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Pierse T, Keogh F, Challis D, O'Shea E. Resource allocation in dementia care: comparing the views of people with dementia, carers and health and social care professionals under constrained and unconstrained budget scenarios. Aging Ment Health 2022; 26:679-687. [PMID: 33663288 DOI: 10.1080/13607863.2021.1889969] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND People with dementia and their carers have a wide range of health and social care needs. People with dementia, carers and health and social care professionals (HSCPs) all have different perspectives on dementia care. Differences among these groups are important for commissioners of services and for front-line HSCPs. OBJECTIVE To compare the service recommendations of people with dementia and carers with those of HSCPs, under different budgetary conditions. METHODS A mixed-methods approach, which builds on the Balance of Care method, was used. Nine workshops were held with 41 participants from three groups: people with dementia, carers and HSCPs. Participants were asked to make decisions on a set of services for case types of dementia under two scenarios: a no budget constraint (NBC) scenario and a budget constraint (BC) scenario. RESULTS While each group allocated resources in broadly similar overall proportions, important differences in emphasis emerged: (i) people with dementia and carers placed more emphasis on psychosocial supports than HSCPs; (ii) carers put more emphasis on respite opportunities for carers; and (iii) carers identified residential care as the most suitable setting for the person with dementia more frequently than health care professionals. CONCLUSION Our findings suggest that the importance of psychosocial interventions, including counselling and peer support programmes, are currently underestimated by HSCPs. The provision of in-home respite is highly valued by carers. Even with unconstrained resources, some carers do not judge home care to be a viable option for dementia case types with high-level care needs.
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Affiliation(s)
- Tom Pierse
- Centre for Economic and Social Research on Dementia, National University of Ireland Galway, Galway, Ireland
| | - Fiona Keogh
- Centre for Economic and Social Research on Dementia, National University of Ireland Galway, Galway, Ireland
| | - David Challis
- Institute of Mental Health, University of Nottingham Innovation Park, Nottingham, UK
| | - Eamon O'Shea
- Centre for Economic and Social Research on Dementia, National University of Ireland Galway, Galway, Ireland
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Mansfield E, Cameron EC, Boyes AW, Carey ML, Nair B, Hall AE, Sanson-Fisher RW. Prevalence and type of unmet needs experienced by carers of people living with dementia. Aging Ment Health 2022; 27:904-910. [PMID: 35356837 DOI: 10.1080/13607863.2022.2053833] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVES Carers of people with dementia experience significant physical, emotional, and social burdens. Needs assessment can provide important information to assist services in providing support to carers to reduce these burdens. However, few studies have examined the prevalence of unmet needs experienced by carers of people with dementia using a quantitative instrument. This study aimed to examine the prevalence and type of unmet needs experienced by carers of people with dementia in Australia. METHODS This was a cross-sectional survey of carers providing support to community-dwelling individuals living with dementia. Carers were recruited through geriatric clinics, aged care providers, support services and community organisations. Consenting carers completed a survey including an 80-item study-specific unmet needs instrument for carers (UNI-C) and sociodemographic characteristics. Descriptive statistics were used to identify the most prevalent unmet needs reported by carers. RESULTS A total of 169 carers (response rate 47%) completed the survey. Most (87%) carers reported at least one unmet need. Carers reported a median of 16.0 (IQR = 24.0; max = 58) out of a possible 80 unmet needs. The most frequently endorsed unmet needs spanned a range of areas including emotional wellbeing, accessing health and aged care services, managing apathy, and finding information. CONCLUSION This study highlighted that a large proportion of carers experience unmet needs associated with caring for someone with dementia. Developing and rigorously testing interventions to meet carers' commonly reported unmet needs are warranted. UNLABELLED Supplemental data for this article is available online at https://doi.org/10.1080/13607863.2022.2053833 .
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Affiliation(s)
- Elise Mansfield
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Emilie C Cameron
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Allison W Boyes
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Mariko L Carey
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Balakrishnan Nair
- Hunter New England Local Health District, New Lambton Heights, John Hunter Hospital, NSW, Australia.,School of Medicine and Public Health (Medical Education and Professional Development), University of Newcastle, Callaghan, NSW, Australia
| | - Alix E Hall
- Hunter New England Local Health District, Hunter New England Population Health, Wallsend, NSW, Australia
| | - Rob W Sanson-Fisher
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
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Kew CL, Juengst SB, Kelley B, Osborne CL. Linking Problems Reported by Care Partners of Individuals With Alzheimer’s Disease and Lewy Body Dementia to the International Classification of Functioning Disability and Health. Gerontol Geriatr Med 2022; 8:23337214221086810. [PMID: 35368457 PMCID: PMC8973046 DOI: 10.1177/23337214221086810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/02/2022] [Accepted: 02/23/2022] [Indexed: 11/25/2022] Open
Abstract
Aim This study aims to classify, describe, and compare the problems reported by care partners of adults with Alzheimer’s disease (AD) and Lewy body dementia (LBD) using the International Classification of Functioning Disability and Health (ICF) Methods Problems that care partners experience were collected during a problem-solving training intervention. The meaningful concepts were then extracted and linked to the ICF using a standardized linking technique. Results 402 meaningful concepts were extracted from 128 problems reported by care partners. 79.4% of the concepts were linkable to the ICF. “Body functions” was most frequently addressed followed by “Activities and participation.” LBD care partners reported more problems (M = 23.6 ± 13.4) on average than AD care partners (M = 19.4 ± 12.1). LBD care partners reported greater relative proportions of problems in mental function (emotional and sleep functions) than AD care partners. Conclusion This study suggests that the experience of LBD care partners may include significantly more challenges and may be more emotionally demanding than the care experience of AD care partners. Interventions designed to support care partners of adults with dementia may need to be tailored to meet the needs of care partners based on the care receiver’s type of dementia.
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Affiliation(s)
- Chung Lin Kew
- Department of Physical Medicine & Rehabilitation, UT Southwestern Medical School, Dallas, TX, USA
- Department of Applied Clinical Research, UT Southwestern Medical School, Dallas, Dallas, TX, USA
- School of Public Health, Texas A&M University College Station, College Station, TX, USA
| | - Shannon B. Juengst
- Department of Physical Medicine & Rehabilitation, UT Southwestern Medical School, Dallas, TX, USA
- Department of Applied Clinical Research, UT Southwestern Medical School, Dallas, Dallas, TX, USA
- Brain Injury Research Center, TIRR Memorial Hermann, Houston, TX, USA
| | - Brendan Kelley
- Department of Neurology, UT Southwestern Medical School, Dallas, TX, USA
| | - Candice L. Osborne
- Department of Physical Medicine & Rehabilitation, UT Southwestern Medical School, Dallas, TX, USA
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Werner NE, Brown JC, Loganathar P, Holden RJ. Quality of Mobile Apps for Care Partners of People With Alzheimer Disease and Related Dementias: Mobile App Rating Scale Evaluation. JMIR Mhealth Uhealth 2022; 10:e33863. [PMID: 35348467 PMCID: PMC9006134 DOI: 10.2196/33863] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 01/16/2022] [Accepted: 02/16/2022] [Indexed: 02/06/2023] Open
Abstract
Background Over 11 million care partners in the United States who provide care to people living with Alzheimer disease and related dementias (ADRD) cite persistent and pervasive unmet needs related to their caregiving role. The proliferation of mobile apps for care partners has the potential to meet care partners’ needs, but the quality of apps is unknown. Objective This study aims to evaluate the quality of publicly available apps for care partners of people living with ADRD and identify design features of low- and high-quality apps to guide future research and user-centered app development. Methods We searched the US Apple App and Google Play stores with the criteria that included apps needed to be available in the US Google Play or Apple App stores, accessible to users out of the box, and primarily intended for use by an informal (family or friend) care partner of a person living with ADRD. We classified and tabulated app functionalities. The included apps were then evaluated using the Mobile App Rating Scale (MARS) using 23 items across 5 dimensions: engagement, functionality, aesthetics, information, and subjective quality. We computed descriptive statistics for each rating. To identify recommendations for future research and app development, we categorized rater comments on score-driving factors for each MARS rating item and what the app could have done to improve the item score. Results We evaluated 17 apps. We found that, on average, apps are of minimally acceptable quality. Functionalities supported by apps included education (12/17, 71%), interactive training (3/17, 18%), documentation (3/17, 18%), tracking symptoms (2/17, 12%), care partner community (3/17, 18%), interaction with clinical experts (1/17, 6%), care coordination (2/17, 12%), and activities for the person living with ADRD (2/17, 12%). Of the 17 apps, 8 (47%) had only 1 feature, 6 (35%) had 2 features, and 3 (18%) had 3 features. The MARS quality mean score across apps was 3.08 (SD 0.83) on the 5-point rating scale (1=inadequate to 5=excellent), with apps scoring highest on average on functionality (mean 3.37, SD 0.99) and aesthetics (mean 3.24, SD 0.92) and lowest on average on information (mean 2.95, SD 0.95) and engagement (mean 2.76, SD 0.89). The MARS subjective quality mean score across apps was 2.26 (SD 1.02). Conclusions We identified apps whose mean scores were more than 1 point below minimally acceptable quality, whereas some were more than 1 point above. Many apps had broken features and were rated as below acceptable for engagement and information. Minimally acceptable quality is likely to be insufficient to meet care partner needs. Future research should establish minimum quality standards across dimensions for care partner mobile apps. Design features of high-quality apps identified in this study can provide the foundation for benchmarking these standards.
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Affiliation(s)
- Nicole E Werner
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, United States
| | - Janetta C Brown
- Indiana University School of Medicine, Indianapolis, IN, United States
| | - Priya Loganathar
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, United States
| | - Richard J Holden
- Department of Health & Wellness Design, School of Public Health-Bloomington, Indiana University, Bloomington, IN, United States
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Abstract
Dementia is recognised as the biggest health crisis of our time in terms of high personal and social costs and wider impact on health and social care systems. Increases in people living with dementia and multimorbidities presents critical challenges for homecare worldwide. Healthcare systems struggle to provide adequate home-care services, delivering limited care restricted to a single-condition focus. This study explored the experiences and expectations of homecare from the multiple perspectives of people living with dementia and multimorbidities and homecare workers providing support. Findings draw from qualititative semi-structured interviews with people with dementia (n=2), their partners (n=2), other partners or family carers (n=6) and homecare workers (n=26). Three themes are idenfiifed: (a) the preference for and value of home; (b) inadequate homecare provision and enhanced care-burden; (c) limited training and education. Despite continued calls for homecare investment, the focus on reduction in costs hides key questions and further dialogue required exploring how people with dementia can be supported to live independendently and flourish at-home. This study considers these complex experiences and care requirements through the prism of disability and human rights frameworks. This paper concludes with consideration of more recent human social rights debate. We critically dicuss what this may mean for people living with dementia and consider the implications for corequisite policy development to optimise available homecare support.
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Borchard J, Bindoff A, Farrow M, Kim S, McInerney F, Doherty K. Family carers of people living with dementia and discussion board engagement in the Understanding Dementia Massive Open Online Course. Aging Ment Health 2022; 27:887-895. [PMID: 35195059 DOI: 10.1080/13607863.2022.2042188] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES This study compared discussion board involvement between family carers and non-carers in the Understanding Dementia Massive Open Online Course (UD-MOOC). METHODS A mixed methods observational cohort study of family carers and non-carers was undertaken over the February-April 2020 UD-MOOC. Discussion board engagement was measured as number of posts and replies and examined longitudinally using mixed models. Discussion topics were explored through structural topic models (STM). Subsequently, thematic analysis of STM derived-topic exemplars was conducted to contextualise these discussions. RESULTS Family carers were (n = 2320) found to post (p < 0.001) and reply (p = 0.029) significantly more often than non-carers (n = 2392). Of the 32-STM derived-topics, meaningful activities (mean Δ = 0.007, 95% CrI [0.005-0.100]), personal stories of diagnosis (mean Δ = 0.007, 95% CrI [0.005-0.009]), and family history of dementia (mean Δ = 0.006, 95% CrI [0.004-0.008]) were discussed significantly more frequently by family carers compared to non-carers. CONCLUSION These results may reflect underlying motivational differences and circumstantial relevance. Perhaps the greater engagement by family carers is related to a sense of having inadequate relevant offline social resources, where engagement in the UD-MOOC discussion boards may serve as means to share experiences with others.
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Affiliation(s)
- Jay Borchard
- Wicking Dementia Research & Education Centre, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Aidan Bindoff
- Wicking Dementia Research & Education Centre, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Maree Farrow
- Wicking Dementia Research & Education Centre, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Sarang Kim
- Wicking Dementia Research & Education Centre, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Fran McInerney
- Wicking Dementia Research & Education Centre, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Kathleen Doherty
- Wicking Dementia Research & Education Centre, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
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Competência do cuidar e seu impacto na qualidade de vida de cuidadores. ACTA PAUL ENFERM 2022. [DOI: 10.37689/acta-ape/2022ao02132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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58
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Yuan F, Anderson JG, Wyatt TH, Lopez RP, Crane M, Montgomery A, Zhao X. Assessing the Acceptability of a Humanoid Robot for Alzheimer’s Disease and Related Dementia Care Using an Online Survey. Int J Soc Robot 2022. [DOI: 10.1007/s12369-021-00862-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Lauritzen J, Sørensen EE, Pedersen PU, Bjerrum MB. Needs of carers participating in support groups and caring for a person with dementia: A focused ethnographic study. DEMENTIA 2022; 21:1219-1232. [DOI: 10.1177/14713012211072928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims The aim is to explore and understand how support group participation meets carers’ perceived needs for information and social and emotional support when caring for a person with dementia who lives at home. Design Focused ethnographic design. Methods Participant observations and semi-structured interviews with 25 carers were conducted. An inductive content analysis of the data was performed. Findings Two themes were identified: “Strengthening the sense of self” and “Managing uncertain benefits.” Conclusion Carers’ level of information about dementia was partly met, thereby strengthening their sense of self and joy. Maintaining shared decision-making in financial matters was viewed as an expression of respect and reciprocity. Getting acquainted with peers and dementia coordinators was viewed as emotional and social support but was also used strategically to gain easier access to health care services. By fulfilling their needs, support group meetings became meaningful, which motivated carers to continue providing care.
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Affiliation(s)
- Jette Lauritzen
- Department of Public Health, Health, Aarhus University, Aarhus, Denmark; and Department of Nursing, Aarhus, Faculty of Health Sciences, VIA University College, Aarhus, Denmark
| | - Erik E Sørensen
- Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark; and Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Preben U Pedersen
- Danish Center of Clinical Guidelines, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Merete B Bjerrum
- Department of Public Health, Health, Aarhus University, Aarhus, Denmark
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Mamom J, Daovisan H. Listening to Caregivers' Voices: The Informal Family Caregiver Burden of Caring for Chronically Ill Bedridden Elderly Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:567. [PMID: 35010827 PMCID: PMC8744801 DOI: 10.3390/ijerph19010567] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/22/2021] [Accepted: 12/30/2021] [Indexed: 02/01/2023]
Abstract
The informal family caregiver burden (IFCB) for chronically ill bedridden elderly patients (CIBEPs) is a major issue worldwide. It is a significant challenge due to the ongoing increased palliative care in the family setting; therefore, we explored the IFCB of caring for CIBEPs in Thailand. This article utilized a qualitative method, the total interpretive structural modeling (TISM) approach, with purposive sampling of thirty respondents between September and December 2020. The data were analyzed using cross-impact matrix multiplication applied to classification (MICMAC) to determine the relationship between the driving and dependence power of the enabling factors. The IFCB of the palliative care of CIBEPs was associated with primary care, nursing, extrinsic monitoring and complication prevention. The results showed that the IFCB involves taking responsibility, daily workload, follow-up caring, caring tasks, caregiving strain, financial distress, patient support, external support and caregiving strategy; thus, assistance with taking responsibility, extrinsic monitoring and follow-up care daily tasks may reduce the caregiver burden.
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Affiliation(s)
- Jinpitcha Mamom
- Department of Adult Nursing and the Aged, Faculty of Nursing, Thammasat University, Khlong Luang, Pathum Thani 12121, Thailand
- Excellence Center in Creative Engineering Design and Development, Faculty of Engineering, Thammasat University, Khlong Luang, Pathum Thani 12121, Thailand
| | - Hanvedes Daovisan
- Human Security and Equity Research Unit, Chulalongkorn University Social Research Institute, Chulalongkorn University, Bangkok 10330, Thailand;
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Mahomed A, Pretorius C. Up-Close and Personal: Conceptualizing the Self as Dementia Caregiver: a Study in Soweto, South Africa. J Cross Cult Gerontol 2022; 37:355-374. [PMID: 36308594 PMCID: PMC9617032 DOI: 10.1007/s10823-022-09460-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2022] [Indexed: 12/24/2022]
Abstract
The aim of this study was to understand how dementia caregivers in the township of Soweto, South Africa interpret their role in the context of caregiving through the personal constructs identified using the Self- Characterization technique. Thirty family caregivers were recruited via purposive sampling methods and completed a Self-Characterization Sketch during semi-structured interviews. Content analysis of construct pairs was thematically coded using the Classification System for Personal Constructs (CSPC) - a reliable method to analyse personal constructs that are generated by constructivist assessments. Findings revealed that caregivers' interpretations of themselves was characterized by moral, emotional and cognitive attributes. Specifically, a sense of mastery, self-efficacy, strength, selflessness and unconditional positive regard characterized the most meaningful constructs of care within caregiver narratives in response to their loved ones with dementia. These adaptive outcomes, despite the challenging, pervasive, complex nature of dementia and its manifestations, suggest psychological and emotional resilience, higher levels of adjustment and caregiver well-being. However, it is important to consider possible consequences such as physical fatigue and burnout despite adaptive outcomes. Therefore, it is recommended that approaches to psychoeducational initiatives, emotional and psychological interventions and awareness campaigns include teaching caregivers how to self-care encourage the importance of consistent exercise, rest, sleep, nutrition as well as reaching out for social support. Lastly, empowering caregivers to use their personal resources would prove valuable in support groups, and individual to facilitate self-awareness, sustained coping and mental health.
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Affiliation(s)
- Aqeela Mahomed
- Department of Psychology, Stellenbosch University, Krotoa Building, Victoria Street, Stellenbosch, 7130 South Africa
| | - Chrisma Pretorius
- Department of Psychology, Stellenbosch University, Krotoa Building, Victoria Street, Stellenbosch, 7130 South Africa ,Department of Psychology, Stellenbosch University, Wilcocks Building, Victoria Street, Stellenbosch, 7130 South Africa
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Smith KM, Scerpella D, Guo A, Hussain N, Colburn JL, Cotter VT, Aufill J, Dy SM, Wolff JL. Perceived Barriers and Facilitators of Implementing a Multicomponent Intervention to Improve Communication With Older Adults With and Without Dementia (SHARING Choices) in Primary Care: A Qualitative Study. J Prim Care Community Health 2022; 13:21501319221137251. [PMID: 36398937 PMCID: PMC9677296 DOI: 10.1177/21501319221137251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Implementing patient- and family-centered communication strategies has proven challenging in primary care, particularly for persons with dementia. To address this, we designed SHARING Choices, a multicomponent intervention combining patient and family partnered agenda setting, electronic portal access, and supports for advance care planning (ACP). This qualitative descriptive study describes factors affecting SHARING Choices implementation within primary care. METHODS Semi-structured interviews or focus groups with patient/family dyads (family, friends, unpaid caregivers) and primary care stakeholders (clinicians, staff, administrators) elicited perceived barriers and facilitators of SHARING Choices implementation. Field notes and interview transcripts were coded using template analysis along the Consolidated Framework for Implementation Research (CFIR) constructs. Content analysis identified themes not readily categorized within CFIR. RESULTS About 22 dyads, including 14 with cognitive impairment, and 30 stakeholders participated in the study. Participants were receptive to the SHARING Choices components. Enablers of SHARING Choices included adaptability of the intervention, purposive engagement of family (particularly for patients with dementia), consistency with organizational priorities, and the relative advantage of SHARING Choices compared to current practices. Perceived barriers to implementation included intervention complexity, space constraints, workflow, and ACP hesitancy. The ACP facilitator was perceived as supportive in addressing individual and organizational implementation barriers including patient health and technology literacy and clinician time for ACP discussions. CONCLUSIONS Patients, family, and primary care clinicians endorsed the objectives and individual components of SHARING Choices. Strategies to enhance adoption were to simplify materials, streamline processes, leverage existing workflows, and embed ACP facilitators within the primary care team.
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Affiliation(s)
- Kelly M Smith
- Michael Garron Hospital - Toronto East Health Network, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
| | - Danny Scerpella
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Amy Guo
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | | - Jennifer Aufill
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sydney M Dy
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jennifer L Wolff
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Dietzel N, Graessel E, Kürten L, Meuer S, Klaas-Ickler D, Hladik M, Chmelirsch C, Kolominsky-Rabas PL. The Dementia Assessment of Service Needs (DEMAND): Development and Validation of a Standardized Needs Assessment Instrument. J Alzheimers Dis 2022; 89:1051-1061. [PMID: 35964189 PMCID: PMC9535555 DOI: 10.3233/jad-220363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Dementia is one of the main triggers for care dependency among older adults who are predominantly cared for at home by relatives. To provide support in the care situation, health systems need valid information about the central needs of the affected people. OBJECTIVE The present study aimed to develop a research instrument to assess the most important needs of people with dementia and their family caregivers. METHODS The development of the 'Dementia Assessment of Service Needs (DEMAND)' took place within the project 'Digital Dementia Registry Bavaria (digiDEM Bayern)'. A focus group and an online survey with dementia experts were conducted to identify the most relevant support services and to develop the design of the instrument. The questionnaire was deployed in the digiDEM baseline data collection. Participants were asked to evaluate the comprehensibility of the questionnaire. Readability was assessed using the Flesch reading ease score. RESULTS Seventeen experts participated in the focus group and 59 people in the online survey. The final questionnaire included 13 support services. One hundred eighty-three participants (50 people with dementia and 133 family caregivers) completed the questionnaire at baseline. The mean comprehensibility score was 3.6 (SD = 2.3). The Flesch reading ease score result was 76. CONCLUSION A research instrument could be developed, enabling people with dementia and family caregivers to directly express their individual needs for specific support services. Results show that the DEMAND is easy to understand and short in execution. Therefore, supply gaps can be identified and transformed into a specific health care plan.
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Affiliation(s)
- Nikolas Dietzel
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Interdisciplinary Center for Health Technology Assessment (HTA) and Public Health (IZPH), Erlangen, Germany
| | - Elmar Graessel
- University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Center for Health Services Research in Medicine, Department of Psychiatryand Psychotherapy, Erlangen, Germany
| | - Lara Kürten
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Interdisciplinary Center for Health Technology Assessment (HTA) and Public Health (IZPH), Erlangen, Germany
| | - Sebastian Meuer
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Interdisciplinary Center for Health Technology Assessment (HTA) and Public Health (IZPH), Erlangen, Germany
| | - Dorothee Klaas-Ickler
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Interdisciplinary Center for Health Technology Assessment (HTA) and Public Health (IZPH), Erlangen, Germany
| | - Markus Hladik
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Interdisciplinary Center for Health Technology Assessment (HTA) and Public Health (IZPH), Erlangen, Germany
| | - Christina Chmelirsch
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Interdisciplinary Center for Health Technology Assessment (HTA) and Public Health (IZPH), Erlangen, Germany
| | - Peter L. Kolominsky-Rabas
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Interdisciplinary Center for Health Technology Assessment (HTA) and Public Health (IZPH), Erlangen, Germany
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Blix BH, Munkejord MC. Indigenous Sami Family Caregivers' Experiences With Accessing and Collaborating With Municipal Health and Care Services. Glob Qual Nurs Res 2022; 9:23333936221123333. [PMID: 36120534 PMCID: PMC9479542 DOI: 10.1177/23333936221123333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 08/16/2022] [Accepted: 08/16/2022] [Indexed: 11/17/2022] Open
Abstract
Previous research has indicated that Indigenous Sami families in Norway use public home-based care services less often than their non-Sami peers. Based on qualitative interviews with Sami family caregivers, we explore what they experience as barriers to accessing public care services for older adults living with dementia, and how they experience collaborating with care services providers. Through a reflexive thematic approach, we identified that rather than a cultural norm of "taking care of one's own," the underuse of public care services among Sami families were related to several intertwined circumstances. The Sami family caregivers reported barriers to accessing public care, such as lack of familiarity with the services and cultural and language concerns and the legacy of history, and drivers for continuing family care, such as blurred distribution of responsibility, lack of continuity of care, and culturally unsafe caring environments and marginalizing practices.
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Henderson C, Knapp M, Martyr A, Gamble LD, Nelis SM, Quinn C, Pentecost C, Collins R, Wu YT, Jones IR, Victor CR, Pickett JA, Jones RW, Matthews FE, Morris RG, Rusted J, Thom JM, Clare L. The Use and Costs of Paid and Unpaid Care for People with Dementia: Longitudinal Findings from the IDEAL Cohort. J Alzheimers Dis 2021; 86:135-153. [PMID: 35001888 DOI: 10.3233/jad-215117] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND The drivers of costs of care for people with dementia are not well understood and little is known on the costs of care for those with rarer dementias. OBJECTIVE To characterize use and costs of paid and unpaid care over time in a cohort of people with dementia living in Britain. To explore the relationship between cohort members' demographic and clinical characteristics and service costs. METHODS We calculated costs of health and social services, unpaid care, and out-of-pocket expenditure for people with mild-to-moderate dementia participating in three waves of the IDEAL cohort (2014- 2018). Latent growth curve modelling investigated associations between participants' baseline sociodemographic and diagnostic characteristics and mean weekly service costs. RESULTS Data were available on use of paid and unpaid care by 1,537 community-dwelling participants with dementia at Wave 1, 1,199 at Wave 2, and 910 at Wave 3. In models of paid service costs, being female was associated with lower baseline costs and living alone was associated with higher baseline costs. Dementia subtype and caregiver status were associated with variations in baseline costs and the rate of change in costs, which was additionally influenced by age. CONCLUSION Lewy body and Parkinson's disease dementias were associated with higher service costs at the outset, and Lewy body and frontotemporal dementias with more steeply increasing costs overall, than Alzheimer's disease. Planners of dementia services should consider the needs of people with these relatively rare dementia subtypes as they may require more resources than people with more prevalent subtypes.
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Affiliation(s)
- Catherine Henderson
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Martin Knapp
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Anthony Martyr
- REACH: The Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Laura D Gamble
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Sharon M Nelis
- REACH: The Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Catherine Quinn
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Claire Pentecost
- REACH: The Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Rachel Collins
- REACH: The Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Yu-Tzu Wu
- REACH: The Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, University of Exeter, Exeter, UK.,Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Ian R Jones
- Wales Institute for Social and Economic Research and Data, Cardiff University, Cardiff, UK
| | - Christina R Victor
- College of Health, Medicine and Life Sciences, Brunel University London, London, UK
| | | | - Roy W Jones
- The Research Institute for the Care of Older People (RICE), Bath, UK
| | - Fiona E Matthews
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Robin G Morris
- King's College London Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | | | - Jeanette M Thom
- School of Health Sciences, University of New South Wales, Kensington, Australia
| | - Linda Clare
- REACH: The Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, University of Exeter, Exeter, UK.,National Institute of Health Research (NIHR) Applied Research Collaboration South-West Peninsula (PenARC), Exeter, UK
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66
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Needs Detection for Carers of Family Members with Dementia. Healthcare (Basel) 2021; 10:healthcare10010045. [PMID: 35052209 PMCID: PMC8775551 DOI: 10.3390/healthcare10010045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/20/2021] [Accepted: 12/24/2021] [Indexed: 11/29/2022] Open
Abstract
Aim: To determine the perceived needs of carers of non-institutionalized family members that suffer from dementia. Methods: Two-steps qualitative study by focus groups of relatives in three centres of different characteristics from the Girona Health Region (step 1) and two in-depth interviews with significant professionals in dementia care (step 2). The analysis was performed based on the interpretation of the transcribed data and the bottom-up coding of categories and themes. The information was triangulated and coding was agreed upon. Results: There were three groups, 26 main carers of community-dwelling relatives with dementia in step 1 and two in-depth interviews with dementia-specialised healthcare and social care professionals in step 2. The demands were categorised according to three main themes: whether they were addressed to the members of care services for more direct and close care, to the agencies for a better joint working and less fragmented system, or to society for better comprehension and social recognition. We emphasize the need for a consultation-liaison reference figure throughout the process both for aspects of greater efficiency in the management of resources and for greater empowerment of carers.
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Moermans VR, Mengelers AM, Bleijlevens MH, Verbeek H, de Casterle BD, Milisen K, Capezuti E, Hamers JP. Caregiver decision-making concerning involuntary treatment in dementia care at home. Nurs Ethics 2021; 29:330-343. [PMID: 34872409 PMCID: PMC8958636 DOI: 10.1177/09697330211041742] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Dementia care at home often involves decisions in which the caregiver must weigh safety concerns with respect for autonomy. These dilemmas can lead to situations where caregivers provide care against the will of persons living with dementia, referred to as involuntary treatment. To prevent this, insight is needed into how family caregivers of persons living with dementia deal with care situations that can lead to involuntary treatment. OBJECTIVE To identify and describe family caregivers' experiences regarding care decisions for situations that can lead to involuntary treatment use in persons living with dementia at home. RESEARCH DESIGN A qualitative descriptive interview design. Data were analysed using the Qualitative Analysis Guide of Leuven. PARTICIPANTS AND RESEARCH CONTEXT A total of 10 family caregivers providing care for 13 persons living with dementia participated in in-depth semi-structured interviews. Participants were recruited by registered nurses via purposive sampling. ETHICAL CONSIDERATION The study protocol was approved by the Ethics Committee of the University Hospitals Leuven and the Medical Ethical Test Committee Zuyderland. FINDINGS Family caregivers experience the decision-making process concerning care dilemmas that can lead to involuntary treatment as complicated, stressful and exhausting. Although they consider safety and autonomy as important values, they struggle with finding the right balance between them. Due to the progressive and unpredictable nature of dementia, they are constantly seeking solutions while they adapt to new situations. Family caregivers feel responsible and experience social pressure for the safety of persons living with dementia. They may be blamed if something adverse happens to the persons living with dementia, which increases an already stressful situation. Their experience is influenced by characteristics of the care triad (persons living with dementia, professional and family caregivers) such as practical and emotional support, knowledge, and previous experiences. DISCUSSION AND CONCLUSION To prevent involuntary treatment, professionals need to proactively inform family caregivers, and they need to support each other in dealing with complex care situations.
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Affiliation(s)
- Vincent Ra Moermans
- Maastricht University, The Netherlands; White Yellow Cross Limburg, Belgium; Living Lab in Ageing and Long-Term Care, the Netherlands
| | | | | | - Hilde Verbeek
- Maastricht University, The Netherlands; Living Lab in Ageing and Long-Term Care, The Netherlands
| | | | - Koen Milisen
- KU Leuven, Belgium; University Hospitals Leuven, Belgium
| | | | - Jan Ph Hamers
- Maastricht University, The Netherlands; Living Lab in Ageing and Long-Term Care, The Netherlands
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Jung S, Song JA, Kim J, Cheon H, Kim J. Family caregiver competence in managing behavioral and psychological symptoms of dementia: A concept synthesis. Jpn J Nurs Sci 2021; 19:e12462. [PMID: 34787364 DOI: 10.1111/jjns.12462] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 09/24/2021] [Accepted: 10/07/2021] [Indexed: 11/28/2022]
Abstract
AIM This study aimed to identify the attributes of "family caregiver competence in managing behavioral psychological symptoms of dementia". METHODS Six electronic databases were searched for studies published between January 1990 and June 2017 with the key words "dementia", "behavioral psychological symptoms of dementia", "caregiver", "coping (managing)", and "competence". From the final fully reviewed 26 articles, descriptions related to family caregiver's dealing with behavioral psychological symptoms of dementia were extracted first. Then, based on Walker and Avant's concept synthesis, the concept of "family caregiver competence in managing behavioral psychological symptoms of dementia" was explored. RESULTS Four attributes, namely "Judging", "Empathizing", "Adjusting", and "Reflecting", comprised of ten categories were identified as constituting the concept of family caregiver competence in managing the behavioral psychological symptoms of dementia. As a meta competence, "reflecting" may play a significant role in improving family caregiver competence by interacting with the other dimensions of competence in managing symptoms. CONCLUSIONS Based on the suggested conceptual model, education or training programs could be developed to improve family caregiver competence in managing behavioral psychological symptoms of dementia. To refine the attributes found in this study, field studies including observations of and interviews with family caregivers need to be conducted. Studies exploring the associations between these attributes are also of value.
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Affiliation(s)
- Sua Jung
- College of Nursing, Korea University, Seoul, Korea
| | - Jun-Ah Song
- College of Nursing, BK21 FOUR R&E Center for Learning Health Systems, Korea University, Seoul, Korea
| | - Jiyeon Kim
- College of Nursing, Korea University, Seoul, Korea
| | | | - Jiyeon Kim
- College of Nursing, Korea University, Seoul, Korea
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Sriram V, Jenkinson C, Peters M. Impact of COVID-19 restrictions on carers of persons with dementia in the UK: a qualitative study. Age Ageing 2021; 50:1876-1885. [PMID: 34224555 PMCID: PMC8384409 DOI: 10.1093/ageing/afab156] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Indexed: 11/18/2022] Open
Abstract
Background informal carers provide the majority of the support for persons with dementia living at
home. Restrictions imposed due to COVID-19 have had a profound impact on the daily life
of the entire population. This study provides insight into the impact of these
restrictions on carers of people with dementia living at home. Design qualitative semi-structured interviews. Participants purposive sample of carers who provide at least 10 hours of care a week for the person
with dementia living at home. Setting UK. Results twenty-three carers were interviewed, and thematic analysis identified three main
themes—Changes to daily life, impact on carer health and wellbeing and reduced support
from health and social support networks. The results highlight the impact of
restrictions imposed on daily life and routines due to the pandemic, wellbeing of
carers, reduced social support, lack of access to health and care professionals and
respite for carers. The restrictions have had negative consequences on carers’
wellbeing, and they have experienced difficulties in accessing formal care services and
respite care. Conclusion carers attempt to continue to provide physical, emotional and practical support for
persons with dementia in the community throughout the COVID-19 restrictions. To prevent
a future carer crisis, carers need better support systems including formal carer
services, telecare solutions that work for them and additional support for respite, as
the restrictions from this pandemic continue.
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Affiliation(s)
- Vimal Sriram
- Address correspondence to: Vimal Sriram, Health Services Research Unit,
Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old
Road Campus, Oxford OX3 7LF, UK. Tel: 00441865 743762.
| | - Crispin Jenkinson
- Health Services Research Unit, Nuffield Department of
Population Health, University of Oxford, Richard Doll
Building, Old Road Campus, Oxford OX3 7LF, UK
| | - Michele Peters
- Health Services Research Unit, Nuffield Department of
Population Health, University of Oxford, Richard Doll
Building, Old Road Campus, Oxford OX3 7LF, UK
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Huang J, Pacheco Barzallo D, Rubinelli S, Münzel N, Brach M, Gemperli A. Professional home care and the objective care burden for family caregivers of persons with spinal cord injury: Cross sectional survey. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2021. [DOI: 10.1016/j.ijnsa.2020.100014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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71
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Stefánsdóttir OÁ, Munkejord MC, Sveinbjarnardóttir EK. Maintaining or letting go of couplehood: Perspectives of older male spousal dementia caregivers. Scand J Caring Sci 2021; 36:742-751. [PMID: 34569074 DOI: 10.1111/scs.13035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 09/01/2021] [Accepted: 09/12/2021] [Indexed: 11/30/2022]
Abstract
Despite the negative implications for their own health, spouses continue to support each other and maintain their couplehood for as long as possible, including when one of them develops a severe illness. However, with some exceptions, the experiences of older male spousal caregivers have been largely overlooked, and our knowledge of the relational aspects of spousal dementia care is scarce. To respond to this knowledge gap, this article explores the following research questions: How do older male spousal caregivers of wives with dementia talk about changes in their couplehood? What transitions or phases in the relationship can be identified as the caring process evolves and the wife's health continues to deteriorate? To answer these questions, we analyse in-depth interviews with eight purposefully selected men aged 67-92 years old from Iceland and Norway. Our findings reveal that the participants felt that they were gradually losing their couplehood in the sense that they lost their shared everyday life routines, intimacy, joint activities, meaningful communication, and dreams and hopes for the future. Four phases of the dementia caring process were identified: the denial phase, the battle phase, the new reality phase and the redefinition phase. We hope that our findings spur more research on relational challenges as experienced by spouses caring for partners with cognitive decline. In conclusion, we argue that interdisciplinary clinical guidelines for a couple-centred approach in elder care should be developed to urge professional care providers to pay attention to the various changes and challenges that dementia couples undergo to meet not only the health and care needs of dementia patients but also those of their spouses.
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Affiliation(s)
| | - Mai Camilla Munkejord
- Dept of Business Administration, Western Norway University of Applied Sciences, Bergen, Norway.,NORCE, Bergen, Norway.,Centre for Care Research West, Western Norway of Applied Sciences, Bergen, Norway
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Klawunn R, Meyer A, Schmeer R, Sebastião M, Behrends M, Kupka T, Wolff D, Dierks ML. [What support does a mobile, assistive app provide for informal caregivers? A qualitative analysis of the MoCaB app user experience]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2021; 165:83-91. [PMID: 34474992 DOI: 10.1016/j.zefq.2021.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 06/24/2021] [Accepted: 06/28/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND In the joint project "Mobile Care Backup" funded by the German Federal Ministry of Education and Research, the smartphone-based app "MoCaB" was developed in close cooperation with informal caregivers. It provides individualized, algorithm-based information and can accompany and support caring relatives in everyday life. After a multi-step development, informal caregivers tested the MoCaB app in a home setting at the end of the research project. The goal was to find out how the test persons evaluate MoCaB and in which form the app can provide support to informal caregivers. METHODS Eighteen test persons caring for relatives participated in a four-week test of MoCaB. Guideline-based qualitative interviews to record usage behavior and experiences with the app were conducted after two and four weeks of testing, transcribed and analyzed using qualitative content analysis. RESULTS The test persons described the care-related information as helpful. The individualized, algorithm-based mode of information delivery and the exercises provided for family caregivers were generally rated as helpful, but their use depends on the individual usage style. Three dimensions can describe the effects of MoCaB: 1) expansion of care-relevant knowledge, 2) stimulation of self-reflection, and 3) behavior towards the care recipients. DISCUSSION With few exceptions, the testing caregivers felt that the MoCaB app was enriching. The support dimensions have an effect at different points in everyday life and vary in intensity, depending on the duration of the existing care activity and the individual preferences of the users. CONCLUSION The way in which caregivers used the app was not always consistent with the expected behaviors. This demonstrates the relevance of open-ended, qualitative research methods in the evaluation of health apps.
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Affiliation(s)
- Ronny Klawunn
- Institut für Epidemiologie, Sozialmedizin und Gesundheitssystemforschung, Medizinische Hochschule Hannover, Hannover, Deutschland.
| | - Antje Meyer
- Institut für Epidemiologie, Sozialmedizin und Gesundheitssystemforschung, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Regina Schmeer
- Stabsstelle Pflegewissenschaft, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Maria Sebastião
- Allgemeinmedizinisches Institut, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - Marianne Behrends
- Peter L. Reichertz Institut für Medizinische Informatik, TU Braunschweig und Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Thomas Kupka
- Peter L. Reichertz Institut für Medizinische Informatik, TU Braunschweig und Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Dominik Wolff
- Peter L. Reichertz Institut für Medizinische Informatik, TU Braunschweig und Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Marie-Luise Dierks
- Institut für Epidemiologie, Sozialmedizin und Gesundheitssystemforschung, Medizinische Hochschule Hannover, Hannover, Deutschland
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Armstrong MJ, Alliance S, Corsentino P, Lunde A, Taylor A. Informal caregiver experiences at the end-of-life of individuals living with dementia with Lewy bodies: An interview study. DEMENTIA 2021; 21:287-303. [PMID: 34340591 DOI: 10.1177/14713012211038428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Individuals with dementia with Lewy bodies (DLB) commonly die from dementia-related causes, but little is known regarding caregiver experiences during the end-of-life period in DLB. This reflects a critical knowledge gap given the high frequency of informal caregiving for individuals with dementia, high caregiver burden in DLB, and the fact that most individuals with DLB die from this disease. Investigators conducted telephone interviews with family members of individuals who died with DLB in the last 5 years. Investigators used a qualitative descriptive approach to analyze interview transcripts. Participants included 15 children, 13 spouses, and 2 other family members. Interviews averaged 31 min. Major themes included caregivers as the main drivers of care for individuals with DLB throughout the disease course and at the end of life, the impact of DLB features (e.g., fluctuations, hallucinations, and delusions) on end-of-life experiences, experiences relating to the caregiving role, death and post-death experiences, and supports employed by caregivers in the end-of-life period. End-of-life experiences for caregivers of individuals with DLB built on the accumulated burden of the disease course, where caregivers were often responsible for driving DLB care-from making the diagnosis to educating healthcare professionals and double-checking medical decisions. While some end-of-life experiences were consistent with those described in dementia palliative care more generally (e.g., financial stresses, poor sleep, being overwhelmed, and needing increased education and support), many DLB features specifically affected end-of-life caregiver experiences, such as the presence of delusions. Improving caregiver experiences at the end of life in DLB will require improved diagnosis and care for individuals with DLB throughout the disease course and also better strategies for treating behavioral symptoms. More research is needed regarding drivers of quality end-of-life experiences for individuals with DLB and their families and how drivers and strategies may differ between dementias.
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Affiliation(s)
- Melissa J Armstrong
- Department of Neurology, 12233University of Florida College of Medicine, Gainesville, FL, USA.,McKnight Brain Institute, University of Florida, Gainesville, FL, USA
| | - Slande Alliance
- Department of Neurology, 12233University of Florida College of Medicine, Gainesville, FL, USA
| | | | - Angela Lunde
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
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Stressors and coping mechanisms of family care-givers of older relatives living with long-term conditions in mainland China: a scoping review of the evidence. AGEING & SOCIETY 2021. [DOI: 10.1017/s0144686x21000817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
As the ageing population in China continues to grow, more people will be living with long-term health conditions and require support from family care-givers. This scoping review therefore aims to explore sources of stress and coping mechanisms adopted by care-givers of older relatives living with long-term conditions in mainland China. Literature searches were conducted in English (CINAHL, EMBASE, MEDLINE, PsycINFO and SCOPUS) and Chinese (CNKI, WANFANG DATA, CQVIP and CBM) databases between October and November 2019. The searches focused on the stressors and coping mechanisms utilised by family care-givers residing in the community. Narrative synthesis was used to identify themes within the data. Forty-six papers were included: 20 papers from English and 26 from Chinese databases. Six themes captured stressors: care-giving time (N = 22), financial resources (N = 17), role and personal strains (N = 42), preparedness (N = 4), social roles (N = 10) and lack of adequate formal support (N = 22); and one theme captured coping (N = 14). Unmet needs of care-givers of older relatives in mainland China were found to be extensive. Only a few studies had attempted to explore the causal link between stressors, coping and the influence of culture. Findings underscore the significance of adequately capturing intricacies around care-givers’ unmet needs, rather than generalising on the basis of culture. Qualitative studies are critical to providing a better understanding of the relationship between stressors, coping and resources afforded to care-givers by their cultural environment. Having such understanding is crucial to inform the development of competent care, which promotes self-efficacy and self-actualisation in care-givers in mainland China.
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Suwa S, Yumoto A, Ueno M, Yamabe T, Hoshishiba Y, Sato M. Practitioners' identification of informal caregivers' difficulties with activities of daily living interventions for older people with dementia in Japan. Psychogeriatrics 2021; 21:466-477. [PMID: 33847046 DOI: 10.1111/psyg.12689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 03/07/2021] [Accepted: 03/09/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Older people with dementia who cannot perform daily activities independently due to cognitive impairment need support at home and in the community. This study identified aspects of activities of daily living (ADL) interventions that advanced dementia care practitioners recognise as challenging for informal caregivers to perform. METHODS We conducted a self-administered cross-sectional survey on advanced dementia care practitioners, including certified nurses, specialising in gerontological, community health, home care, and visiting nursing, nurses specialising in dementia certified by the Japanese Nursing Association, and dementia care leaders certified by prefectural governors. The participants rated a caregivers' extent of difficulty in aspects of ADL interventions on a four-point Likert scale. Factor analysis was performed to determine ADL intervention aspects that are recognised by advanced dementia care practitioners as challenging for informal caregivers. RESULTS The highest loaded factors for mild, moderate, and severe cognitive impairment stages were 'right time to draw attention,' 'opportunities to perform ADL,' and 'communicating how to perform ADL without giving up,' respectively. Therefore, it is imperative to educate informal caregivers about the effects of cognitive impairment on ADL performance in people with dementia and enable them to provide concrete ADL interventions and tips to support the persons' autonomy and independence. The Cronbach's alpha values of the highest loaded factors for mild, moderate, and severe cognitive impairment stages were 0.851, 0.925, and 0.946, respectively. Moreover, the cumulative contribution ratios of each stage were 46.04%, 50.52%, and 47.36%, respectively. CONCLUSION This study dealt with identifying informal caregivers' difficulties with ADL interventions across the stages of dementia. Informal caregivers should be supported on aspects of ADL interventions that are potentially difficult for them to perform. Useful educational content and approaches in training programs for informal caregivers should be developed to enable them to help people with Alzheimer's disease maintain ADL performance toward 'ageing in place' even as the disease progresses.
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Affiliation(s)
- Sayuri Suwa
- Graduate School of Nursing, Chiba University, Chiba, Japan
| | - Akiyo Yumoto
- Graduate School of Nursing, Chiba University, Chiba, Japan
| | - Mari Ueno
- School of Nursing, Jichi Medical University, Tochigi, Japan
| | - Tomoko Yamabe
- Department of Business, Japan Visiting Nursing Foundation, Tokyo, Japan
| | - Yumiko Hoshishiba
- Department of Social Policy, Mitsubishi UFJ Research and Consulting Co., Ltd., Tokyo, Japan
| | - Mihoko Sato
- Department of Management, Japan Visiting Nursing Foundation, Tokyo, Japan
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Gudnadottir M, Ceci C, Kirkevold M, Björnsdóttir K. Community-based dementia care re-defined: Lessons from Iceland. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:1091-1099. [PMID: 32885543 DOI: 10.1111/hsc.13143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 06/26/2020] [Accepted: 07/27/2020] [Indexed: 06/11/2023]
Abstract
Studies of families caring for persons with dementia living at home often reflect feelings of being forgotten and abandoned by the authorities to shoulder the responsibility for care-giving. This has increased interest in how formal services can better support these families. This article analyses how health and social care professionals envision the needs of families of persons with dementia living in the community. It also describes the contributions of the formal care system to these families. The study design was qualitative. It involved interviews with professionals (N = 20), field observations from the settings where they worked, and public documents addressing care-giving for people with dementia. Data were analysed using the framework method. The findings reflected how those providing services to persons experiencing cognitive changes mainly understood the services as specialised. They focused on the diagnosis and treatment of the individual with dementia. They considered other aspects of care, such as attending to practical issues of daily life, to be a private matter, for which the family was responsible. In later stages of dementia, specialised day programs become available, offering rehabilitation to motivate positive daily living-for both the person experiencing dementia and family-centred supporters. Professionals in the field described primary care, community-based healthcare and home care services as poorly equipped to support these families. Participants acknowledged that families were often under a lot of stress and might need more support earlier in the illness. However, they saw themselves as powerless. Towards the end of the data collection, services were being re-designed to emphasise the role of primary care. In light of its holistic and family-centred approach, primary care may be well placed to integrate relational understanding of living with dementia and specialised knowledge of dementia treatment.
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Affiliation(s)
| | - Christine Ceci
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Marit Kirkevold
- Institute of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
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Badia M, Orgaz MB, Vicario-Molina I, González-Ortega E, Gómez-Vela M, Aza A, Martín-Delgado MA. Transcultural adaptation and psychometric properties of Family Quality of Life Survey for caregivers of people with neurodegenerative disease: a study of Spanish families who live in the rural Spain-Portugal cross-border. Health Qual Life Outcomes 2021; 19:172. [PMID: 34193154 PMCID: PMC8242286 DOI: 10.1186/s12955-021-01809-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 06/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Neurodegenerative diseases (NDs) are one of the main causes of disability and dependence that have a great impact both on the quality of life of people with disabilities and their families. A majority of people with NDs receive care and support from the family, but there is no tool in Spain with which to measure whole-family QOL. The aim of this study was the translation, cultural adaptation, and validation of the FQOLS-Dementia into Spanish to assess FQOL among family members of individuals with NDs who live in the Spain-Portugal cross-border area. METHOD The Spanish version was translated and adapted following the international guidelines for cross-cultural adaptation tests. A sample of 300 family caregivers was interviewed, applying an adapted version of the Family Quality Survey (FQOLS-Dementia). Confirmatory factor analysis was performed to validate the factor structure, and convergent validity was examined with Pearson's correlation coefficients of the global FQOL with the domains. Internal consistency reliability was determined using Cronbach's alpha. RESULTS The domain structure of the FQOLS-ND showed a good fit. In the convergent validity, it was found that the total score and the subscale domain scores were associated with the global FQOL score, except for the Values domain. Internal consistency of nine domain subscales was strong (α = 0.80 to 0.91), and excellent for the total FQOL (α = 0.85) and the global FQOL (α = 0.87). CONCLUSION The FQOLS-ND presented good validity and reliability in caregiver families with individuals with ND, so its application shows its usefulness in detecting areas of improvement and intervention strategies for FQOL in the Spain-Portugal cross-border area.
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Affiliation(s)
- Marta Badia
- Institute on Community Integration (INICO), Faculty of Psychology, University of Salamanca, Avda. de la Merced, 109-131, 37005 Salamanca, Spain
| | - M. Begoña Orgaz
- Institute on Community Integration (INICO), Faculty of Psychology, University of Salamanca, Avda. de la Merced, 109-131, 37005 Salamanca, Spain
| | - Isabel Vicario-Molina
- Teacher Training College of Zamora, University of Salamanca, Avda. Príncipe de Asturias s/n, 49029 Zamora, Spain
| | - Eva González-Ortega
- Teacher Training College of Zamora, University of Salamanca, Avda. Príncipe de Asturias s/n, 49029 Zamora, Spain
| | - María Gómez-Vela
- Institute on Community Integration (INICO), Faculty of Psychology, University of Salamanca, Avda. de la Merced, 109-131, 37005 Salamanca, Spain
| | - Alba Aza
- Institute on Community Integration (INICO), Faculty of Psychology, University of Salamanca, Avda. de la Merced, 109-131, 37005 Salamanca, Spain
| | - M. Antonia Martín-Delgado
- Regional Health Management (RHM) of Castille and Leon (Spain), Paseo de Zorrilla, 1, 47007 Valladolid, Spain
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78
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Ashrafizadeh H, Gheibizadeh M, Rassouli M, Hajibabaee F, Rostami S. Explain the Experience of Family Caregivers Regarding Care of Alzheimer's Patients: A Qualitative Study. Front Psychol 2021; 12:699959. [PMID: 34248803 PMCID: PMC8264438 DOI: 10.3389/fpsyg.2021.699959] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 05/27/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Due to the long-term and progressive nature of Alzheimer's disease, these patients need caregivers who will be responsible for their long-term care and who may then experience an increasing burden related to the progressive disease course, so it is important to understand the experiences of caregivers. The aim of this study was to explain the experience of family caregivers regarding care of Alzheimer's patients. Methods: The present qualitative study employed a conventional content analysis approach and was conducted in Iran in 2020. This research was done through in-depth and semi-structured interviews with 11 qualified caregivers enrolled in a purposive sampling method. Interviews continued until data saturation. Data analysis was performed simultaneously with data collection. Interviews were recorded, transcribed and analyzed through Graneheim and Lundman style content analysis and data management was done with MAXQDA software. In order to achieve the accuracy and validity of the study, the Four-Dimensions Criteria (FDC) by Lincoln and Guba, credibility, dependability, confirmability, and transformability were considered and used. Results: A total of 11 caregivers with mean age and standard deviation 48, ±26.12 participated in the study. The acquired data were put in two main categories of "burnout and exhaustion" with six subcategories and "excellence and personal growth" with three subcategories. Conclusion: In this study, we found that perceptions of caregivers' role were not the same among study participants, who experienced both positive and negative dimensions of care provision to AD patients. The care experience has a spectrum that, in some people, leads to positive outcomes such as growth. A major part of caregiver challenges is related to the burden of caregiving strain and the erosive nature of the disease. Therefore, health planners should identify the challenges, pain and suffering of caregivers and seek to address them through appropriate strategies.
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Affiliation(s)
- Hadis Ashrafizadeh
- Nursing and Midwifery School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mahin Gheibizadeh
- Nursing Care Research Center in Chronic Diseases, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Maryam Rassouli
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Hajibabaee
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahnaz Rostami
- Nursing Care Research Center in Chronic Diseases, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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79
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Klein OA, Boekholt M, Afrin D, Dornquast C, Dreier-Wolfgramm A, Keller A, Michalowsky B, Zwingmann I, Teipel S, Thyrian JR, Kilimann I, Hoffmann W. Effectiveness of a digitally supported care management programme to reduce unmet needs of family caregivers of people with dementia: study protocol for a cluster randomised controlled trial (GAIN). Trials 2021; 22:401. [PMID: 34134744 PMCID: PMC8206900 DOI: 10.1186/s13063-021-05290-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 04/23/2021] [Indexed: 11/28/2022] Open
Abstract
Background Up to two-thirds of dementia care is provided by family caregivers who often experience high burden, little support and adverse health outcomes. Enabling and supporting family caregivers to provide care at home prevents early institutionalisation of the person with dementia and alleviates the economic burden of dementia in the long term. General practitioners (GPs), as the first point of contact, have a key role in identifying and managing burden and care needs of family caregivers. However, in routine care, this opportunity is often limited by time constraints and even if caregiver needs are recognised, detailed information about regionally available support and advice on healthcare services is often lacking. Methods This is a cluster randomised, controlled trial investigating the clinical use and cost-effectiveness of a digitally supported care management programme for caregivers of people with dementia (PwD). Five hundred family caregivers will be randomised at GP offices, specialist practices and memory clinics, with about n=250 participants per arm. Participants are eligible if they are the primary family caregiver of a PwD, are at least 18 years of age and provide informed consent. Participants in the intervention group will receive an individualised care management plan, which will be carried out by qualified study nurses in collaboration with the treating GP. All participants will receive a baseline assessment and a 6-months follow-up assessment. Participants in the wait-list control group will receive usual care. Starting at the 6 months’ follow-up, the former controls will also receive an individualised management plan. Primary outcomes are the number of unmet needs (incl. the Camberwell Assessment of Need for the Elderly, CANE) and health-related quality of life (EQ-5D-5L) at 6 months. Secondary outcomes include caregiver burden (Zarit Burden Interview, ZBI), social support (Lubben Social Network Scale, LSNS), the use of medical and non-medical services (Questionnaire for the Use of Medical and Non-Medical Services, FIMA) and resource utilisation (Resource Utilisation in Dementia, RUD). The primary analysis will be based on intention-to-treat. Between- and within-group analyses and a cost-effectiveness analysis will be conducted to estimate the effect of the tablet PC-based care management programme. This trial is funded by the German Federal Joint Committee (G-BA) Innovation Fund. Discussion The findings of this trial will be useful in informing and improving current healthcare system structures and processes to support family dementia caregivers within routine care practices. Trial registration ClinicalTrials.gov NCT04037501. Registered on 30 July 2019. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05290-w.
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Affiliation(s)
- Olga A Klein
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Rostock, Germany.
| | - Melanie Boekholt
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany
| | - Dilshad Afrin
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany
| | - Christina Dornquast
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany
| | - Adina Dreier-Wolfgramm
- Hamburg University of Applied Sciences (HAW), Faculty of Business and Social Sciences, Department of Nursing and Management, Hamburg, Germany
| | - Armin Keller
- Institute of Medical Psychology and Medical Sociology, Medical Faculty, University of Rostock, Rostock, Germany
| | - Bernhard Michalowsky
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany
| | - Ina Zwingmann
- European University of Applied Sciences (EU FH), Rostock, Germany
| | - Stefan Teipel
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Rostock, Germany.,Department for Psychosomatic and Psychotherapeutical Medicine, University Hospital Rostock, Rostock, Germany
| | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany.,Institute for Community Medicine, Section Epidemiology and Community Health, University Medicine Greifswald, Greifswald, Germany
| | - Ingo Kilimann
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Rostock, Germany.,Department for Psychosomatic and Psychotherapeutical Medicine, University Hospital Rostock, Rostock, Germany
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany.,Institute for Community Medicine, Section Epidemiology and Community Health, University Medicine Greifswald, Greifswald, Germany
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80
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Sadavoy J, Sajedinejad S, Chiu M. A quasi-experimental study of the effectiveness of the Reitman Centre CARERS group intervention on family caregivers of persons with dementia. Int J Geriatr Psychiatry 2021; 36:811-821. [PMID: 33271636 DOI: 10.1002/gps.5481] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 11/29/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES This study aims to determine the effectiveness of the Reitman Centre CARERS program on key outcomes in family caregivers (CGs) of people with dementia (PWD). The Reitman Centre CARERS program is an innovative, group psychotherapeutic skills-training intervention based on integrated problem solving techniques (PST), simulation learning and group psychotherapy designed to address each CGs' unique situation. METHOD Family CGs of PWD (n = 264) that were referred to Reitman Center and the partner sites were evaluated before and after completion of the 8-week CARERS program in comparison with a wait-list control group (n = 83) who received regular care in a quasi-experimental, non-randomized, multiple group, multisite trial. General linear model was used to compare the results after adjusting for baseline measures and changes in the care recipients' daily activities (Katz Index of Independence in Activities of Daily Living). RESULTS The results indicated the effectiveness and superiority of the CARERS program over usual care on measures of CG's perceived stress, depression, burden, competence, role overload, emotion and avoidance-focused coping. CONCLUSION The CARERS program as a multi-component intervention is an effective intervention that significantly improves functioning, coping skills and well-being of dementia CGs.
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Affiliation(s)
- Joel Sadavoy
- Department of Psychiatry, Reitman Centre and Enhancing Care Program, Sinai Health, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, The Cyril & Dorothy, Joel & Jill Reitman Centre for Alzheimer's Support and Training, Sinai Health, Toronto, Ontario, Canada
| | - Sima Sajedinejad
- Department of Psychiatry, The Cyril & Dorothy, Joel & Jill Reitman Centre for Alzheimer's Support and Training, Sinai Health, Toronto, Ontario, Canada
| | - Mary Chiu
- Department of Psychiatry, The Cyril & Dorothy, Joel & Jill Reitman Centre for Alzheimer's Support and Training, Sinai Health, Toronto, Ontario, Canada
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81
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Vos EE, de Bruin SR, van der Beek AJ, Proper KI. " It's Like Juggling, Constantly Trying to Keep All Balls in the Air": A Qualitative Study of the Support Needs of Working Caregivers Taking Care of Older Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5701. [PMID: 34073386 PMCID: PMC8198548 DOI: 10.3390/ijerph18115701] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/18/2021] [Accepted: 05/24/2021] [Indexed: 12/30/2022]
Abstract
Many informal caregivers of older adults combine their caregiving tasks with a paid job. Adequate support is important to enable them to combine paid work with caregiving, while maintaining their health and wellbeing. To date, however, knowledge about working caregivers' support needs is fragmented. This study, therefore, aimed to obtain more insight into the support needs of working caregivers of older adults. We conducted six online semi-structured focus group interviews with in total 25 working caregivers of older adults living at home. Data were complemented with information from seven working caregivers participating in the study's advisory board. Data were analyzed using inductive and deductive thematic analysis. Six themes related to working caregivers' needs were identified: (1) Recognition of caregivers, including the challenges they face; (2) Attention for caregivers' health, wellbeing and ability to cope; (3) Opportunities to share care responsibilities; (4) Help with finding and arranging care and support; (5) Understanding and support from the work environment; (6) Technological support tailored to the needs and capacities of caregivers and older adults. To address these needs, working caregivers suggested several options in multiple domains of life (i.e., work, home and social life, care environment, personal health and wellbeing). To successfully support them, a multi-faceted effort, involving actors from multiple settings, is needed.
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Affiliation(s)
- Eline E. Vos
- Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Antonie van Leeuwenhoeklaan 9, 3721 MA Bilthoven, The Netherlands;
| | - Simone R. de Bruin
- Research Group Living Well with Dementia, Department of Health and Wellbeing, Windesheim University of Applied Sciences, Campus 2, P.O. Box 10090, 8000 GB Zwolle, The Netherlands;
| | - Allard J. van der Beek
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 BT Amsterdam, The Netherlands;
| | - Karin I. Proper
- Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Antonie van Leeuwenhoeklaan 9, 3721 MA Bilthoven, The Netherlands;
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 BT Amsterdam, The Netherlands;
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82
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Rico-Blázquez M, García-Sanz P, Martín-Martín M, López-Rodríguez JA, Morey-Montalvo M, Sanz-Cuesta T, Rivera-Álvarez A, Araujo-Calvo M, Frías-Redondo S, Escortell-Mayor E, Cura-González ID. Effectiveness of a home-based nursing support and cognitive restructuring intervention on the quality of life of family caregivers in primary care: A pragmatic cluster-randomized controlled trial. Int J Nurs Stud 2021; 120:103955. [PMID: 34051585 DOI: 10.1016/j.ijnurstu.2021.103955] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 04/15/2021] [Accepted: 04/17/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Caregivers of patients with chronic conditions or disability experience fatigue, burden and poor health-related quality of life. There is evidence of the effectiveness of support interventions for decreasing this impact. However, little is known about the benefits of home-based nursing intervention in primary health care. OBJECTIVES To evaluate the effectiveness of a home-based, nurse-led-intervention (CuidaCare) on the quality of life of caregivers of individuals with disabilities or chronic conditions living in the community, measured at 12-month follow-up. METHODS A pragmatic, two-arm, cluster-randomized controlled trial with a 1-year follow-up period was performed between June 2013 and December 2015. Consecutive caregivers aged 65 years or older, all of whom assumed the primary responsibility of caring for people with disabling conditions for at least 6 months a year, were recruited from 22 primary health care centers. Subsequently, 11 centers were randomly assigned to usual care group, and 11 were assigned to the intervention group. The caregivers in the intervention group received the usual care and additional support (cognitive restructuring, health education and emotional support). The primary outcome was quality of life, assessed with the EQ-5D instrument (visual analog scale and utility index score); the secondary outcome variables were perception of burden, anxiety, and depression. Data were collected at baseline, at the end of the intervention, and at the 6- and 12-month follow-up visits. We analyzed the primary outcome as intention-to-treat, and missing data were added using the conditional mean single imputation method. RESULTS A total of 224 caregivers were included in the study (102 in the intervention group and 122 in the usual care group). Generalized Estimating Equation models showed that the CuidaCare intervention was associated with a 5.46 point (95% CI: 2.57; 8.35) change in the quality of life, as measured with the visual analog scale adjusted for the rest of the variables at 12 months. It also produced an increase of 0.04 point (95% CI: 0.01; 0.07) in the utilities. No statistically significant differences were found between the two groups at 12 months with respect to the secondary outcomes. CONCLUSIONS The findings suggest that incorporating a home-based, nurse-led-intervention for caregivers into primary care can improve the health-related quality of life of caregivers of patients with chronic or disabling conditions.
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Affiliation(s)
- Milagros Rico-Blázquez
- Research Unit. Gerencia Asistencial Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain; Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Spain; PhD student. Doctoral Program in Epidemiology and Public Health (Interuniversity), Universidad Rey Juan Carlos, Madrid, Spain; Nursing Department. Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Madrid, Spain.
| | - Petra García-Sanz
- Juncal Healthcare Centre, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
| | - María Martín-Martín
- Juncal Healthcare Centre, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
| | - Juan A López-Rodríguez
- Research Unit. Gerencia Asistencial Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain; Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Spain; Fundación para la Investigación e Innovación Biosanitaria de Atención Primaria de la Comunidad de Madrid (FIIBAP), Madrid, Spain; General Ricardos Healthcare Centre, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain; Preventive Medicine and Public Health Area, Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Mariel Morey-Montalvo
- Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Spain; Fundación para la Investigación e Innovación Biosanitaria de Atención Primaria de la Comunidad de Madrid (FIIBAP), Madrid, Spain
| | - Teresa Sanz-Cuesta
- Research Unit. Gerencia Asistencial Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain; Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Araceli Rivera-Álvarez
- Abrantes Healthcare Centre, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
| | - Mercedes Araujo-Calvo
- Manuel Merino Healthcare Centre, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
| | - Soledad Frías-Redondo
- Unidad de Atención al Usuario, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
| | - Esperanza Escortell-Mayor
- Research Unit. Gerencia Asistencial Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain; Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Spain; PhD student. Doctoral Program in Epidemiology and Public Health (Interuniversity), Universidad Rey Juan Carlos, Madrid, Spain; Nursing Department. Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Madrid, Spain; Juncal Healthcare Centre, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain; Fundación para la Investigación e Innovación Biosanitaria de Atención Primaria de la Comunidad de Madrid (FIIBAP), Madrid, Spain; General Ricardos Healthcare Centre, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain; Preventive Medicine and Public Health Area, Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain; Abrantes Healthcare Centre, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain; Manuel Merino Healthcare Centre, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain; Unidad de Atención al Usuario, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
| | - Isabel Del Cura-González
- Research Unit. Gerencia Asistencial Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain; Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Spain; Preventive Medicine and Public Health Area, Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
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Contextual Therapy for Couples who are Primary Caregivers for a Parent(s) with Alzheimer’s Disease. CONTEMPORARY FAMILY THERAPY 2021. [DOI: 10.1007/s10591-021-09576-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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84
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Désormeaux-Moreau M, Michel CM, Vallières M, Racine M, Poulin-Paquet M, Lacasse D, Gionet P, Genereux M, Lachiheb W, Provencher V. Mobile Apps to Support Family Caregivers of People With Alzheimer Disease and Related Dementias in Managing Disruptive Behaviors: Qualitative Study With Users Embedded in a Scoping Review. JMIR Aging 2021; 4:e21808. [PMID: 33861207 PMCID: PMC8087965 DOI: 10.2196/21808] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 01/30/2021] [Accepted: 02/14/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND People with Alzheimer disease and related dementias often display disruptive behaviors (eg, aggression, wandering, and restlessness), which increase family caregivers' burden of care. However, there are few tools currently available to help these caregivers manage disruptive behaviors. Mobile apps could meet this need, but to date little is known about them. OBJECTIVE The aims of our study were to identify existing mobile apps designed to support family caregivers of people with Alzheimer disease and related dementias in managing disruptive behaviors; explore whether family caregivers view these mobile apps as relevant to meeting their needs and as useful in managing disruptive behaviors; and document the types of mobile apps that are of interest and appeal to most family caregivers (with regard to format, ergonomics, and clarity). METHODS A review of mobile apps initially conducted in February 2018 was updated in March 2019 with 2 platforms (App Store [Apple Inc.] and Google Play [Google]). The selected apps were first analyzed independently by 3 raters (2 students and 1 researcher) for each of the platforms. A focus group discussion was then held with 4 family caregivers to explore their perceptions of the apps according to their needs and interests. The content of the discussion was analyzed. RESULTS Initially, 7 of 118 apps identified met the inclusion criteria. An eighth app, recommended by one of the knowledge users, was added later. Four family caregivers (women aged between 58 and 78 years) participated in the discussion. Participants expressed a preference for easy-to-understand apps that provide concrete intervention strategies. They reported being most inclined to use two apps, Dementia Advisor and DTA Behaviours. CONCLUSIONS Few mobile apps on the market meet the needs of family caregivers in terms of content and usability. Our results could help to address this gap by identifying what family caregivers deem relevant in a mobile app to help them manage disruptive behaviors.
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Affiliation(s)
- Marjorie Désormeaux-Moreau
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
- Institut universitaire de première ligne en santé et services sociaux, Centre intégré universitaire de santé et de services sociaux de l'Estrie, Centre hospitalier universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Charlie-Maude Michel
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Mélanie Vallières
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Maryse Racine
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Myriame Poulin-Paquet
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Delphine Lacasse
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Pascale Gionet
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Melissa Genereux
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
- Public Health Directory, Centre intégré universitaire de santé et de services sociaux de l'Estrie, Centre hospitalier universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Wael Lachiheb
- Research Center on Aging, Centre intégré universitaire de santé et de services sociaux de l'Estrie, Centre hospitalier universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Véronique Provencher
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
- Research Center on Aging, Centre intégré universitaire de santé et de services sociaux de l'Estrie, Centre hospitalier universitaire de Sherbrooke, Sherbrooke, QC, Canada
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85
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Horton MC, Oyebode J, Clare L, Megson M, Shearsmith L, Brayne C, Kind P, Hoare Z, Al Janabi H, Hewison V, Tennant A, Wright P. Measuring Quality of Life in Carers of People With Dementia: Development and Psychometric Evaluation of Scales measuring the Impact of DEmentia on CARers (SIDECAR). THE GERONTOLOGIST 2021; 61:e1-e11. [PMID: 31688902 PMCID: PMC8023371 DOI: 10.1093/geront/gnz136] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVES A 2008 European consensus on research outcome measures in dementia care concluded that measurement of carer quality of life (QoL) was limited. Three systematic reviews (2012, 2017, and 2018) of dementia carer outcome measures found existing instruments wanting. In 2017, recommendations were published for developing reliable measurement tools of carers' needs for research and clinical application. The aim of this study was to develop a new instrument to measure the QoL of dementia carers (family/friends). METHODS Items were generated directly from carers following an inductive needs-led approach. Carers (n = 566) from 22 English and Welsh locations then completed the items and comparator measures at three time points. Rasch, factor, and psychometric (reliability, validity, responsiveness, and minimally important differences [MIDs]) analyses were undertaken. RESULTS Following factor analysis, the pool of 70 items was refined to three independent scales: primary SIDECAR-D (direct impact of caring upon carer QOL, 18 items), secondary SIDECAR-I (indirect impact, 10 items), and SIDECAR-S (support and information, 11 items). All three scales satisfy Rasch model assumptions. SIDECAR-D, I, S psychometrics: reliability (internal ≥ .70; test-retest ≥ .85); convergent validity (as hypothesized); responsiveness (effect sizes: D: moderate; I and S: small); MIDs (D = 9/100, I = 10/100, S = 11/100). DISCUSSION AND IMPLICATIONS SIDECAR scales demonstrate robust measurement properties, meeting COSMIN quality standards for study design and psychometrics. SIDECAR provides a theoretically based needs-led QoL profile specifically for dementia carers. SIDECAR is free for use in public health, social care, and voluntary sector services, and not-for-profit organizations.
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Affiliation(s)
- Mike C Horton
- Psychometric Laboratory for Health Sciences, University of Leeds, UK
| | - Jan Oyebode
- Centre for Applied Dementia Studies, University of Bradford, UK
| | - Linda Clare
- Centre for Research in Ageing and Cognitive Health, University of Exeter, UK
| | - Molly Megson
- Leeds Institute of Medical Research at St James’s, University of Leeds, UK
| | - Leanne Shearsmith
- Leeds Institute of Medical Research at St James’s, University of Leeds, UK
| | - Carol Brayne
- Cambridge Institute of Public Health, University of Cambridge, UK
| | - Paul Kind
- Leeds Institute of Health Sciences, University of Leeds, UK
| | - Zoe Hoare
- School of Health Sciences, Bangor University, UK
| | - Hareth Al Janabi
- Institute of Applied Health Research, University of Birmingham, UK
| | | | - Alan Tennant
- Psychometric Laboratory for Health Sciences, University of Leeds, UK
| | - Penny Wright
- Centre for Research in Ageing and Cognitive Health, University of Exeter, UK
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86
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Palumbo MV, Rambur B, McKenna LP. Living at Home with Dementia Now More Complicated with COVID-19. HEALTH & SOCIAL WORK 2021; 45:289-292. [PMID: 33313804 PMCID: PMC7799082 DOI: 10.1093/hsw/hlaa029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 06/15/2020] [Accepted: 07/06/2020] [Indexed: 06/12/2023]
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87
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Abstract
OBJECTIVES Caring for a person with dementia is associated with poor mental, physical, and social health, which makes it important to consider how carers are best supported in their caring role to preserve both their and the person with dementia's well-being. At present, a robust instrument to assess carers' support needs does not exist. This study aimed to develop a self-reported questionnaire to assess the support needs of carers of people with dementia. The objectives were to: (1) generate items, (2) pilot test, and (3) field-test the questionnaire. DESIGN Development and field-testing of a new questionnaire. SETTINGS Primary and secondary health and social care of informal carers and people with dementia in nine municipalities and one dementia clinic in a hospital in Denmark. PARTICIPANTS Eight experts, 12 carers, and 7 digital users participated in pilot testing. 301 carers participated in field-testing. MEASUREMENTS Items for inclusion were generated based on interviews and literature review. An iterative process of data collection was applied to establish face and content validity of the Dementia Carer Assessment of Support Needs Tool (DeCANT) using Content Validity Index among experts and cognitive interviews with carers. Field-testing of DeCANT among carers included using the 12-item Short Form Health Survey, the Barthel-20 Index, and the Neuropsychiatric Inventory. RESULTS Initially, an item pool of 63 items was generated, and pilot testing reduced this to 42 items. Subsequent field-testing resulted in a 25-item version of DeCANT, and confirmatory factor analysis of three hypothesized models demonstrated a marginally better fit to a four-factor model with fit indices of: χ2 = 775.170 (p < 0.001), root mean square error of approximation = 0.073, Comparative Fit Index = 0.946, the Tucker-Lewis Index = 0.938, and weighted root mean residual (WRMR) = 1.265. CONCLUSIONS DeCANT is a 25-item carer-reported questionnaire that can be used to help identify their support needs when caring for a person with dementia to enable supportive interventions and improve carers' health and well-being.
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88
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Werner P, Tur-Sinai A, AboJabel H. Examining Dementia Family Caregivers' Forgone Care for General Practitioners and Medical Specialists during a COVID-19 Lockdown. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3688. [PMID: 33916152 PMCID: PMC8036927 DOI: 10.3390/ijerph18073688] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 12/16/2022]
Abstract
The present study aimed to assess dementia caregivers' reports of the prevalence and correlates of forgone care regarding visits to a general practitioner (GP) and to a specialist during the COVID-19 lockdown in Israel, using Andersen's Behavioral Model of Healthcare Utilization. A cross-sectional study using an online survey was conducted with 73 Israeli family caregivers of persons with dementia residing in the community (81% Jews, 86% female, mean age = 54). Overall, one out of two participants reported having to delay seeking needed help from a GP or a specialist for themselves, as well as for their relatives with dementia, during the COVID-19 lockdown period. Among the predisposing factor, education was associated with caregivers' reports regarding forgone care for themselves as well as for their loved ones. Living with the care-receiver and income level were the enabling factors associated with forgone care for caregivers. Finally, feelings of burden were associated with caregivers' forgone care and feelings of loneliness and perceptions of the care-receiver's cognitive functioning were associated with care-receivers' forgone care. Our findings show that it is essential that this population receive appropriate practical and emotional support at times of distress and crisis to enable them to continue with their caregiving role.
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Affiliation(s)
- Perla Werner
- Department of Community Mental Health, University of Haifa, Mt. Carmel, Haifa 3498838, Israel;
| | - Aviad Tur-Sinai
- Department of Health Systems Management, The Max Stern Yezreel Valley College, Yezreel Valley 1930600, Israel;
- School of Nursing, University of Rochester Medical Center, Rochester, NY 14627-0446, USA
| | - Hanan AboJabel
- Department of Community Mental Health, University of Haifa, Mt. Carmel, Haifa 3498838, Israel;
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89
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Assessing caregiver needs. Int Psychogeriatr 2021; 33:331-334. [PMID: 33970062 DOI: 10.1017/s1041610220003877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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90
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Clark IN, Baker FA, Tamplin J, Lee YEC, Cotton A, Stretton-Smith PA. "Doing Things Together Is What It's About": An Interpretative Phenomenological Analysis of the Experience of Group Therapeutic Songwriting From the Perspectives of People With Dementia and Their Family Caregivers. Front Psychol 2021; 12:598979. [PMID: 33868077 PMCID: PMC8044441 DOI: 10.3389/fpsyg.2021.598979] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 03/10/2021] [Indexed: 12/13/2022] Open
Abstract
Background The wellbeing of people living with dementia and their family caregivers may be impacted by stigma, changing roles, and limited access to meaningful opportunities as a dyad. Group therapeutic songwriting (TSW) and qualitative interviews have been utilized in music therapy research to promote the voices of people with dementia and family caregivers participating in separate songwriting groups but not together as dyads. Procedures This study aimed to explore how ten people with dementia/family caregiver dyads experienced a 6-week group TSW program. Dyads participated in homogenous TSW groups involving 2-4 dyads who were either living together in the community (2 spousal groups) or living separately because the person with dementia resided in a care home (1 family group, 1 spousal group). The TSW program, informed by personhood, couplehood, family centered and group process frameworks, involved creating original lyrics through song parody and song collage. Qualified Music Therapists facilitated sessions and interviewed each dyad separately. Interviews were analyzed using interpretative phenomenological analysis. Findings Five recurrent group themes were developed, indicating group TSW: (1) was a positive shared experience, benefiting both members of the dyad and motivating further engagement with music; (2) stimulated mental processes and reignited participants' interests and skills; (3) provided meaningful opportunities for reflection and connection with memories and life experiences; and (4) prompted interaction and collaboration, leading to social connections, empathic relationships and experiences of inclusion. Participants also highlighted how: (5) the facilitated process supported engagement, highlighting abilities and challenging doubts. Conclusion Dyads identified group TSW as an opportunity to recognize strengths, voice ideas and opinions, share meaningful experiences, and do "more with music." Participants valued TSW as a new, creative and stimulating experience that enabled connection with self and others and led to feelings of pride and achievement. Our findings further recognize how therapeutic intention and approach were reflected in participants' engagement and responses regardless of dementia stage and type, dyad relationship, or musical background. This research may broaden perspectives and expand understanding about how people with dementia and their family caregivers access and engage in music therapy.
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Affiliation(s)
- Imogen N Clark
- Melbourne Conservatorium of Music, Faculty of Fine Arts and Music, The University of Melbourne, Melbourne, VIC, Australia
| | - Felicity A Baker
- Melbourne Conservatorium of Music, Faculty of Fine Arts and Music, The University of Melbourne, Melbourne, VIC, Australia.,Centre for Research in Music and Health, Norwegian Academy of Music, Oslo, Norway
| | - Jeanette Tamplin
- Melbourne Conservatorium of Music, Faculty of Fine Arts and Music, The University of Melbourne, Melbourne, VIC, Australia.,Austin Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Young-Eun C Lee
- Melbourne Conservatorium of Music, Faculty of Fine Arts and Music, The University of Melbourne, Melbourne, VIC, Australia.,Austin Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Alice Cotton
- Melbourne Conservatorium of Music, Faculty of Fine Arts and Music, The University of Melbourne, Melbourne, VIC, Australia
| | - Phoebe A Stretton-Smith
- Melbourne Conservatorium of Music, Faculty of Fine Arts and Music, The University of Melbourne, Melbourne, VIC, Australia
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91
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Elsner SA, Salek SS, Finlay AY, Hagemeier A, Bottomley CJ, Katalinic A, Waldmann A. Validation of the German version of the Family Reported Outcome Measure (FROM-16) to assess the impact of disease on the partner or family member. Health Qual Life Outcomes 2021; 19:106. [PMID: 33761949 PMCID: PMC7992821 DOI: 10.1186/s12955-021-01738-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 03/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Family Reported Outcome Measure (FROM-16) assesses the impact of a patient's chronic illness on the quality of life (QoL) of the patient's partner or family members. The aim of the study was to translate, explore the structure of and validate the FROM-16. METHODS The questionnaire was translated from English into German (forward, backward, four independent translators). Six interviews with family members were conducted to confirm the questionnaire for linguistic, conceptual, semantic and experiential equivalence and its practicability. The final German translation was tested for internal consistency, reproducibility and test validity. Criterion validity was tested by correlating the scores of the FROM-16 and the Global Health Scale (GHS). Principal component analysis, factor analysis, and confirmatory factor analysis was used to assess the questionnaire's structure and its domains. Reliability and reproducibility were tested computing the intraclass correlation coefficient (ICC) using one sample t-test for testing the hypothesis that the difference between the scores was not different from zero. RESULTS Overall, 83 family members (61% female, median age: 61 years) completed the questionnaire at two different times (mean interval: 22 days). Internal consistency was good for the FROM-16 scores (Cronbach's α for total score = 0.86). In those with stable GHS, the ICC for the total score was 0.87 and the difference was not different from zero (p = 0.262) indicating reproducible results. A bi-factor model with a general factor including all items, and two sub-factors comprising the items from the original 2-factor construct had the best fit. CONCLUSIONS The German FROM-16 has good reliability, test validity and practicability. It can be considered as an appropriate and generic tool to measure QoL of a patient's partner or family member. Due to the presence of several cross-loadings we do not recommend the reporting of the scores of the two domains proposed for the original version of FROM-16 when using the German version. Thus, in reporting the results emphasis should be put on the total score. TRIAL REGISTRATION Retrospectively registered: DRKS00021070.
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Affiliation(s)
- Susanne A Elsner
- Institute for Social Medicine and Epidemiology, University of Luebeck, Ratzeburger Allee 160, 23562, Luebeck, Germany.
| | - Sam S Salek
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, AL10 9AB, UK.,Outcomes Research, Institute for Medicines Development, Cardiff, CF23 6NP, UK
| | - Andrew Y Finlay
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, CF14 4XN, UK
| | - Anna Hagemeier
- Institute for Social Medicine and Epidemiology, University of Luebeck, Ratzeburger Allee 160, 23562, Luebeck, Germany
| | | | - Alexander Katalinic
- Institute for Social Medicine and Epidemiology, University of Luebeck, Ratzeburger Allee 160, 23562, Luebeck, Germany.,Cancer Registry Schleswig-Holstein, University of Luebeck, Luebeck, Germany
| | - Annika Waldmann
- Institute for Social Medicine and Epidemiology, University of Luebeck, Ratzeburger Allee 160, 23562, Luebeck, Germany
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92
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Dietzel N, Kürten L, Karrer L, Reichold M, Köhler L, Nagel A, Chmelirsch C, Seebahn K, Hladik M, Meuer S, Kirchner A, Holm K, Selau M, Wendel M, Trinkwalter J, Prokosch HU, Graessel E, Kolominsky-Rabas PL. Digital Dementia Registry Bavaria-digiDEM Bayern: study protocol for a multicentre, prospective, longitudinal register study. BMJ Open 2021; 11:e043473. [PMID: 33558357 PMCID: PMC7871684 DOI: 10.1136/bmjopen-2020-043473] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Dementia is one of the most relevant widespread diseases, with a prevalence of currently 50 million people with dementia worldwide. The care of people with dementia will be one of the major challenges for healthcare systems worldwide. Digitalisation offers new possibilities to improve both dementia healthcare and health outcomes research as a fundament for national healthcare planning. The 'Digital Dementia Registry Bavaria-digiDEM Bayern' aims to improve the understanding of the complexity and long-term progression of dementia and the current care situation in Bavaria. Moreover, by offering digital services, digiDEM will actively contribute to improving the care situation in Bavaria. METHODS AND ANALYSIS: digiDEM will recruit people with dementia and their family caregivers in all administrative regions of Bavaria. All participants will undergo dementia screening prior to study inclusion in order to identify people with mild cognitive impairment and mild-to-moderate dementia. Participants will be followed up over a period of three years. Sociodemographic data, type of dementia, symptoms, diagnosis, cognitive trajectories, activities of daily living, behavioural and psychological symptoms, falls, resource utilisation, caregiver burden, quality of life, needs of people with dementia and their caregivers, mobility, use of media and sources of information will be assessed. The project will implement a digital web-based platform for data collection. Data will be collected by means of standardised online or face-to-face interviews. ETHICS AND DISSEMINATION The study obtained ethical approval from the Ethics Committee of the Medical Faculty of Friedrich-Alexander-University Erlangen-Nürnberg (FAU) (application number: 253_20 B). Findings will be used for evidence-based decision-making for health decision-makers in order to optimise dementia healthcare in the state of Bavaria. Specific analyses will be conducted for the participating research partners. Results of the study will be published in peer-reviewed journals.
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Affiliation(s)
- Nikolas Dietzel
- Interdisciplinary Center for Health Technology Assessment and Public Health (IZPH), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Lara Kürten
- Interdisciplinary Center for Health Technology Assessment and Public Health (IZPH), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Linda Karrer
- Interdisciplinary Center for Health Technology Assessment and Public Health (IZPH), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Michael Reichold
- Chair of Medical Informatics, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Laura Köhler
- Medical Valley European Metropolitan Region Nuremberg Association, Erlangen, Germany
| | - Andreas Nagel
- Interdisciplinary Center for Health Technology Assessment and Public Health (IZPH), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Christina Chmelirsch
- Interdisciplinary Center for Health Technology Assessment and Public Health (IZPH), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Kathrin Seebahn
- Interdisciplinary Center for Health Technology Assessment and Public Health (IZPH), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Markus Hladik
- Interdisciplinary Center for Health Technology Assessment and Public Health (IZPH), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Sebastian Meuer
- Interdisciplinary Center for Health Technology Assessment and Public Health (IZPH), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Anna Kirchner
- Interdisciplinary Center for Health Technology Assessment and Public Health (IZPH), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Kristina Holm
- Interdisciplinary Center for Health Technology Assessment and Public Health (IZPH), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Marina Selau
- Chair of Medical Informatics, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Marco Wendel
- Medical Valley European Metropolitan Region Nuremberg Association, Erlangen, Germany
| | - Jörg Trinkwalter
- Medical Valley European Metropolitan Region Nuremberg Association, Erlangen, Germany
| | - Hans-Ulrich Prokosch
- Chair of Medical Informatics, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Elmar Graessel
- Center for Health Services Research in Medicine, Department of Psychiatry and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Peter L Kolominsky-Rabas
- Interdisciplinary Center for Health Technology Assessment and Public Health (IZPH), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
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93
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Gilmore-Bykovskyi A, Cotton Q, Morgan J, Block L. Diverse perspectives on hospitalisation events among people with dementia: protocol for a multisite qualitative study. BMJ Open 2021; 11:e043016. [PMID: 33550256 PMCID: PMC7925923 DOI: 10.1136/bmjopen-2020-043016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION People living with dementia (PLWD) are more likely to experience hospitalisation events (hospitalisation, rehospitalisation) than those without dementia. Many hospitalisation events, particularly rehospitalisation within 30 days of discharge, are thought to be avoidable. Yet our understanding of dementia-specific risk and protective factors surrounding avoidable hospitalisation is limited to specific intersetting transitions and predominantly clinician perspectives. Broader insights are needed to design accessible and effective solutions for reducing avoidable hospitalisations. We have designed the Stakeholders Understanding of Prevention Protection and Opportunities to Reduce HospiTalizations (SUPPORT) Study to address these gaps. The objectives of the SUPPORT Study are to elicit and examine family caregiver, community and hospital providers' perspectives on avoidable hospitalisation events among PLWD, and to identify opportunities for effective prevention. METHODS AND ANALYSIS We will conduct a multisite, descriptive qualitative study to interview around 100 family caregivers, community and hospital providers. We will identify and sample from regions and communities with higher socio-contextual disadvantage and hospital utilisation, and will aim to recruit individuals representing diverse racial/ethnic backgrounds. Interviews will follow a descriptive qualitative design in conjunction with constant comparison techniques to sample divergent situations and events. We will employ a range of analytical approaches to address specific research questions including thematic (inductive and deductive), comparative and dimensional analysis. Interviews will be conducted individually or in focus groups and follow a semistructured interview guide. ETHICS AND DISSEMINATION The study is approved by the University of Wisconsin-Madison Institutional Review Board. Informed consent procedures will incorporate steps to evaluate capacity to provide informed consent in the event that participants express concerns with thinking or memory or demonstrate challenges recalling study details during the consent process to ensure capacity to consent to participation. A series of publicly available reports, seminars and symposia will be undertaken in collaboration with collaborating organisation partners.
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Affiliation(s)
- Andrea Gilmore-Bykovskyi
- Nursing, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Division of Geriatrics, Department of Medicine, University of Wisconsin-Madison School of Medicine & Public Health, Madison, Wisconsin, USA
| | - Quinton Cotton
- Nursing, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Jennifer Morgan
- Nursing, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Laura Block
- Nursing, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Dalgarno EL, Gillan V, Roberts A, Tottie J, Britt D, Toole C, Clarkson P. Home care in dementia: The views of informal carers from a co-designed consultation. DEMENTIA 2021; 20:2261-2277. [PMID: 33530737 PMCID: PMC8564226 DOI: 10.1177/1471301221990504] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND In the United Kingdom, there is a current priority for high-quality dementia care provided at home. However, home care or domiciliary care is an area where problems have been reported, in terms of a lack of consistency, coordination and appropriate responses to the specific needs of those with dementia. The views of informal carers, who often must respond to these problems when supporting relatives, are crucial in shedding light on the issues and in seeking to promote solutions. METHODS This study explored the views of informal carers of those with dementia concerning home care, through a consultation using an electronic survey. The survey questions were designed by informal carers, through a public involvement group within an existing programme of dementia research. The survey elicited responses from 52 informal carers in 2017/18. The data were analysed qualitatively using framework analysis. FINDINGS Carers' views focused on the need for investment into meaningful personalisation, recognising the value of providing care and valuing formal carers, systemic failings of care coordination and provision and the importance of ongoing collaboration and care planning. CONCLUSION Based on a framework drawn from the views of informal carers themselves, this study articulated issues of concern for home care and its delivery for people with dementia. Attempts should be made to make dementia home care more consistently personalised, inclusive and collaborative with informal carers and key others involved. Further areas to explore include working conditions of formal carers and current models utilised in homecare provision.
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Affiliation(s)
| | - Vincent Gillan
- Social Care and Society, 5292University of Manchester, Manchester, UK
| | - Amy Roberts
- Social Care and Society, 5292University of Manchester, Manchester, UK
| | - Jean Tottie
- Family Carer, Together in Dementia, Liverpool, UK
| | | | | | - Paul Clarkson
- Social Care and Society, 5292University of Manchester, Manchester, UK
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95
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Ludwig C, Graham ID, Lavoie J, Gifford W, Stacey D. Ethical considerations for engaging frail and seriously ill patients as partners in research: sub-analysis of a systematic review. RESEARCH INVOLVEMENT AND ENGAGEMENT 2021; 7:8. [PMID: 33517912 PMCID: PMC7849091 DOI: 10.1186/s40900-021-00254-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 01/21/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND The commitment to engage patients as partners in research has been described as a political, moral and ethical imperative. Researchers feel ill-equipped to deal with potential ethical implications of engaging patients as partners. The aim of this study is to identify the ethical considerations related to engaging frail and seriously ill (FSI) patients as partners in research. METHODS We conducted a sub-analysis of a prior systematic review of 30 studies that engaged FSI patients as partners in research. Studies were included if they reported ethical considerations associated with partnering. We performed deductive content analysis, data were categorized according to Beauchamp and Childress' Principles of Biomedical Ethics (2019): autonomy, non-maleficence, beneficence, and justice. RESULTS Twenty-five studies were included. Common ethical considerations reported in relation to the principles were: autonomy - promoting desired level of involvement, addressing relational and intellectual power, facilitating knowledge and understanding of research; non-maleficence - protection from financial burden, physical and emotional suffering; beneficence - putting things right for others, showing value-added, and supporting patient-partners; and, justice - achieving appropriate representation, mutual respect for contributions, and distributing risks and benefits. CONCLUSIONS When partnering with FSI patients, research teams need to establish shared values and ensure processes are in place to identify and address ethical issues. Researchers and patients should work together to clarify the intent and outcomes of the partnership, actively address power differentials, recognize and minimize the potential for unintended harm, and strive to maximize the benefits of partnership. SYSTEMATIC REVIEW REGISTRATION The protocol for the original systematic review has been registered with the International Prospective Register of Systematic Reviews PROSPERO (CRD42019127994).
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Affiliation(s)
- Claire Ludwig
- University of Ottawa, Faculty of Health Sciences, School of Nursing, Roger Guindon Hall, 451 Smyth Road, Ottawa, Ontario K1H 8M5 Canada
| | - Ian D. Graham
- University of Ottawa, Faculty of Health Sciences, School of Nursing, Roger Guindon Hall, 451 Smyth Road, Ottawa, Ontario K1H 8M5 Canada
- University of Ottawa, Faculty of Medicine, School of Epidemiology and Public Health, 600 Peter Morand Crescent, Ottawa, K1G 5Z3 Ontario Canada
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, 501 Smyth Road, Ottawa, Ontario K1H 8L6 Canada
| | - Josee Lavoie
- Geriatric Psychiatry Program, Royal Ottawa Mental Health Centre, 1145 Carling Avenue, Ottawa, Ontario K1Z 7K4 Canada
| | - Wendy Gifford
- University of Ottawa, Faculty of Health Sciences, School of Nursing, Roger Guindon Hall, 451 Smyth Road, Ottawa, Ontario K1H 8M5 Canada
| | - Dawn Stacey
- University of Ottawa, Faculty of Health Sciences, School of Nursing, Roger Guindon Hall, 451 Smyth Road, Ottawa, Ontario K1H 8M5 Canada
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, 501 Smyth Road, Ottawa, Ontario K1H 8L6 Canada
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96
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Liu HY, Hsu WC, Shyu YIL, Wang YN, Huang TH, Lin YE, Huang CH. Finding a balance in family caregiving for people with dementia: A correlational longitudinal study. J Adv Nurs 2021; 77:2278-2292. [PMID: 33434343 DOI: 10.1111/jan.14747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 11/11/2020] [Accepted: 12/10/2020] [Indexed: 11/28/2022]
Abstract
AIMS The "Finding a Balance Point" framework was used to explore the caregiving process over time for family caregivers of people with dementia in Taiwan. This study aimed to: (a) identify Taiwanese caregivers' different balance trajectories; (b) explore predictors of trajectory group membership; and (c) examine associations of different balance trajectories with caregiving outcomes. DESIGN A correlational longitudinal design was used. METHODS Data were collected from 200 family caregivers' self-completed questionnaires and they were followed over 2 years (June 2015-May 2017). Discrete balance trajectories were identified by group-based trajectory modelling. Predictors of trajectory group membership were identified from potential predictors of caregiving characteristics and caregiving factors using multivariate logistic regression. Associations of trajectory groups with caregiving outcomes (depressive symptoms and health-related quality of life) were explored using the generalized estimating equation. RESULTS Balance trajectories best fit a two-group trajectory model (poor and good). Caregivers with a poor sense of balance between competing needs were more likely to have more depressive symptoms (b = 11.71, 95% CI [9.04, 14.38], p < .001), worse physical health (b = -6.22, 95% CI [-8.71, -3.74], p < .001), and worse mental health (b = -11.1, 95% CI [-13.58, -8.63], p < .001) than caregivers with a good sense of balance. Caregivers experiencing lower role strain (b = -1.45, SE = 0.48, p = .003) or higher predictability (b = 2.83, SE = 0.76, p < .001) were more likely to belong to the good-balance group. CONCLUSIONS Caregivers with poor balance between competing needs are more likely to have worse caregiving outcomes. Role strain and predictability significantly predicted balance trajectory groups. Family caregivers with lower caregiving task difficulty and/or better knowledge of the care receiver were more likely to be in the good balance trajectory group. IMPACT Our findings support the framework, "Finding a Balance Point," and clarify the family caregiving process for people with dementia. This framework could be used to tailor interventions for home care nurses to improve family caregivers' caregiving outcomes.
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Affiliation(s)
- Hsin-Yun Liu
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan (R.O.C.)
| | - Wen-Chuin Hsu
- Dementia Center, Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan (R.O.C.).,School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan (R.O.C.)
| | - Yea-Ing L Shyu
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan (R.O.C.).,Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan (R.O.C.).,Department of Nursing, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (R.O.C.)
| | - Yu-Nu Wang
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan (R.O.C.)
| | - Tzu-Hsin Huang
- Department of Nursing, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan (R.O.C.)
| | - Yueh-E Lin
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan (R.O.C.).,Department of Nursing, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan (R.O.C.)
| | - Chun-Hsia Huang
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan (R.O.C.)
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97
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Czapka EA, Sagbakken M. Challenges related to providing care for parents with dementia across borders: A qualitative study on transnational carers in Oslo. J Aging Stud 2020; 55:100893. [PMID: 33272459 DOI: 10.1016/j.jaging.2020.100893] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 09/05/2020] [Accepted: 09/28/2020] [Indexed: 01/02/2023]
Abstract
Migration requires people to re-define their caring roles, develop new caring strategies and negotiate the scope of care with the family in the country of origin. The main aim of this paper is to identify and describe challenges related to transnational care provided for people with dementia. Transnational caring itself poses many challenges for families but caring for a person living with dementia can be especially difficult. The qualitative data presented in this article was collected in 2018 as part of a larger study focusing on understandings, experiences and responses to age-related cognitive impairment among families with minority ethnic backgrounds. The data includes seven semi-structured in-depth interviews with migrants in Oslo who were engaged in transnational caring activities for their parents living with dementia. The participants in our study experienced numerous challenges related to providing care across borders to their parents. Some of the challenges were typical for transnational caring and were associated with care regimes in the countries of parents' and participants' residence, motives for providing care, participants' socio-economic situation and family relations. The other challenges were due to specific care needs of people living with dementia.
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Affiliation(s)
- Elżbieta Anna Czapka
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, Pilestredet 32, 0130 Oslo, Norway.
| | - Mette Sagbakken
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, Pilestredet 32, 0130 Oslo, Norway.
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98
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Gilmore-Bykovskyi A, Mullen S, Block L, Jacobs A, Werner NE. Nomenclature Used by Family Caregivers to Describe and Characterize Neuropsychiatric Symptoms. THE GERONTOLOGIST 2020; 60:896-904. [PMID: 31688933 DOI: 10.1093/geront/gnz140] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Neuropsychiatric symptoms (NPS) are a core feature of Alzheimer's disease and related dementias that are characterized by a fluctuating course. NPS are challenging to manage and contribute to high rates of burden among family caregivers. Successful information exchange between clinicians and family caregivers is critical for facilitating effective management of NPS. However, this communication is often challenging due to inconsistent terminology and classification of symptoms and limited understanding of how family caregivers recognize and describe symptoms. The objective of this study was to examine the language family caregivers' use to describe and contextualize NPS. RESEARCH DESIGN AND METHODS Descriptive qualitative study of 20 family caregivers in a mostly urban county in the Midwestern United States using semistructured interviews. Caregiver descriptions of NPS were analyzed using directed content and text analysis to examine terminology, followed by a thematic analysis approach to examine contextualization of NPS. RESULTS Caregivers employed shared terminologies to describe NPS that differed substantially from clinical terminology used to classify symptoms. Caregivers frequently engaged sense-making as a strategy to explain NPS. This sense-making served to contextualize patterns in behavior and was characterized by explanatory, situational, and strategy-oriented frameworks for understanding behavior in terms of its purpose and meaning. Caregivers' descriptions of NPS reflected broad overlap between individual NPS (i.e., agitation and care resistance) that would generally be considered clinically distinct symptoms. DISCUSSION AND IMPLICATIONS Nomenclature surrounding NPS may vary considerably between family caregivers and clinicians, and should be evaluated in partnership with people with dementia and their caregivers to ensure supportive interventions and resources are responsive to caregivers' interpretation of symptoms and sense-making.
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Affiliation(s)
- Andrea Gilmore-Bykovskyi
- School of Nursing Madison, Wisconsin.,Division of Geriatrics, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin.,Geriatric Research Education and Clinical Center (GRECC), William S. Middleton Hospital, United States Department of Veterans Affairs, Madison, Wisconsin
| | | | | | | | - Nicole E Werner
- Division of Geriatrics, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin.,Department of Industrial and Systems Engineering, College of Engineering, University of Wisconsin-Madison, Madison, Wisconsin
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99
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Rutkowski RA, Ponnala S, Younan L, Weiler DT, Bykovskyi AG, Werner NE. A process-based approach to exploring the information behavior of informal caregivers of people living with dementia. Int J Med Inform 2020; 145:104341. [PMID: 33242761 DOI: 10.1016/j.ijmedinf.2020.104341] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/13/2020] [Accepted: 11/09/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND PURPOSE Informal caregivers of persons living with dementia have significant unmet information needs that, if met, would better equip them to provide effective care. Despite the existence of health information technologies, websites, resources, and organizations dedicated to dementia caregiving, caregivers continue to report unmet information needs. Caregivers' continued unmet information needs suggest a misalignment between information products, and caregivers' information behavior-how caregivers generate, acquire, manage, use, communicate, and seek information. Researchers have developed conceptual models for understanding caregivers' information behavior, but these models are limited in that they are task-oriented, and they assume that caregivers' information needs will be met if they engage in information behavior. To address these limitations, the present study sought to explore caregivers' information behavior as a sociotechnical-systems-based process. METHODS We conduced semi-structured interviews with 30 self-identified caregivers to explore their daily experience of caregiving activities, including their information behavior. We applied a process-based conceptual framework that takes into account inputs, processes, outputs, and feedback mechanisms within a sociotechnical system to guide analysis. The process of interest was caregivers' information behavior as modeled by the information-seeking and communication model (ISCM). We conducted a deductive content analysis guided by the components of the ISCM. We then used team-based affinity diagramming to collapse and categorize the ISCM components into inputs, processes, outputs, and feedback. RESULTS We developed a conceptual model to depict caregivers' information behavior as a sociotechnical-systems-based process of inputs, processes, and outputs that feedback into the system. The conceptual model consisted of three inputs (i.e., information users, information providers, and information products), three information seeking and communication processes (i.e., information access, information interaction, and information assessment and processing), two outputs (i.e., utility and credibility), and feedback. DISCUSSION AND CONCLUSION Building on and addressing the gaps in previous information behavior models, our conceptual framework advances the previous task-level understandings of caregivers' information behavior into a comprehensive feedback-driven, process-level perspective consisting of context-based inputs, information seeking and communication processes, outputs, and feedback. A sociotechnical-systems-based understanding of caregivers' information behavior allows for misalignments between information providers and products, and caregivers' information behavior not only to be illuminated, but systematically addressed.
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Affiliation(s)
- Rachel A Rutkowski
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, United States
| | - Siddarth Ponnala
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, United States
| | - Laura Younan
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, United States
| | - Dustin T Weiler
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, United States
| | | | - Nicole E Werner
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, United States.
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Bressan V, Visintini C, Palese A. What do family caregivers of people with dementia need? A mixed-method systematic review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:1942-1960. [PMID: 32542963 DOI: 10.1111/hsc.13048] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 05/10/2020] [Accepted: 05/13/2020] [Indexed: 06/11/2023]
Abstract
Caring for people with dementia is a major challenge for relatives and society worldwide. Understanding the family caregivers' needs is crucial to promote their care-giving role during the disease trajectory. The aim of this mixed-method systematic review was to identify and synthetise the existing literature on the needs of family caregivers of people with dementia at home. PubMed, CINAHL, Cochrane Database of Systematic Reviews and PsycINFO databases were systematically explored to find quantitative, qualitative and mixed-method studies published between 2009 and 2019. A total of 1,196 citations were retrieved and 34 studies were included in the review. The variety of interrelated needs emerged from studies has been summarised in four themes: (a) Being supported, (b) Receiving accessible and personalised information, (c) Being trained and educated to care for their beloved with dementia and (d) Finding a balance. Care-giving for individuals with dementia is an ever-changing process characterised by continuous adjustments to their needs. The majority of a family caregivers' needs are oriented towards receiving support, help in offering daily care and finding a balance between the care-giving role and their own personal needs. For family caregivers, receiving information is a priority to improve their knowledge and to develop coping abilities, care skills and strategies aimed at promoting a balance between care assistance duties and their own needs. They also need social, psychological and emotional support and access to flexible, tailored and timely formal care. Further studies are recommended to detect changes in family caregivers' needs throughout the disease progression in order to tailor formal care offered by social and healthcare services.
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