for their well-being.
  • There are numerous evidence-based strategies online that caregivers can use, and this study specifically searched the internet to find and analyze these resources.
  • The review found 39 relevant websites offering 164 strategies for better communication, which were organized into 26 types and emphasized the importance of personalized and flexible approaches tailored to individual needs and the context of each interaction.
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Background: Sleep disturbances are common and distressing for people with dementia and their families. Non-pharmacological interventions should be first-line management, avoiding harmful pharmacological side-effects, but there is none with known effectiveness. We aimed to establish whether DREAMS START, a multicomponent intervention, reduced sleep disturbance in people with dementia living at home compared with usual care.

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Article Synopsis
  • A study assessed the impact of 12 modifiable risk factors related to dementia across seven Latin American countries, revealing that about 54% of dementia cases could be attributed to these risks.
  • Data was collected from over 100,000 individuals in Argentina, Brazil, Bolivia, Chile, Honduras, Mexico, and Peru between 2015 and 2021, focusing on factors like education, hearing loss, and lifestyle choices.
  • The findings highlighted that obesity, physical inactivity, and depression were the leading contributors to dementia risk in these countries, indicating a higher population-attributable fraction compared to global estimates.
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Objectives: The primary aim of this pragmatic stepped-wedge cluster RCT was to determine the efficacy of a co-designed dementia specialist training program (the PITCH program) for home care workers (HCWs) to improve their confidence and knowledge when providing care for clients living with dementia.

Methods: HCWs who provided care to clients with dementia were recruited from seven home care service provider organisations in Australia between July 2019 and May 2022, and randomised into one of 18 clusters. The primary outcome was HCW's sense of self-competence in providing care services to people living with dementia at 6 months post PITCH training measured by the Sense of Competence in Dementia Care Staff (SCIDS) Scale.

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Introduction: We report a mixed-methods process evaluation embedded within a randomised controlled trial. We aimed to test and refine a theory of change model hypothesising key causal assumptions to understand how the New Interventions for Independence in Dementia Study (NIDUS)-Family (a manualised, multimodal psychosocial intervention), was effective relative to usual care, on the primary outcome of Goal Attainment Scaling (GAS) over 1 year.

Methods: In 2021-2022, intervention-arm dyads completed an acceptability questionnaire developed to test causal assumptions.

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Unlabelled: Social connection is important for long-term care (LTC) residents' quality of life and care. However, there is a lack of consensus on how to measure it and this limits ability to find what improves and impairs social connection in LTC homes. We therefore aimed to systematically review and evaluate the measurement properties of existing measures of social connection for LTC residents, to identify which, if any, measures can be recommended.

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Background: Individual-level interventions for dementia risk factors could reduce costs associated with dementia and some are cost-effective. We aimed to estimate the cost-effectiveness of population-level interventions for tackling dementia risk factors.

Methods: In this economic modelling study, we included recommended population-based interventions from a previously published review article for which there was consistent and robust evidence of effectiveness in tackling a dementia risk factor (tobacco smoking, excess alcohol use, hypertension, obesity, air pollution, and head injury).

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Article Synopsis
  • People with dementia often lack awareness of their social functioning abilities, which can lead to negative outcomes for both them and their caregivers.
  • This study examined how this awareness relates to the severity of dementia in individuals over 65 from Germany, Japan, and the UK using the Social Functioning in Dementia scale.
  • Findings showed that while patients and caregivers agreed on some aspects of social functioning, patients tended to overestimate their communication and sensitivity skills compared to their caregivers, highlighting the need for better understanding and support for families.
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