Increasing Global Prevalence Of Dementia

Introduction

Ascertaining the effectiveness of chosen literatures in disseminating information on particular topic is essential. It avoids the risk of relying on unauthentic sources. This makes it essential to critically review the chosen sources. For this purpose Critical Appraisal Skills Programme [CASP] checklists can be effective.

Considering the above discussed aspects, the present assignment would focus dealing with the topic of mental health nursing in which dementia will be focused upon. In this context, 3 articles will be chosen which would be analyzed with the help of CASP model.

Problems and questions addressed in the Literature Review

For the purpose of analyzing the problems and questions which are being addressed in the literature review in the chosen articles, the PICO structure will be used.  

For the purpose of searching these papers, the researcher researched for the articles with the help of using certain key words associated with the topic of specialty practice. The search focused on retrieving studies which are focused on mental health with particular emphasis on dementia. The keywords which have been used on the part of the researcher are, dementia, decision making, intervention and care training, prevalence.

This systematic search for the purpose of collecting the articles has been done with the help of Google search engine. It has also been carried out with the help of bibliographic databases like CINAHL and Medline (Subirana et al., 2007).

For the purpose of conducting this research, theme of keywords have been developed in which the first theme is based on the issue of dementia, the second theme was based on impact of the condition, loss of the ability of decision making and third theme focused on the ways of managing the condition and associated intervention.     

In the process of conducting the search, on the part of the researcher Boolean Operator ‘and’ ‘or’ ‘not’ has been used which helped in either broadening or limiting the search result (Holloway & Galvin, 2016). In the process of searching the articles manual search has also been used which provided with the scope of reviewing the articles in which the article’s abstract, list of references and title was evaluated in order to determine if the particular study should be included or not. For the purpose of collecting the desired articles, certain exclusion and inclusion criteria have been used for effectively determining of the article is supposed to be included or not.

The inclusion criteria are as follows:

• If the particular study focused on the issue of dementia?
• Does the study include the issues or impact associated with dementia?
• If the study deals with a particular intervention for further developing certain aspects associated with the condition?
• The article has been published with in a period of 2007-2018
• The article being published in English language
• The study is a full text study

The exclusion criteria are:

• The articles not focusing on dementia as its focus of mental health condition
• It has not been published which has been published before 2007
• The study not available in full text study

With the help of Medline the first search was conducted. In this first search, 5 articles were retrieved. These 5 articles to some extent seemed to be in alignment with the chosen theme. In context to same theme the second search was carried out with the help of CINAHL database which provided 7 relevant articles (White, 2014). On following the limiting factors a total of 5 articles were chosen.       

All the chosen 5 articles were manually reviewed basing on inclusion and exclusion criteria. On the basis of the review, 3 articles successfully matched the inclusion criteria which finally were considered for the review.  

For the purpose of appraising the chosen articles CASP will be used as the tool (Voss, & Rehfuess, 2013). It is with the help of using this tool in order to evaluate the articles that would help in determining the validity, relevance and results of the articles.

Article 1- The DECIDE Study: Dementia carers making informed decisions

Article 2- The global prevalence of dementia: A systematic review and meta analysis

Article 3- Systematic review of the effective components of psychosocial interventions delivered by care home staff to people with dementi

The synthesis of the chosen 3 articles would be done on the basis of the evaluation of CASP tool.

Article 1- The DECIDE Study: Dementia carers making informed decisions

The validity of the results of the review

Was the review successful in clearly focusing on a specific area of question?

The clear specification of the particular literature on a particular focused question can be seen from the fact that the study focused on family carers, associated with dementia patients along with individuals with dementia. In this context, in the process of recruiting the participant, it clearly focused on 41 carers (21 control and 20 intervention) (Lord, 2016).  The study clearly focused on the implementation of the intervention of DECIDE manual and the associated impact on decisional conflict. On the basis of the fact it may be stated that the study is effective in addressing a specifically focused area of question.

Has the researcher been successful in opting for the right types of paper?

In this context the success of the study can be clearly observed by the fact that for the purpose of developing the DECIDE manual, the researcher had conducted a systematic literature review, performed individual interviews with individuals providing care services to healthcare professionals, family carers along with individuals with dementia. Followed by piloting, on the part of the researcher the chosen intervention i.e. DECIDE manual was evaluated with the help of randomized control trial wherein, family carers providing with support for decision making process in case of dementia patients were also incorporated (Taylor et al., 2015)..  This clearly established the success of the researcher in effectively addressing question of the researcher and opting for the appropriate study design reflecting the success of the researcher in choosing the right type of paper.    

Is it worth continuing?

Has the researcher successfully included relevant studies?

The fact that, for the collection of studies on the basis of which the study would be conducted, the researcher relied on Medline databse, set certain inclusion and exclusion criteria along with updating the search on 15^th January 2016. On the basis of these facts it may be stated that the researcher was successful in choosing authentic and relevant studies which has needed for the purpose of conducting the study (Falagas et al., 2008).

On the part of the researcher, was there enough focus on evaluating the quality of the included studies?

The researcher has clearly emphasized on replicable and rigorous process in formulating DECIDE manual. In this process, individuals with dementia, care professionals, family carers were also included. Thus, on the basis of this fact it may be stated that aim of the study which was evaluating the acceptability and feasibility of decision aid has been effectively evaluated along with the population included . It may be stated that the quality of the included studies has been effectively focused on the part of the researcher.  

Has the result of the reviews been combined and if it was reasonable to do so?

In comparison to the present study, in context to other studies it may be observed that most studies asked purposive or convenience samples of family carers regarding inevitably and decision making, those which volunteer discussed regarding their individuals experiences may systematically differ from who did not. In addition to that, in case of qualitative studies focus can be seen to be given on collecting data about the complexity associated with decision making (Torpy et al., 2009). In this process, certain contexts of decisions which were reported in studies, inevitably gets lost. In regards to this study it may be observed that focus has been given on context of decisions that were reported by the participants. Thus the difference in various studies and absence of combining the results is noticeable in the chosen literature.    

What was the total outcome of the review?

The study came up with outcome of the fact that DECIDE manual was acceptable and useful on the part of the carers. The study further stated that all the participants found the manual to be relevant and useful in the decision making process. However, the carers were of the opinion that DECIDE manual failed in addressing disagreement among the family members along with negotiating services.

To what extent was the result of the study precise in nature?

The fact that the result of the study was precise in nature can be stated on the basis of the fact that the study clearly mentioned and included its confidence intervals wherein in case of hospital anxiety CI was [-251, 305, p= 846], depression scores was CI [- 133, 3.98], p= 319 (Lord, 2016). This clearly specifies the preciseness of the result.

Is the result of the study applicable in the local population?

The result of the study put forward the fact that carers found DECIDE manual useful and relevant. It further stated that carers found the manual to be acceptable. In order to come to this conclusion the researcher had used responses of care users with dementia, family carers and care professionals (Livingston et al., 2010).. This makes the result of the study applicable for local population as well.   

Has the study considered all the important outcomes?

Though the research provided with the outcome or response of the carers and professionals, an in depth focus on the response of the care users i.e. dementia patients with the implementation of the manual would have helped in collecting different responses of individuals with dementia care services making the response complete.

Are the benefits associated with DECIDE manual worth the costs and harms?

There is no particular harm associated with implementation of DECIDE manual. However, due to the DECIDE manual may result in costing more money due to the fact that it may facilitate more individuals in decision making for shifting their relatives to a care home but its incorporation would help in minimizing the  issue with decision making in case of dementia patients (Samsi & Manthorpe, 2013).  

On evaluating the study it may be observed that it comprised of certain strengths and limitation.

Article 2- The global prevalence of dementia: A systematic review and meta analysis

The validity of the results of the review

Was the review successful in clearly focusing on a specific area of question?

The researcher has given clear emphasis on individuals affected with dementia, for which individuals aged 60 or more belonging from Global Burden of Disease regions that included 21 countries have been focused on the part of the researcher (Prince et al., 2013).  This reflects the success of the researcher in having a clear focus on specific aspect of the topic of research.

Has the researcher been successful in opting for the right types of paper?

On the part of the researcher the focus of the research was to conduct a systematic review of global literature regarding the prevalence of dementia along with establishing the prevalence rate of dementia among the 21 nations in Global Burden Disease regions. The entire study has focused on the chosen area of research which was aimed on the part of the researcher. It is for this purpose the researcher included 135 publications associated with the area of research. Thus, it puts forward the fact that the researcher was successful in choosing the right type of paper for the research.    

Is it worth continuing?

Has the researcher successfully included relevant studies?

For the purpose of conducting the study, electronic databases have been relied upon in which M.P. and C.F. analyzed abstracts of the chosen publications. In addition to that guidance of expert consensus group for ADI/Lancet estimates were taken into consideration (Prince et al., 2013). In addition to that for the purpose of choosing the needed article inclusion and exclusion was also set on the basis of which the article were chosen. On this basis it may be stated that the researcher was successful in including relevant studies.   

On the part of the researcher, was there enough focus on evaluating the quality of the included studies?

In this study no specification regarding the rigor of the research can be seen to have been specified on the part of the researcher which questions the emphasis on evaluation of quality of the included studies.  

Has the result of the reviews been combined and if it was reasonable to do so?

In this study, on the part of the researcher it may be observed that various studies were identified in each GBD world regions. The study reflected a reasonable coverage for 11 of the 21 GBD regions. It can be seen to be clearly specified on the part of the researcher in E1.  

What was the total outcome of the review?

The research came up with a clear outcome in which it specifies that within the age group of ≥60 years differed in narrow band. It was 5%-7% in majority of the world regions having higher prevalence in Latin America that was seen to have lower prevalence in sub-Saharan African regions. It further provided with statistics that as of 2010. 35.6 million Individuals were living with dementia across the world which is expected to rise to 115.4 million by 2015 (who, 2012). Thus it clearly establishes the fact that the research provided with a clear outcome.     

To what extent was the result of the study precise in nature?

The data provided in the study can be stated to be precise in nature. It can be established with the help of the fact that in case of studies that reported unweighted prevalence the researcher extracted 95% of confidence intervals.   

Is the result of the study applicable in the local population?

In this particular study, the researcher focused on the age group of individuals 60 years or above belonging from 21 Global Burden of Disease regions for the purpose of determining age standardized prevalence rate of dementia (Prince et al., 2013). On the basis of the chosen population for this study it can be seen to be implementable in the local population as well it is due to that the fact that it is within the chosen population of the specific age in which the prevalence of the condition is seen to be high. This makes the paper applicable in the local population as well.   

Has the study considered all the important outcomes?

In the present study, the researcher has highlighted on 21 Global Burden of Disease regions for the purpose of determining the prevalence of dementia wherein the specifications associated with every region has been highlighted upon. This was an integral aspect of the study for the purpose of understanding the scenario of the included regions. Thus it may be stated that the essential aspects associated with the study has been taken into consideration.

Can the benefits associated with the intervention mentioned in the study worth the harms and costs?

This study focused on planning, policy formulation along with allocation of health and welfare resources in regards to dementia care (Moreiran et al., 2014). In context to the above mentioned interventions focused on the part of the researcher in this study has no particular harm associated with it. However, if the policies and practices of the government is formulated effectively and planned on the basis of the projections of the study, it would result in shift in allocation of resources to the care services of the older people which would help in minimizing the prevalence of dementia (O’Connor et al., 2007). Thus it will not be wrong to state that the intervention specified in the study is cost effective.  

On evaluating the study it may be observed that it comprised of certain strengths and limitation

Article 3- Systematic review of the effective components of psychosocial interventions delivered by care home staff to people with dementia

Was the review successful in clearly focusing on a specific area of question?

The researcher clearly focused on 49 paper which emphasized on care services provided by care home staff to individuals with dementia (Rapaport et al., 2017). In this research, the researcher focused on psychosocial intervention as its major point of emphasis. Thus, it clearly establishes the fact that the researcher was successful in giving a clear focus on the chosen area of research.  

Has the researcher been successful in opting for the right types of paper?

On the part of the researcher, in this study focus has been given on the different aspects associated with psychosocial intervention which result in enhanced outcome of the care users with dementia like DCM intervention and its impact (Livingston et al., 2014). In this context if the research question is analyzed it may be noticed that the researcher aimed at having an understanding of the elements of psychosocial intervention which is associated with enhanced outcomes of dementia patients. In addition to that the researcher, for the purpose of opting quantitative studies which are high in quality emphasized on the fact that if the chosen paper allocated its control groups through independent randomization (Bowen, 2009). Thus it reflected the fact that researcher of this paper was success in choosing the right paper.   

Is it worth continuing?

Has the researcher successfully included relevant studies?

In this particular research, on the part of the researcher, electronic databases like EMBASE, PsychINFO and MEDLINE has been used. In this regard, for the purpose of choosing quality articles which is relevant to the topic of research operationalised checklists which was derived from standard criteria has been used (Badia, 2011). On this basis it will not be wrong to state that the researcher was successful in inclusion of relevant studies needed for successful completion of the study.     

On the part of the researcher, was there enough focus on evaluating the quality of the included studies?

In this study no specification regarding the rigor of the research can be seen to have been specified on the part of the researcher resulting in question the focus of the researcher in examining the quality of the included studies.  

Has the result of the reviews been combined and if it was reasonable to do so?

The result in this research can be seen to be combined with different other studies as well. It can be clearly observed with the help of the fact that staff engagement was seen to be associated with reduced aggressive behavior and agitation in different studies (Andrews et al., 2009). The significance of on-site support for putting skills into practice was also observed to be common in different studies. Thus it is due to this alignment with the findings from different studies which resulted in incorporation of this information in this study.  

What was the total outcome of the review?

The study provided with the outcome that psychosocial intervention can turn out to be effective in enhancing the outcome of the residents and staff with dementia in care home. It establishes the fact that the researcher has been effective in providing with a clear outcome of the research.     

To what extent was the result of the study precise in nature?

The specification or preciseness of the information or data presented in the study is questionable. It is due to the fact that the author has not provided with any information regarding confidence intervals associated with the data that has been used in the study (Rapaport et al., 2017).    

Is the result of the study applicable in the local population?

The study focused on impact associated with implementation of psychosocial interventions among care home staff, who provides with care services to dementia patients (Signe & Elmståhl, 2008). In case of local population as well local population seeks care services from care home staff making the study applicable to local population as well.

Has the study considered all the important outcomes?

The study main focused on the opinions and perspectives of the staffs, care worker and organization. However, it lacked any specification about the opinion or experience of the care users with implementation of psychosocial intervention (Dewing, 2007).. Thus, the inclusion of the experiences of the care users with implementation of psychosocial invention would have resulted in consideration of all the essential aspects of the study.

Can the benefits associated with the intervention mentioned in the study worth the harms and costs?

No significant harms are associated with psychosocial intervention. However, with the help of implementation of psychosocial intervention the quality of life of the care users can be enhanced along with minimizing the care cost associated with dementia by reducing the complexity of the condition (Moniz-Cook et al., 2008). Thus the benefits associated with psycho-social intervention can be stated to be cost effective.

Conclusion

On the basis of review of the above chosen 3 articles it may be stated that, three articles contributes to the knowledge of dementia. With the help of Article 1, the impact associated with implementation of DECIDE manual in the decision making process of dementia patients may be gained, similarly article 2 helps in understanding the prevalence rate of dementia globally and associated impact of policies on the condition and with the help of article 3 the impact of psychosocial intervention in care services of dementia patients can be perceived. Thus it will not be wrong to state that the chosen 3 articles helps in gaining knowledge associated with dementia care.

References

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