Background
Methods
Design
Participants
Round one (December 2013): generating information
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How would you define dementia for a lay person?
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What key facts are essential to understanding dementia?
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What key facts about dementia are frequently misunderstood by lay people?
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What key facts about dementia should people in your field know?
Round two (February 2014): rating knowledge statements
Round three (March 2014): confirming consensus
Measurement and analysis
Results
Round 1 (n = 19) | Round 2 (n =17) | Round 3 (n = 15) | |
---|---|---|---|
Female gender | 8 | 7 | 6 |
Country | |||
Australia | 15 | 13 | 11 |
United States | 2 | 2 | 2 |
United Kingdom | 2 | 2 | 2 |
Occupation | |||
University academic | 11 | 10 | 9 |
Clinician (Geriatrician or nurse specialist) | 6 | 5 | 4 |
Not for profit/advocacy organization manager | 2 | 2 | 2 |
Reported areas of expertise1 | |||
Clinical care | 35% | ||
Dementia education | 23% | ||
Advocacy | 13% | ||
Service delivery | 13% | ||
Neuropsychology | 10% | ||
Research | 6% |
Round one: identifying factual statements about dementia
A:
|
Basic characteristics of dementia (14% of total items)
|
1 | Dementia refers to a group of diseases that affect the brain. |
2 | People with dementia have a disease that affects the structure and function of their brain. |
3 | Dementia is not a psychological condition. |
4 | Dementia always becomes worse over time. |
5 | Dementia is a terminal condition that will result in death. |
6 | Dementia most commonly affects older adults. |
7 | Dementia can occur in younger adults. |
8 | Dementia is not a part of normal ageing. |
9 | Prevalence of dementia is increasing within many societies. |
B:
|
Symptoms and progression (30% of total items)
|
10 | Dementia affects people across five domains: cognitive, functional, psychiatric, behavioural, and physical. |
11 | Difficulty swallowing is a symptom of dementia. |
12 | Difficulty with movement is a symptom of dementia. |
13 | Difficulty speaking is a symptom of dementia. |
14 | Memory loss is a symptom of dementia. |
15 | Behavioural changes are symptoms of dementia. |
16 | Personality changes are symptoms of dementia. |
17 | Wandering is a symptom of dementia. |
18 | Confusion is a symptom of dementia. |
19 | Difficulty making decisions is a symptom of dementia. |
20 | Difficulty with problem solving is a symptom of dementia. |
21 | Difficulty with learning is a symptom of dementia. |
22 | Cognitive and functional losses can fluctuate in a person with dementia. |
23 | Symptoms of dementia differ by type of underlying disease. |
24 | People with dementia often have other chronic medical conditions. |
25 | It may take years for dementia to develop to the point that it affects cognition and functioning. |
26 | Dementia has discernable stages. |
27 | The course of dementia is unpredictable. |
28 | It is possible to communicate with a person who has advanced dementia. |
29 | A person with advanced dementia may be able to communicate non-verbally. |
C:
|
Diagnosis and assessment (17% of total items)
|
30 | Alzheimer’s disease is the most common form of dementia. |
31 | Dementia with Lewy Bodies is a common form of dementia. |
32 | Vascular dementia is a common form of dementia. |
33 | Fronto-temporal dementia is a common form of dementia. |
34 | Definitive diagnosis of dementia in a living patient is difficult. |
35 | Early diagnosis of dementia improves treatment outcomes. |
36 | A high proportion of people who have dementia do not have a diagnosis. |
37 | Assessment of a person with dementia is important to determine whether they are suffering from treatable and co-existing medical and psychiatric conditions. |
38 | Depression in a person with dementia should be identified and treated. |
39 | Delirium should be ruled out in a person with suspected dementia. |
40 | Pain in a person with dementia should be identified and treated. |
D:
|
Treatment and prevention (15% of total items)
|
41 | There is currently no cure for dementia. |
42 | Symptoms of dementia can be improved with medication. |
43 | Psychosocial interventions can improve quality of life for people with dementia. |
44 | Non-pharmacological interventions are often more appropriate for treating dementia-related behavioural problems. |
45 | Psychotropic medications may cause undue harm to a person with dementia. |
46 | Cognitive stimulation for the person with dementia can improve symptoms. |
47 | Exercise for the person with dementia can improve symptoms. |
48 | Some of the risk factors for dementia are modifiable. |
49 | A healthful lifestyle can reduce the risk of developing dementia. |
50 | In most cases, having parents with dementia does not greatly increase the risk of developing the condition. |
E:
|
Care for people with dementia (24% of total items)
|
51 | It is possible for a person with dementia to live independently during the initial stages of the condition. |
52 | Most people who have dementia live in their own homes in the community. |
53 | People with dementia are not always a risk to themselves and others. |
54 | People with dementia will eventually require a high level of care and assistance with activities of daily living. |
55 | It is important to plan the future care of a person once a diagnosis of dementia has been made. |
56 | Education following diagnosis is important to help a person with dementia and their carer to manage the condition. |
57 | The wishes of a person with dementia should be taken into account when planning for their treatment and care. |
58 | A palliative approach to care is appropriate for a person with dementia. |
59 | A person-centred approach to care is appropriate for a person with dementia. |
60 | Aggressive and invasive treatments are often not appropriate for people with dementia. |
61 | Relationships remain important for a person with dementia. |
62 | People with dementia should continue to be involved in meaningful physical, social, and mental activities. |
63 | Caring for a person with dementia can be stressful. |
64 | Caregivers of people with dementia require support. |
65 | A person with dementia may retain more understanding than they can express. |
66 | A person’s past can be important for understanding behavioural problems. |
Round two: rating knowledge statements
Round three: confirming consensus
Item | Category | Interquartile range | Responders scoring 5 in round 3 (%) | Score change between rounds 2 and 3 (z) | Significance (p) |
---|---|---|---|---|---|
Full consensus items (n = 5) | |||||
Dementia refers to a group of diseases that affect the brain | Characteristics of dementia | 0 | 100% | -1.63 | .10 |
Behavioural changes are symptoms of dementia | Symptoms and progression | 0 | 100% | -2.00 | .05 |
Assessment of a person with dementia is important to determine whether they are suffering from treatable and co-existing medical and psychiatric conditions | Diagnosis and assessment | 0 | 100% | -2.00 | .04* |
Non-pharmacological interventions are often more appropriate for treating dementia-related behavioural problems | Treatment and prevention | 0 | 100% | -1.63 | .10 |
It is possible for a person with dementia to live independently during the initial stages of the condition. | Care for people with dementia | 0 | 100% | -1.89 | .06 |
Very high consensus items (n = 31) | |||||
People with dementia have a disease that affects the structure and function of their brain. | Characteristics of dementia | 0 | 93% | -1.51 | .13 |
Dementia is not a part of normal ageing. | Characteristics of dementia | 0 | 87% | -1.13 | .26 |
Dementia is a terminal condition that will result in death. | Characteristics of dementia | 0 | 80% | -1.47 | .14 |
Dementia most commonly affects older adults. | Characteristics of dementia | 0 | 80% | -2.00 | .05 |
Memory loss is a symptom of dementia. | Symptoms and progression | 0 | 93% | -1.63 | .10 |
Difficulty with problem solving is a symptom of dementia. | Symptoms and progression | 0 | 93% | -1.89 | .06 |
Dementia affects people across five domains: cognitive, functional, psychiatric, behavioural, and physical. | Symptoms and progression | 0 | 87% | -1.47 | .14 |
Difficulty making decisions is a symptom of dementia. | Symptoms and progression | 0 | 87% | -1.41 | .16 |
Difficulty with learning is a symptom of dementia. | Symptoms and progression | 0 | 87% | -1.73 | .08 |
It is possible to communicate with a person who has advanced dementia. | Symptoms and progression | 0 | 87% | -1.41 | .16 |
A person with advanced dementia may be able to communicate non-verbally. | Symptoms and progression | 0 | 87% | -1.41 | .16 |
Pain in a person with dementia should be identified and treated. | Diagnosis and assessment | 0 | 93% | -1.41 | .16 |
Delirium should be ruled out in a person with suspected dementia. | Diagnosis and assessment | 0 | 87% | -1.52 | .13 |
Depression in a person with dementia should be identified and treated. | Diagnosis and assessment | 0 | 87% | -1.63 | .10 |
Alzheimer’s disease is the most common form of dementia. | Diagnosis and assessment | 0 | 80% | -1.19 | .23 |
Psychotropic medications may cause undue harm to a person with dementia. | Treatment and prevention | 0 | 93% | -1.86 | .06 |
There is currently no cure for dementia. | Treatment and prevention | 0 | 87% | -1.47 | .14 |
Psychosocial interventions can improve quality of life for people with dementia. | Treatment and prevention | 0 | 80% | -1.27 | .21 |
Some of the risk factors for dementia are modifiable. | Treatment and prevention | 0 | 80% | -1.89 | .06 |
The wishes of a person with dementia should be taken into account when planning for their treatment and care. | Care for people with dementia | 0 | 93% | 0.00 | 1.00 |
A person-centred approach to care is appropriate for a person with dementia. | Care for people with dementia | 0 | 93% | -1.00 | .32 |
Caring for a person with dementia can be stressful. | Care for people with dementia | 0 | 93% | -2.06 | .04* |
Caregivers of people with dementia require support. | Care for people with dementia | 0 | 93% | 0.00 | 1.00 |
A person with dementia may retain more understanding than they can express. | Care for people with dementia | 0 | 93% | -2.24 | .03* |
Most people who have dementia live in their own homes in the community. | Care for people with dementia | 0 | 87% | -.82 | .41 |
Education following diagnosis is important to help a person with dementia and their carer to manage the condition. | Care for people with dementia | 0 | 87% | -.82 | .41 |
Aggressive and invasive treatments are often not appropriate for people with dementia. | Care for people with dementia | 0 | 87% | -2.06 | .04* |
Relationships remain important for a person with dementia. | Care for people with dementia | 0 | 87% | 0.00 | 1.00 |
People with dementia should continue to be involved in meaningful physical, social, and mental activities. | Care for people with dementia | 0 | 87% | -1.41 | .16 |
A person’s past can be important for understanding behavioural problems. | Care for people with dementia | 0 | 87% | -.54 | .60 |
It is important to plan the future care of a person once a diagnosis of dementia has been made. | Care for people with dementia | 0 | 80% | -1.60 | .11 |
Very low consensus items (n = 11) | |||||
Dementia is not a psychological condition. | Characteristics of dementia | 2 | 13% | -.42 | .67 |
Difficulty with movement is a symptom of dementia. | Symptoms and progression | 2 | 27% | -1.30 | .19 |
Difficulty with swallowing is a symptom of dementia. | Symptoms and progression | 2 | 27% | -1.66 | .10 |
People with dementia often have other chronic medical conditions. | Symptoms and progression | 2 | 27% | -.09 | .93 |
The course of dementia is unpredictable. | Symptoms and progression | 2 | 20% | .00 | 1.00 |
Wandering is a symptom of dementia. | Symptoms and progression | 2 | 13% | -1.04 | .30 |
Difficulty speaking is a symptom of dementia. | Symptoms and progression | 2 | 13% | -.42 | .68 |
Dementia has discernable stages. | Symptoms and progression | 2 | 6% | -1.31 | .19 |
Early diagnosis of dementia improves treatment outcomes. | Diagnosis and assessment. | 2 | 27% | -1.29 | .20 |
Exercise for the person with dementia can improve symptoms. | Treatment and prevention | 2 | 27% | -1.75 | .08 |
A palliative approach to care is appropriate for a person with dementia. | Care for people with dementia. | 2 | 40% | -.88 | .38 |