Use of nutritional complete supplements in older adults with dementia: systematic review and meta-analysis of clinical outcomes

Background & Aims: Malnutrition is prevalent in people diagnosed with dementia however ensuring adequate oral intake within this group is often problematic. It is important to determine whether providing nutritionally complete oral nutritional supplements (ONS) drinks is an effective way of improving clinical outcomes for older people with dementia. This paper systematically reviewed clinical, wellbeing and nutritional outcomes in people with long-term cognitive impairment. Methods: The CINAHL, Medline and EMBASE databases were searched from their inception until January 2012. Reference lists of the included papers, foreign language papers and review articles obtained were manually searched. Results: Twelve articles were included in the review containing 1076 people in the supplement groups (intervention) and 748 people in the control groups. Meta-analysis shows there was a significant improvement in weight (p=<0.0001), Body Mass Index (BMI) (p=<0.0001) and cognition at 6.5+/-3.9 month follow up (p=0.002) when supplements were given compared to the control group. Conclusions: Providing ONS drinks has a positive effect on weight gain and cognition at follow up in older people with dementia. Additional research is required in both comparing nutritional supplements to vitamin/mineral tablets and high protein/calorie shots and clinical outcomes relevant to hospitalised people with dementia.

Relating computer tasks to existing knowledge to improve accessibility for older adults

Routine computer tasks are often difficult for older adult computer users to learn and remember. People tend to learn new tasks by relating new concepts to existing knowledge. However, even for 'basic' computer tasks there is little, if any, existing knowledge on which older adults can base their learning. This paper investigates a custom file management interface that was designed to aid discovery and learnability by providing interface objects that are familiar to the user. A study was conducted which examined the differences between older and younger computer users when undertaking routine file management tasks using the standard Windows desktop as compared with the custom interface. Results showed that older adult computer users requested help more than ten times as often as younger users when using a standard windows/mouse configuration, made more mistakes and also required significantly more confirmations than younger users. The custom interface showed improvements over standard Windows/mouse, with fewer confirmations and less help being required. Hence, there is potential for an interface that closely mimics the real world to improve computer accessibility for older adults, aiding self-discovery and learnability.

Older adults encode-but do not always use-perceptual details: intentional versus unintentional effects of detail on memory judgments

Investigations of memory deficits in older individuals have concentrated on their increased likelihood of forgetting events or details of events that were actually encountered (errors of omission). However mounting evidence demonstrates that normal cognitive aging also is associated with an increased propensity for errors of commission-shown in false alarms or false recognition. The present study examined the origins of this age difference. Older and younger adults each performed three types of memory tasks in which details of encountered items might influence performance. Although older adults showed greater false recognition of related lures on a standard (identical) old/new episodic recognition task, older and younger adults showed parallel effects of detail on repetition priming and meaning-based episodic recognition (decreased priming and decreased meaning-based recognition for different relative to same exemplars). The results suggest that the older adults encoded details but used them less effectively than the younger adults in the recognition context requiring their deliberate, controlled use.

A new rapid detection threshold method for use with older adults: reducing fatigue whilst maintaining accuracy

Taste and smell detection threshold measurements are frequently time consuming especially when the method involves reversing the concentrations presented to replicate and improve accuracy of results. These multiple replications are likely to cause sensory and cognitive fatigue which may be more pronounced in elderly populations. A new rapid detection threshold methodology was developed that quickly located the likely position of each individuals sensory detection threshold then refined this by providing multiple concentrations around this point to determine their threshold. This study evaluates the reliability and validity of this method. Findings indicate that this new rapid detection threshold methodology was appropriate to identify differences in sensory detection thresholds between different populations and has positive benefits in providing a shorter assessment of detection thresholds. The results indicated that this method is appropriate at determining individual as well as group detection thresholds.

Validation of the NANA (Novel Assessment of Nutrition and Ageing) touch screen system for use at home by older adults

Prospective measurement of nutrition, cognition, and physical activity in later life would facilitate early detection of detrimental change and early intervention but is hard to achieve in community settings. Technology can simplify the task and facilitate daily data collection. The Novel Assessment of Nutrition and Ageing (NANA) toolkit was developed to provide a holistic picture of an individual's function including diet, cognition and activity levels. This study aimed to validate the NANA toolkit for data collection in the community. Forty participants aged 65 years and over trialled the NANA toolkit in their homes for three 7-day periods at four-week intervals. Data collected using the NANA toolkit were compared with standard measures of diet (four-day food diary), cognitive ability (processing speed) and physical activity (self-report). Bland–Altman analysis of dietary intake (energy, carbohydrates, protein fat) found a good relationship with the food diary and cognitive processing speed and physical activity (hours) were significantly correlated with their standard counterparts. The NANA toolkit enables daily reporting of data that would otherwise be collected sporadically while reducing demands on participants; older adults can complete the daily reporting at home without a researcher being present; and it enables prospective investigation of several domains at once

Thirst for knowledge: the effects of curiosity and interest on memory in younger and older adults

Given age-related memory impairments, one’s level of curiosity or interest could enhance memory for certain information. In the current study, younger and older adults read trivia questions, rated how curious they were to learn each answer, provided confidence and interest ratings, and judgments of learning (JOL) after learning the answer. No age-related differences in memory were found. Analyses indicated that curiosity and interest contributed to the formation of JOLs. Additionally, interest had a unique increasing relationship with older, but not younger, adults’ memory performance after a week. The results suggest that subjective interest may serve to enhance older adults’ memory.

Resources, staff beliefs and organizational culture: factors in the use of information and communication technology for adults with intellectual disabilities

Background  Access to, and the use of, information and communication technology (ICT) is increasingly becoming a vital component of mainstream life. First-order (e.g. time and money) and second-order factors (e.g. beliefs of staff members) affect the use of ICT in different contexts. It is timely to investigate what these factors may be in the context of service provision for adults with intellectual disabilities given the role ICT could play in facilitating communication and access to information and opportunities as suggested in Valuing People. Method  Taking a qualitative approach, nine day service sites within one organization were visited over a period of 6 months to observe ICT-related practice and seek the views of staff members working with adults with intellectual disabilities. All day services were equipped with modern ICT equipment including computers, digital cameras, Internet connections and related peripherals. Results  Staff members reported time, training and budget as significant first-order factors. Organizational culture and beliefs about the suitability of technology for older or less able service users were the striking second-order factors mentioned. Despite similar levels of equipment, support and training, ICT use had developed in very different ways across sites. Conclusion  The provision of ICT equipment and training is not sufficient to ensure their use; the beliefs of staff members and organizational culture of sites play a substantial role in how ICT is used with and by service users. Activity theory provides a useful framework for considering how first- and second-order factors are related. Staff members need to be given clear information about the broader purpose of activities in day services, especially in relation to the lifelong learning agenda, in order to see the relevance and usefulness of ICT resources for all service users.

Investigating familiar interfaces to help older adults learn computer applications more easily

Many older adults wish to gain competence in using a computer, but many application interfaces are perceived as complex and difficult to use, deterring potential users from investing the time to learn them. Hence, this study looks at the potential of ‘familiar’ interface design which builds upon users’ knowledge of real world interactions, and applies existing skills to a new domain. Tools are provided in the form of familiar visual objects, and manipulated like real-world counterparts, rather than with buttons, icons and menus found in classic WIMP interfaces. This paper describes the formative evaluation of computer interactions that are based upon familiar real world tasks, which supports multitouch interaction, involves few buttons and icons, no menus, no right-clicks or double-clicks and no dialogs. Using an example of an email client to test the principles of using “familiarity”, the initial feedback was very encouraging, with 3 of the 4 participants being able to undertake some of the basic email tasks with no prior training and little or no help. The feedback has informed a number of refinements of the design principles, such as providing clearer affordance for visual objects. A full study is currently underway.

Advances in Model-Based Traffic Vision

Model based vision allows use of prior knowledge of the shape and appearance of specific objects to be used in the interpretation of a visual scene; it provides a powerful and natural way to enforce the view consistency constraint. A model based vision system has been developed within ESPRIT VIEWS: P2152 which is able to classify and track moving objects (cars and other vehicles) in complex, cluttered traffic scenes. The fundamental basis of the method has been previously reported. This paper presents recent developments which have extended the scope of the system to include (i) multiple cameras, (ii) variable camera geometry, and (iii) articulated objects. All three enhancements have easily been accommodated within the original model-based approach

Case-based analysis in user requirements modelling for knowledge construction

Context: Learning can be regarded as knowledge construction in which prior knowledge and experience serve as basis for the learners to expand their knowledge base. Such a process of knowledge construction has to take place continuously in order to enhance the learners’ competence in a competitive working environment. As the information consumers, the individual users demand personalised information provision which meets their own specific purposes, goals, and expectations. Objectives: The current methods in requirements engineering are capable of modelling the common user’s behaviour in the domain of knowledge construction. The users’ requirements can be represented as a case in the defined structure which can be reasoned to enable the requirements analysis. Such analysis needs to be enhanced so that personalised information provision can be tackled and modelled. However, there is a lack of suitable modelling methods to achieve this end. This paper presents a new ontological method for capturing individual user’s requirements and transforming the requirements onto personalised information provision specifications. Hence the right information can be provided to the right user for the right purpose. Method: An experiment was conducted based on the qualitative method. A medium size of group of users participated to validate the method and its techniques, i.e. articulates, maps, configures, and learning content. The results were used as the feedback for the improvement. Result: The research work has produced an ontology model with a set of techniques which support the functions for profiling user’s requirements, reasoning requirements patterns, generating workflow from norms, and formulating information provision specifications. Conclusion: The current requirements engineering approaches provide the methodical capability for developing solutions. Our research outcome, i.e. the ontology model with the techniques, can further enhance the RE approaches for modelling the individual user’s needs and discovering the user’s requirements.

Efficient and accurate experimental design for enzyme kinetics: Bayesian studies reveal a systematic approach

In areas such as drug development, clinical diagnosis and biotechnology research, acquiring details about the kinetic parameters of enzymes is crucial. The correct design of an experiment is critical to collecting data suitable for analysis, modelling and deriving the correct information. As classical design methods are not targeted to the more complex kinetics being frequently studied, attention is needed to estimate parameters of such models with low variance. We demonstrate that a Bayesian approach (the use of prior knowledge) can produce major gains quantifiable in terms of information, productivity and accuracy of each experiment. Developing the use of Bayesian Utility functions, we have used a systematic method to identify the optimum experimental designs for a number of kinetic model data sets. This has enabled the identification of trends between kinetic model types, sets of design rules and the key conclusion that such designs should be based on some prior knowledge of K-M and/or the kinetic model. We suggest an optimal and iterative method for selecting features of the design such as the substrate range, number of measurements and choice of intermediate points. The final design collects data suitable for accurate modelling and analysis and minimises the error in the parameters estimated. (C) 2003 Elsevier Science B.V. All rights reserved.

Evoked prior learning experience and approach to learning as predictors of academic achievement

Background. In separate studies and research from different perspectives, five factors are found to be among those related to higher quality outcomes of student learning (academic achievement). Those factors are higher self-efficacy, deeper approaches to learning, higher quality teaching, students’ perceptions that their workload is appropriate, and greater learning motivation. University learning improvement strategies have been built on these research results. Aim. To investigate how students’ evoked prior experience, perceptions of their learning environment, and their approaches to learning collectively contribute to academic achievement. This is the first study to investigate motivation and self-efficacy in the same educational context as conceptions of learning, approaches to learning and perceptions of the learning environment. Sample. Undergraduate students (773) from the full range of disciplines were part of a group of over 2,300 students who volunteered to complete a survey of their learning experience. On completing their degrees 6 and 18 months later, their academic achievement was matched with their learning experience survey data. Method. A 77-item questionnaire was used to gather students’ self-report of their evoked prior experience (self-efficacy, learning motivation, and conceptions of learning), perceptions of learning context (teaching quality and appropriate workload), and approaches to learning (deep and surface). Academic achievement was measured using the English honours degree classification system. Analyses were conducted using correlational and multi-variable (structural equation modelling) methods. Results. The results from the correlation methods confirmed those found in numerous earlier studies. The results from the multi-variable analyses indicated that surface approach to learning was the strongest predictor of academic achievement, with self-efficacy and motivation also found to be directly related. In contrast to the correlation results, a deep approach to learning was not related to academic achievement, and teaching quality and conceptions of learning were only indirectly related to achievement. Conclusions. Research aimed at understanding how students experience their learning environment and how that experience relates to the quality of their learning needs to be conducted using a wider range of variables and more sophisticated analytical methods. In this study of one context, some of the relations found in earlier bivariate studies, and on which learning intervention strategies have been built, are not confirmed when more holistic teaching–learning contexts are analysed using multi-variable methods.