Category Archives: Blogging

An Innovation Center Model to Transform Health Systems to Improve Care of Older Adults

The US population is aging faster than at any other time in our history. This growth, coupled with a slow adaptive health policy framework, is creating an urgent need to reengineer and improve the quality, safety, and cost‐effectiveness of health systems to meet the needs of older adults and embrace the success we have achieved with longevity. Without rapid adoption of evidence‐based models that are known to improve safety and health outcomes, we significantly jeopardize the lives of thousands of older adults receiving care under our current health systems’ processes and models. This article describes an innovation and operations infrastructure that was successfully tested in two independent and geographically distinct community health systems. This operations and implementation framework can be scaled and used to accelerate the changes needed to improve care for older adults in health systems throughout the United States.

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From tragedy, life: Organ donors give ultimate gift

Published on Monday, November 11, 2019

By: Ruth Cummins, [email protected]

In life and in death, 13 was Abbie O’Cain’s lucky number.

As a 12-year-old sixth-grader and cheerleader at Carroll Academy in Carrollton, she won the crown for “Most Beautiful.” Her contestant number, mom Stephanie Edwards said, was 13.

Thirteen days before a brain aneurysm took Abbie’s life, she had been baptized. At her funeral, “13 people were saved,” Edwards said. “The reading was 1 Corinthians 13:13 .. Faith, hope and love, but the greatest of these is love.”

Portrait of Abbie O'Cain
Abbie

Just a week after earning her crown, Abbie died March 30, 2019, at the University of Mississippi Medical Center’s Batson Children’s Hospital. When it came time to say goodbye to Abbie, Stephanie Edwards said, choosing to donate her organs wasn’t the hard part.

“As a mother, I never knew I would have to make that decision with my child, although I knew I wanted to donate mine,” she said.

“It’s such a special gift.”

Those who make that same difficult decision in the midst of traumatic grief have extended the lives of many receiving transplants at the Medical Center and in surrounding states.

A standing-room only crowd attended Friday's Wall of Heroes ceremony.
A standing-room-only crowd attends Friday’s Wall of Heroes ceremony.

Donors young and old are represented by their photos on a Wall of Heroes. One is located at UMMC’s University Hospital, and a second one is in the Children’s Hospital. A collaborative effort of UMMC, the Mississippi Organ Recovery Agency and the Mississippi Lions Eye Bank, the memorial displays are a tribute to honor patients who gave the final gift of organ, eye or tissue donation.

Abbie’s name, along with those of dozens more adult and child donors, were recited Friday during the annual Wall of Heroes recognition ceremony at UMMC’s Chapel. “It’s one small way that we can show our gratitude and honor them for the heroes they are,” said Kellie Wier, MORA’s director of hospital development.

The need for organ donation is great. As of Oct. 28, 170 organs had been transplanted in 2019 at UMMC, the state’s only transplant center. Of that number, 110 were kidneys; eight, pancreas; 38, liver; and 14, heart.

Another 1,300-plus Mississippi residents await a transplant, and the national waiting list is more than 114,000. Nationally, an average 20 people die each day while waiting for an organ, and a new person is added to the transplant waiting list every 10 minutes.

Gina Smith describes the loss of her daughter Carmen, an organ donor.

Gina Smith describes the loss of her daughter, Carmen, an organ donor.

One organ donor can save eight lives, and one tissue and eye donor can improve the lives of 50 or more.

“She saved four lives with the donation of five organs, and one person was lucky enough to get two of them,” Gina Smith of Louisville said of her daughter Carmen, who died in 2015 at age 12 after suffering a traumatic brain injury.

A talented barrel racer, Carmen was in Jackson for a competition when she took a tumble at the Mississippi State Fairgrounds and landed on concrete. She was treated at UMMC’s Emergency Department and admitted to the pediatric intensive care unit, but her condition deteriorated. “I knew in my heart that if Carmen could help other people with the organs she didn’t need, she would want to do that,” her mom said.

Donor heart recipient Timothy Lewis speaks at the Wall of Heroes ceremony. Five years ago, he received the heart of an 18-year old.

Timothy Lewis, a donor heart recipient, speaks at the Wall of Heroes ceremony.

Timothy Lewis of Jackson knows what it feels like from the other side. Almost six years ago, near death from end-stage heart failure, Lewis received the heart of an 18-year-old young man whose family, in their most painful moments, made that gift of life.

Today, Lewis pays it forward as a Medical Center volunteer, spending much of his time ministering to patients who just received a new organ or who continue to wait. “I will walk this journey with them,” Lewis said. “I have been the one lying in that bed.”

Know that your loved one’s photo on the Wall of Heroes won’t be forgotten, but instead will be seen by thousands of visitors and patients at UMMC, Lewis told donor families who were part of the overflow crowd Friday. “They are beautiful superheroes who had an immense effect on generations and communities,” he said.

JordanMathews1.jpg

Jordan Mathews, an organ donor at age 21, began playing baseball at age 6.

Twenty-six people at the ceremony, from arm babies to senior citizens, wore identical T-shirts in memory of Jordan Mathews, a 21-year-old baseball star and rising senior at Tougaloo College. Just days before his death in August following an asthma attack, Jordan was preparing to sign a contract to play minor league ball for the Atlanta Braves, said his mom, Sheila Kidd.

A family entourage that also included his grandmother, his sister and a plethora of aunts, uncles and cousins drove almost five hours, in a total eight vehicles, from Sylacauga, Ala., to see Jordan’s photo unveiled on the Wall of Heroes.

Her son was a community volunteer, worked in his church audiovisual ministry, and had played baseball since he was 6, Kidd said. “He did so much,” she said

“On his driver’s license, he had that little heart,” Kidd said of the symbol designating the license holder as an organ donor. “I wanted to honor his wishes.”

John Marc O'Cain changed his jersey number to his sister's lucky number 13 for the 2019 football season at Carroll Academy.
John Marc O’Cain changed his Carroll Academy jersey number to his sister’s lucky number – 13 – for the 2019 football season.

Abbie’s brother, John Marc O’Cain, didn’t make it to the Wall of Heroes ceremony. The starting junior fullback and linebacker for the Carroll Academy Rebels was preparing for that night’s second-round playoff game against Sylva-Bay Academy. He and Abbie, who killed her first buck earlier this year, had an unbreakable bond.

This fall, John Marc is playing with a new number on his jersey.

Thirteen.

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Life in Emergistan: The 26-Year Intern

Wolters Kluwer Health

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Development and Dissemination of an Interprofessional Online Dementia Training Curriculum


OBJECTIVES

Despite the growing number of individuals with dementia, clinicians skilled in caring for people with dementia, especially in rural areas, are lacking. The Program for Advancing Cognitive Disorders Education for Rural Staff (PACERS) was designed to improve clinician competency and comfort when caring for individuals with dementia. Based on an interprofessional needs assessment, six 1‐hour training modules were created: (1) Dementia and Delirium, (2) Identifying and Assessing for Dementia, (3) Treating Dementia: Case Studies, (4) Normal Cognitive Aging and Dementia Caregiving, (5) Addressing Decision Making and Safety in Dementia, and (6) Dementia and Driving. Each module is available for free on the Department of Veterans Affairs Talent Management System (TMS) for employees and the free TrainingFinder Real‐time Affiliate Integrated Network (TRAIN) platform for clinicians in the community. One continuing education unit is earned upon completion of each module.

DESIGN

Posttest.

SETTING

Online training at VA TMS and TRAIN.

PARTICIPANTS

To date, more than 3000 modules have been completed by interprofessional healthcare learners (eg, nurses, physicians, psychologists, and social workers).

MEASUREMENTS

Satisfaction, perceived utility of training, knowledge, skills, and attitudes were assessed.

RESULTS

The learners reported high satisfaction (mean [M] > 4) and ability to apply the knowledge and skills learned from the module to their job (M > 4) on a Likert scale (1 = Strongly disagree to 5 = Strongly agree).

CONCLUSION

Learners also reported perceived impact on both direct patient care (eg, ability to provide education and support to individuals with dementia and their caregivers) and system‐level care (eg, more appropriate referrals). Given the number of users and their evaluation data, PACERS can serve as a model curriculum for online interprofessional dementia training.

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After accident, Ole Miss senior back in school, thanks to SON students

Published on Thursday, November 7, 2019

By: Kate Royals, [email protected]

Summer Jefferson, a senior at the University of Mississippi majoring in biochemistry, is a planner and a self-described “type A” personality.

Her plan last summer was to take the medical school admissions exam and return to the University of Mississippi to finish her senior year. But a week and half before she was scheduled to take the MCAT, a bad car accident and spinal injury threatened to derail her carefully laid plans.

Jefferson, a native of Cumming, Ga., was driving home from Oxford one day in July when a pile of debris in the road caused her to lose control of her car. She does not remember the car flipping three times or at what point one of her vertebrae was fractured.

She regained consciousness when the car landed in a still position. The first thing she remembers is getting out of the car and someone had stopped to help her.

“Coincidentally, it was a nurse who stopped to help me and called the ambulance,” Jefferson said. “I got out of the car and she told me to just lay down on the grass.”

Summer Jefferson's vehicle after the car wreck that threatened to keep her from returning to Ole Miss for her senior year.
Jefferson’s vehicle was a tangle of glass and steel after the car wreck that threatened to keep her from returning to Ole Miss.

As soon as she lied down, Jefferson, who had dealt with scoliosis all her life, knew something was not right with her spine.

“If someone was trying to kill me, I could’ve gotten back up. But I knew something was wrong with my back,” she said.

Paramedics picked her up and put her in an ambulance, which drove her to a small emergency room in Hamilton, Ala., where she had the wreck. Jefferson told the doctor he needed to look at her spine as soon as he could, and after checking for head injuries, a basic X-ray revealed she was right.

She had fractured her L2 vertebra and needed to go to Tupelo 45 minutes away to get a back brace. Her friends from Ole Miss drove her there while her parents started the trip from Cumming.

“I was on pain medication for two weeks I think. Then basically I was like, ‘I have got to stop this, I need to start getting ready for school and transition off of this,’” she said. 

Luckily, Jefferson did not need surgery to repair the fracture – but the road to recovery was still a long, and often painful, one. She spoke to her neurosurgeon and asked what she needed to do to be able to return to school.

“I was in a back brace and by the time school started I was still in a lot of pain. I wasn’t immobile, but I am usually a very fast-paced kind of person and I was really kind of limping along,” she remembered. “She (my neurosurgeon) said ‘Honestly, I don’t know if you’re going to be able to go back.’”

But Jefferson was determined: she transitioned off the pain medication and eventually was taking only regular doses of Advil. She and her mother got to work figuring out how she would get help with regular activities since her mobility was extremely limited. She wouldn’t be able to drive until her spine healed, and simple activities like blow drying her hair and making breakfast would be impossible to do without assistance.    

With no family in the Oxford area, they began calling home health agencies to ask about caregiving services for her. Every company had the same response: no.

“It was really, really heartbreaking because I really had to go back to school,” she said.

Portrait of Dr. Neeli Kirkendall
Kirkendall

With five days left before the semester started, Jefferson spoke with a neighbor in Cumming whose daughter, a college student, has cerebral palsy and receives help from students in the nursing school at her college. Jefferson reached out to Dr. Neeli Kirkendall, an assistant professor in the UM School of Nursing’s Oxford branch.

Kirkendall remembers getting the phone call from a distraught Jefferson the week before classes began. After hearing her story, Kirkendall sent out an email to all the students in the Accelerated Bachelors of Science in Nursing program, a 12-month, three-semester program that allows people with a bachelor’s degree in another field to receive their BSN. Kirkendall, who directs the service learning activities for the program, immediately got several responses, and one student, Carson Luke of Oxford, created a Google Document to organize the schedule. 

Jefferson made it back to Oxford two days before classes began, a change from her usual arrival a week before the school year starts to take part in various activities for clubs and groups she belongs to.

Beginning on the first day of classes, a pair of nursing students went over to Jefferson’s house to help her make breakfast, put on her make-up and blow dry her hair. Their presence also fulfilled one major requirement of Jefferson’s neurosurgeon: that someone always be in the house when she showers in case of a fall. Once she was ready, they drove her to class.

In all, eight nursing students worked together over the next several months to help Jefferson in the mornings.

“There’s never, to my knowledge, been a day she needed care and wasn’t cared for,” said Kirkendall. “We had not even taught the students skills such as how to do Foleys or IVs, but they were already showing those intrinsic characteristics of care and compassion. Those are character traits you cannot teach.”

Luke, along with fellow students Kimball Beck, Sarah Brouchaert, Katherine Fowlkes, Emily Hennigan, Jessica McIntosh, Mary Brooks Thigpen and Marlee Watts, were all eager to help.

Watts, who is from Brookhaven, entered the Accelerated BSN program with the goal of becoming a pediatric nurse.

“I think when Dr. Kirkendall was telling us about Summer … I just kind of went back to my senior year, it’s such an exciting time and I was ready to do all these fun things. I put myself in her shoes, like (thinking) ‘How would this affect me?’” said Watts. “I would feel so helpless. Once I did that, there wasn’t even a hesitation. Carson Luke and I were like ‘Yea, we’ve got to do something.’”

Luke and Watts would go together in the mornings and developed a routine. Luke would make breakfast while Watts helped Jefferson get ready. The first day of school, Jefferson had pictures she needed to get ready for, so Watts curled her hair.

“The first few weeks in nursing school we were learning how to take care of people and still give them their dignity. It was really beneficial to actually experience that and have a way to actually do it,” Watts said.

The nursing students were also learning about therapeutic conversations at the time, and Watts said her interactions with Jefferson helped her to understand their value.

“We’d always talk to her and ask how her classes were going and what the hardest part was and what she struggled most with (in relation to her injury),” she said. “I don’t think she realized how much she helped us learn, especially in the first few months we were in school putting all the pieces together. It’s really easy to be stuck in the books and reading and really forget it’s not just about the test and the books, these are real people we’re taking care of.” 

The setup was a win-win: Jefferson said without the nursing students’ help, she would not have been able to come back to school. Between their help on weekday mornings and her parents alternating weekend visits, Jefferson managed her classes, was released from her neurosurgeon in mid-October and is currently weaning off the back brace. She is scheduled to take the MCAT over Christmas break.

“I’m very, very grateful,” Jefferson said. “The girls were so kind, so helpful, and compassionate. When you imagine someone (you would want) going into the field of health care – these girls are the epitome of it. If they had not been able to come and volunteer, I would not have been able to come back to school and finish my year.”

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Viewpoint: Sepsis Is the Hill to Die on

Wolters Kluwer Health

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Living in the Community With Dementia: Who Receives Paid Care?


OBJECTIVES

Paid caregivers (eg, home health aides and personal care attendants) provide hands‐on care that helps individuals with dementia live in the community. This study (a) characterizes paid caregiving among community‐dwelling individuals with dementia and (b) identifies factors associated with receipt of paid care.

DESIGN

Cross‐sectional analysis.

SETTING

The 2015 National Health and Aging Trends Study (NHATS), a nationally representative study of Medicare recipients aged 65 years and older.

PARTICIPANTS

Community‐dwelling individuals with dementia (n = 899).

MEASUREMENTS

Paid and family caregiving support was determined by participant or proxy report of help received with functional tasks. Multivariable logistic regression was used to examine factors associated with receipt of paid care. NHATS population sampling weights were used to produce national paid caregiving prevalence estimates.

RESULTS

Only 25.5% of community‐dwelling individuals with dementia received paid care, and 10.8% received 20 hours or more of paid care per week. For those who received it, paid care accounted for approximately half of the 83 total caregiving hours (paid and family) that they received each week. Among the subgroup of individuals with advanced dementia (those with impairment in dressing, bathing, toileting, and managing medications and finances), nearly half (48.3%) received paid care. Multivariable analysis, adjusting for sociodemographic, family caregiving support, functional, and clinical characteristics, found that the odds of receiving paid care were higher among men (odds ratio [OR] = 1.91; 95% confidence interval [CI] = 1.24‐2.95), the unmarried (OR = 2.20; 95% CI = 1.31‐3.70), those with Medicaid (OR = 2.16; 95% CI = 1.27‐3.66), and those requiring more help with activities of daily living (ADLs) (OR = 1.32; 95% CI = 1.18‐1.48) and instrumental ADLs (OR = 1.29; 95% CI = 1.14‐1.46).

CONCLUSIONS

New ways of making paid caregiving more accessible throughout the income spectrum are required to support family caregivers and respect the preferences of individuals with dementia to remain living in the community.

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During milestone year, UMMC’s DAISY Awards extend recognition scope

Published on Monday, November 4, 2019

By: Ruth Cummins, [email protected]

It was about a year ago that 4 Wiser nurse manager LeAnn Harcharik got the call from a frantic nurse on her floor: My dad’s been hurt, he’s coming to UMMC, and they say he might not make it.

The nurse wanted the chance to tell him goodbye, but she was almost two hours away, preparing to drive her elderly mother to Jackson. Harcharik long-distance wrapped her arms around her coworker and made it happen.

She walked to the injured man’s bedside and held her cell phone to his ear. His daughter was able to give him her love.

“It was hard for me to do that, but she trusted me with the most precious gift that I could give her,” said Harcharik, whose 19-year career has been spent at the University of Mississippi Medical Center.

On Friday, Harcharik became the first person to receive UMMC’s DAISY Nurse Leader Award, a highlight of the Medical Center’s celebration of its 10th year of awarding DAISY recognition to exemplary nurses and the national DAISY program’s 20th anniversary.

Until this year, only a handful of UMMC unit nurses or nursing teams each year received a DAISY, which stands for Diseases Attacking the Immune System. Going forward, one DAISY Nurse Leader Award will be presented annually so that nurses who make a difference in a leadership role can also be recognized, said Patrice Donald, magnet program manager in the Office of Nursing Quality and Development.

Nurses from throughout the Medical Center gathered for the 10th anniversary celebration of the DAISY Awards at UMMC.

Nurses from throughout the Medical Center gather for the 10th anniversary celebration of the DAISY Awards at UMMC.

“They exhibit trust, compassion, mutual respect and ethical behavior,” she said of the 15 nominees. “They promote and enhance the image of nursing in the workplace, the community and the profession.”

Established in 2000 by members of the family of former patient Patrick Barnes, the California-based DAISY Foundation presents the DAISY Award for Extraordinary Nurses to the unsung heroes of the profession. Winners are nominated by anyone in their organization, plus patients or patient family members.

About 1,700 health care facilities in all 50 states and in 11 other countries honor their nurses with the DAISY Award. The DAISY Committee at UMMC reviews nominations every two months and selects up to two winners each cycle who meet the criteria for going over and beyond the expectations of a nurse.

The DAISY Team Award is presented once annually, and several School of Nursing students and faculty members also receive the award each year. The DAISY Award program will spread to the ambulatory setting in the coming year.

The award’s flower symbol “reminds us that daisies grow all year around, just like our nurses work 24 hours, seven days a week, 365 days a year,” Heather Pierce, manager of registered nurse development and professional practice in Nursing Quality and Development, told those gathered for the celebration in the Student Union.

“There are many varieties of daisies, just like the 3,000 nurses we have here at UMMC,” she said.

Over the past decade, Medical Center nurses have received 11,734 DAISY Award nominations, some in that number more than once, said Terri Gillespie, chief nursing executive and clinical services officer for the UMMC Health System. Of the 121 nurses receiving the award, 66 still work at the Medical Center, she said.

Kevin Cook, CEO of the UMMC Health System, lists the many contributions of UMMC's 3,000-member nursing workforce.

Kevin Cook, CEO of the UMMC Health System, lists the many contributions of UMMC’s 3,000-member nursing workforce.

“You are the heart of the health system,” Kevin Cook, chief executive officer of the Health System, told the group. “You’re the ones holding the patient’s hand in the middle of the night, and calming the family members.

“Our patients want to know that they are not just cared for, but they’re cared about,” Cook said. “Thank you for what you do. It makes an enormous difference to the communities we serve, and in the lives of our patients.”

In addition to Harcharik, those nominated for the Nurse Leader Award were Joy Akanji, nurse manager in Student and Employee Health; Bill Brister, nurse manager on 2 South; Paige Dimacco, Children’s administrative house supervisor; Ann Downs, shift supervisor in the Newborn Center; Nancy Kaye Flanagin, nurse manager on the nursing resource team; Tricia Freeman, manager of clinical outcomes in transplant and ventricular assist device; Becky Harrison, nurse educator in the Newborn Center; and 

Lori Oxley, nurse manager on 4 Children’s; Alice Chaney Herndon, nurse manager on the Mother-Baby Unit; Anna Martha Holmes, nurse educator on 3 South; Sonja Huntley, nurse educator on the Mother-Baby Unit; Slay Jeffords, nurse manager in the Neonatal Intensive Care Unit; Briana Petty, nurse manager on 4 North; and Anita Vanderford, associate director of ambulatory operations in the Children’s Cancer Clinic.

Harcharik, the Medical Center’s nursing leaders say, is firm but fair, motivates her staff to have the good qualities she herself exemplifies, and encourages her fellow nurses with breakfast gatherings and by spotlighting them on video monitors during their birthday month.

It’s her nursing team that deserves the accolades, Harcharik says. “They make my job easy,” she said.

Watching her sister give birth to two children cemented her desire to be a nurse, an avocation she imagined for herself as a child playing with a toy doctor’s kit. Harcharik received her master of science in nursing at UMMC.

“I knew I wanted to take care of people,” Harcharik said. “People are so sick. They need someone to be their person when they don’t have anyone else.”

Nominees for the DAISY Nurse Leader Award are, front row, from left, Paige Dimacco, Kaye Flanagin, Bill Brister, LeAnn Harcharik, Joy Akanji, Briana Petty, Alice Chaney Herndon and Sonja Huntley; and back row, from left, Anita Vanderford, Martha Holmes, Patricia Freeman, Slay Jeffords, Becky Harrison, Ann Adams Downs and Lori Oxley.

Nominees for the DAISY Nurse Leader Award include, front row from left, Paige Dimacco, Kaye Flanagin, Bill Brister, Harcharik, Joy Akanji, Briana Petty, Alice Chaney Herndon and Sonja Huntley; and back row from left, Anita Vanderford, Martha Holmes, Patricia Freeman, Slay Jeffords, Becky Harrison, Ann Adams Downs and Lori Oxley.

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InFocus: The Best Three Treatments for Migraine

Wolters Kluwer Health

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Severity of Neuropsychiatric Symptoms and Distress in Dementia among Older People in Central Africa (EPIDEMCA Study)


OBJECTIVES

Neuropsychiatric symptoms are common in dementia. Limited data are available concerning their association with dementia in developing countries. Our aim was to describe the severity of neuropsychiatric symptoms among older people, evaluate the distress experienced by caregivers, and assess which neuropsychiatric symptoms were specifically associated with dementia among older adults in Central Africa.

DESIGN

This study is part of the EPIDEMCA program, a cross‐sectional multicenter population‐based study.

SETTING

The EPIDEMCA program was conducted from November 2011 to December 2012 in urban and rural areas of the Central African Republic and the Republic of the Congo.

PARTICIPANTS

Participants were older people (≥65 y) included in the EPIDEMCA program who underwent a neuropsychiatric evaluation. The sample included overall 532 participants, of whom 130 participants had dementia.

MEASUREMENTS

Neuropsychiatric symptoms were assessed with the brief version of the Neuropsychiatric Inventory including the evaluation of severity and associated distress. Diagnostic and Statistical Manual of Mental Disorders, 4th ed., Text Revision, criteria were followed to diagnose dementia. A logistic regression model was used to identify associated neuropsychiatric symptoms.

RESULTS

The prevalence of neuropsychiatric symptoms was 89.9% (95% confidence interval = 84.6‐95.1) among people living with dementia. The overall median severity score for neuropsychiatric symptoms was 9 [interquartile range [IQR] = 6‐12], and the overall median distress score was 7 [IQR = 4‐10]. Overall median scores of both severity and distress were significantly increased with the number of neuropsychiatric symptoms, the presence of dementia, and dementia severity. Depression, delusions, apathy, disinhibition, and aberrant motor behavior were associated with dementia after multivariate analysis.

CONCLUSION

This report is one of the few population‐based studies on neuropsychiatric symptoms among older people with dementia in Sub‐Saharan Africa and the first one evaluating the severity of those symptoms and distress experienced by caregivers. Individual neuropsychiatric symptoms were strongly associated with dementia in older people and require great attention considering their burden on populations.

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