1
|
Huang L, Liu Z, Li Y. Incompleteness features in the descriptive discourse of Chinese elders with and without Alzheimer's disease. CLINICAL LINGUISTICS & PHONETICS 2023; 37:1171-1185. [PMID: 35818887 DOI: 10.1080/02699206.2022.2092423] [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: 12/05/2021] [Revised: 04/04/2022] [Accepted: 06/14/2022] [Indexed: 06/15/2023]
Abstract
Alzheimer's disease (AD) can manifest itself with prominent language dysfunction. Incompleteness in discourse refers to the lack of indispensable sentence-constructing elements that hinder communication fluency and accuracy. The current study investigates how the pattern of incompleteness is associated with the descriptive discourse produced by elders withoutAD and those with different stages ofAD. The Chinese discourse samples were collected from the picture description of 40 elders with mild probableAD (Mini-Mental State Examination (MMSE) 21-26, Montreal Cognitive Assessment Scale-Basic (MoCA-B) 15-19), 40 elders with moderate probableAD (MMSE 11-20, MoCA-B 10-14), and 40 controls (MMSE 26-29, MoCA-B 24-29). The total production of incomplete sentences and six incompleteness features were examined. The MildAD, ModerateAD, and Control groups differed in the total output of the incomplete sentence. Group differences also emerged in four incompleteness features: missing subject, missing predicate, missing object, and missing functional word. The ModerateAD group differed from the MildAD group with respect to most significant features, while MildAD and Control groups were very similar. The results suggested thatAD impairs the sentence construction ability of Chinese elders, especially at the later stage. These statistically significant differences between the groups might provide some references when diagnosing the risk and possibility of cognitive impairment of Chinese elders, facilitating the design of clinical evaluation or screening for probableAD.
Collapse
Affiliation(s)
- Lihe Huang
- The Research Center for Aging, Language and Care, Tongji University, Shanghai, China
| | - Zhuoya Liu
- The Research Center for Aging, Language and Care, Tongji University, Shanghai, China
- Research Centre for Language, Cognition, and Neuroscience, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Yunxia Li
- The Research Center for Aging, Language and Care, Tongji University, Shanghai, China
- Department of Neurology, School of Medicine, Tongji University, Shanghai Tongji Hospital, Shanghai, China
| |
Collapse
|
2
|
Beach B, Bélanger-Hardy L, Harding S, Rodrigues Perracini M, Garcia L, Tripathi I, Gillis M, Dow B. Caring for the caregiver: Why policy must shift from addressing needs to enabling caregivers to flourish. Front Public Health 2022; 10:997981. [PMID: 36339159 PMCID: PMC9626797 DOI: 10.3389/fpubh.2022.997981] [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: 07/19/2022] [Accepted: 09/28/2022] [Indexed: 01/26/2023] Open
Abstract
Policies supporting caregivers ("caregiver policies") are limited in the extent to which they meet the needs of those who care for others. Where policies do exist, they focus on relieving the burdens associated with caring or the needs of the person they care for, rather than consider the holistic needs of the caregiver that would enable them to flourish. We argue that the established approach to caregiver policies reflects a policy failure, requiring a reassessment of current practice related to caregiver support. Often, caregiver policies target the care recipient rather than the caregiver's needs. Through a consultative exercise, we identified five areas of need that existing caregiver policies touch upon. Yet current approaches remain piecemeal and inadequate in a global context. Caregiver policies should not just relieve burden to the extent that caregivers can continue in the role, but they should support caregivers to flourish, and future work may benefit from drawing on related frameworks from positive psychology, such as the PERMA™ model; this is important for both policymakers and researchers.
Collapse
Affiliation(s)
- Brian Beach
- Research Department of Epidemiology and Public Health, University College London, London, United Kingdom,*Correspondence: Brian Beach
| | | | - Susana Harding
- International Longevity Centre – Singapore, Singapore, Singapore
| | | | - Linda Garcia
- LIFE Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Ishika Tripathi
- LIFE Research Institute, University of Ottawa, Ottawa, ON, Canada
| | | | - Briony Dow
- National Ageing Research Institute, Parkville, VIC, Australia
| |
Collapse
|
3
|
Dams J, Grochtdreis T, König HH. Health-related quality of life of individuals sharing a household with persons with dementia. Qual Life Res 2022; 31:2319-2329. [PMID: 34919197 PMCID: PMC9250476 DOI: 10.1007/s11136-021-03065-z] [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] [Subscribe] [Scholar Register] [Accepted: 12/07/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Previous research has found a negative effect of dementia on the health-related quality of life (HrQoL) of persons with dementia (PWD) and their primary informal caregivers. However, the impact of dementia on HrQoL of other individuals sharing a household with PWD has not been investigated to date. The current study therefore aimed to determine differences in the HrQoL between those sharing a household with PWD and those not living with PWD. In addition, factors related to the HrQoL of those sharing a household with PWD were evaluated. METHODS The analyses were based on data from the German Socio-Economic Panel, using the SF-12 to measure HrQoL. Mixed-effects models were calculated to compare the HrQoL of those sharing a household with PWD and persons not living with PWD, as well as to determine factors related to the HrQoL of those sharing a household with PWD. Bootstrapping was used where residuals were not normally distributed. RESULTS Mixed-effect models showed a significantly lower HrQoL among those sharing a household with PWD, compared to those not living with PWD. Number of diseases, number of persons in the household, marital status and educational level were significantly related to HrQoL among those sharing a household with PWD. DISCUSSION The HrQoL of those sharing a household with PWD was reduced compared to persons not living with PWD. Further, those living with PWD in small households, or those with multi-morbidities had a lower HrQoL. Further research focusing on HrQoL in the social environment of PWD is needed.
Collapse
Affiliation(s)
- Judith Dams
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Thomas Grochtdreis
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| |
Collapse
|
4
|
Positive experiences in dementia care-giving: findings from the IDEAL programme. AGEING & SOCIETY 2022. [DOI: 10.1017/s0144686x22000526] [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
There is a growing evidence base that identifying positive experiences in providing care can have a beneficial influence on carer wellbeing. However, there is a need to better understand what carers identify as the positive aspects of care-giving. The aim of this study is to explore the satisfying aspects of providing care to people with dementia. This study utilised Time 1 data from 1,277 carers of people in the mild-to-moderate stages of dementia taking part in the IDEAL (Improving the experience of Dementia and Enhancing Active Life) cohort study. Responses from 900 carers who answered the open-ended question ‘What is your greatest satisfaction in caring for your relative/friend?’ were analysed using thematic analysis. From the responses, 839 carers detailed satisfactions. Eight themes were identified, pertaining to three groups of beneficiaries: carers, people with dementia and the dyad. Perceived benefits for carers included identifying aspects of personal growth, seeing glimpses of the person, feeling they were making a difference and doing their duty. For the person with dementia, these included retaining independence, receiving good quality care and being happy. Dyadic benefits concerned the continuation of the relationship between carer and person with dementia. The findings highlight the need to take a dyadic approach when conceptualising positive experiences in providing care. Further research is needed to understand the role these positive experiences play and to develop interventions. Professionals working with carers should identify and validate these experiences.
Collapse
|
5
|
Asfia SKBM, Bucholc J, McCaffrey N, Mihalopoulos C, Muldowney A, Engel L. Understanding the Quality of Life Impacts of Providing Informal Care to People with Dementia: A Systematic Review of Qualitative Studies. J Alzheimers Dis 2022; 88:1293-1309. [PMID: 35754273 DOI: 10.3233/jad-220219] [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: 11/15/2022]
Abstract
BACKGROUND There is currently a lack of a comprehensive review identifying the broad scope of factors that impact quality of life (QoL) of informal carers of people with dementia to validate existing measures and inform the provision of support services for carers of people with dementia that impact QoL domains important to them. OBJECTIVE To explore and identify QoL impacts on informal carers from providing care to people with dementia. METHODS A systematic review was conducted across four databases: EMBASE, CINAHL, PsychINFO, and Medline. Eligible studies consisted of published, peer-reviewed, qualitative studies focusing on lived experiences of informal carers of people with dementia. Non-English studies and quantitative studies were excluded. Screening of included studies was conducted independently by three reviewers. A "best-fit" framework synthesis was used to combine the qualitative data, applying deductive and inductive analysis techniques. Quality assessment was conducted using the Critical Appraisal Skills Programme. RESULTS Of the 4,251 articles identified, 59 articles were included. Five main themes pertaining to QoL aspects were identified that included coping (emotion-coping and problem-coping), relationship with the person with dementia (sense of loss and change in relationship), support (formal support and informal support), interference with life (control over caring situation and freedom and independence), and health (physical health, emotional and mental health, and social health). CONCLUSION This study identified domains of QoL that are impacted by providing informal care to people living with dementia, offering a conceptual framework for instrument validation and development as well as guidance for service provision.
Collapse
Affiliation(s)
| | - Jessica Bucholc
- Deakin University, Institute for Health Transformation, Burwood, Victoria, Australia
| | - Nikki McCaffrey
- Deakin University, Institute for Health Transformation, Burwood, Victoria, Australia
| | - Cathrine Mihalopoulos
- Deakin University, Institute for Health Transformation, Burwood, Victoria, Australia.,Monash University, School of Public Health and Preventive Medicine, Melbourne, Victoria, Melbourne, Australia
| | - Anne Muldowney
- Carers Australia, Unit 2/11 McKay Ln, Turner, Australian Capital Territory, Australia
| | - Lidia Engel
- Deakin University, Institute for Health Transformation, Burwood, Victoria, Australia.,Monash University, School of Public Health and Preventive Medicine, Melbourne, Victoria, Melbourne, Australia
| |
Collapse
|
6
|
Aza A, Gómez-Vela M, Badia M, Begoña Orgaz M, González-Ortega E, Vicario-Molina I, Montes-López E. Listening to families with a person with neurodegenerative disease talk about their quality of life: integrating quantitative and qualitative approaches. Health Qual Life Outcomes 2022; 20:76. [PMID: 35525943 PMCID: PMC9077340 DOI: 10.1186/s12955-022-01977-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 04/15/2022] [Indexed: 11/29/2022] Open
Abstract
Background The diagnosis of a neurodegenerative disease (ND) produces profound changes in the quality of life of the affected families. Despite the vital importance of these processes, the scientific literature has addressed this topic almost exclusively relating to the main caregiver or using limited approaches. Thus, the main objective of this research is to achieve a deeper understanding of the quality of family life of people with a neurodegenerative disease, following a mixed-method approach that combines quantitative and qualitative methodology. Methods The quantitative instrument was the Spanish version of the Family Quality of Life Survey-Neurodegenerative Disease (FQOLS-ND), which was completed by 300 participating families. The qualitative methodology was used in two focus groups with family caregivers, with a total of 21 participants. Results On the one hand, confirmation of the dimensional structure of the scale in the focus groups was obtained and, on the other hand, the results of family quality of life in attainment and satisfaction were shown to be high for Family Relations and Careers and Planning for Careers and low for Support from Services and Leisure and Recreation. Conclusions The results of this study, through the combination of quantitative and qualitative information, helps to identify key issues to optimize services that respond to the priority needs of families. Supplementary Information The online version contains supplementary material available at 10.1186/s12955-022-01977-z.
Collapse
Affiliation(s)
- Alba Aza
- Institute on Community Integration (INICO), Faculty of Psychology, University of Salamanca, Avda. De la Merced, 109-131, 37005, Salamanca, Castile and Leon, Spain.
| | - María Gómez-Vela
- Institute on Community Integration (INICO), Faculty of Education, University of Salamanca, Salamanca, Spain
| | - Marta Badia
- Institute on Community Integration (INICO), Faculty of Psychology, University of Salamanca, Avda. De la Merced, 109-131, 37005, Salamanca, Castile and Leon, Spain
| | - M Begoña Orgaz
- Institute on Community Integration (INICO), Faculty of Psychology, University of Salamanca, Avda. De la Merced, 109-131, 37005, Salamanca, Castile and Leon, Spain
| | | | | | - Estrella Montes-López
- Department of Sociology and Communication, Faculty of Social Sciences, University of Salamanca, Salamanca, Spain
| |
Collapse
|
7
|
Ostrand R, Gunstad J. Using Automatic Assessment of Speech Production to Predict Current and Future Cognitive Function in Older Adults. J Geriatr Psychiatry Neurol 2021; 34:357-369. [PMID: 32723128 PMCID: PMC8326891 DOI: 10.1177/0891988720933358] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Neurodegenerative conditions like Alzheimer disease affect millions and have no known cure, making early detection important. In addition to memory impairments, dementia causes substantial changes in speech production, particularly lexical-semantic characteristics. Existing clinical tools for detecting change often require considerable expertise or time, and efficient methods for identifying persons at risk are needed. This study examined whether early stages of cognitive decline can be identified using an automated calculation of lexical-semantic features of participants' spontaneous speech. Unimpaired or mildly impaired older adults (N = 39, mean 81 years old) produced several monologues (picture descriptions and expository descriptions) and completed a neuropsychological battery, including the Modified Mini-Mental State Exam. Most participants (N = 30) returned one year later for follow-up. Lexical-semantic features of participants' speech (particularly lexical frequency) were significantly correlated with cognitive status at the same visit and also with cognitive status one year in the future. Thus, automated analysis of speech production is closely associated with current and future cognitive test performance and could provide a novel, scalable method for longitudinal tracking of cognitive health.
Collapse
Affiliation(s)
- Rachel Ostrand
- Department of Healthcare and Life Sciences, IBM Research, Yorktown Heights, NY, USA,Rachel Ostrand, Department of Healthcare and Life Sciences, IBM Research, 1101 Kitchawan Road, Yorktown Heights, NY 10598, USA.
| | - John Gunstad
- Department of Psychological Sciences & Brain Health Research Institute, Kent State University, Kent, OH, USA
| |
Collapse
|
8
|
Donnellan WJ, Warren JG. Emotional word use in informal carers of people living with dementia: A linguistic analysis of online discussion forums (Preprint). JMIR Aging 2021; 5:e32603. [PMID: 35713942 PMCID: PMC9250063 DOI: 10.2196/32603] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 02/21/2022] [Accepted: 03/25/2022] [Indexed: 12/02/2022] Open
Abstract
Background Informal dementia care is uniquely stressful and necessitates effective methods of identifying and understanding the needs of potentially at-risk carers so that they can be supported and sustained in their roles. One such method is examining carers’ engagement in online support platforms. Research has explored emotional word use on online discussion forums as a proxy for underlying emotional functioning. We are not aware of any research that has analyzed the content of posts on discussion forums specific to carers of people living with dementia in order to examine their emotional states. Objective We addressed the following research questions: (1) To what extent does emotional language use differ between carers of people living with dementia and noncarers? (2) To what extent does emotional language use differ between spousal and parental carers? (3) To what extent does emotional language use differ between current and former carers? Methods We used the Linguistic Inquiry and Word Count (LIWC) program to examine emotional word use on a UK-based online forum for informal carers of people living with dementia and a discussion forum control group. Carers were separated into different subgroups for the analysis: current and former, and spousal and parental. Results We found that carers of people living with dementia used significantly more negative, but not positive, emotion words than noncarers. Spousal carers used more emotion words overall than parental carers, specifically more negative emotion words. Former carers used more emotional words overall than current carers, specifically more positive words. Conclusions The findings suggest that informal carers of people living with dementia may be at increased risk of negative emotional states relative to noncarers. Greater negativity in spousal carers may be explained by increased caregiver burden, whereas greater positivity in former carers may be explained by functional relief of caregiving responsibilities. The theoretical/applied relevance of these findings is discussed.
Collapse
|
9
|
Khan Z, Da Silva MV, Nunez K, Kalafatis C, Nowicki S, Walker Z, Testad I, Francis P, Ballard C. Investigating the effects of impairment in non-verbal communication on neuropsychiatric symptoms and quality of life of people living with dementia. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2021; 7:e12172. [PMID: 33969179 PMCID: PMC8088100 DOI: 10.1002/trc2.12172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 02/19/2021] [Accepted: 04/23/2021] [Indexed: 11/07/2022]
Abstract
INTRODUCTION People living with dementia in nursing homes have complex needs; impairments in cognition, communication, and daily function; neuropsychiatric symptoms (NPS); and poor quality of life (QoL). The current study examines impairments in non-verbal communication as a potential driver of NPS and QoL. METHODS One hundred nursing home residents with dementia were assessed using the Emory Dyssemia Index (EDI), Neuropsychiatric Inventory Nursing Home version (NPI-NH), Quality of Life in Alzheimer's Disease (QoL-AD) at baseline, 12-, and 24-week follow-up. RESULTS The quantile regression (0.5) model indicated that impairment of non-verbal communication was independently associated with the severity of NPS (P = .001) and proxy reported QoL (P < .05), levels of agitation (P < .05), and professional caregiver burden (P < .05). DISCUSSION These results highlight a novel potential approach to improve NPS and QoL using retained elements of non-verbal communication, particularly for people with severe dementia.
Collapse
Affiliation(s)
- Zunera Khan
- Institute of PsychiatryPsychology and NeuroscienceKing's College LondonLondonUK
| | | | | | - Chris Kalafatis
- Institute of PsychiatryPsychology and NeuroscienceKing's College LondonLondonUK
| | | | | | - Ingelin Testad
- Centre for Age‐related Medicine ‐ SESAMStavanger University HospitalStavangerNorway
| | - Paul Francis
- Exeter University Medical SchoolUniversity of ExeterExeterUK
| | - Clive Ballard
- Exeter University Medical SchoolUniversity of ExeterExeterUK
| |
Collapse
|
10
|
Hovland CA, Mallett CA. Positive Aspects of Family Caregiving for Older Adults at End-of-Life: A Qualitative Examination. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2021; 17:64-82. [PMID: 33682635 DOI: 10.1080/15524256.2021.1888845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Family caregivers of older adults with dementia have significant challenges across many domains. While this role has been found to be burdensome on the caregiver, increasingly, though, there are also significant positive aspects reported by caregivers (known as the positive aspects of caregiving-PAC). This participatory qualitative study of 30 United States caregivers of family members age 65 and older who died with a dementia-related diagnoses used in-depth qualitative interviews and directed content analysis to understand the data. The study addressed a gap in the research literature and asked about caregiver's positive experiences during their family members' last weeks of life and investigated what this meant for the caregiver. Three primary themes were identified: (1) The Importance and Impact of Family Traditions/Celebrations, (2) Use of Humor in Living and the Difficult Experiences at End-of-Life, and (3) "The Gift of Caregiving." These findings are explored and reviewed in light of other research looking at the positive aspects of caregiving for caregivers taking care of persons living with dementia, finding concurrence and some uniqueness across the results. Implications of the findings for families and social work professionals are reviewed.
Collapse
Affiliation(s)
- Cynthia A Hovland
- School of Social Work, Cleveland State University, Cleveland, Ohio, USA
| | | |
Collapse
|
11
|
Yu DSF, Cheng ST, Kwok T. Developing and testing of an integrative theoretical model to predict positive aspects of caregiving among family caregivers of persons with dementia: A study protocol. J Adv Nurs 2020; 77:401-410. [PMID: 33068058 DOI: 10.1111/jan.14561] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/07/2020] [Accepted: 07/23/2020] [Indexed: 11/30/2022]
Abstract
AIMS The aim is to develop and test an integrative model based on the stress and coping paradigm and the existential paradigm, to explain positive aspects of caregiving among family caregivers of persons with dementia. DESIGN A mixed method research, comprises a longitudinal exploratory study and a descriptive qualitative study. METHODS A total of 370 family caregivers will be recruited from community elderly centres. Questionnaires on positive aspects of caregiving and its predictors (including active dementia management strategies, meaning-focused coping, and self-efficacy) and contextual factors (including social support, religiosity, continuous good dyadic relationship quality, and intrinsic motivation towards caregiving) will be administered. Positive aspects of caregiving will be reassessed six months later. Path analysis will be used to test the hypothesized model. A subsample of 30 family caregivers will be interviewed individually to explore how positive aspects of caregiving develop from the caregiving experience. Inductive thematic analysis will be used to for the qualitative data analysis. The funding was approved in January 2018. DISCUSSION Positive aspects of caregiving represents the extent to which the caregiving experience is seen as enriching an individual's life space and resulted in health protective effects. With the increasing evidence to indicate its associating factors, it is imperative to identify the theoretical model to comprehensively elucidate the process for its development. IMPACT Theoretically, this study will advance the knowledge of dementia caregiving by generating a comprehensive theory-driven predictive model to explain how positive aspects of caregiving is developed among the family caregivers. In terms of nursing practice, the findings can inform the development of intervention to improve positive aspects of caregiving and thereby acts as a catalyst to promote the paradigm shift from 'reducing limitations' to 'optimizing strengths' in family caregivers support services.
Collapse
Affiliation(s)
- Doris S F Yu
- LKS Faculty of Medicine, The University of Hong Kong, Shatin, Hong Kong
| | - Sheung-Tak Cheng
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong, Hong Kong
| | - Timothy Kwok
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
| |
Collapse
|
12
|
Swall A, Williams C, Marmstål Hammar L. The value of "us"-Expressions of togetherness in couples where one spouse has dementia. Int J Older People Nurs 2019; 15:e12299. [PMID: 31886633 PMCID: PMC7317469 DOI: 10.1111/opn.12299] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/13/2019] [Accepted: 11/29/2019] [Indexed: 11/27/2022]
Abstract
Background Living with dementia involves both illness and health, and self‐care and care from others. As most persons with dementia live in their own homes, dementia affects not only the person with the disease, but also family, commonly the partner. Research shows that spousal carers feel as though they are losing their partners since they can no longer share thoughts, feelings and experiences as a couple. Aim The aim of the study was to describe the sense of togetherness of the spouses when one spouse has dementia. Method The sample consists of 18 recorded conversations between 15 persons with dementia and their spouses. The filmed conversations were transcribed verbatim and then analysed using qualitative content analysis. Findings One overarching theme arose: Dementia preserved and challenged the value of “us.” It can be challenging for a couple in which one partner has dementia to preserve a sense of togetherness and to have the relationship they wish for. Conclusion Based on our results, we suggest that practitioners should help couples to strengthen their bond as a couple so as to maintain a sense of well‐being. Future studies should examine couplehood under differing conditions, such as long‐ versus short‐term relationships. Prior relationship quality may also be a factor that influences the sense of couplehood following a serious health challenge, such as dementia. Implication for practice When spouses were able to live together, their relationship was enriched at many levels. Their love for each other strengthened them as a unit – as an “us” – where togetherness seemed to be strong. Future studies need to examine whether the sense of couplehood varies depending on the length of the relationship (i.e., a relationship of many years or a relatively new relationship).
Collapse
Affiliation(s)
- Anna Swall
- School of Education, Health and Society, Dalarna University, Falun, Sweden
| | | | - Lena Marmstål Hammar
- School of Education, Health and Society, Dalarna University, Falun, Sweden.,Division of Nursing, Department of Neurobiology, Care Sciences, Karolinska Institute, Stockholm, Sweden.,Care and Social Welfare, School of Health, Mälardalen University, Västerås, Sweden
| |
Collapse
|
13
|
Slegers A, Filiou RP, Montembeault M, Brambati SM. Connected Speech Features from Picture Description in Alzheimer's Disease: A Systematic Review. J Alzheimers Dis 2019; 65:519-542. [PMID: 30103314 DOI: 10.3233/jad-170881] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The language changes that occur over the course of Alzheimer's disease (AD) can impact communication abilities and have profound functional consequences. Picture description tasks can be used to approximate everyday communication abilities of AD patients. As various methods and variables have been studied over the years, current knowledge about the most affected features of AD discourse in the context of picture descriptions is difficult to summarize. This systematic review aims to provide researchers with an overview of the most common areas of impairment in AD discourse as they appear in picture description tasks. Based on the 44 articles fulfilling inclusion criteria, our findings reflect a multidimensional pattern of changes in the production (speech rate), syntactic (length of utterance), lexical (word-frequency and use of pronouns), fluency (repetitions and word-finding difficulties), semantic (information units), and discourse (efficiency) domains. We discuss our findings in the light of current research and point to potential scientific and clinical uses of picture description tasks in the context of AD.
Collapse
Affiliation(s)
- Antoine Slegers
- Département de Psychologie, Université de Montréal, Montréal, QC, Canada.,Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CRIUGM), CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, QC, Canada
| | - Renée-Pier Filiou
- Département de Psychologie, Université de Montréal, Montréal, QC, Canada.,Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CRIUGM), CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, QC, Canada
| | - Maxime Montembeault
- Département de Psychologie, Université de Montréal, Montréal, QC, Canada.,Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CRIUGM), CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, QC, Canada
| | - Simona Maria Brambati
- Département de Psychologie, Université de Montréal, Montréal, QC, Canada.,Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CRIUGM), CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, QC, Canada
| |
Collapse
|
14
|
Brown A, Page TE, Daley S, Farina N, Basset T, Livingston G, Budgett J, Gallaher L, Feeney Y, Murray J, Bowling A, Knapp M, Banerjee S. Measuring the quality of life of family carers of people with dementia: development and validation of C-DEMQOL. Qual Life Res 2019; 28:2299-2310. [PMID: 31030366 PMCID: PMC6620239 DOI: 10.1007/s11136-019-02186-w] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2019] [Indexed: 11/17/2022]
Abstract
PURPOSE We aimed to address gaps identified in the evidence base and instruments available to measure the quality of life (QOL) of family carers of people with dementia, and develop a new brief, reliable, condition-specific instrument. METHODS We generated measurable domains and indicators of carer QOL from systematic literature reviews and qualitative interviews with 32 family carers and 9 support staff, and two focus groups with 6 carers and 5 staff. Statements with five tailored response options, presenting variation on the QOL continuum, were piloted (n = 25), pre-tested (n = 122) and field-tested (n = 300) in individual interviews with family carers from North London and Sussex. The best 30 questions formed the C-DEMQOL questionnaire, which was evaluated for usability, face and construct validity, reliability and convergent/discriminant validity using a range of validation measures. RESULTS C-DEMQOL was received positively by the carers. Factor analysis confirmed that C-DEMQOL sum scores are reliable in measuring overall QOL (ω = 0.97) and its five subdomains: 'meeting personal needs' (ω = 0.95); 'carer wellbeing' (ω = 0.91); 'carer-patient relationship' (ω = 0.82); 'confidence in the future' (ω = 0.90) and 'feeling supported' (ω = 0.85). The overall QOL and domain scores show the expected pattern of convergent and discriminant relationships with established measures of carer mental health, activities and dementia severity and symptoms. CONCLUSIONS The robust psychometric properties support the use of C-DEMQOL in evaluation of overall and domain-specific carer QOL; replications in independent samples and studies of responsiveness would be of value.
Collapse
Affiliation(s)
- Anna Brown
- School of Psychology, University of Kent, Canterbury, CT2 7NP, UK.
| | - Thomas E Page
- School of Psychology, University of Kent, Canterbury, CT2 7NP, UK
| | - Stephanie Daley
- Centre for Dementia Studies, Brighton and Sussex Medical School, University of Sussex, Brighton, BN1 9RY, UK
| | - Nicolas Farina
- Centre for Dementia Studies, Brighton and Sussex Medical School, University of Sussex, Brighton, BN1 9RY, UK
| | - Thurstine Basset
- Lived Experience Advisory Panel, Sussex Partnership NHS Foundation Trust, Hove, BN3 7HQ, UK
| | - Gill Livingston
- Division of Psychiatry, University College London, London, W1T 7NF, UK
| | - Jessica Budgett
- Division of Psychiatry, University College London, London, W1T 7NF, UK
| | - Laura Gallaher
- Centre for Dementia Studies, Brighton and Sussex Medical School, University of Sussex, Brighton, BN1 9RY, UK
| | - Yvonne Feeney
- Centre for Dementia Studies, Brighton and Sussex Medical School, University of Sussex, Brighton, BN1 9RY, UK
| | - Joanna Murray
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AF, UK
| | - Ann Bowling
- Health Sciences, University of Southampton, Southampton, SO17 1BJ, UK
| | - Martin Knapp
- Department of Social Policy, London School of Economics, London, CT1 3LX, UK
| | - Sube Banerjee
- Centre for Dementia Studies, Brighton and Sussex Medical School, University of Sussex, Brighton, BN1 9RY, UK
| |
Collapse
|
15
|
Garand L, Morse JQ, ChiaRebecca L, Barnes J, Dadebo V, Lopez OL, Dew MA. Problem-solving therapy reduces subjective burden levels in caregivers of family members with mild cognitive impairment or early-stage dementia: Secondary analysis of a randomized clinical trial. Int J Geriatr Psychiatry 2019; 34:957-965. [PMID: 30868641 PMCID: PMC6579659 DOI: 10.1002/gps.5095] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 03/05/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Interventions addressing burden have limited impact among long-term family caregivers. We examined whether problem-solving therapy (PST) would reduce burden levels of caregivers of individuals diagnosed with mild cognitive impairment (MCI) or early-stage dementia (AD). METHODS Caregivers (N = 73) randomly received PST or nutritional training (NT). Burden measures were assessed over 1-year post-intervention. RESULTS Relative to NT, caregivers receiving PST endorsed improved perceived burden levels over time, regardless of the type of caregiver. Distress over the care recipient's dementia-related behaviors remained low over time among MCI caregivers receiving PST, while these burden levels among MCI caregivers receiving NT rose over time. AD caregivers receiving PST endorsed reductions in these burden levels over time, while AD caregivers in the NT group endorsed higher burden levels over time. CONCLUSION PST, taught early in the caregiving trajectory, improves subjective burden levels among caregivers of family members with relatively mild cognitive deficits.
Collapse
Affiliation(s)
- Linda Garand
- Duquesne University School of Nursing, Pittsburgh, Pennsylvania, United States
| | | | - Lichun ChiaRebecca
- Duquesne University School of Nursing, Pittsburgh, Pennsylvania, United States
| | - Jennifer Barnes
- Duquesne University School of Nursing, Pittsburgh, Pennsylvania, United States
| | - Victoria Dadebo
- Duquesne University School of Pharmacy, Pittsburgh, Pennsylvania, United States
| | - Oscar L Lopez
- Departments of Neurology and Psychiatry. Director, Alzheimer Disease Research Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Mary Amanda Dew
- Departments of Psychiatry, Biostatistics, Epidemiology, Psychology and Clinical and Translational Science, University of Pittsburgh Schools of Medicine and Public Health, Pittsburgh, Pennsylvania, United States
| |
Collapse
|
16
|
Greenwood N, Smith R. Motivations for being informal carers of people living with dementia: a systematic review of qualitative literature. BMC Geriatr 2019; 19:169. [PMID: 31208351 PMCID: PMC6580594 DOI: 10.1186/s12877-019-1185-0] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 06/10/2019] [Indexed: 11/19/2022] Open
Abstract
Background Informal, often family carers play a vital role in supporting people living with dementia in the community. With ageing populations, the part played by these carers is increasing making it important that we understand what motivates them to take on the role. This systematic review aimed to identify and synthesise qualitative literature describing what motivates people to care for someone with dementia. Methods The review followed the Centre for Reviews and Dissemination (CRD) guidelines. Six electronic databases were searched from their first records until August 2018. Synthesis was narrative. Results Twenty-six studies fitting the inclusion criteria were identified. Carers described multiple, inter-related motives for caring for someone with dementia. Caring was generally described as a reflection of long-standing family relationships between carers and the care recipients, whether by blood or marriage. Commonly offered motivations included love, reciprocity, filial piety, duty and obligation. Conclusions Perhaps the most striking finding was the similarity in these motivations irrespective of gender or relationship with the care recipient. Family relationship and shared history underlay most motivations. Future research should include more longitudinal studies incorporating within study comparisons between different demographic groups to give greater confidence in identifying similarities and differences between demographic groups.
Collapse
Affiliation(s)
- Nan Greenwood
- Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, 6th Floor Hunter Wing, Cranmer Terrace, London, SW17 0RE, UK.
| | - Raymond Smith
- Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, 6th Floor Hunter Wing, Cranmer Terrace, London, SW17 0RE, UK
| |
Collapse
|
17
|
Coping with Cognitive Impairment in People with Parkinson's Disease and Their Carers: A Qualitative Study. PARKINSONS DISEASE 2018; 2018:1362053. [PMID: 29850013 PMCID: PMC5911314 DOI: 10.1155/2018/1362053] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 01/22/2018] [Indexed: 11/17/2022]
Abstract
Cognitive impairment is common in Parkinson's disease (PD). However, the psychosocial impact of living and coping with PD and cognitive impairment in people with PD and their carers have not been explored. This paper draws on a qualitative study that explores the subjective impact of cognitive impairment on people with PD and their carers. Thirty-six one-to-one interviews were completed; people with PD were from three groups: normal cognition, mild cognitive impairment, and dementia. Data collection and analysis were iterative, and verbatim transcripts were analysed using thematic analysis. Themes were interpreted in consultation with coping and adaptation theory. The analysis revealed four main themes: threats to identity and role, predeath grief and feelings of loss in carers, success and challenges to coping in people with PD, and problem-focused coping and finding meaning in caring. Our data highlight how cognitive impairment can threaten an individual's self-perception; the ostensible effects of cognitive impairment depended on the impact individual's perceived cognitive impairment had on their daily lives. For carers, cognitive impairment had a greater emotional impact than the physical symptoms of PD. The discussion that developed around protective factors provides possible opportunities for future interventions, such as psychological therapies to improve successful adjustment.
Collapse
|
18
|
“I Didn’t Expect to Learn as Much as I Did”: Rewards of Caregiving in Young Adulthood. JOURNAL OF ADULT DEVELOPMENT 2018. [DOI: 10.1007/s10804-018-9284-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
19
|
Potier F, Degryse JM, de Saint-Hubert M. Impact of caregiving for older people and pro-inflammatory biomarkers among caregivers: a systematic review. Aging Clin Exp Res 2018; 30:119-132. [PMID: 28474314 DOI: 10.1007/s40520-017-0765-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 04/20/2017] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Evidence suggests that providing care for an older loved one may present a risk to the health of the caregiver. To understand the link between the psychosocial stress of caregiving and damage to the health of caregivers, numerous studies have assessed the presence of inflammatory biomarkers among caregivers. These biomarkers are measured to understand the relationships between the social stress of caregiving and the health of caregivers. OBJECTIVE To provide a complete summary of the current literature regarding the most clinically relevant pro-inflammatory biomarkers associated with caregiving. METHODS We searched articles in MEDLINE and EMBASE from January 1980 to 30 April 2016 for all studies that assessed biomarkers (cortisol, interleukin-6 and c-reactive protein) among caregivers of community-dwelling older persons. The quality of the selected studies was assessed by two reviewers using the STROBE or CONSORT checklist. RESULTS Twenty-four studies were included. Most of the studies were cross-sectional and focused on dementia caregiving. Increases in biomarkers were associated with problems such as disturbed sleep, burden or pain and caregiving characteristics, including daily stressors and the duration of caregiving. Cognitive-behavioural therapy and participation in leisure activities were associated with significantly lower levels of cortisol and IL-6, respectively. DISCUSSION We found little evidence concerning the association between caregiving status and biomarkers of stress and inflammation. We discuss potential sources of bias and suggest some directions for further research. This stress model can be expanded by taking into account the positive aspects of caregiving and the potential resources of caregivers.
Collapse
Affiliation(s)
- Florence Potier
- Department of Geriatrics, Centre Hospitalier Universitaire Université Catholique de Louvain Namur, 1, rue Dr G. Therasse, Mont-Godinne, 5530, Namur, Belgium.
- Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium.
| | - Jean-Marie Degryse
- Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Marie de Saint-Hubert
- Department of Geriatrics, Centre Hospitalier Universitaire Université Catholique de Louvain Namur, 1, rue Dr G. Therasse, Mont-Godinne, 5530, Namur, Belgium
- Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
| |
Collapse
|
20
|
Ennis L, Mansell W, McEvoy P, Tai S. A systematic scoping review and synthesis of dementia and communication theory. DEMENTIA 2017; 18:2261-2281. [PMID: 29216743 DOI: 10.1177/1471301217744069] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aim This review considers the theoretical literature concerning communication between a person with dementia and a person without dementia. Methods Theoretical accounts of communication between a person with dementia and a person without dementia were identified through database searches, hand searching of reference lists and contacting experts in the topic area. Results Twenty-one articles were included in the final review, yielding 18 different theoretical accounts of communication in the context of dementia. Thematic synthesis showed that four categories could account for the majority of the material described in these theories, even though they were derived from very different perspectives. These categories were mutuality, personhood, anxiety reduction and environmental considerations. Discussion The four categories identified in the thematic synthesis were reminiscent of Kitwood’s theory of person-centred dementia care. Different interpretations of this finding are considered. Most theoretical accounts focused on the relational aspects of communication. This meant that societal and individual accounts of communication in the context of dementia were relatively impoverished in terms of theory. Conclusions There is widespread agreement regarding the important components of good quality communication in the context of dementia. This suggests exciting opportunities for collaboration between apparently disparate bodies of literature. Individual and societal accounts of communication in the context of dementia are relatively neglected and would benefit from more research.
Collapse
|
21
|
Romeo R, Knapp M, Salverda S, Orrell M, Fossey J, Ballard C. The cost of care homes for people with dementia in England: a modelling approach. Int J Geriatr Psychiatry 2017; 32:1466-1475. [PMID: 27911013 DOI: 10.1002/gps.4637] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 10/29/2016] [Accepted: 11/08/2016] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To examine the cost of care for people with dementia in institutional care settings, to understand the major cost drivers and to highlight opportunities for service development. METHODS Data on 277 residents with dementia in 16 UK residential or nursing homes were collected. We estimated care and support costs and fitted models to the data. Sensitivity analyses were also conducted. RESULTS Care home residents cost £792 weekly: 95% of the costs accounted for by direct fees. Hospital contacts contributed the largest proportion of the additional costs. Having an established diagnosis of dementia (b = 0.070; p < 0.05) was associated with higher costs. No association was found between cost and needs (b = -0.002; p = 0.818). CONCLUSION The absence of an association between cost and needs emphasizes the importance of a more needs-based costing system which could result in clinical and economic advantages. Copyright © 2016 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Renee Romeo
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Martin Knapp
- London School of Economics and Political Science, London, UK
| | - Suzanne Salverda
- Department of Health Economics (Modelling and Simulation), Evidera, London, UK
| | - Martin Orrell
- Institute of Mental Health, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Jane Fossey
- Oxford Health NHS Foundation Trust, Fulbrook Centre, Oxford, UK.,Department of Psychiatry, University of Oxford, UK
| | - Clive Ballard
- Executive Dean of Medicine, University of Exeter, London, UK
| |
Collapse
|
22
|
Yu DSF, Cheng ST, Wang J. Unravelling positive aspects of caregiving in dementia: An integrative review of research literature. Int J Nurs Stud 2017; 79:1-26. [PMID: 29128685 DOI: 10.1016/j.ijnurstu.2017.10.008] [Citation(s) in RCA: 211] [Impact Index Per Article: 30.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 10/12/2017] [Accepted: 10/13/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Family caregiving is the crucial informal care resource to lessen the burdens associated with dementia. Research in this field has focused on reducing the caregiver's burden, but little attention has been given to promoting the positive aspects of caregiving. OBJECTIVES To conduct a systematic critical review of research on the nature of positive aspects of caregiving, and the factors predicting this phenomenon among family caregivers of dementia patients, with the ultimate purpose of gaining insights to explain how and why it emerges. REVIEW METHODS A systematic search of the literature was undertaken in the databases OvidMedline, CINAHL, PsycINFO, Web of Science and Scopus, using the keywords 'care* AND Alzheimer OR dementia AND 'positive aspect' OR 'positive experience' OR 'positive perceptions' OR reward OR gain OR 'satisfaction with care*' OR 'care* satisfaction' OR benefit OR uplift OR meaning OR enjoyment OR pleasure OR growth OR hope OR gratification. The Critical Appraisal Skills Programme checklists for qualitative and cohort studies were used to evaluate data quality. Narrative data synthesis was undertaken using the five-stage Whittermore and Knafl method. RESULTS A total of 3862 articles were identified, of which 41 were included in this review. The key findings are that positive aspects of caregiving among family caregivers of dementia patients form a multi-dimensional construct which covers four key domains: a sense of personal accomplishment and gratification, feelings of mutuality in a dyadic relationship, an increase of family cohesion and functionality, and a sense of personal growth and purpose in life. By integrating the findings about the nature and conditions predicting positive aspects of caregiving, the presence of three conditions was identified as promoting the emergence of such qualities i) personal and social affirmation of role fulfilment, ii) effective cognitive emotional regulation and iii) contexts which favour finding meaning in the caregiving process. CONCLUSION The findings of this review provide insight into catalysing the paradigm shift from 'reducing stress' to 'optimising positive experience' in developing caregiving support services for dementia, and may guide future empirical study to explain this unique dimension of caregiving experience.
Collapse
Affiliation(s)
- Doris S F Yu
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong.
| | - Sheung-Tak Cheng
- Psychology and Gerontology, Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong.
| | - Jungfang Wang
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong.
| |
Collapse
|
23
|
van Knippenberg RJM, de Vugt ME, Ponds RW, Myin-Germeys I, Verhey FRJ. Dealing with Daily Challenges in Dementia (Deal-id Study): An Experience Sampling Study to Assess Caregivers' Sense of Competence and Experienced Positive Affect in Daily Life. Am J Geriatr Psychiatry 2017; 25:852-859. [PMID: 28040429 DOI: 10.1016/j.jagp.2016.10.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 07/27/2016] [Accepted: 10/28/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Positive emotions and feelings of competence seem to play an important role in the well-being of caregivers of people with dementia. Both are likely to fluctuate constantly throughout the caretaking process. Unlike standard retrospective methods, momentary assessments in daily life can provide insight into these moment-to-moment fluctuations. Therefore, in this study both retrospective and momentary assessments were used to examine the relationship between caregivers' sense of competence and their experienced positive affect (PA) in daily life. METHODS Thirty Dutch caregivers provided momentary data on PA and daily sense of competence ratings for 6 consecutive days using the experience sampling methodology. Additionally, they reported retrospectively on their sense of competence with a traditional questionnaire. RESULTS A positive association was found between retrospective and daily measured sense of competence. Caregivers reported corresponding levels of sense of competence on both measures. Both daily and retrospective sense of competence were positively associated with the experienced levels of PA. However, daily sense of competence appeared to be the strongest predictor. Regarding the variability in PA, only daily sense of competence showed a significant association, with a higher daily sense of competence predicting a more stable PA pattern. CONCLUSION This study provides support for redirecting caregiver support interventions toward enhancement of positive rather than negative experiences and focusing more on caregivers' momentary emotional experiences. Momentary assessments are a valuable addition to standard retrospective measures and provide a more comprehensive and dynamic view of caregiver functioning.
Collapse
Affiliation(s)
- Rosalia J M van Knippenberg
- Department of Psychiatry and Neuropsychology and Alzheimer Center Limburg, School for Mental Health and Neurosciences, Maastricht University, Maastricht, The Netherlands
| | - Marjolein E de Vugt
- Department of Psychiatry and Neuropsychology and Alzheimer Center Limburg, School for Mental Health and Neurosciences, Maastricht University, Maastricht, The Netherlands.
| | - Rudolf W Ponds
- Department of Psychiatry and Neuropsychology and Alzheimer Center Limburg, School for Mental Health and Neurosciences, Maastricht University, Maastricht, The Netherlands
| | - Inez Myin-Germeys
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Frans R J Verhey
- Department of Psychiatry and Neuropsychology and Alzheimer Center Limburg, School for Mental Health and Neurosciences, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
24
|
Sharp BK. Stress as Experienced by People with Dementia: An Interpretative Phenomenological Analysis. DEMENTIA 2017; 18:1427-1445. [PMID: 28599594 DOI: 10.1177/1471301217713877] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Health and social care research on stress in dementia has predominantly considered the stress experienced by family and professional carers. Focus on the person with dementia has frequently laid emphasis on the impact of stress-related behaviour on others and how such behaviour might be 'managed'. This paper describes a qualitative study which gives voice to people with dementia on the subject of stress and responds to the need for a better understanding of stress as it is experienced by people with dementia themselves. An interpretative phenomenological analysis was conducted on data collected from a purposive sample of people diagnosed with varying types of dementia from across Scotland. Discussions across five focus groups consisting of 21 participants with dementia in total generated data which was audio and video recorded, and analysed thematically. Five key themes emerged, described in the participants' own words, which were: (1) 'Something's torn, your life's torn'; (2) 'Families can bring stress'; (3) 'It's the stress of living with dementia'; (4) 'A whole new set of rules'; and (5) 'It's our lives and we'll get it under control ourselves'. These themes reflect experiences of loss, challenges to one's sense of self, relationship dynamics, living with the symptoms of dementia, learning to do things differently and establishing coping mechanisms that provide control. Study participants illustrated individual potential for adapting and coping with some of the most stressful aspects of living with dementia, challenging assumptions of inevitable fixed decline and progressive vulnerability to stress. Participants describe a process of recovery in their perceptions of self-worth, purpose and value in life following diagnosis.
Collapse
Affiliation(s)
- Barbara K Sharp
- Alzheimer Scotland, Glasgow, UK; Alzheimer Scotland Centre for Policy and Practice, University of West of Scotland, Hamilton, UK
| |
Collapse
|
25
|
Farina N, Page TE, Daley S, Brown A, Bowling A, Basset T, Livingston G, Knapp M, Murray J, Banerjee S. Factors associated with the quality of life of family carers of people with dementia: A systematic review. Alzheimers Dement 2017; 13:572-581. [DOI: 10.1016/j.jalz.2016.12.010] [Citation(s) in RCA: 143] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 12/03/2016] [Accepted: 12/21/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Nicolas Farina
- Centre for Dementia Studies Brighton and Sussex Medical School Brighton UK
| | | | - Stephanie Daley
- Centre for Dementia Studies Brighton and Sussex Medical School Brighton UK
| | - Anna Brown
- School of Psychology University of Kent Canterbury UK
| | - Ann Bowling
- Health Sciences University of Southampton Southampton UK
| | - Thurstine Basset
- Lived Experience Advisory Panel Sussex Partnership NHS Foundation Trust Hove UK
| | | | - Martin Knapp
- Department of Social Policy London School of Economics London UK
| | - Joanna Murray
- Institute of Psychiatry, Psychology & Neuroscience King's College London London UK
| | - Sube Banerjee
- Centre for Dementia Studies Brighton and Sussex Medical School Brighton UK
| |
Collapse
|
26
|
Bjørge H, Sæteren B, Ulstein ID. Experience of companionship among family caregivers of persons with dementia: A qualitative study. DEMENTIA 2016; 18:228-244. [DOI: 10.1177/1471301216666172] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We examined how caregivers experienced the influence of dementia on their relationships with afflicted family members. Family caregivers (n = 15; 11 women and four men; age 39–92 years) of people with dementia participated in semi-structured interviews. The data were analyzed according to Kvale and Brinkman. The analysis identified one overarching theme, experiences of companionship, and four subthemes, namely experiences of loss and loneliness; role change; communication alteration; and caring considerations and coping resources. The caregivers described their companionship with the family member, including warm feelings of reciprocity, as well as contradictory feelings, such as feelings of being burdened. They expressed a desire to continue caring for their relative and emphasized the positive aspects of their relationship. Knowledge about dementia, together with a good relationship with their ill family member, facilitated the caring role. These results highlight the importance of receiving information about dementia-related challenges and the implications of being a caregiver.
Collapse
Affiliation(s)
- Heidi Bjørge
- Faculty of Health Science, Department of Nursing and Health Promotion, Oslo and Akershus University College of Applied Science, Norway
| | - Berit Sæteren
- Faculty of Health Science, Department of Nursing and Health Promotion, Oslo and Akershus University College of Applied Science, Norway
| | - Ingun Dina Ulstein
- Department of Psychiatry of Old Age, Oslo University Hospital Trust, Norway; Institute of Clinical Medicine, University of Oslo, Norway
| |
Collapse
|
27
|
Potgieter JC, Heyns PM. Caring for a Spouse with Alzheimer's Disease: Stressors and Strengths. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2016. [DOI: 10.1177/008124630603600307] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study focused on the experiences of eight female participants who were responsible for the daily care of their husbands, all of whom were diagnosed with Alzheimer's disease. An essentially qualitative research approach, triangulated with certain quantitative measures, was used to identify both stressors and strengths reported by these caregivers. Results from mental health questionnaires showed that the comprehensive social, economic and health-related stressors experienced by caregivers put them at risk of developing serious mental health problems. However, qualitative data obtained from support group discussions, individual interviews and personal diaries highlighted the particular strengths that these caregivers showed and made use of during the caregiving process. These identified sources of resilience might in future contribute towards the development of a programme aimed at keeping this, and similar groups known to be prone to the development of stress-related illnesses, psychologically strong.
Collapse
Affiliation(s)
- J. C. Potgieter
- Department of Psychology, School of Psychosocial Behavioural Sciences, Faculty of Health Sciences, North-West University, Private Bag X6001, Potchefstroom, 2520, South Africa
| | - P. M. Heyns
- Department of Psychology, University of the Free State, South Africa
| |
Collapse
|
28
|
Lloyd J, Patterson T, Muers J. The positive aspects of caregiving in dementia: A critical review of the qualitative literature. DEMENTIA 2016; 15:1534-1561. [DOI: 10.1177/1471301214564792] [Citation(s) in RCA: 136] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Positive aspects of caregiving in dementia have been identified as important in understanding the experiences of carers, yet the research base lacks clear definitions of key concepts. Qualitative research explores carers’ experiences of positive aspects of caregiving in rich detail which lends itself to supporting theory development. The aim of the present review was to critically evaluate the empirical findings of qualitative studies that have explored positive aspects of caregiving in dementia. A systematic search of the literature revealed 14 studies that met this aim. Carers described multiple positive dimensions of caregiving and identified several factors that were important in supporting their positive caregiving experience. The present review evidences a solid base of understanding of the positive aspects of caregiving in dementia from which concepts and theories can be further developed. Clinical and research implications are discussed.
Collapse
Affiliation(s)
- Joanna Lloyd
- Department of Psychology and Behavioural Sciences, Coventry University, Coventry, UK
| | - Tom Patterson
- Department of Psychology and Behavioural Sciences, Coventry University, Coventry, UK
| | - Jane Muers
- Department of Psychology and Behavioural Sciences, Coventry University, Coventry, UK
| |
Collapse
|
29
|
Abstract
Interactions between six participants with a dementia syndrome were observed and recorded across an eight-week therapeutic group, using audio and video equipment. Sessions were analysed using ‘template analysis’ methodology. Three codes were used to describe participants' behaviour and discussion in the group. These described discussion of participants' experience of dementia, their responses to the group itself and ways in which participants used the group to fulfil their own needs. Subordinate codes illustrated these levels of participation. Participants offered practical and emotional support and listened, reflected and responded to others, whilst also using the group to meet their own needs. Group development was generally consistent with that of small groups for people without a dementia. The findings raise questions about the abilities that may be retained by people with a mild or moderate degree of dementia and challenge assumptions about ‘lack of insight’, and the positioning of people with a dementia as passive. The importance of providing contexts in which people with a dementia can express their abilities and reciprocate within relationships is discussed. Arguments for the efficacy of psychotherapeutic support for people with a dementia, and the inclusion of their perspectives in both research and practice are also considered.
Collapse
|
30
|
Førsund LH, Kiik R, Skovdahl K, Ytrehus S. Constructing togetherness throughout the phases of dementia: a qualitative study exploring how spouses maintain relationships with partners with dementia who live in institutional care. J Clin Nurs 2016; 25:3010-25. [PMID: 27431274 DOI: 10.1111/jocn.13320] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2016] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To explore and describe how spouses involve themselves in the relationship with their partners with dementia who live in institutional care. BACKGROUND Positive reciprocity between partners has been proven to be significant for spouses with partners living with dementia at home. However, little is known about spousal involvement after placement of a partner in an institutional setting. This subject was therefore the focus of this study. DESIGN Constructivist grounded theory was used to develop meaningful concepts considering the relational processes experienced and described by the spouses. METHODS Interviews were conducted with 15 spouses (eight women and seven men ranging in age from 64-90 years) of dementia-afflicted persons living in institutional care. Theoretical sampling, constant comparison and memo-writing guided the data collection and analysis. RESULTS The analysis showed how the spouses adopted different visiting routines to preserve continuity in their relationship throughout the phases of dementia. Three categories described how these visiting routines were used and adapted along with their partners' dementia progressions in the process of constructing togetherness: 'maintaining involvement and intimacy to preserve continuity in their relationship,' 'structuring visits to facilitate interaction and communication' and 'pursuing moments of mutuality to preserve continuity in a deteriorating relationship.' CONCLUSIONS Being involved and experiencing continuity in the relationship seemed important to the spouses after their partners' placement in institutional care. In the process of constructing togetherness, visiting routines were used to facilitate situations in which they could connect with their partners. These routines were continuously adjusted throughout the phases of dementia. RELEVANCE TO CLINICAL PRACTICE There is a need for a systematic approach to provide sufficient support to spouses throughout their partners' dementia progressions to assist their ongoing involvement.
Collapse
Affiliation(s)
- Linn Hege Førsund
- Faculty of Health Sciences, University College of Southeast Norway, Drammen, Norway. .,Department of Social Work and Health Science, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Riina Kiik
- Department of Social Work and Health Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kirsti Skovdahl
- Faculty of Health Sciences, University College of Southeast Norway, Drammen, Norway
| | - Siri Ytrehus
- The Faculty of Health Studies, Sogn og Fjordane University College, Sogndal, Norway
| |
Collapse
|
31
|
Edwards HB, Savović J, Whiting P, Leach V, Richards A, Cullum S, Cheston R. Quality of relationships as predictors of outcomes in people with dementia: a systematic review protocol. BMJ Open 2016; 6:e010835. [PMID: 27044583 PMCID: PMC4823463 DOI: 10.1136/bmjopen-2015-010835] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Serious adverse outcomes for people with dementia include institutionalisation, hospitalisation, death, development of behavioural and psychiatric symptoms, and reduced quality of life. The quality of the relationship between the person with dementia and their informal/family carer is thought to affect the risk of these outcomes. However, little is known about which aspects of relationship quality are important, or how they affect outcomes for people with dementia. METHODS AND ANALYSIS This will be a systematic review of the literature. Electronic databases MEDLINE, EMBASE, Web of Science, PsycInfo, the Cochrane Database, ALOIS and OpenGrey will be searched from inception. 2 independent reviewers will screen results for eligibility with standardised criteria. Data will be extracted for relevant studies, and information on the associations between relationship quality and dementia outcomes will be synthesised. Meta-analysis will be performed if possible to calculate pooled effect sizes. Narrative synthesis will be performed if study heterogeneity rules out meta-analysis. ETHICS AND DISSEMINATION Ethical review is not necessary as this review summarises data from previous studies. Results will be disseminated via peer-reviewed publication. Results will also be disseminated to a patient and public involvement group and an expert panel for their views on the findings and implications for future work. TRIAL REGISTRATION NUMBER CRD42015020518.
Collapse
Affiliation(s)
- Hannah B Edwards
- School of Social and Community Medicine, University of Bristol and National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West, Bristol, UK
| | - Jelena Savović
- School of Social and Community Medicine, University of Bristol and National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West, Bristol, UK
| | - Penny Whiting
- School of Social and Community Medicine, University of Bristol and National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West, Bristol, UK
| | - Verity Leach
- School of Social and Community Medicine, University of Bristol and National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West, Bristol, UK
| | - Alison Richards
- School of Social and Community Medicine, University of Bristol and National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West, Bristol, UK
| | - Sarah Cullum
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | | |
Collapse
|
32
|
Spouses' experience of living with a partner diagnosed with a dementia: a synthesis of the qualitative research. Int Psychogeriatr 2016; 28:537-56. [PMID: 26750862 DOI: 10.1017/s1041610215002239] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The majority of people diagnosed with a dementia live at home with the support of their spouse. While this situation has advantages, it brings many challenges for the spouse, particularly dealing with the emotional impact of the behavioral changes associated with the dementia. A growing body of qualitative research has focused on understanding the spousal caregiver perspective of living with a partner diagnosed with dementia. The aim of this study was to complete a synthesis of the results of published qualitative studies that have explored the spousal experience. METHOD An electronic database search of Ovid Medline, CINAHL, EMBASE, and PsychINFO from January 1980 to September 2014 was conducted. Sixteen studies met the inclusion criteria. Verbatim quotes of the participant interview data derived from these studies were collated and a thematic analysis was conducted. RESULTS Synthesis of the published data revealed five major themes. The theme of "loss of partner" was central, and around this central experience spouses described various processes: acknowledging change, being in crisis, adapting and adjusting, accepting and moving forward. CONCLUSIONS These findings provide insights into the day-to-day adjustments and experiences of spousal caregivers whilst highlighting the importance of considering the impact of cognitive decline and dementia in a social-relational context.
Collapse
|
33
|
Engel S, Reiter-Jäschke A, Hofner B. „EduKation demenz®“. Z Gerontol Geriatr 2016; 49:187-95. [DOI: 10.1007/s00391-016-1034-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 01/05/2016] [Accepted: 01/25/2016] [Indexed: 10/22/2022]
|
34
|
Butler A, Gallagher D, Gillespie P, Crosby L, Ryan D, Lacey L, Coen R, O'Shea E, Lawlor B. Frailty: a costly phenomenon in caring for elders with cognitive impairment. Int J Geriatr Psychiatry 2016; 31:161-8. [PMID: 26136186 DOI: 10.1002/gps.4306] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 04/22/2015] [Accepted: 04/28/2015] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Dementia draws on a variety of public and private resources. There is increasing pressure to define the cost components in this area to improve resource allocation and accountability. The aim of this study was to characterize frailty in a group of cognitively impaired community-dwelling elders and evaluate its relationship with cost and resource utilization. METHODS We assessed a cross-sectional, convenient sample of 115 cognitively impaired patients of age >55 years who attended the National Memory Clinic in St James' University Hospital, a Trinity College-affiliated hospital in Dublin, Ireland. Participants had a clinical diagnosis of possible Alzheimer's disease or mild cognitive impairment. Frailty was measured using the biological syndrome model. Formal health and social care costs and daily informal caregiving costs were collected and the total costs of care estimated by applying the appropriate unit cost estimate for each resource activity. Stepwise regression models were constructed to establish the factors associated with increased care costs. RESULTS Patient dependence, frailty and number of co-morbid illnesses explained 43.3% of the variance in observed daily informal care costs in dementia and cognitively impaired patients. Dependence was the sole factor retained in an optimal model explaining 19% of the variance in formal health and social care costs. CONCLUSION Frailty retained a strong association with daily informal care costs even in the context of other known risk factors for increasing care costs. Interventions that reduce frailty as well as patient dependence on others may be associated with cost savings.
Collapse
Affiliation(s)
- Aine Butler
- St James's Hospital, Mercer's Institute for Research on Ageing, Dublin, Ireland
| | - Damien Gallagher
- St James's Hospital, Mercer's Institute for Research on Ageing, Dublin, Ireland
| | - Paddy Gillespie
- School of Business and Economics, National University of Ireland Galway, Galway, Ireland
| | - Lisa Crosby
- St James's Hospital, Mercer's Institute for Research on Ageing, Dublin, Ireland
| | - Deirdre Ryan
- St James's Hospital, Mercer's Institute for Research on Ageing, Dublin, Ireland
| | | | - Robert Coen
- St James's Hospital, Mercer's Institute for Research on Ageing, Dublin, Ireland
| | - Eamon O'Shea
- Irish Centre for Social Gerontology, National University of Ireland Galway, Galway, Ireland
| | - Brian Lawlor
- St James's Hospital, Mercer's Institute for Research on Ageing, Dublin, Ireland
| |
Collapse
|
35
|
Donnellan WJ, Bennett KM, Soulsby LK. What are the factors that facilitate or hinder resilience in older spousal dementia carers? A qualitative study. Aging Ment Health 2015; 19:932-9. [PMID: 25410637 DOI: 10.1080/13607863.2014.977771] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Much is known about the factors making caring for a spouse with dementia burdensome. However, relatively little is known about factors that help some spouses become resilient. We define resilience as 'the process of negotiating, managing and adapting to significant sources of stress or trauma'. We aimed to assess whether spousal dementia carers can achieve resilience and to highlight which assets and resources they draw on to facilitate or hinder resilience, using an ecological framework . METHOD Twenty in-depth qualitative interviews with spousal carers from two carer support groups and a care home in North West England. RESULTS Eight participants were resilient and 12 were not. A resilient carer was characterised as someone who stays positive and actively maintained their relationship and loved one's former self. Resilient carers were knowledgeable and well supported by family but especially friends, with whom they shared this knowledge. They were more actively engaged with services such as respite care. CONCLUSION There is a need to move towards more ecological models of resilience. We propose that access to assets and resources is not always sufficient to facilitate resilience. Implications of these findings are discussed.
Collapse
Affiliation(s)
- Warren J Donnellan
- a Department of Psychological Sciences , University of Liverpool , Liverpool , UK
| | | | | |
Collapse
|
36
|
Banerjee S. A flying START for carers of people with dementia. Lancet Psychiatry 2014; 1:489-90. [PMID: 26361293 DOI: 10.1016/s2215-0366(14)00070-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 11/12/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Sube Banerjee
- Centre for Dementia Studies, Brighton and Sussex Medical School, University of Sussex, Brighton BN1 9RY, UK.
| |
Collapse
|
37
|
Yong ASL, Price L. The Human Occupational Impact of Partner and Close Family Caregiving in Dementia: A Meta-Synthesis of the Qualitative Research, Using a Bespoke Quality Appraisal Tool. Br J Occup Ther 2014. [DOI: 10.4276/030802214x14071472109879] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Introduction: In 2009, the United Kingdom Department of Health identified the need to assist families so that people with dementia can remain living at home. Occupational therapists could support families and their loved ones at home by understanding the human occupational impact of caregiving. This impact includes how one is influenced by values and motivated to perform activities shaped by experiences and life roles. The purpose of this review was to synthesize qualitative research related to family dementia caregiving, extrapolating information about the human occupational impact on the caregiver. The aim was to inform occupational therapy practice. Method: A search was conducted across a range of electronic databases. A quality appraisal tool was specifically developed for the study appraisal and data extraction process. Data were extracted and analysed within the Model of Human Occupation framework. Findings: Twenty studies were included in this review. Five themes emerged: adapting to dementia; staying motivated and in control; preserving occupational balance and wellbeing; gaining meaning from the caregiver role; and losses and burden. Conclusion: The human occupational impact of caregiving affects the quality and decision-making of care for families. Occupational therapists are well placed to support families through the stages of dementia.
Collapse
Affiliation(s)
- Audrey Su Lin Yong
- Advanced Occupational Therapist, Sussex Partnership NHS Foundation Trust, Eastbourne Downs and Weald Community Learning Disability Service, East Sussex
| | - Lee Price
- Principal Lecturer, University of Brighton, School of Health Sciences, Eastbourne, East Sussex
| |
Collapse
|
38
|
Balfour A. Developing therapeutic couple work in dementia care – the living together with dementia project. PSYCHOANALYTIC PSYCHOTHERAPY 2014. [DOI: 10.1080/02668734.2014.934524] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
39
|
Potential therapeutic strategies for Alzheimer's disease targeting or beyond β-amyloid: insights from clinical trials. BIOMED RESEARCH INTERNATIONAL 2014; 2014:837157. [PMID: 25136630 PMCID: PMC4124758 DOI: 10.1155/2014/837157] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Revised: 06/23/2014] [Accepted: 06/25/2014] [Indexed: 01/25/2023]
Abstract
Alzheimer's disease (AD) is a progressive neurodegenerative disorder with two hallmarks: β-amyloid plagues and neurofibrillary tangles. It is one of the most alarming illnesses to elderly people. No effective drugs and therapies have been developed, while mechanism-based explorations of therapeutic approaches have been intensively investigated. Outcomes of clinical trials suggested several pitfalls in the choice of biomarkers, development of drug candidates, and interaction of drug-targeted molecules; however, they also aroused concerns on the potential deficiency in our understanding of pathogenesis of AD, and ultimately stimulated the advent of novel drug targets tests. The anticipated increase of AD patients in next few decades makes development of better therapy an urgent issue. Here we attempt to summarize and compare putative therapeutic strategies that have completed clinical trials or are currently being tested from various perspectives to provide insights for treatments of Alzheimer's disease.
Collapse
|
40
|
Ehrlich K, Boström AM, Mazaheri M, Heikkilä K, Emami A. Family caregivers' assessments of caring for a relative with dementia: a comparison of urban and rural areas. Int J Older People Nurs 2014; 10:27-37. [PMID: 24433340 DOI: 10.1111/opn.12044] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 10/29/2013] [Indexed: 11/29/2022]
Abstract
AIM This study aimed to describe and compare urban and rural family caregivers' reactions to caring for a relative with dementia and to examine the associations between caregiving and socio-demographic factors. BACKGROUND Most studies on family caregivers' experiences caring for older people with dementia have been conducted in urban areas, and little is known about the experiences of family caregivers living in rural areas. DESIGN A cross-sectional study design was used. METHODS A total of 102 caregivers (response rate 85%) from urban (n=57) and rural (n=46) areas completed the Caregiver Reaction Assessment (CRA) Scale and demographic information. Data were analysed using descriptive and inferential statistics and linear regression models. RESULTS Overall, family caregivers reported high satisfaction even if they also reported high impact on finances and daily living. Rural caregivers experienced a higher negative impact on finances but reported more support from family members than urban caregivers. Age, gender and relationship were significantly associated with four of the five CRA subscales. Educational level and geographical setting were not associated with any of the CRA subscales. CONCLUSIONS The results of the study raise questions about the financial situation of older female caregivers and on the expectations of built-in family structures in urban and rural areas. Further studies focusing on the meaning and constitution of a family would help us to understand how these factors influence family caregiving both in rural and urban areas. IMPLICATIONS FOR PRACTICE To provide person-centred care and to avoid stereotyped caregiving, a better picture of traditions in family caregiving can improve a more differentiated and appropriate professional caregiving pliable with the cultural context in which it is carried out.
Collapse
Affiliation(s)
- Kethy Ehrlich
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute, Huddinge, Sweden; Department of Geriatric Medicine, Danderyd Hospital, Stockholm, Sweden
| | | | | | | | | |
Collapse
|
41
|
Savundranayagam MY, Orange JB. Matched and mismatched appraisals of the effectiveness of communication strategies by family caregivers of persons with Alzheimer's disease. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2014; 49:49-59. [PMID: 24372885 DOI: 10.1111/1460-6984.12043] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Communication problems stemming from Alzheimer's disease (AD) often result in misunderstandings that can be linked with problem behaviours and increased caregiver stress. Moreover, these communication breakdowns also can result either from caregivers' use of ineffective communication strategies, which paradoxically are perceived as helpful, or can occur as a result of not using effective communication strategies that are perceived as unhelpful. AIMS The two primary aims were to determine the effectiveness of strategies used to resolve communication breakdowns and to examine whether caregivers' ratings of strategy effectiveness were consistent with evidence from video-recorded conversations and with effective communication strategies documented in the literature. METHODS & PROCEDURES Twenty-eight mealtime conversations were recorded using a sample of 15 dyads consisting of individuals with early, middle and late clinical-stage AD and their family caregivers. Conversations were analysed using the trouble-source repair paradigm to identify the communication strategies used by caregivers to resolve breakdowns. Family caregivers also rated the helpfulness of communication strategies used to resolve breakdowns. Analyses were conducted to assess the overlap or match between the use and appraisals of the helpfulness of communication strategies. OUTCOMES & RESULTS Matched and mismatched appraisals of communication strategies varied across stages of AD. Matched appraisals by caregivers of persons with early-stage AD were observed for 68% of 22 communication strategies, whereas caregivers of persons with middle- and late-stage AD had matched appraisals for 45% and 55% of the strategies, respectively. Moreover, caregivers of persons with early-stage AD had matched appraisals over and above making matched appraisals by chance alone, compared with caregivers of persons in middle- and late-stage AD. CONCLUSIONS & IMPLICATIONS Mismatches illustrate the need for communication education and training, particularly to establish empirically derived evidence-based communication strategies over the clinical course of AD.
Collapse
|
42
|
Russell P, Banerjee S, Watt J, Adleman R, Agoe B, Burnie N, Carefull A, Chandan K, Constable D, Daniels M, Davies D, Deshmukh S, Huddart M, Jabin A, Jarrett P, King J, Koch T, Kumar S, Lees S, Mir S, Naidoo D, Nyame S, Sasae R, Sharma T, Thormod C, Vedavanam K, Wilton A, Flaherty B. Improving the identification of people with dementia in primary care: evaluation of the impact of primary care dementia coding guidance on identified prevalence. BMJ Open 2013; 3:e004023. [PMID: 24366579 PMCID: PMC3884610 DOI: 10.1136/bmjopen-2013-004023] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Revised: 10/21/2013] [Accepted: 11/20/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Improving dementia care is a policy priority nationally and internationally; there is a 'diagnosis gap' with less than half of the cases of dementia ever diagnosed. The English Health Department's Quality and Outcomes Framework (QOF) encourages primary care recognition and recording of dementia. The codes for dementia are complex with the possibility of underidentification through miscoding. We developed guidance on coding of dementia; we report the impact of applying this to 'clean up' dementia coding and records at a practice level. DESIGN The guidance had five elements: (1) identify Read Codes for dementia; (2) access QOF dementia register; (3) generate lists of patients who may have dementia; (4) compare search with QOF data and (5) review cases. In each practice, one general practitioner conducted the exercise. The number of dementia QOF registers before and after the exercise was recorded with the hours taken to complete the exercise. SETTING London primary care. PARTICIPANTS 23 (85%) of 27 practices participated, covering 79 312 (19 562 over 65 s) participants. OUTCOMES The number on dementia QOF registers; time taken. RESULTS The number of people with dementia on QOF registers increased from 1007 to 1139 (χ(2)=8.17, p=0.004), raising identification rates by 8.8%. It took 4.7 h per practice, on an average. CONCLUSIONS These data demonstrate the potential of a simple primary care coding exercise, requiring no specific training, to increase the dementia identification rate. An improvement of 8.8% between 2011 and 2012 is equivalent to that of the fourth most improved primary care trust in the UK. In absolute terms, if this effects were mirrored across the UK primary care, the number of cases with dementia identified would rise by over 70 000 from 364 329 to 434 488 raising the recognition rate from 46% to 54.8%. Implementing this exercise appears to be a simple and effective way to improve recognition rates in primary care.
Collapse
Affiliation(s)
- Paul Russell
- General Practice, Waltham Forest CCG, London, UK
| | - Sube Banerjee
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Tamar Koch
- General Practice, Islington CCG, London, UK
| | - Sanjoy Kumar
- General Practice, Waltham Forest CCG, London, UK
| | | | - Sinan Mir
- General Practice, Hammersmith and Fulham CCG, London, UK
| | | | | | | | | | | | | | | | - Breda Flaherty
- Division of Medical Education, Brighton and Sussex Medical School, Brighton, UK
| |
Collapse
|
43
|
Robinson OC. Sampling in Interview-Based Qualitative Research: A Theoretical and Practical Guide. QUALITATIVE RESEARCH IN PSYCHOLOGY 2013. [DOI: 10.1080/14780887.2013.801543] [Citation(s) in RCA: 602] [Impact Index Per Article: 54.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
44
|
Mulhern B, Rowen D, Brazier J, Smith S, Romeo R, Tait R, Watchurst C, Chua KC, Loftus V, Young T, Lamping D, Knapp M, Howard R, Banerjee S. Development of DEMQOL-U and DEMQOL-PROXY-U: generation of preference-based indices from DEMQOL and DEMQOL-PROXY for use in economic evaluation. Health Technol Assess 2013; 17:v-xv, 1-140. [PMID: 23402232 DOI: 10.3310/hta17050] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Dementia is one of the most common and serious disorders in later life and the economic and personal cost of caring for people with dementia is immense. There is a need to be able to evaluate interventions in dementia using cost-effectiveness analyses, but the generic preference-based measures typically used to measure effectiveness do not work well in dementia. Existing dementia-specific measures can effectively measure health-related quality of life but in their current form cannot be used directly to inform cost-effectiveness analysis using quality-adjusted life-years as the measure of effectiveness. OBJECTIVES The aim was to develop two brief health-state classifications, one from DEMQOL and one from DEMQOL-Proxy, to generate health states amenable to valuation. These classification systems consisted of items taken from DEMQOL and DEMQOL-Proxy so they can be derived from any study that has used these instruments. DATA SOURCES In the first stage of the study we used a large, clinically representative sample aggregated from two sources: a sample of patients and carers attending a memory service in south London and a sample of patients and carers from other community services in south London. This included 644 people with a diagnosis of mild/moderate dementia and 689 carers of those with mild/moderate dementia. For the valuation study, the general population sample of 600 respondents was drawn to be representative of the UK general population. Households were sampled in urban and rural areas in northern England and balanced to the UK population according to geodemographic profiles. In the patient/carer valuation study we interviewed a sample of 71 people with mild dementia and 71 family carers drawn from a memory service in south London. Finally, the instruments derived were applied to data from the HTA-SADD (Study of Antidepressants for Depression in Dementia) trial. REVIEW METHODS This was a complex multiphase study with four linked phases: phase 1 - derivation of the health-state classification system; phase 2 - general population valuation survey and modelling to produce values for every health state; phase 3 - patient/carer valuation survey; and phase 4 - application of measures to trial data. RESULTS All four phases were successful and this report details this development process leading to the first condition-specific preference-based measures in dementia, an important new development in this field. LIMITATIONS The first limitation relates to the lack of an external data set to validate the DEMQOL-U and DEMQOL-Proxy-U classification systems. Throughout the development process we have made decisions about which methodology to use. There are other valid techniques that could be used and it is possible to criticise the choices that we have made. It is also possible that the use of a mild to moderate dementia sample has resulted in classification systems that do not fully reflect the challenges of severe dementia. CONCLUSION The results presented are sufficiently encouraging to recommend that the DEMQOL instruments be used alongside a generic measure such as the European Quality of Life-5 Dimensions (EQ-5D) in future studies of interventions in dementia as there was evidence that they can be more sensitive for patients at the milder end of disease and some limited evidence that the person with dementia measure may be able to reflect deterioration. FUNDING The National Institute for Health Research Health Technology Assessment programme.
Collapse
Affiliation(s)
- B Mulhern
- Health Economics and Decision Science, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Banerjee S, Hellier J, Romeo R, Dewey M, Knapp M, Ballard C, Baldwin R, Bentham P, Fox C, Holmes C, Katona C, Lawton C, Lindesay J, Livingston G, McCrae N, Moniz-Cook E, Murray J, Nurock S, Orrell M, O'Brien J, Poppe M, Thomas A, Walwyn R, Wilson K, Burns A. Study of the use of antidepressants for depression in dementia: the HTA-SADD trial--a multicentre, randomised, double-blind, placebo-controlled trial of the clinical effectiveness and cost-effectiveness of sertraline and mirtazapine. Health Technol Assess 2013; 17:1-166. [PMID: 23438937 DOI: 10.3310/hta17070] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Depression is common in dementia, causing considerable distress and other negative impacts. Treating it is a clinical priority, but the evidence base is sparse and equivocal. This trial aimed to determine clinical effectiveness of sertraline and mirtazapine in reducing depression 13 weeks post randomisation compared with placebo. DESIGN Multicentre, parallel-group, double-blind placebo-controlled randomised controlled trial of the clinical effectiveness of sertraline and mirtazapine with 13- and 39-week follow-up. SETTING Nine English old-age psychiatry services. PARTICIPANTS A pragmatic trial. Eligibility: probable or possible Alzheimer's disease (AD), depression (4+ weeks) and Cornell Scale for Depression in Dementia (CSDD) score of 8+. EXCLUSIONS clinically too critical (e.g. suicide risk); contraindication to medication; taking antidepressants; in another trial; and having no carer. INTERVENTIONS (1) Sertraline; (2) mirtazapine; and (3) placebo, all with normal care. Target doses: 150 mg of sertraline or 45 mg of mirtazapine daily. MAIN OUTCOME MEASURES OUTCOME CSDD score. Randomisation: Allocated 1 : 1 : 1 through Trials Unit, independently of trial team. Stratified block randomisation by centre, with randomly varying block sizes; computer-generated randomisation. Blinding: Double blind: medication and placebo identical for each antidepressant. Referring clinicians, research workers, participants and pharmacies were blind. Statisticians blind until analyses completed. RESULTS Numbers randomised: 326 participants randomised (111 placebo, 107 sertraline and 108 mirtazapine). OUTCOME Differences in CSDD at 13 weeks from an adjusted linear-mixed model: mean difference (95% CI) placebo-sertraline 1.17 (-0.23 to 2.78; p = 0.102); placebo-mirtazapine 0.01 (-1.37 to 1.38; p = 0.991); and mirtazapine-sertraline 1.16 (-0.27 to 2.60; p = 0.112). HARMS Placebo group had fewer adverse reactions (29/111, 26%) than sertraline (46/107, 43%) or mirtazapine (44/108, 41%; p = 0.017); 39-week mortality equal, five deaths in each group. CONCLUSIONS This is a trial with negative findings but important clinical implications. The data suggest that the antidepressants tested, given with normal care, are not clinically effective (compared with placebo) for clinically significant depression in AD. This implies a need to change current practice of antidepressants being the first-line treatment of depression in AD. From the data generated we formulated the following recommendations for future work. (1) The secondary analyses presented here suggest that there would be value in carrying out a placebo-controlled trial of the clinical effectiveness and cost-effectiveness of mirtazapine in the management of Behavioural and Psychological Symptoms of Dementia. (2) A conclusion from this study is that it remains both ethical and essential for trials of new medication for depression in dementia to have a placebo arm. (3) Further research is required to evaluate the impact that treatments for depression in people with dementia can have on their carers not only in terms of any impacts on their quality of life, but also the time they spend care-giving. (4) There is a need for research into alternative biological and psychological therapies for depression in dementia. These could include evaluations of new classes of antidepressants (such as venlafaxine) or antidementia medication (e.g. cholinesterase inhibitors). (5) Research is needed to investigate the natural history of depression in dementia in the community when patients are not referred to secondary care services. (6) Further work is needed to investigate the cost modelling results in this rich data set, investigating carer burden and possible moderators to the treatment effects. (7) There is scope for reanalysis of the primary outcome in terms of carer and participant CSDD results.
Collapse
Affiliation(s)
- S Banerjee
- Brighton and Sussex Medical School, BSMS Teaching Building, University of Sussex, Brighton, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Chang WZD, Bourgeois M. Effects of Memory Aids on the Conversations of Elderly Chinese Persons. ACTA ACUST UNITED AC 2013. [DOI: 10.1179/136132812804731767] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
47
|
Large S, Slinger R. Grief in caregivers of persons with Alzheimer's disease and related dementia: a qualitative synthesis. DEMENTIA 2013; 14:164-83. [PMID: 24339095 DOI: 10.1177/1471301213494511] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article provides a meta-synthesis of studies focusing on grief in caregivers of people with Alzheimer's disease or related dementia. Through a systematic search, 11 articles met the inclusion criteria that care receivers had a diagnosis of Alzheimer's disease or related dementia, caregivers were informal caregivers, and the study focused on caregiver grief. The meta-synthesis followed a meta-ethnography approach based on reciprocal translation. Six themes were identified, namely challenges of caregiving, losses and changes in the relationship, the role of dementia in grief, striving despite dementia, utilising social support and death as a relief from caregiving. Themes are discussed within an integrated framework showing the connected relationships between themes. The devised framework of themes illustrates the general experience of caregiver grief and can be used to devise specific, targeted interventions to help caregivers to identify and work through their grief.
Collapse
|
48
|
Social support and six-month outcome among elderly patients hospitalised via emergency department: The SAFES Cohort Study. Eur Geriatr Med 2013. [DOI: 10.1016/j.eurger.2013.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
49
|
de Vugt ME, Verhey FRJ. The impact of early dementia diagnosis and intervention on informal caregivers. Prog Neurobiol 2013; 110:54-62. [PMID: 23689068 DOI: 10.1016/j.pneurobio.2013.04.005] [Citation(s) in RCA: 139] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Revised: 03/27/2013] [Accepted: 04/04/2013] [Indexed: 11/17/2022]
Abstract
In the absence of disease modifying therapies for dementia, the question rises what the benefits are of an early dementia diagnosis for patients and their caregivers. This paper reviews the caregiver perspective in dementia and addresses the question what the consequences are of promoting earlier dementia diagnosis. An early diagnosis offers caregivers the opportunity to advance the process of adaptation to the caregiver role. Caregivers that are better able to adapt to the changes that characterize dementia, feel more competent to care and experience less psychological problems. However, drawbacks of an early diagnosis may outweigh the benefits if people are left with a diagnosis but little support. There is convincing evidence that multicomponent caregiver interventions in the mild to moderate dementia stages are effective to improve caregiver well-being and delay institutionalization. However, there still exist a gap between the improved possibilities to diagnose people in the predementia stage versus the scarce knowledge on intervention effects in this very early stage. This stresses the urgent need for more research on early caregiver interventions that enhance role adaptation and that include long-term follow-up and cost-effectiveness evaluation. Early interventions may help caregivers in anticipating and accepting the future care role and transitions, with the increased possibility that caregivers can still involve the patient in the decision making process. As levels of stress and burden are still low in the predementia stage it provides excellent opportunities to empower the resources of caregivers.
Collapse
Affiliation(s)
- Marjolein E de Vugt
- School for Mental Health and Neuroscience, Alzheimer Centre Limburg, Maastricht University Medical Centre, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
| | | |
Collapse
|
50
|
Grose J, Frost J, Richardson J, Skirton H. Using meta-ethnography to understand the emotional impact of caring for people with increasing cognitive impairment. Nurs Health Sci 2013; 15:113-23. [PMID: 23305557 DOI: 10.1111/j.1442-2018.2012.00727.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 05/31/2012] [Accepted: 06/28/2012] [Indexed: 11/25/2022]
Abstract
The majority of people with degenerative neurological conditions are cared for within their own families. Cognitive impairment can be a significant and increasing symptom of these conditions. In this article we report how a team of experienced researchers carried out a meta-ethnography of qualitative research articles focusing on the impact of caring for a loved one with cognitive impairment. We followed the seven-step process outlined by Noblit and Hare. Synthesized findings from 31 papers suggest emotional impact is complex and uncertain and varies from day to day. The benefit of using meta-ethnography is that the results represent a larger sample size and a reinterpretation of multiple studies can hold greater application for practice. The results of this study offer an opportunity for nurses to be aware of both the positive and negative sides of caring and being cared for. This knowledge can be used to discuss with patients and carers how best to prepare for decreasing cognition and still maintain a worthwhile quality of life.
Collapse
Affiliation(s)
- Jane Grose
- Faculty of Health, Education and Society, Plymouth University, Devon, UK.
| | | | | | | |
Collapse
|