Dementia prevention guidelines should explicitly mention deprivation
Dementia due to brain diseases such as Alzheimer's affects 55 million people, and in the year 2019 alone, represented a cost of US $1.3 trillion globally. This is cited by Daly (2023), who focuses in this paper on the neuroethics of dementia in the context of prevention.
Daly seeks to enrich the discussion of risk factors for later-life amnestic dementia by considering the brain's relationship with its environment across a person's lifetime, and he is especially interested in deprivation, which he understands to be any lack of environmental resources leading to an unmet need: ‘[t]here are three kinds of deprivation that the brain might experience that are most relevant to dementia: sensorimotor, social, and socioeconomic.’ Daly argues that deprivation is an ‘independent and overlooked risk factor for dementia that invites upstream action against inequalities.’
Daly notes that research and policymaking in relation to dementia risk reduction have thus far concentrated almost exclusively on how individuals' health behaviours change their risk profile. This lifestyle-centred focus, asserts Daly, poses ethical challenges and is therapeutically inadequate. Future prevention guidelines, he argues, should explicitly identify deprivation as a risk factor and should develop around the need for a fairer society. ‘Meanwhile, interventions and discourse based on lifestyle modification should respect the principle of “no ought without support.”’
What are the experiences of supportive care in people affected by brain cancer
Primary malignant brain tumours account for 1.7% of all cancers, with a global incidence of 3.9 per 100,000. High-grade gliomas are the most common variant in adults, who have a median survival rate of 12–15 months. This is cited by Paterson et al (2023) who describe a qualitative systematic review that aimed to understand experiences of supportive care in people affected by brain cancer and their informal caregivers.
They evaluated 33 studies, representing a total sample of 671 participants that included 303 patients and 368 informal caregivers. Significantly, all informal caregivers reported that they lacked the support, information, and preparation to take on and adapt to this role. Paterson et al (2023) highlight the need for increased caregiver support to alleviate distress and suffering among caregivers and state that this can be achieved by providing family-based cancer care. The importance of this is emphasised by research demonstrating that caregivers' distress can have an impact on patients' distress, long-term adjustment, and anxiety.
Opportunities for interventions to address unmet needs of patients and their informal caregivers include better care coordination to allow targeted informational support; implementation of holistic needs assessments, for patients and caregivers; improved community support provision; anticipatory proactive rather than reactive care; and ‘improved opportunities for emotional care with early streamlined integration for palliative care services.’
Yoga may reduce anxiety symptoms
The global prevalence of depressive disorders and anxiety disorders is estimated at 20% and between 3.8% to 25%, respectively. Martinez-Calderon et al (2023) make the point that recent reviews have reported improvements in brain health with tai chi or yoga, and that mind-body practices have conferred mental health benefits compared to control interventions among people with disorders like schizophrenia or post-traumatic stress.
To determine the effect of mind–body exercises on anxiety and depression symptoms in adults with anxiety or depressive disorders, Martinez-Calderon (2023) undertook a meta-analysis that evaluated 23 studies of 1420 individuals.
The study results showed that yoga interventions were not only superior to controls in reducing anxiety symptoms in anxiety disorders, but also that yoga-based interventions decreased depression symptoms in depressive disorders. However, it must be noted that ‘the certainty of the evidence was judged as very low for all outcomes due to concerns of high risk of bias, indirectness of the evidence, inconsistency, and imprecision of the results.’
The authors conclude that although yoga-based interventions may help contribute to improved mental health in adults diagnosed with depressive or anxiety disorders, there is a need for methodological improvements to help advance the quality of clinical trials in this field.
Patient–healthcare provider communication and hearing loss
Communicating well with older adults is challenging for many healthcare providers, and it is known that hearing loss is a modifiable risk factor for cognitive decline. Specifically, age-related hearing loss (ARHL) is the second commonest illness in aged people worldwide, affecting around one-third of people aged 65 to 74 years and almost half of those over 75 years.
These observations are cited by Lu et al (2023) whose qualitative study, using semi-structured interviews, describes the communication challenges faced by 13 people aged over 65 years with ARHL and suggests potential ameliorative strategies based on the participants' personal experiences. The participants attended a support service for older adults with ARHL in the South of Ireland, and interviews were audio-recorded.
The study found that almost half of older adults, including hearing aids users, reported mishearing healthcare providers in clinical settings, and the authors cite studies that have pointed to background noise, multiple people talking simultaneously and poor pronunciation between two similar words as representing barriers to clear communication. With background noise, consonant confusion can give rise to communication misunderstanding, with many consonants containing high-frequency sounds often lost, while low-frequency sounds remain clear.
Healthcare providers, the authors conclude, ‘should be made aware of the hearing issues and associated communication difficulties posed, within the context of the development of patient-centred strategies to improve patient safety.