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Impact of brief education on healthy seniors’ attitudes and healthcare choices about Alzheimer's disease and associated symptoms

Published online by Cambridge University Press:  03 May 2018

Robyn E. Waxman ,
Barbara J. Russell ,
Oscar C. T. Iu  and
Benoit H. Mulsant
Robyn E. Waxman*
Affiliation:
Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada Centre for Addiction and Mental Health, Toronto, Ontario, Canada Ontario Shores Centre for Mental Health Sciences, Whitby, Ontario, Canada
Barbara J. Russell
Affiliation:
Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada Centre for Addiction and Mental Health, Toronto, Ontario, Canada University Health Network, Toronto, Ontario, Canada
Oscar C. T. Iu
Affiliation:
Centre for Addiction and Mental Health, Toronto, Ontario, Canada
Benoit H. Mulsant
Affiliation:
Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada Centre for Addiction and Mental Health, Toronto, Ontario, Canada
*
Correspondence should be addressed to: Robyn E. Waxman, Ontario Shores Centre for Mental Health Sciences, 700 Gordon Street, Whitby, Ontario L1N 5S9, Canada. Phone: +(416) 450-1330; Fax: +(905) 430-4465. Email: waxmanro@ontarioshores.ca.
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Abstract

Objective:

The primary objective of this study was to determine whether a brief education session about Alzheimer's disease (AD) stages and associated behavioral and psychological symptoms of dementia (BPSD) changes healthy seniors’ treatment choices. A secondary objective was to determine whether pharmacotherapy to reduce BPSD would be preferred over other potentially more restrictive interventions.

Methods:

Participants (n = 32; 8 men; aged > 64years; no self-reported dementia diagnosis) were assigned to one of ten group sessions during which they received information about AD and BPSD. Our a-priori hypotheses were: (1) education about AD stages significantly changes care preferences in moderate and severe stages, i.e. less active treatment options (no CPR/hospitalization) are chosen as the disease progresses; and (2) most participants prefer pharmacotherapy over restraints and seclusion to manage BPSD. The main outcome measure was a change in the interventions chosen including CPR and hospitalization. Participants completed three questionnaires and two decisional grids before and after the information session. Qualitative data were derived from discussions during the session.

Results:

Participants expressed a wide range of attitudes about AD, BPSD, and their management. Those who are born in Canada, had a proxy, and a university education, each have around half of the odds of receiving treatment compared to those in the complementary group. (OR 0.47, 0.40, 0.43) Finally, not knowing someone with AD increases the odds of wanting a treatment by around six times (OR 6.4). Pharmacological measures were preferred over restraints.

Conclusions:

Education about dementia and advance directives should consider the person's educational background and experience with dementia. Discussing BPSD may impact a person's advance directives and preferences.

Keywords

Alzheimer's diseasebehavioral and psychological symptoms of dementiaadvance directives
Type
Original Research Article
Information
International Psychogeriatrics , Volume 30 , Issue 12: Issue Theme: Positive Psychiatry , December 2018 , pp. 1889 - 1897
Copyright
Copyright © International Psychogeriatric Association 2018 

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