Family Caregivers and Transition to Long-Term Care

The Role of Health care Professionals in the Decision-Making Process of Family Caregivers Regarding Placement of a Cognitively Impaired Elderly Relative

In this article, we explore the role of health care professionals within the decision-making process of family caregivers regarding placement of a cognitively impaired elderly relative. Grounded theory was used to describe interactions with health care professionals, modulating the caregivers’ decision-making process. A total of 18 caregivers of cognitively impaired elderly relatives were interviewed every 6 months over an average of 20 months. Results showed that health care professionals were involved in the decision-making process in three ways: (a) in assessing the need for placement; (b) in helping caregivers navigate through the health care system; and (c) in taking care of family dynamics. There were great variations in the way health care professionals supported caregivers. Future research is needed to identify professional interventions that are helpful for caregivers and in which context.

Improving the management of waiting lists for long term care

Initially prepared for the South East Local Health Integration Network in Ontario, this literature review focuses on interventions to improve the management of waiting lists for admission to long-term care facilities. The review identified studies relating to four types of interventions: (1) different models for prioritizing patients, (2) ways to improve the accuracy of waiting lists, (3) the use of alternative care settings, and (4) altering the level of home care.

From Institution to ‘Home’: Family Perspectives on a Unique Relocation Process

Cette étude phénoménologique et herméneutique a donné un aperçu des expériences des membres des familles des résidents qui ont été diagnostiqués d’une démence légère à modérée et qui ont été déménagés de leur institution de soins dans une résidence medicalisée unique. Des entrevues semi-dirigées ont été realisées avec 10 membres de la famille, dont six thèmes ont émergé : (a) la communication en cours, (b) de secours et de contentement, (c) des activités significatives, (d) un environnement amélioré, (e) le fonctionnement amélioré, et (f) le personnel engagé. Ces résultats ont des implications importantes pour la prestation des soins et la planification des programmes futurs dans les soins aux résidents ayant des besoins spéciaux. Surtout, nous pouvons conclure que les résultats axés sur le client des soins produit des résultats positifs pour les résidents et les membres des familles.

Planning and Decision Making for Care Transitions

The need to plan for future health care and residential adjustments increases with age, growing frailty, and restrictions in coverage of long-term care and will continue to grow with population aging. Older adults' lack of financial preparation for health care costs, insufficient knowledge about available options, and inadequate communication about care-related values has become an increasing public health challenge. This chapter describes a model of Preparation for Future Care (PFC), which encompasses different levels and domains of planning. Research about the extent to which planning is helpful in navigating care transitions is reviewed, and barriers and facilitators of planning including individual, familial, cultural, and national long-term care policy factors are discussed. Planning in the context of dementia and practical approaches that can be taken to enhance PFC is addressed, as well as recommendations for future research in the area of planning and decision making in the context of care transitions.

Approaching the end of life and dying with dementia in care homes: the accounts of family carers

Research into end of life and dying with dementia in care homes from the family carer's perspective is limited. From the available evidence, it appears that family carers find themselves in an unfamiliar situation about which they lack knowledge and experience. Whilst dementia tends not to be acknowledged as a terminal illness by many family carers, they are expected to make end of life decisions on behalf of their relatives. Family carer decision-making is underpinned by values of quality of life, previously expressed wishes, comfort provision and dignity preservation. This is often approached when family carers are grieving for the anticipated loss of their relative and have their own personal needs that require to be addressed. Within a care home setting, a curative care–palliative care split is unhelpful in resolving these tensions and a model of comprehensive care appears a more appropriate approach. This requires ongoing communication between the person with dementia, family members and professionals from the early stages of the condition.

Light therapy for managing cognitive, sleep, functional, behavioural, or psychiatric disturbances in dementia

BACKGROUND

Rest-activity and sleep-wake cycles are controlled by the endogenous circadian rhythm generated by the suprachiasmatic nuclei (SCN) of the hypothalamus. Degenerative changes in the SCN appear to be a biological basis for circadian disturbances in people with dementia, and might be reversed by stimulation of the SCN by light.

OBJECTIVES

The review assesses the evidence of effectiveness of light therapy in managing cognitive, sleep, functional, behavioural, or psychiatric disturbances associated with dementia.

SEARCH STRATEGY

The Specialized Register of the Cochrane Dementia and Cognitive Improvement Group (CDCIG), The Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL and LILACS were searched on 4 March 2008 using the terms: "bright light*", "light box*", "light visor*", "dawn-dusk*", phototherapy, "photo therapy", "light therapy" "light treatment", light* . The CDCIG Specialized Register contains records from all major health care databases (The Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL, LILACS) as well as from many trials databases and grey literature sources.

SELECTION CRITERIA

All relevant, randomized clinical trials in which light therapy, at any intensity and duration, was compared with a control group for the effect on managing cognition, sleep, function, behavioural, or psychiatric disturbances (as well as changes in institutionalization rates or cost of care) in people with dementia of any type and degree of severity.

DATA COLLECTION AND ANALYSIS

Three reviewers independently assessed the retrieved articles for relevance and methodological quality, and extracted data from the selected studies. Statistically significant differences in outcomes between the treatment and control groups at end of treatment and follow-up were examined. Each study was summarized using a measure of effect (e.g. mean difference).

MAIN RESULTS

Eight trials met the inclusion criteria. However, three of the studies could not be included in the analyses because of inappropriate reported study analyses or inability to retrieve the required data from the investigators. This review revealed no adequate evidence of the effectiveness of light therapy in managing cognition, sleep, function, behaviour, or psychiatric disturbances associated with dementia.

AUTHORS' CONCLUSIONS

There is insufficient evidence to assess the value of light therapy for people with dementia. Most of the available studies are not of high methodological quality and further research is required.

Whatever It Takes: Informal Caregiving Dynamics in Blood and Marrow Transplantation

PURPOSE/OBJECTIVES

To describe the dynamics of commitment, expectations, and negotiation from the perspective of caregivers of patients undergoing blood and marrow transplantation (BMT).

RESEARCH APPROACH

Descriptive, exploratory, qualitative methodology.

SETTING

Comprehensive cancer center in a major southern U.S. city.

PARTICIPANTS

40 caregivers of patients undergoing BMT.

METHODOLOGIC APPROACH

Story theory guided audiotaped dialogues with caregivers.

MAIN RESEARCH VARIABLES

Commitment, expectations, and negotiation.

FINDINGS

Commitment is an enduring responsibility that encourages supportive presence, inspires life changes to make the patient a priority, and leads to a self-affirming, loving connection. Expectations are clarified as expectation management, which is envisioning the future and yearning to return to normal, taking one day at a time, gauging behavior from past experiences, and reconciling treatment twists and turns. Role negotiation is appropriate pushing by a caregiver toward patient independence after getting a handle on complex care and attending to patient voice (patient preferences and wishes).

CONCLUSIONS

Commitment, expectation management, and role negotiation sustain informal caregivers in their role.

INTERPRETATION

Acknowledging caregivers' contributions, giving focused information as needed, and providing a safe environment in which to build coherent caregiving stories can assist caregivers. Research is needed to confirm the effectiveness of interventions with caregivers and to understand patients' role in the dynamics of informal caregiving.