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Balvert SCE, Del Sordo GC, Milders MV. The efficacy of dyadic interventions for community-dwelling people with dementia and their caregivers: A systematic review and meta-analysis. Ageing Res Rev 2024; 96:102258. [PMID: 38479479 DOI: 10.1016/j.arr.2024.102258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 03/01/2024] [Accepted: 03/03/2024] [Indexed: 03/24/2024]
Abstract
Most people with dementia live at home and depend on informal caregivers for care. Both caregivers and persons with dementia can experience negative psychological and behavioural effects as the disease progresses. Non-pharmacological interventions can alleviate these effects and dyadic interventions, involving both caregiver and person with dementia, may be particularly effective. In this systematic review, the effect of dyadic interventions involving community-dwelling persons with dementia and their informal caregivers was researched. This article is an update of a review of dyadic interventions up to 2012 (Van't Leven et al., 2013). Twenty-two randomized controlled trials published between January 2012 and March 2023 met eligibility criteria, representing 3857 dyads. Results of a meta-analysis showed no overall intervention effect. Thirteen studies reported positive intervention effects, 9 studies reported no intervention effects. Intervention content and participant characteristics and knowledge of the disease varied widely between the studies reviewed. Effective interventions were those that matched activities for the person with dementia to their interests and abilities and educating the caregiver about dementia and communication. Interventions of moderate length (3-4 months) tended to be more effective than longer or shorter interventions. Future studies should further explore the factors contributing to the effects of dyadic interventions.
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Affiliation(s)
- Sanne C E Balvert
- Department of Clinical Neuropsychology, VU University Amsterdam, van der Boechorststraat 7, Amsterdam 1081 BT, the Netherlands
| | - Giovanna C Del Sordo
- New Mexico State University, Psychology Department, 1780 E University Ave, Las Cruces, NM 88003, USA
| | - Maarten V Milders
- Department of Clinical Neuropsychology, VU University Amsterdam, van der Boechorststraat 7, Amsterdam 1081 BT, the Netherlands.
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Bonds Johnson K, Higgins M, Epps F, Brewster GS, Alexander K, Hepburn K. Tele-Savvy Outcomes of Non-Hispanic Black American and White Caregivers. THE GERONTOLOGIST 2024; 64:gnad044. [PMID: 37067896 PMCID: PMC10733122 DOI: 10.1093/geront/gnad044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Indexed: 04/18/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Tele-Savvy is a synchronous/asynchronous psychoeducation program for caregivers of community-dwelling persons living with Alzheimer's disease and related dementias (ADRD) designed to increase caregivers' competence and confidence (mastery) in caregiving. Its overall efficacy was tested in a randomized controlled trial. RESEARCH DESIGN AND METHODS This secondary data analysis examined the caregiver mastery and psychological health (i.e., perceived stress, depressive symptoms, and burden) outcome of 153 non-Hispanic Black American and White caregivers (31 non-Hispanic Black American and 122 White caregivers) from baseline to 6 months postintervention. Given the difference in the sample sizes of Black and White caregivers, a descriptive post hoc subgroup analysis was conducted of 21 non-Hispanic Black American and 20 White adult children and grandchildren caregivers. RESULTS In the overall sample, Black American caregivers demonstrated higher levels of mastery and lower levels of distress than White caregivers at baseline and across all time points. Over time, White caregivers, but not Black American caregivers, experienced significantly improved levels of mastery and significantly lowered levels of depression. Within the subgroup analysis, except for a moderate effect size in the management of situation scores over time among Black American adult children caregivers, similar results were obtained. DISCUSSION AND IMPLICATIONS The findings highlight the strengths and shortcomings of the Tele-Savvy program in improving caregiver mastery and reducing negative psychological health outcomes. Intentionally tailoring the Tele-Savvy program to certain racial and caregiving groups may hold promise in meeting the needs of more ADRD caregivers. CLINICAL TRIAL REGISTRATION NCT03033875.
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Affiliation(s)
| | - Melinda Higgins
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Fayron Epps
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Glenna S Brewster
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Karah Alexander
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Kenneth Hepburn
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
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Berkemer E, Bär M. [Outreach dyadic support program for persons with dementia and relatives by dementia nursing experts: qualitative results from a pilot study in rural areas]. Z Gerontol Geriatr 2023; 56:561-566. [PMID: 36112214 PMCID: PMC10589127 DOI: 10.1007/s00391-022-02106-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND AND OBJECTIVE The quality of life of persons with dementia and their relatives crucially depends on whether they succeed in establishing a stable home care situation. In this study, an outreach dyadic support program for persons with dementia and relatives was carried out by dementia nursing experts (DNE) for the first time. The aim of the nurse-led dyadic support program focuses on the lifeworld benefits for dyads and the benefits towards coping with dementia and crisis management in their home environment. Does it turn out to be a suitable offer for dyads in rural areas? Could the program originally developed for therapists be carried out by DNE? METHODS Using an interview guideline, 12 episodic interviews were conducted with dyads and additionally two focus groups (n = 5 relatives and n = 2 dementia nursing experts). The interviews were recorded, transcribed verbatim and analyzed using content analysis. RESULTS The results of a qualitative evaluation with a multiperspective approach are presented. The participating dyadic benefit depends on several factors, e.g. dyadic relationship, stage of dementia, in different ways. The outreach approach is therefore important. The dyadic setting is mostly seen as helpful, a need for additional one-to-one meetings is desired. The program can be used by DNE, the shift can even be an advantage. It is questionable whether temporary support lasts over the entire course of the disease. CONCLUSION The results show that home care situations can be improved for dyads through the nurse-led program, they can even benefit by DNE. The possibility of one-to-one meetings and follow-up care should be given. The outreach approach is crucial for rural areas. The results point to the need for more outreach care for persons with dementia in order to reduce stress and strengthen identity and action resources.
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Affiliation(s)
- Esther Berkemer
- Fachbereich Sozial- und Gesundheitswesen, Hochschule für Wirtschaft und Gesellschaft, Ernst-Boehe-Str. 4, 67059, Ludwigshafen am Rhein, Deutschland.
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Huggins M, Pesut B, Puurveen G. Interventions for Caregivers of Older Adults with Dementia Living in the Community: A Rapid Review of Reviews. Can J Aging 2023; 42:425-433. [PMID: 36799030 DOI: 10.1017/s0714980823000016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
This rapid review of systematic reviews examines non-professional interventions that have been implemented to support family caregivers of older adults with dementia who are living in the community. There is a robust body of empirical literature examining such interventions for family caregivers; therefore, this rapid review includes only systematic reviews. MEDLINE, CINAHL, and EMBASE databases were searched from September 2020 to December 2020, and 19 systematic reviews were selected for a full review. Psychosocial, psychoeducational, social support, and multicomponent interventions consistently show positive impacts on a variety of outcomes. The evidence suggests that multicomponent interventions that are tailored to the needs of individual caregivers are the most impactful interventions and should be utilized in future program development. The most effective combination of interventions is unknown and warrants further investigation. However, the repeated success of psychoeducational, psychosocial, and social support interventions suggests that when used together, they may be a successful combination that contributes to positive impacts on caregivers. This multicomponent intervention should be flexible, as interventions are most effective when they are tailored to the individual needs of caregivers and adapted over time as the needs of the caregiver and person living with dementia change with disease progression.
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Affiliation(s)
- Madison Huggins
- Health Ethics and Diversity Lab, University of British Columbia Okanagan, School of Nursing Asc, Kelowna, BC, Canada
| | - Barbara Pesut
- Palliative and End of Life Care, University of British Columbia Okanagan, School of Nursing Asc, Kelowna, BC, Canada
| | - Gloria Puurveen
- Health Ethics and Diversity Lab, University of British Columbia Okanagan, School of Nursing Asc, Kelowna, BC, Canada
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Novais T, Vanhems E, Coste MH, Krolak-Salmon P. Educational care for patients with Alzheimer's disease and their caregivers in France: A mapping proposal. PATIENT EDUCATION AND COUNSELING 2023; 111:107692. [PMID: 36917885 DOI: 10.1016/j.pec.2023.107692] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/08/2023] [Accepted: 03/01/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES To formalize a proposal for educational approach for patients with Alzheimer's disease and related dementias (ADRD) and caregivers across existing diagnosis/care organizations and structures. METHODS Three steps:1/ identifying the existing organizations and structures that could be involved in educational care; 2/ identifying the main educational skills of interest for ADRD patients and caregivers; 3/ conducting a survey among these organizations and structures to achieve a mapping proposal of educational care. RESULTS Nine organizations and structures, and 29 educational skills of interest were identified for the step 3 survey. Overall, 423 organizations/structures completed the step 3 survey. Twelve of 29 educational skills were covered by 50% of organizations/structures included. The most covered skills were "Maintaining autonomy in daily living activities", "coping with cognitive disorders", and "coping with behavioral disorders". CONCLUSIONS A mapping of educational care that could be provided by the different structures and organizations involved in the ADRD care pathway was proposed regarding their missions and intervention place. PRACTICE IMPLICATIONS Policy makers and funding bodies will need to invest in the healthcare professionals' training about educational approach and ADRD in order to extend educational care throughout the patient's care pathway.
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Affiliation(s)
- Teddy Novais
- Department of Pharmacy, Charpennes Hospital, Hospices Civils de Lyon, Villeurbanne, F-69100, France; Lyon Institute for Aging, Hospices Civils de Lyon, F-69000 Lyon, France; Research on Healthcare Performance (RESHAPE), INSERM U1290, University Lyon1, F-69000 Lyon, France.
| | - Elyse Vanhems
- Lyon Institute for Aging, Hospices Civils de Lyon, F-69000 Lyon, France
| | | | - Pierre Krolak-Salmon
- Lyon Institute for Aging, Hospices Civils de Lyon, F-69000 Lyon, France; Clinical Research Centre (CRC) - VCF (Aging - Brain - Frailty), Charpennes Hospital, University Hospital of Lyon, Villeurbanne, F-69000 Lyon, France; Neuroscience Research Centre of Lyon (CRNL), F-69000 Lyon, France
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Choi JH, Koo BH, Seo WS, Cheon EJ, Sung HM, Kim JY, Jeong HS, Kim Y, Kim HG. Characteristics of Cognitive Function Changes and Related Factors in Individuals With Cognitive Impairment During the Pandemic of COVID-19: A Retrospective Chart Review Study. Psychiatry Investig 2023; 20:109-119. [PMID: 36891595 PMCID: PMC9996141 DOI: 10.30773/pi.2022.0223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 11/13/2022] [Indexed: 02/25/2023] Open
Abstract
OBJECTIVE This study aimed to explore the characteristics and factors related to changes in cognitive function in vulnerable individuals with cognitive impairment during the coronavirus disease 2019 (COVID-19) pandemic. METHODS Among patients who visited a local university hospital with subjective cognitive complaints, those who had been tested for cognitive function at least once after the onset of COVID-19 and tested regularly at least three times within the last 5 years were included (1st, the initial screening; 2nd, the test immediately before the COVID-19 pandemic; 3rd, the most recent test after the pandemic). Finally, 108 patients were included in this study. They were divided into groups according to whether the Clinical Dementia Rating (CDR) was maintained/improved and deteriorated. We investigated the characteristics of the changes in cognitive function and related factors during COVID-19. RESULTS When comparing CDR changes before and after COVID-19, there was no significant difference between the two groups (p=0.317). Alternatively, the main effect of the time when the test was conducted was significant (p<0.001). There was also a significant difference in the interaction between the groups and time. When the effect of the interaction was analyzed, the CDR score of the maintained/ improved group significantly decreased before COVID-19 (1st-2nd) (p=0.045). After COVID-19 (2nd-3rd), the CDR score of the deteriorated group was significantly higher than that of the maintained/improved group (p<0.001). Mini-Mental State Examination recall memory and changes in activity during COVID-19 were significantly associated with CDR deterioration. CONCLUSION Memory dysfunction and decreased activity during the COVID-19 pandemic are strongly related to the deterioration of cognitive impairment.
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Affiliation(s)
- Jin-Hui Choi
- Gimcheon Medical Center, Gimcheon, Republic of Korea
| | - Bon-Hoon Koo
- Department of Psychiatry, Yeungnam University College of Medicine, Yeungnam University Medical Center, Daegu, Republic of Korea
| | - Wan-Seok Seo
- Department of Psychiatry, Yeungnam University College of Medicine, Yeungnam University Medical Center, Daegu, Republic of Korea
| | - Eun-Jin Cheon
- Department of Psychiatry, Yeungnam University College of Medicine, Yeungnam University Medical Center, Daegu, Republic of Korea
| | - Hyung-Mo Sung
- Department of Psychiatry, Soonchunhyang University College of Medicine, Soonchunhyang University Medical Center, Gumi, Republic of Korea
| | - Ji Yean Kim
- Department of Psychology, Yeungnam University Medical Center, Daegu, Republic of Korea
| | - Hyun-Seok Jeong
- Department of Psychology, Yeungnam University Medical Center, Daegu, Republic of Korea
| | - Younggyo Kim
- Department of Psychology, Yeungnam University Medical Center, Daegu, Republic of Korea
| | - Hye-Geum Kim
- Department of Psychiatry, Yeungnam University College of Medicine, Yeungnam University Medical Center, Daegu, Republic of Korea
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Ghosh M, Dunham M, O'Connell B. Systematic review of dyadic psychoeducational programs for persons with dementia and their family caregivers. J Clin Nurs 2022. [DOI: 10.1111/jocn.16570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/02/2022] [Accepted: 10/18/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Manonita Ghosh
- School of Nursing and Midwifery Edith Cowan University Joondalup Western Australia Australia
| | - Melissa Dunham
- School of Nursing and Midwifery Edith Cowan University Joondalup Western Australia Australia
| | - Beverly O'Connell
- School of Nursing and Midwifery Edith Cowan University Joondalup Western Australia Australia
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Delphin-Combe F, Coste MH, Bachelet R, Llorens M, Gentil C, Giroux M, Paire-Ficout L, Ranchet M, Krolak-Salmon P. An innovative therapeutic educational program to support older drivers with cognitive disorders: Description of a randomized controlled trial study protocol. Front Neurol 2022; 13:901100. [PMID: 35923824 PMCID: PMC9339957 DOI: 10.3389/fneur.2022.901100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 06/29/2022] [Indexed: 11/13/2022] Open
Abstract
Older drivers face the prospect of having to adjust their driving habits because of health problems, which can include neurocognitive disorders. Self-awareness of driving difficulties and the interaction between individual with neurocognitive disorders and natural caregiver seem to be important levers for the implementation of adaptation strategies and for the subsequent voluntary cessation of driving when the cognitive disorders become too severe. This study aims to evaluate an educational program for patient/natural caregiver dyads who wish to implement self-regulation strategies in driving activity, and to improve self-awareness of driving ability. The ACCOMPAGNE program is based on seven group workshops, which target the dyad. The workshops deal with the impact of cognitive, sensory and iatrogenic disorders on driving. They tackle questions about responsibility, and about autonomy and social life. They also provide alternative solutions aimed at maintaining outward-looking activities even if driving is reduced or stopped. A randomized controlled trial is planned to evaluate the effectiveness of the program 2 months and 6 months after inclusion, and to compare this to the effectiveness of conventional approaches. The main outcome of this trial (i.e., the implementation of self-regulated driving strategies), will be measured based on scores on the “Current Self-Regulatory Practices” subscale of the Driver Perception and Practices Questionnaire. The Driving Habits Questionnaire will be used to measure secondary outcomes (indicators of driving changes; indicators of changes in mood, quality of life and caregiver burden; and self-awareness of driving abilities). Indicators will be collected for both patients and natural caregivers. This cognitive, social and psychological program should allow older individuals with cognitive disorders to drive more safely, and help to maintain the quality of life and mood of both patient and natural caregiver despite driving limitations. The patient's care path would be optimized, as he/she would become an actor in the process of giving up driving, which will, most certainly, be needed at some point in the progress of neurocognitive disorders. This process ranges from becoming aware of driving difficulties, to implementing self-regulation strategies, through to complete cessation of driving when necessary.Clinical trial registration numberNCT04493957.
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Affiliation(s)
- Floriane Delphin-Combe
- Memory Clinical and Research Center of Lyon (CMRR), Lyon Institute for Elderly, Hospices Civils de Lyon, Lyon, France
- *Correspondence: Floriane Delphin-Combe
| | - Marie-Hélène Coste
- Memory Clinical and Research Center of Lyon (CMRR), Lyon Institute for Elderly, Hospices Civils de Lyon, Lyon, France
| | - Romain Bachelet
- Memory Clinical and Research Center of Lyon (CMRR), Lyon Institute for Elderly, Hospices Civils de Lyon, Lyon, France
| | - Mélissa Llorens
- Memory Clinical and Research Center of Lyon (CMRR), Lyon Institute for Elderly, Hospices Civils de Lyon, Lyon, France
| | - Claire Gentil
- Memory Clinical and Research Center of Lyon (CMRR), Lyon Institute for Elderly, Hospices Civils de Lyon, Lyon, France
| | - Marion Giroux
- Memory Clinical and Research Center of Lyon (CMRR), Lyon Institute for Elderly, Hospices Civils de Lyon, Lyon, France
| | | | - Maud Ranchet
- TS2-LESCOT, Univ Gustave Eiffel, IFSTTAR, Univ Lyon, Lyon, France
| | - Pierre Krolak-Salmon
- Memory Clinical and Research Center of Lyon (CMRR), Lyon Institute for Elderly, Hospices Civils de Lyon, Lyon, France
- INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Center, Brain Dynamics and Cognition Team, Lyon, France
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Chan SY, Yu HW, Yang MC, Lee YC, Chen YM. The Impact of Multiple Long-Term Care Services Use on Dementia and Nondementia Caregivers’ Health Care Utilization and Costs. J Appl Gerontol 2022; 41:2341-2352. [DOI: 10.1177/07334648221114110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background The study examined the effects of multiple long-term care (LTC) services (i.e., using both social and professional care services) on caregivers of service recipients with and without dementia. Methods We retrieved data for 10,771 caregivers of older adults in the Ten-Year Long-Term Care Project (TLTCP) in Taiwan. We examined the effects of care recipients’ initial prescription of single or multiple LTC services on their caregivers’ healthcare services use, including outpatient, emergency department (ED), and inpatient services. Results For care recipients prescribed a single LTC service, dementia caregivers had 0.82 more ED visits and 10.4% higher total fees than nondementia caregivers ( p < .05). However, for care recipients prescribed multiple LTC services, dementia caregivers and nondementia caregivers used healthcare services at similar levels, and dementia caregivers had 3.5% lower per-visit outpatient fees ( p < .05). Discussion Providing multiple LTC services for people with dementia results in great benefit to their caregivers.
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Affiliation(s)
- Su-Yuan Chan
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Hsiao-Wei Yu
- Department of Gerontology and Health Care Management, College of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Ming-Ching Yang
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Yue-Chune Lee
- Institute of Health and Welfare Policy, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ya-Mei Chen
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
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Papadakos J, Samoil D, Umakanthan B, Charow R, Jones JM, Matthew A, Nissim R, Sayal A, Giuliani ME. What are we doing to support informal caregivers? A scoping review of caregiver education programs in cancer care. PATIENT EDUCATION AND COUNSELING 2022; 105:1722-1730. [PMID: 34810056 DOI: 10.1016/j.pec.2021.10.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 09/09/2021] [Accepted: 10/08/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES The cancer system is experiencing a rise in cancer prevalence, a workforce shortage, and is resource-stretched. In this environment, informal caregivers (unpaid family caregivers of cancer patients) are required to take on expanded care roles and experience the debilitating effects of caregiver burden. Education programs are increasingly being developed to support caregivers. The aim of this review is to summarize what is known about these programs. METHODS A scoping review was conducted from May 2019 to January 2020. The literature search yielded 34,906 articles. RESULTS 119 articles were included, and ninety-two (77%) were focused on in-person psychoeducational programs. CONCLUSION Most caregiver programs have a unidimensional focus on psychoeducational training, demonstrating a need for more comprehensive programming to address the full spectrum of caregiver needs. PRACTICE IMPLICATIONS Clinicians and educators must collaborate to create accessible, equitable education programs that comprehensibly address the needs of unpaid family caregivers beyond addressing psychological aspects of cancer care. This will ensure that a broader range of patients and caregivers are equipped with the knowledge and skills needed to cope with a cancer diagnosis, navigate the health system and to maintain their quality of life.
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Affiliation(s)
- Janet Papadakos
- Cancer Health Literacy Research Centre, Princess Margaret Cancer Centre, Toronto, Canada; Patient Education, Ontario Health (Cancer Care Ontario), Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; The Institute for Education Research (TIER), University Health Network, Toronto, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada.
| | - Diana Samoil
- Cancer Health Literacy Research Centre, Princess Margaret Cancer Centre, Toronto, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
| | - Ben Umakanthan
- Cancer Health Literacy Research Centre, Princess Margaret Cancer Centre, Toronto, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
| | - Rebecca Charow
- Cancer Health Literacy Research Centre, Princess Margaret Cancer Centre, Toronto, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
| | - Jennifer M Jones
- Cancer Rehabilitation & Survivorship Program, Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
| | - Andrew Matthew
- Cancer Rehabilitation & Survivorship Program, Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
| | - Rinat Nissim
- Cancer Rehabilitation & Survivorship Program, Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
| | - Aman Sayal
- Cancer Health Literacy Research Centre, Princess Margaret Cancer Centre, Toronto, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
| | - Meredith E Giuliani
- Cancer Health Literacy Research Centre, Princess Margaret Cancer Centre, Toronto, Canada; The Institute for Education Research (TIER), University Health Network, Toronto, Canada; Psychosocial Oncology & Palliative Care, Princess Margaret Cancer Centre, Toronto, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
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Bat BKK, Chan JYC, Chan TK, Huo Z, Yip BHK, Wong MCS, Tsoi KKF. Comparing drawing under instructions with image copying for mild cognitive impairment (MCI) or dementia screening: a meta-analysis of 92 diagnostic studies. Aging Ment Health 2022; 26:1019-1026. [PMID: 33999724 DOI: 10.1080/13607863.2021.1922599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Drawing is a major component of cognitive screening for dementia. It can be performed without language restriction. Drawing pictures under instructions and copying images are different screening approaches. The objective of this study was to compare the diagnostic performance between drawing under instructions and image copying for MCI and dementia screening. METHOD A literature search was carried out in the OVID databases with keywords related to drawing for cognitive screening. Study quality and risk of bias were assessed by QUADAS-2. The level of diagnostic accuracy across different drawing tests was pooled by bivariate analysis in a random effects model. The area under the hierarchical summary receiver-operating characteristic curve (AUC) was constructed to summarize the diagnostic performance. RESULTS Ninety-two studies with sample size of 22,085 were included. The pooled results for drawing under instructions showed a sensitivity of 79% (95% CI: 76 - 83%) and a specificity of 80% (95% CI: 77 - 83%) with AUC of 0.87 (95% CI: 0.83 - 0.89). The pooled results for image copying showed a sensitivity of 71% (95% CI: 62 - 79%) and a specificity of 83% (95% CI: 72 - 90%) with AUC of 0.83 (95% CI: 0.80 - 0.86). Clock-drawing test was the screening test used in the majority of studies. CONCLUSION Drawing under instructions showed a similar diagnostic performance when compared with image copying for cognitive screening and the administration of image copying is relatively simpler. Self-screening for dementia is feasible to be done at home in the near future.
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Affiliation(s)
- Baker K K Bat
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Joyce Y C Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Tak Kit Chan
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Zhaohua Huo
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Benjamin H K Yip
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Martin C S Wong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Kelvin K F Tsoi
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.,Stanley Ho Big Data Decision Analytics Research Centre, The Chinese University of Hong Kong, Hong Kong, China
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StäB - besonders geeignet für die Gerontopsychiatrie? DNP - DER NEUROLOGE & PSYCHIATER 2021. [PMCID: PMC8632201 DOI: 10.1007/s15202-021-4767-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Villars H, Cantet C, de Peretti E, Perrin A, Soto-Martin M, Gardette V. Impact of an educational programme on Alzheimer's disease patients' quality of life: results of the randomized controlled trial THERAD. ALZHEIMERS RESEARCH & THERAPY 2021; 13:152. [PMID: 34511121 PMCID: PMC8436545 DOI: 10.1186/s13195-021-00896-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/30/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Although educational interventions are recommended in Alzheimer's disease (AD), studies assessing the impact of interventions such as "therapeutic patient education" are scarce. Indeed, the intrinsic nature of the disease is considered a barrier to patients' involvement in such approaches. We aimed to evaluate an intervention by using a "dyadic" approach (patient and caregiver) in both intervention and assessment. METHODS THERAD is a monocentric, randomized, controlled trial assessing the effects of a 2-month educational programme in mild to moderately severe AD patients among 98 dyads (caregiver/patient) on caregiver-reported patient quality of life (QOL) at 2 months. Community-dwelling patients and their caregivers were recruited in ambulatory units of the French Toulouse University Hospital. Self-reported patient QOL, autonomy, behavioural and psychological symptoms and caregiver QOL and burden were collected at 2, 6 and 12 months. Linear mixed models were used in modified intention-to-treat populations. We also performed sensitivity analysis. RESULTS A total of 196 dyads were included, 98 in each group. The mean age of the patients was 82 years, 67.7% were women, diagnosed with AD (+/- cerebrovascular component) (mean MMSE =17.6), and 56.9% lived with a partner. The mean age of the caregivers was 65.7 years, and 64.6% were women (52.3% offspring/42.6% spouses), with a moderate burden (mean Zarit score = 30.9). The mean caregiver-reported patient QOL was lower than the self-reported QOL (28.61 vs. 33.96). We did not identify any significant difference in caregiver-reported patients' QOL (p = 0.297) at 2 months, but there was a significant difference in self-reported patients' QOL at 2 months (p = 0.0483) or 6 months (p = 0.0154). No significant difference was found for the secondary outcomes. The results were stable in the sensitivity analyses. CONCLUSIONS This randomized controlled trial assessing an educational intervention in 196 dyads (Alzheimer's disease affected patient/caregiver) highlights the need to better consider the patient's point of view, since only the self-reported QOL was improved. Additional studies using this dyadic approach are necessary in targeted subpopulations of caregivers (spouse vs. child, gender) and of patients (severity of cognitive impairment or behavioural disturbances) TRIAL REGISTRATION: THERAD study NCT01796314 . Registered on February 19, 2013.
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Affiliation(s)
- Hélène Villars
- Geriatric Department, Toulouse University Hospital, Hopital La Grave- Cité de la Santé Place Lange TSA 60 033, 31059, Toulouse Cedex 9, France.
| | - Christelle Cantet
- Inserm UMR 1295: Center for Research in Population Health (CERPOP) - Department of Epidemiology and Public Health, University of Toulouse, II F-31073, 37, allées Jules Guesde, 31073, Toulouse cedex, France
| | - Eva de Peretti
- Geriatric Department, Toulouse University Hospital, Hopital La Grave- Cité de la Santé Place Lange TSA 60 033, 31059, Toulouse Cedex 9, France
| | - Amelie Perrin
- Geriatric Department, Toulouse University Hospital, Hopital La Grave- Cité de la Santé Place Lange TSA 60 033, 31059, Toulouse Cedex 9, France
| | - Maria Soto-Martin
- Geriatric Department, Toulouse University Hospital, Hopital La Grave- Cité de la Santé Place Lange TSA 60 033, 31059, Toulouse Cedex 9, France
| | - Virginie Gardette
- Geriatric Department, Toulouse University Hospital, Hopital La Grave- Cité de la Santé Place Lange TSA 60 033, 31059, Toulouse Cedex 9, France
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Wiegelmann H, Wolf-Ostermann K, Brannath W, Arzideh F, Dreyer J, Thyrian R, Schirra-Weirich L, Verhaert L. Sociodemographic aspects and health care-related outcomes: a latent class analysis of informal dementia care dyads. BMC Health Serv Res 2021; 21:727. [PMID: 34301241 PMCID: PMC8299572 DOI: 10.1186/s12913-021-06708-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 06/28/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Studies revealed the importance to assess dementia care dyads, composed of persons with dementia and their primary informal caregivers, in a differentiated way and to tailor support services to particular living and care circumstances. Therefore, this study aims first to identify classes of dementia care dyads that differ according to sociodemographic, care-related and dementia-specific characteristics and second, to compare these classes with regard to healthcare-related outcomes. METHODS We used data from the cross-sectional German DemNet-D study (n = 551) and conducted a latent class analysis to investigate different classes of dementia care dyads. In addition, we compared these classes with regard to the use of health care services, caregiver burden (BIZA-D), general health of the informal caregiver (EQ-VAS) as well as quality of life (QoL-AD) and social participation (SACA) of the person with dementia. Furthermore, we compared the stability of the home-based care arrangements. RESULTS Six different classes of dementia care dyads were identified, based on best Bayesian Information Criterion (BIC), significant likelihood ratio test (p < 0.001), high entropy (0.87) and substantive interpretability. Classes were labelled as "adult child parent relationship & younger informal caregiver", "adult child parent relationship & middle aged informal caregiver", "non family relationship & younger informal caregiver", "couple & male informal caregiver of older age", "couple & female informal caregiver of older age", "couple & younger informal caregiver". The classes showed significant differences regarding health care service use. Caregiver burden, quality of life of the person with dementia and stability of the care arrangement differed also significantly between the classes. CONCLUSION Based on a latent class analysis this study indicates differences between classes of informal dementia care dyads. The findings may give direction for better tailoring of support services to particular circumstances to improve healthcare-related outcomes of persons with dementia and informal caregivers.
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Affiliation(s)
- Henrik Wiegelmann
- grid.7704.40000 0001 2297 4381Institute for Public Health and Nursing Research, Health Sciences Bremen, University of Bremen, Grazer Straße 4, 28359 Bremen, Germany
| | - Karin Wolf-Ostermann
- grid.7704.40000 0001 2297 4381Institute for Public Health and Nursing Research, Health Sciences Bremen, University of Bremen, Grazer Straße 4, 28359 Bremen, Germany
| | - Werner Brannath
- grid.7704.40000 0001 2297 4381Competence Centre for Clinical Trials, University of Bremen and Clinic Bremen-Mitte, Bremen, Germany
| | - Farhad Arzideh
- grid.7704.40000 0001 2297 4381Competence Centre for Clinical Trials, University of Bremen and Clinic Bremen-Mitte, Bremen, Germany
| | - Jan Dreyer
- grid.424247.30000 0004 0438 0426German Centre for Neurodegenerative Diseases (DZNE), Site Witten, Germany
| | - Rene Thyrian
- grid.424247.30000 0004 0438 0426German Centre for Neurodegenerative Diseases (DZNE), Site Witten, Germany
| | - Liane Schirra-Weirich
- grid.466086.a0000 0001 1010 8830Department of Social Services, Centre for Participation Research, Catholic University of Applied Sciences of North Rhine-Westphalia, Cologne, Germany
| | - Lisa Verhaert
- grid.466086.a0000 0001 1010 8830Department of Social Services, Centre for Participation Research, Catholic University of Applied Sciences of North Rhine-Westphalia, Cologne, Germany
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Effects of e-Health Training and Social Support Interventions for Informal Caregivers of People with Dementia-A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157728. [PMID: 34360020 PMCID: PMC8345641 DOI: 10.3390/ijerph18157728] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/15/2021] [Accepted: 07/19/2021] [Indexed: 01/11/2023]
Abstract
Along with the burden commonly experienced by informal caregivers (ICs) of people with dementia (PwD), associated with the progressive decline that accompanies dementia, the lockdown due to the public health crisis has had a great negative impact on the emotional wellbeing, physical health, and social relationships of ICs. Support interventions through telemedicine represent an opportunity for ICs to learn the skills required for the care and maintenance of social networks. In this work, a narrative review of the effects of e-health training and social support interventions was carried out. A literature search was conducted using the ProQuest, Ovid, and Scopus databases. Information regarding social support (SS), psychological interventions, and training for the management of medications and behavioral changes was extracted. One hundred and nine studies were included in this review. Forums and training platforms were the main tools for ICs. The most effective platforms to improve SS include the participation of both ICs and health professionals. However, no significant improvements in objective caring skills were identified. Platforms developed specifically for ICs should be based in tools that ICs are familiar with, because many ICs have not yet incorporated Information and Communication Technologies in many activities of their daily lives. Education in the digitalization to ICs of PwD should be one of the priority objectives in telehealth interventions.
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Wiegelmann H, Speller S, Verhaert LM, Schirra-Weirich L, Wolf-Ostermann K. Psychosocial interventions to support the mental health of informal caregivers of persons living with dementia - a systematic literature review. BMC Geriatr 2021; 21:94. [PMID: 33526012 PMCID: PMC7849618 DOI: 10.1186/s12877-021-02020-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 01/11/2021] [Indexed: 02/03/2023] Open
Abstract
Background Informal caregivers of persons living with dementia have an increased risk of adverse mental health effects. It is therefore important to systematically summarize published literature in order to find out which mental health interventions generate effective support for informal caregivers of persons living with dementia. The objective of this study is to conduct a systematic review of intervention content, effectiveness and subgroup differentiation of mental health interventions for informal caregivers of persons with dementia living at home. Method We searched four electronic databases (PubMed, PsychINFO, Scopus and CINAHL) and included only methodically high-quality randomized controlled trials (RCTs), published in English or German language between 2009 and 2018. The intervention programmes focused on mental health of family caregivers. A narrative synthesis of the included studies is given. Results Forty-eight publications relating to 46 intervention programmes met the inclusion criteria. Burden, depression and quality of life (QoL) are the predominant parameters that were investigated. Twenty-five of forty-six interventions (54.3%) show positive effects on at least one of the outcomes examined. Most often, positive effects are reported for the outcome subjective burden (46.2%). Only six studies explicitly target on a certain subgroup of informal dementia caregivers (13%), whereas all other interventions (87%) target the group as a whole without differentiation. Conclusion The most beneficial results were found for cognitive behavioural approaches, especially concerning the reduction of depressive symptoms. Besides this, leisure and physical activity interventions show some good results in reducing subjective caregiver burden. In order to improve effectiveness, research and practice may focus on developing more targeted interventions for special dementia informal caregiver subgroups. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02020-4.
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Affiliation(s)
- Henrik Wiegelmann
- Institute for Public Health and Nursing Research, Health Sciences Bremen, University of Bremen, Grazer Straße 4, 28359, Bremen, Germany.
| | - Sarah Speller
- Institute for Public Health and Nursing Research, Health Sciences Bremen, University of Bremen, Grazer Straße 4, 28359, Bremen, Germany
| | - Lisa-Marie Verhaert
- Department of Social Services, Centre for Participation Research, Catholic University of Applied Sciences of North Rhine-Westphalia, Robert-Schuman-Straße 25, 52066, Aachen, Germany
| | - Liane Schirra-Weirich
- Department of Social Services, Centre for Participation Research, Catholic University of Applied Sciences of North Rhine-Westphalia, Robert-Schuman-Straße 25, 52066, Aachen, Germany
| | - Karin Wolf-Ostermann
- Institute for Public Health and Nursing Research, Health Sciences Bremen, University of Bremen, Grazer Straße 4, 28359, Bremen, Germany
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Raj SE, Mackintosh S, Fryer C, Stanley M. Home-Based Occupational Therapy for Adults With Dementia and Their Informal Caregivers: A Systematic Review. Am J Occup Ther 2021; 75:7501205060p1-7501205060p27. [PMID: 33399054 DOI: 10.5014/ajot.2020.040782] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE People with dementia require tailored interventions to support participation and performance in their desired occupations, and informal caregivers need interventions that reduce caregiving burden to enable them to continue with their roles. OBJECTIVE This systematic review investigated whether home-based occupational therapy interventions for adults with dementia and their informal caregivers optimized care recipients' performance of daily occupations and reduced caregiving burden and improved caregivers' sense of competence. DATA SOURCES Eight databases were searched from 1946 to November 2019 using MeSH terms, keywords, and subject headings as appropriate for each database. Inclusion criteria were quantitative studies investigating the effects of home-based therapy provided by a qualified occupational therapist for adults with dementia and their informal caregivers. STUDY SELECTION AND DATA COLLECTION Study selection, data collection, and methodological quality assessments using the Critical Appraisal Skills Programme criteria tool were performed independently by two reviewers. Data analysis involved a two-stage process. FINDINGS From 1,229 articles identified through searches, 970 titles and abstracts were screened for eligibility after removal of duplicates. Twenty studies reported in 22 articles were included. Moderate evidence supported interventions provided jointly for adults with dementia and their informal caregivers using a combination of intervention strategies. Included studies demonstrated high risk of bias, particularly in blinding of outcome assessments. CONCLUSIONS AND RELEVANCE Combining individualized interventions framed in client-centeredness can enhance occupational performance for adults with dementia, reduce caregiving burden, and improve informal caregivers' sense of competence. Further research on leisure and home management occupations is warranted. WHAT THIS ARTICLE ADDS The findings provide evidence supporting the effectiveness of home-based occupational therapy for people with dementia and their informal caregivers for consideration by funders of services.
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Affiliation(s)
- Sujatha E Raj
- Sujatha E. Raj, BOT, MSc(OT), is PhD Candidate, UniSA Allied Health & Human Performance, University of South Australia, Adelaide, South Australia, Australia;
| | - Shylie Mackintosh
- Shylie Mackintosh, PhD, MSc, BAppSc(Physio), is Associate Professor and Dean of Allied Health Programs, UniSA Allied Health & Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Caroline Fryer
- Caroline Fryer, PhD, Grad Dip (Clin Epi), BAppSc(Physio), is Senior Lecturer, Physiotherapy Program, UniSA Allied Health & Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Mandy Stanley
- Mandy Stanley, PhD, MSc(OT), BAppSc(OT), is Associate Professor, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
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Wang H, Cui H, Wang M, Yang C. What You Believe Can Affect How You Feel: Anger Among Caregivers of Elderly People With Dementia. Front Psychiatry 2021; 12:633730. [PMID: 33897493 PMCID: PMC8058189 DOI: 10.3389/fpsyt.2021.633730] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 03/08/2021] [Indexed: 11/24/2022] Open
Abstract
Background and Purpose: Anger has been recognized as a commonly experienced emotion among caregivers of elderly people with dementia. While several cognitive behavioral therapy (CBT)-based intervening methods have been developed, limited research has systematically examined the associations between dementia-related cognition and caregiving anger. Currently, we focused on three representative and well-studied cognitive constructs, person-centered attitude (PCA), dementia representation (DR), and empathy, exploring how they related to caregiving anger. Methods & Results: In total, 327 caregivers (239 female) participated in the study and finished online questionnaires. Multi-variable regression analyzes showed that PCA (βPCA = -0.22**) and empathy (βempathy = -0.18**) could negatively predict caregiving anger. However, all DR dimensions had no influence on caregiving anger except coherence (βcoherence = -0.24**) in the current study. Conclusion: Generally, lower caregiving anger was associated with: (1) being more empathic; (2) having a person-centered attitude; and (3) having a comprehensive understanding of dementia. The results of this study provide detailed suggestions for the development of anger management programs for caregivers of people with dementia.
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Affiliation(s)
- Haoran Wang
- Dalian Seventh People's Hospital, Dalian, China
| | - Hongmei Cui
- Qindao Mental Health Center, Qingdao University, Qingdao, China
| | - Meng Wang
- Qindao Mental Health Center, Qingdao University, Qingdao, China
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19
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Banerjee D, Rabheru K, Ivbijaro G, de Mendonca Lima CA. Dignity of Older Persons With Mental Health Conditions: Why Should Clinicians Care? Front Psychiatry 2021; 12:774533. [PMID: 34867557 PMCID: PMC8632867 DOI: 10.3389/fpsyt.2021.774533] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 10/11/2021] [Indexed: 01/07/2023] Open
Abstract
With a steady increase in population aging, the proportion of older people living with mental illness is on rise. This has a significant impact on their autonomy, rights, quality of life and functionality. The biomedical approach to mental healthcare has undergone a paradigm shift over the recent years to become more inclusive and rights-based. Dignity comprises of independence, social inclusion, justice, equality, respect and recognition of one's identity. It has both subjective and objective components and influences life-satisfaction, treatment response as well as compliance. The multi-dimensional framework of dignity forms the central anchor to person-centered mental healthcare for older adults. Mental health professionals are uniquely positioned to incorporate the strategies to promote dignity in their clinical care and research as well as advocate for related social/health policies based on a human rights approach. However, notwithstanding the growing body of research on the neurobiology of aging and old age mental health disorders, dignity-based mental healthcare is considered to be an abstract and hypothetical identity, often neglected in clinical practice. In this paper, we highlight the various components of dignity in older people, the impact of ageism and mental health interventions based on dignity, rights, respect, and equality (including dignity therapy). It hopes to serve as a framework for clinicians to incorporate dignity as a principle in mental health service delivery and research related to older people.
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Affiliation(s)
| | - Kiran Rabheru
- University of Ottawa, International Longevity Centre (ILC), Ottawa, ON, Canada
| | - Gabriel Ivbijaro
- Department of Psychiatry, NOVA University, Lisbon, Portugal.,Department of Psychiatry, The Wood Street Medical Centre, London, United Kingdom
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20
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Bartels SL, van Knippenberg RJM, Köhler S, Ponds RW, Myin-Germeys I, Verhey FRJ, de Vugt ME. The necessity for sustainable intervention effects: lessons-learned from an experience sampling intervention for spousal carers of people with dementia. Aging Ment Health 2020; 24:2082-2093. [PMID: 31368355 DOI: 10.1080/13607863.2019.1647130] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Caring for a person with dementia can be challenging over the years. To support family carers throughout their entire caregiving career, interventions with a sustained effectivity are needed. A novel 6-week mobile health (mHealth) intervention using the experience sampling method (ESM) showed positive effects on carers' well-being over a period of 2 months after the intervention. In this study, the effects after 6 months of the selfsame intervention were examined to evaluate the sustainability of positive intervention effects. METHOD The 6-week mHealth intervention consisted of an experimental group (ESM self-monitoring and personalized feedback), a pseudo-experimental group (ESM self-monitoring without feedback), and a control group (providing regular care without ESM self-monitoring or feedback). Carers' sense of competence, mastery, and psychological complaints (depression, anxiety and perceived stress) were evaluated pre- and post-intervention as well as at two follow-up time points. The present study focuses on the 6-month follow-up data (n = 50). RESULTS Positive intervention effects on sense of competence, perceived stress, and depressive symptoms were not sustained over 6-month follow-up. CONCLUSION The benefits of this mHealth intervention for carers of people living with dementia were not sustained over a long time. Similarly, other psychosocial interventions for carers of people with dementia rarely reported long-lasting effects. In order to sustainably contribute to carers' well-being, researchers and clinicians should continuously ensure flexible adjustment of the intervention and consider additional features such as ad-hoc counseling options and booster sessions. In this regard, mHealth interventions can offer ideally suited and unique opportunities.
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Affiliation(s)
- Sara Laureen Bartels
- Department of Psychiatry and Neuropsychology and Alzheimer Centre Limburg, School for Mental Health and Neurosciences, Maastricht University, Maastricht, The Netherlands
| | - Rosalia J M van Knippenberg
- Department of Psychiatry and Neuropsychology and Alzheimer Centre Limburg, School for Mental Health and Neurosciences, Maastricht University, Maastricht, The Netherlands
| | - Sebastian Köhler
- Department of Psychiatry and Neuropsychology and Alzheimer Centre Limburg, School for Mental Health and Neurosciences, Maastricht University, Maastricht, The Netherlands
| | - Rudolf W Ponds
- Department of Psychiatry and Neuropsychology and Alzheimer Centre Limburg, School for Mental Health and Neurosciences, Maastricht University, Maastricht, The Netherlands
| | - Inez Myin-Germeys
- Department of Neurosciences, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Frans R J Verhey
- Department of Psychiatry and Neuropsychology and Alzheimer Centre Limburg, School for Mental Health and Neurosciences, Maastricht University, Maastricht, The Netherlands
| | - Marjolein E de Vugt
- Department of Psychiatry and Neuropsychology and Alzheimer Centre Limburg, School for Mental Health and Neurosciences, Maastricht University, Maastricht, The Netherlands
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21
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van Haeften-van Dijk AM, Meiland FJ, Hattink BJ, Bakker TJ, Dröes RM. A comparison of a community-based dementia support programme and nursing home-based day care: Effects on carer needs, emotional burden and quality of life. DEMENTIA 2020; 19:2836-2856. [PMID: 31315451 DOI: 10.1177/1471301219861767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Within an implementation study, we investigated the effectiveness of a combined community-based day care programme for persons with dementia and their carers versus traditional psychogeriatric nursing home-based day care. The effects on needs, sense of competence, burden and quality of life of the family carers were studied. METHODS A pretest-posttest control group design among family carers of people with dementia who joined community-based day care centres (n = 67) or nursing home-based day care centres (n = 64). RESULTS After six months, family carers using community-based day care more often expressed an unmet need for support regarding psychological distress than carers utilising nursing home-based day care. No effect of community-based day care on sense of competence was found. However, carers with a low sense of competence at baseline using community-based compared to nursing home-based day care became less emotionally burdened by behaviour and mood problems of their relative.Conclusion and discussion: Overall, no added value of community-based day care on needs, sense of competence, burden and quality of life was found. Increased unmet needs on psychological distress may have been caused by the increased awareness of carers participating in the carer programme of community-based day care regarding their own unmet support needs. For carers with a low sense of competence, community-based day care proves to decrease the impact of behaviour and mood problems of their relative. A larger controlled follow-up study is recommended to understand the long-term effects of community-based day care over nursing home-based day care.
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Affiliation(s)
| | - Franka J Meiland
- Department of Psychiatry and Department of General Practice and Elderly Care Medicine, Amsterdam UMC, the Netherlands
| | | | - Ton Jem Bakker
- Rotterdam University of Applied Sciences and Stichting Wetenschap Balans, the Netherlands
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Devi F, Yuan Q, Wang P, Tan GTH, Roshan Goveas R, Ng LL, Chong SA, Subramaniam M. Positive aspect of caregiving among primary informal dementia caregivers in Singapore. PLoS One 2020; 15:e0237677. [PMID: 32817648 PMCID: PMC7440648 DOI: 10.1371/journal.pone.0237677] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 07/30/2020] [Indexed: 11/18/2022] Open
Abstract
Background The present study investigated the factor structure of positive aspects of caregiving (PAC) scale among primary informal caregivers providing care to persons with dementia (PWD) in Singapore. Methods 282 primary informal caregivers of PWD were recruited from the Institute of Mental Health, and Changi General Hospital and administered the 9-item PAC scale. A confirmatory factor analyses (CFA) was conducted to test the model fit of the 9-item PAC proposed by the scale developer and multiple linear regression was used to investigate the significant socio-demographic correlates. Results CFA showed that the 2-factor structure including ‘Self-Affirmation’ and ‘Outlook on Life’ had an acceptable model fit. After controlling for confounding variables, Malay caregivers were associated with higher scores on PAC and ‘Self-Affirmation’ compared to caregivers of other ethnicities. Caregivers with Secondary or below education level had higher PAC and ‘Outlook on Life’ scores. Caregivers who had received formal training scored higher in PAC, ‘Self-Affirmation’ and ‘Outlook on Life’. Discussion The present study confirmed that the 2-factor structure of the 9-item PAC was suitable for informal caregivers of PWD in Singapore. The findings have important implications for locally available interventions to enhance caregiver’s psychological well-being and reduce burden of care.
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Affiliation(s)
- Fiona Devi
- Research Division, Institute of Mental Health, Singapore, Singapore
- * E-mail:
| | - Qi Yuan
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Peizhi Wang
- Research Division, Institute of Mental Health, Singapore, Singapore
| | | | - Richard Roshan Goveas
- Department of Geriatric Psychiatry, Institute of Mental Health, Singapore, Singapore
| | - Li Ling Ng
- Department of Psychological Medicine, Changi General Hospital, Singapore, Singapore
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore, Singapore
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Duan-Porter W, Ullman K, Rosebush C, McKenzie L, Ensrud KE, Ratner E, Greer N, Shippee T, Gaugler JE, Wilt TJ. Interventions to Prevent or Delay Long-Term Nursing Home Placement for Adults with Impairments-a Systematic Review of Reviews. J Gen Intern Med 2020; 35:2118-2129. [PMID: 31898134 PMCID: PMC7352002 DOI: 10.1007/s11606-019-05568-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 11/05/2019] [Accepted: 11/20/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND With continued growth in the older adult population, US federal and state costs for long-term care services are projected to increase. Recent policy changes have shifted funding to home and community-based services (HCBS), but it remains unclear whether HCBS can prevent or delay long-term nursing home placement (NHP). METHODS We searched MEDLINE (OVID), Sociological Abstracts, PsycINFO, CINAHL, and Embase (from inception through September 2018); and Cochrane Database of Systematic Reviews, Joanna Briggs Institute Database, AHRQ Evidence-based Practice Center, and VA Evidence Synthesis Program reports (from inception through November 2018) for English-language systematic reviews. We also sought expert referrals. Eligible reviews addressed HCBS for community-dwelling adults with, or at risk of developing, physical and/or cognitive impairments. Two individuals rated quality (using modified AMSTAR 2) and abstracted review characteristics, including definition of NHP and interventions. From a prioritized subset of the highest-quality and most recent reviews, we abstracted intervention effects and strength of evidence (as reported by review authors). RESULTS Of 47 eligible reviews, most focused on caregiver support (n = 10), respite care and adult day programs (n = 9), case management (n = 8), and preventive home visits (n = 6). Among 20 prioritized reviews, 12 exclusively included randomized controlled trials, while the rest also included observational studies. Prioritized reviews found no overall benefit or inconsistent effects for caregiver support (n = 2), respite care and adult day programs (n = 3), case management (n = 4), and preventive home visits (n = 2). For caregiver support, case management, and preventive home visits, some reviews highlighted that a few studies of higher-intensity models reduced NHP. Reviews on other interventions (n = 9) generally found a lack of evidence examining NHP. DISCUSSION Evidence indicated no benefit or inconsistent effects of HCBS in preventing or delaying NHP. Demonstration of substantial impacts on NHP may require longer-term studies of higher-intensity interventions that can be adapted for a variety of settings. Registration PROSPERO # CRD42018116198.
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Affiliation(s)
- Wei Duan-Porter
- Center for Care Delivery and Outcomes Research, VAHSRD Minneapolis VA Health Care System, Minneapolis, MN, USA.
- University of Minnesota Medical School, Minneapolis, MN, USA.
| | - Kristen Ullman
- Center for Care Delivery and Outcomes Research, VAHSRD Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Christina Rosebush
- Center for Care Delivery and Outcomes Research, VAHSRD Minneapolis VA Health Care System, Minneapolis, MN, USA
- School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Lauren McKenzie
- Center for Care Delivery and Outcomes Research, VAHSRD Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Kristine E Ensrud
- Center for Care Delivery and Outcomes Research, VAHSRD Minneapolis VA Health Care System, Minneapolis, MN, USA
- University of Minnesota Medical School, Minneapolis, MN, USA
- School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Edward Ratner
- University of Minnesota Medical School, Minneapolis, MN, USA
- Geriatric Research Education & Clinical Center, Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Nancy Greer
- Center for Care Delivery and Outcomes Research, VAHSRD Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Tetyana Shippee
- School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Joseph E Gaugler
- School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Timothy J Wilt
- Center for Care Delivery and Outcomes Research, VAHSRD Minneapolis VA Health Care System, Minneapolis, MN, USA
- University of Minnesota Medical School, Minneapolis, MN, USA
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Young HM, Bell JF, Whitney RL, Ridberg RA, Reed SC, Vitaliano PP. Social Determinants of Health: Underreported Heterogeneity in Systematic Reviews of Caregiver Interventions. THE GERONTOLOGIST 2020; 60:S14-S28. [PMID: 32057083 PMCID: PMC7019663 DOI: 10.1093/geront/gnz148] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Indexed: 01/08/2023] Open
Abstract
Background and Objectives Although most people have some experience as caregivers, the nature and context of care are highly variable. Caregiving, socioeconomic factors, and health are all interrelated. For these reasons, caregiver interventions must consider these factors. This review examines the degree to which caregiver intervention research has reported and considered social determinants of health. Research Design and Methods We examined published systematic reviews and meta-analyses of interventions for older adults with age-related chronic conditions using the PRISMA and AMSTAR 2 checklists. From 2,707 papers meeting search criteria, we identified 197 potentially relevant systematic reviews, and selected 33 for the final analysis. Results We found scant information on the inclusion of social determinants; the papers lacked specificity regarding race/ethnicity, gender, sexual identity, socioeconomic status, and geographic location. The majority of studies focused on dementia, with other conditions common in later life vastly underrepresented. Discussion and Implications Significant gaps in evidence persist, particularly for interventions targeting diverse conditions and populations. To advance health equity and improve the effectiveness of interventions, research should address caregiver heterogeneity and improve assessment, support, and instruction for diverse populations. Research must identify aspects of heterogeneity that matter in intervention design, while recognizing opportunities for common elements and strategies.
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Affiliation(s)
- Heather M Young
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento
| | - Janice F Bell
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento
| | - Robin L Whitney
- The Valley Foundation School of Nursing, San Jose State University, San Jose, California
| | - Ronit A Ridberg
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento
| | - Sarah C Reed
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento
| | - Peter P Vitaliano
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle
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Cheng ST, Zhang F. A comprehensive meta-review of systematic reviews and meta-analyses on nonpharmacological interventions for informal dementia caregivers. BMC Geriatr 2020; 20:137. [PMID: 32293325 PMCID: PMC7158025 DOI: 10.1186/s12877-020-01547-2] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 04/02/2020] [Indexed: 01/01/2023] Open
Abstract
Background Many reviews with conflicting findings on dementia caregiver interventions have been published. A meta-review was conducted to synthesize the findings of systematic reviews and meta-analyses. Methods MEDLINE, PsycINFO, CINAHL and Cochrane Library were searched to identify reviews published during 2006–2018. Results Sixty reviews covering > 500 intervention studies were selected and appraised with Assessment of Multiple Systematic Reviews (AMSTAR) II. The great majority of studies were of low quality according to AMSTAR II, but quality factors appeared unrelated to the conclusions obtained. Depression was most modifiable, with effects found across a spectrum of interventions (psychoeducation, counseling/psychotherapy, occupational therapy, mindfulness-based interventions, multicomponent interventions, etc.). Evidence of intervention effect was also found for quality of life (psychoeducation), mastery (psychoeducation, occupational therapy and multicomponent interventions) and communication skills (communication training). Null or weak results were found for anxiety, social support and burden. Support groups and respite were generally ineffective. There was no evidence that dyadic programs were better than caregiver-only programs, or that programs delivered individually or in groups would differ in their impacts. The evidence also does not support multicomponent interventions to have broader impacts than single-component programs. Methodological issues in the existing reviews (e.g., selective use of studies to serve different research purposes and inconsistent classification of interventions) were noted and taken into account when interpreting findings. Conclusions This meta-review clarified variations in review methodology and identified a few potent groups of intervention (most notably psychoeducation, psychotherapy, occupational therapy, and multicomponent interventions), although no intervention type had broad effects on caregiver outcomes. We note that improvements are needed in the reporting of intervention studies and in making the classification of interventions more transparent and consistent. We further recommend fewer and larger-scale reviews and more attention to positive outcomes in order to better inform the field. Developing interventions with broader impacts and packaging them to meet caregivers’ changing needs in the course of dementia should be a priority for researchers and practitioners.
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Affiliation(s)
- Sheung-Tak Cheng
- Department of Health and Physical Education, The Education University of Hong Kong, 10 Lo Ping Road, Tai Po, N.T, Hong Kong. .,Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norwich, UK.
| | - Fan Zhang
- Department of Health and Physical Education, The Education University of Hong Kong, 10 Lo Ping Road, Tai Po, N.T, Hong Kong
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26
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Evans S, Evans S, Brooker D, Henderson C, Szcześniak D, Atkinson T, Bray J, Amritpal R, Saibene FL, d'Arma A, Scorolli C, Chattat R, Farina E, Urbańska K, Rymaszewska J, Meiland F, Dröes RM. The impact of the implementation of the Dutch combined Meeting Centres Support Programme for family caregivers of people with dementia in Italy, Poland and UK. Aging Ment Health 2020; 24:280-290. [PMID: 30520312 DOI: 10.1080/13607863.2018.1544207] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: The MEETINGDEM research project aimed to implement the combined Dutch Meeting Centre Support Programme (MCSP) for community-dwelling people with dementia and caregivers within Italy, Poland and UK and to assess whether comparable benefits were found in these countries as in the Netherlands.Method: Nine pilot Meeting Centres (MCs) participated (Italy-5, Poland-2, UK-2). Effectiveness of MCSP was compared to usual care (UC) on caregiver outcomes measuring competence (SSCQ), mental health (GHQ-12), emotional distress (NPI-Q) and loneliness (UCLA) analysed by ANCOVAs in a 6-month pre-test/post-test controlled trial. Interviews using standardised measures were completed with caregivers.Results: Pre/post data were collected for 93 caregivers receiving MCSP and 74 receiving UC. No statistically significant differences on the outcome measures were found overall. At a country level MC caregivers in Italy showed significant better general mental health (p = 0.04, d = 0.55) and less caregiver distress (p = 0.02, d = 0.62) at post-test than the UC group. Caregiver satisfaction was rated on a sample at 3 months (n = 81) and 6 months (n = 84). The majority of caregivers reported feeling less burdened and more supported by participating in MCSP.Conclusion: The moderate positive effect on sense of competence and the greater mental health benefit for lonely caregivers using the MCSP compared to UC as found in the original Dutch studies were not replicated. However, subject to study limitations, caregivers in Italy using MCSP benefitted more regarding their mental health and emotional distress than caregivers using UC. Further evaluation of the benefits of MCSP within these countries in larger study samples is recommended.
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Affiliation(s)
- Shirley Evans
- Association for Dementia Studies, University of Worcester, Worcester, UK
| | - Simon Evans
- Association for Dementia Studies, University of Worcester, Worcester, UK
| | - Dawn Brooker
- Association for Dementia Studies, University of Worcester, Worcester, UK
| | - Cate Henderson
- London School of Economics, United Kingdom London School of Economics and Political Science, London, UK
| | - Dorota Szcześniak
- Division of Consultation Psychiatry and Neuroscience, Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | - Teresa Atkinson
- Association for Dementia Studies, University of Worcester, Worcester, UK
| | - Jennifer Bray
- Association for Dementia Studies, University of Worcester, Worcester, UK
| | - Rehill Amritpal
- London School of Economics and Political Science, London, UK
| | | | | | | | - Rabih Chattat
- Department of Philosophy and Communication Studies, University of Bologna, Bologna, Italy
| | | | | | - Joanna Rymaszewska
- Department of Psychology, University of Bologna, Bologna, Italy.,Division of Consultation Psychiatry and Neuroscience, Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | - Franka Meiland
- Department of Psychiatry, VU University Medical Centre, Amsterdam, The Netherlands
| | - Rose-Marie Dröes
- Department of Psychiatry, VU University Medical Centre, Amsterdam, The Netherlands
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Law W, Kwok TCY. Impacts of a multicomponent intervention programme on neuropsychiatric symptoms in people with dementia and psychological health of caregivers: A feasibility pilot study. Int J Geriatr Psychiatry 2019; 34:1765-1775. [PMID: 31390090 DOI: 10.1002/gps.5191] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 08/05/2019] [Indexed: 01/25/2023]
Abstract
OBJECTIVES The objectives of this study are to explore the feasibility of a multicomponent intervention programme and to evaluate its impacts on behavioural and psychological symptoms of dementia (BPSD) and psychological health of caregivers. METHODS Fifty-six community-dwelling people with dementia (PWD) and knee osteoarthritis (OA) and their caregivers were recruited and randomized into the intervention group (IG) or comparison group (CG). Each participant in both groups received an individual physiotherapy session (personalized home exercises and care education) and underwent 8 weeks of a 1-hour-structured group exercise session weekly at a day care centre. They were instructed to follow the prescribed home exercise. The IG received a multicomponent programme, combining knee OA-specific therapeutic exercise with self-management support, while the CG attended the routine group exercise programme. The attendance rate and reasons for non-attendance were recorded for evaluating the feasibility. The Chinese versions of the Revised Scale for Caregiving Self-Efficacy (RSCSE) and the Neuropsychiatric Inventory Questionnaire (NPI-Q) were measured at the baseline and postintervention. RESULTS Fifty-four dyads completed the programme with high attendance rate (94.4%). Compared with the CG, caregivers in the IG significantly improved in three domains of RSCSE scores (P ≤ .005) and caregivers' distress (P = .004) after the intervention. However, no effects were observed in terms of BPSD severity in PWD. No adverse events or falls were reported. CONCLUSION This multicomponent programme is feasible and safe for dementia caregivers and older people with mild-to-moderate dementia and knee OA. The programme has beneficial effects on caregiving self-efficacy and distress of dementia caregivers.
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Affiliation(s)
- Waiyan Law
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Timothy C Y Kwok
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Sha Tin, Hong Kong
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Bertrand E, Naylor R, Laks J, Marinho V, Spector A, Mograbi DC. Cognitive stimulation therapy for brazilian people with dementia: examination of implementation' issues and cultural adaptation. Aging Ment Health 2019; 23:1400-1404. [PMID: 30444133 DOI: 10.1080/13607863.2018.1488944] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: The prevalence of dementia has been increasing particularly in developing countries. However, people with dementia (PwD) in Brazil are currently offered no psychosocial treatment upon diagnosis. Cognitive stimulation therapy (CST) that originated in the UK has proven benefits on cognition and quality of life in PwD. We investigate the possible issues for the implementation of CST for the Brazilian population and its cultural appropriateness. Method: Individual interviews and focus groups were conducted with PwD, their caregivers and health professionals (n = 37). Data were recorded and transcribed, before being analyzed using Framework Analysis. Results: Regarding the issues for implementation of CST in the Brazilian population, two main themes emerged, 'Barriers' and 'Facilitators', along with nine subthemes. Overall, the activities and materials were seen as being appropriate for use with the Brazilian population, some minor changes were suggested. Conclusions: The results indicate that CST is appropriate for use in the Brazilian population, only some cultural adaptations are necessary. In the stakeholders' opinions, CTS intervention is needed in Brazil, due to the lack of treatment options for PwD in developing countries.
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Affiliation(s)
- Elodie Bertrand
- a Department of Psychology, Pontifical Catholic University of Rio de Janeiro , Rio de Janeiro , Brazil.,b Department of Psychology, Universidade do Grande Rio (Unigranrio) , Duque de Caxias , Brazil
| | - Renata Naylor
- a Department of Psychology, Pontifical Catholic University of Rio de Janeiro , Rio de Janeiro , Brazil
| | - Jerson Laks
- c Institute of Psychiatry, Federal University of Rio de Janeiro , Rio de Janeiro , Brazil.,d Post Graduation Translational Biomedicine Programme, Universidade do Grande Rio (Unigranrio) , Duque de Caxias , Brazil
| | - Valeska Marinho
- c Institute of Psychiatry, Federal University of Rio de Janeiro , Rio de Janeiro , Brazil
| | - Aimee Spector
- e Division of Psychology and Language Sciences, University College London , London , UK
| | - Daniel C Mograbi
- a Department of Psychology, Pontifical Catholic University of Rio de Janeiro , Rio de Janeiro , Brazil.,f Institute of Psychiatry, Psychology & Neuroscience, King's College London , London , UK
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Warrick N, Prorok JC, Seitz D. Care of community-dwelling older adults with dementia and their caregivers. CMAJ 2019; 190:E794-E799. [PMID: 29970368 DOI: 10.1503/cmaj.170920] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Natalie Warrick
- Cancer Care Ontario (Warrick, Prorok, Seitz); Institute of Health Policy, Management and Evaluation (Warrick), University of Toronto, Toronto, Ont.; School of Public Health and Health Systems (Prorok), University of Waterloo, Waterloo, Ont.; Department of Psychiatry (Seitz), Queen's University, Kingston, Ont
| | - Jeanette C Prorok
- Cancer Care Ontario (Warrick, Prorok, Seitz); Institute of Health Policy, Management and Evaluation (Warrick), University of Toronto, Toronto, Ont.; School of Public Health and Health Systems (Prorok), University of Waterloo, Waterloo, Ont.; Department of Psychiatry (Seitz), Queen's University, Kingston, Ont
| | - Dallas Seitz
- Cancer Care Ontario (Warrick, Prorok, Seitz); Institute of Health Policy, Management and Evaluation (Warrick), University of Toronto, Toronto, Ont.; School of Public Health and Health Systems (Prorok), University of Waterloo, Waterloo, Ont.; Department of Psychiatry (Seitz), Queen's University, Kingston, Ont.
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30
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Wuttke-Linnemann A, Baake R, Fellgiebel A. Dyadic Wind of Change: New Approaches to Improve Biopsychological Stress Regulation in Patients with Dementia and Their Spousal Caregivers. J Alzheimers Dis 2019; 68:1325-1337. [PMID: 30909228 DOI: 10.3233/jad-181025] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Patients with dementia (PWD) and their caregivers experience long-term stress, leading to accelerated disease progression and to stress-related morbidity. Previous research focused on intrapersonal biopsychological stress responses. Quite recently, dyadic interrelations between caregivers and PWD and their effects on stress and caregiver burden have received more attention, giving rise to dyadic intervention studies. However, while it is of importance to consider both the patient and the caregiver from a dyadic point of view, evaluation of these dyadic interventions considering underlying mechanisms is still lacking. We therefore extend the current literature on dyadic processes between PWD and caregivers by transferring the knowledge about underlying stress-modulating dyadic processes in healthy couples to the dementia patient-caregiver constellation. By targeting dyadic stress co-regulation between PWD and caregivers, we expect significant therapeutic effectiveness. The aims of this article are two-fold: 1) We aim to provide a rationale for incremental benefits of considering dyadic processes among caregivers and PWD by means of elucidating underlying mechanisms and 2) we aim to emphasize the need to evaluate these underlying mechanisms by means of objective physiological stress markers in both PWD and caregivers. Knowledge on these underlying mechanisms will ultimately help developing dyadic interventions tailored to the needs of both PWD and their caregivers.
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Affiliation(s)
- Alexandra Wuttke-Linnemann
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany.,Center for Mental Health in Old Age, Landeskrankenhaus (AöR), Mainz, Germany
| | - Ricarda Baake
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany.,Center for Mental Health in Old Age, Landeskrankenhaus (AöR), Mainz, Germany
| | - Andreas Fellgiebel
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany.,Center for Mental Health in Old Age, Landeskrankenhaus (AöR), Mainz, Germany
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Abstract
UNLABELLED ABSTRACTBackground:Neuropsychiatric symptoms (NPI) of dementia are important determinants of caregiver burden, while caregiver coping styles and competences can relieve burden. Caregivers differ in coping with the demands made on them and in experienced burden. What changes in caregivers explain recovery from burden, and which caregiver characteristics predict recovery from burden over time, and does treatment make a difference? METHODS This study into recovery from burden was a secondary analysis of data collected in a formerly conducted randomized controlled trial (RCT) on the integrated reactivation and rehabilitation (IRR) programme in a psychiatric-skilled nursing home, compared to usual care (UC; i.e. day care, assisted living arrangements, and nursing home wards). For this secondary analysis, longitudinal data on persons with dementia and caregivers were used from baseline (T1), end of treatment (T2), and at nine months (T3). RESULTS Caregivers with an improved sense of competence (SCS) who care for persons with dementia with a decreased severity of NPI have the highest chance of recovering from burden (CSI). Caregivers with a tendency to feel involved with others and sympathize with others (affiliation, ICL-R) have a slightly lower probability of improvement with respect to their sense of competence in the short term. The number of improved caregivers was higher in IRR than UC. CONCLUSION Recovery depends on both an improved sense of competence and a decreased severity of NPI. Combined interventions that address both NPI and focus on enhancing caregiver's sense of competence have added value when it comes to decreasing caregiver burden.
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Mazurek J, Szcześniak D, Lion KM, Dröes RM, Karczewski M, Rymaszewska J. Does the Meeting Centres Support Programme reduce unmet care needs of community-dwelling older people with dementia? A controlled, 6-month follow-up Polish study. Clin Interv Aging 2019; 14:113-122. [PMID: 30666097 PMCID: PMC6331064 DOI: 10.2147/cia.s185683] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction In Poland we lack a multidisciplinary and coordinated system of care for people with dementia, which would take the form of an evidence-based pathway and the number of reports on the holistic approach to caring for people living with this diagnosis is very low. Aim of the study The aim of the study was to investigate whether the Meeting Centres Support Programme (MCSP) is effective in meeting the needs of older people with dementia. Participants and methods This was done by comparing the experiences of people with dementia themselves and that of their carers at baseline and at follow-up, after 6 months of participation in MCSP or Usual Care (UC). Results The study included 47 people diagnosed with mild-to-moderate dementia (n=24, MCSP group; n=23, UC control group) and 42 informal carers (n=22, MCSP group; n=20, UC control group), all living in Wroclaw in Poland and involved in the European JPND-MEETINGDEM project. To assess cognitive functioning and severity of dementia, the Mini-Mental State Examination and Global Deterioration Scale were used. The needs were assessed using the Camberwell Assessment of Need for the Elderly. The most frequently reported unmet needs at baseline both by the persons with dementia and their carers included activities of daily living, psychological distress, and the need for company. Compared to the UC group the unmet needs were reduced considerably in the MCSP group providing convincing evidence that MCSP is effective in reducing unmet needs over a 6-month period. Conclusion MCSP may be regarded as a good example of comprehensive post-diagnostic support for patients with mild-to-moderate dementia as well as their informal carers.
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Affiliation(s)
- Justyna Mazurek
- Department and Division of Medical Rehabilitation, Wroclaw Medical University, Wrocław, Poland,
| | - Dorota Szcześniak
- Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | | | - Rose-Marie Dröes
- Department of Psychiatry, VU University Medical Centre/GGZ in Geest, Amsterdam, the Netherlands
| | - Maciej Karczewski
- Department of Mathematics, Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland
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Zucchella C, Sinforiani E, Tamburin S, Federico A, Mantovani E, Bernini S, Casale R, Bartolo M. The Multidisciplinary Approach to Alzheimer's Disease and Dementia. A Narrative Review of Non-Pharmacological Treatment. Front Neurol 2018; 9:1058. [PMID: 30619031 PMCID: PMC6300511 DOI: 10.3389/fneur.2018.01058] [Citation(s) in RCA: 121] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 11/21/2018] [Indexed: 12/22/2022] Open
Abstract
Background: Alzheimer's disease (AD) and dementia are chronic diseases with progressive deterioration of cognition, function, and behavior leading to severe disability and death. The prevalence of AD and dementia is constantly increasing because of the progressive aging of the population. These conditions represent a considerable challenge to patients, their family and caregivers, and the health system, because of the considerable need for resources allocation. There is no disease modifying intervention for AD and dementia, and the symptomatic pharmacological treatments has limited efficacy and considerable side effects. Non-pharmacological treatment (NPT), which includes a wide range of approaches and techniques, may play a role in the treatment of AD and dementia. Aim: To review, with a narrative approach, current evidence on main NPTs for AD and dementia. Methods: PubMed and the Cochrane database of systematic reviews were searched for studies written in English and published from 2000 to 2018. The bibliography of the main articles was checked to detect other relevant papers. Results: The role of NPT has been largely explored in AD and dementia. The main NPT types, which were reviewed here, include exercise and motor rehabilitation, cognitive rehabilitation, NPT for behavioral and psychological symptoms of dementia, occupational therapy, psychological therapy, complementary and alternative medicine, and new technologies, including information and communication technologies, assistive technology and domotics, virtual reality, gaming, and telemedicine. We also summarized the role of NPT to address caregivers' burden. Conclusions: Although NPT is often applied in the multidisciplinary approach to AD and dementia, supporting evidence for their use is still preliminary. Some studies showed statistically significant effect of NPT on some outcomes, but their clinical significance is uncertain. Well-designed randomized controlled trials with innovative designs are needed to explore the efficacy of NPT in AD and dementia. Further studies are required to offer robust neurobiological grounds for the effect of NPT, and to examine its cost-efficacy profile in patients with dementia.
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Affiliation(s)
| | - Elena Sinforiani
- Alzheimer's Disease Assessment Unit, Laboratory of Neuropsychology, IRCCS Mondino Foundation, Pavia, Italy
| | - Stefano Tamburin
- Neurology Unit, University Hospital of Verona, Verona, Italy
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Angela Federico
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Elisa Mantovani
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Sara Bernini
- Alzheimer's Disease Assessment Unit, Laboratory of Neuropsychology, IRCCS Mondino Foundation, Pavia, Italy
| | - Roberto Casale
- Neurorehabilitation Unit, Department of Rehabilitation, HABILITA, Bergamo, Italy
| | - Michelangelo Bartolo
- Neurorehabilitation Unit, Department of Rehabilitation, HABILITA, Bergamo, Italy
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Pini S, Ingleson E, Megson M, Clare L, Wright P, Oyebode JR. A Needs-led Framework for Understanding the Impact of Caring for a Family Member With Dementia. THE GERONTOLOGIST 2018; 58:e68-e77. [PMID: 29562360 PMCID: PMC5946854 DOI: 10.1093/geront/gnx148] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 10/02/2017] [Indexed: 11/15/2022] Open
Abstract
Background and Objectives Approximately half the care for people with dementia is provided by families. It is therefore imperative that research informs ways of maintaining such care. In this study, we propose that a needs-led approach can provide a useful, novel means of conceptualizing the impact of caring on the lives of family carers. Our aim was to develop and present a needs-led framework for understanding how providing care impacts on carers’ fulfilment of needs. Design and Methods In this qualitative study, we conducted 42 semistructured interviews with a purposively diverse sample of family carers to generate nuanced contextualized accounts of how caring impacted on carers’ lives. Our inductive thematic analysis focused upon asking: “What need is being impacted here?” in order to generate a needs-led framework for understanding. Results Nine themes were widely endorsed. Each completed the sentence: “Being a carer impacts on fulfilling my need to/for….”: Freedom; feel close to my relative; feel in control of my life; be my own person; protect my relative; share/express my thoughts and feelings; take care of myself; feel connected to the people around me; get things done. Discussion and Implications These needs echo those from other research areas, with relational needs emerging as particularly central. The needs-led approach offers a perspective that is able to capture both stresses and positive aspects of caregiving. We recommend that clinical interviewing using Socratic questioning to discover human needs that are being impacted by caring would provide a valuable starting point for care planning.
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Affiliation(s)
- Simon Pini
- Patient Centred Outcome Research Group, St James's Institute of Oncology, University of Leeds, West Yorkshire, UK
| | - Emma Ingleson
- Patient Centred Outcome Research Group, St James's Institute of Oncology, University of Leeds, West Yorkshire, UK
| | - Molly Megson
- Patient Centred Outcome Research Group, St James's Institute of Oncology, University of Leeds, West Yorkshire, UK
| | | | - Penny Wright
- Patient Centred Outcome Research Group, St James's Institute of Oncology, University of Leeds, West Yorkshire, UK
| | - Jan R Oyebode
- Centre for Applied Dementia Studies, University of Bradford, Bradford, West Yorkshire, UK
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Ha JH, Kwak M, Han JW, Lee HJ, Ingersoll-Dayton B, Spencer B, Kim KW. The effectiveness of a couple-based intervention for people living with mild Alzheimer's disease and their spousal caregivers in Korea. DEMENTIA 2018; 20:831-847. [PMID: 30470154 DOI: 10.1177/1471301218811547] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND OBJECTIVES We evaluated the effectiveness of a Korean version of the Couples Life Story Approach (CLSA-K), a structured life-review program originally developed in the U.S. to help older adults with dementia and their spousal caregivers engage with each other and improve their quality of life.Research design and methods: Fifty mild people living with mild Alzheimer's disease and their spouses were recruited and 37 couples completed the five-week CLSA-K program. Data on psychosocial outcomes-i.e., depressive symptoms, talkativeness, mutuality (for both caregivers and care recipients) and burden (for caregivers)-were collected one week prior to (Time 1) and one week after the intervention (Time 2). Using repeated measures generalized linear models, we examined the differences in the amounts and patterns of the changes in outcomes according to age, gender, and the care-recipients' level of cognitive impairment. RESULTS Some participants benefited from the CLSA-K program, while others did not. For caregivers, mental health, and marital quality remained stable, while caregiver burden increased among those with spouses who had moderate levels of cognitive impairment. For care-recipients, younger and male participants showed increased talkativeness. DISCUSSION AND IMPLICATIONS CLSA-K appears to be promising for specific subgroups of participants in Korea. Multi-component or other approaches may be more beneficial for other couples. Cultural differences as well as social positions may play a role in the acceptability and efficacy of the couple-based intervention.
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Affiliation(s)
- Jung-Hwa Ha
- Department of Social Welfare, Seoul National University, Korea
| | - Minyoung Kwak
- Department of Social Work, The 26451Chinese University of Hong Kong, PR China
| | - Ji Won Han
- Department of Neuropsychiatry, 65462Seoul National University Bundang Hospital, Korea
| | - Hyeon Jung Lee
- Department of Anthropology, Seoul National University, Korea
| | | | - Beth Spencer
- School of Social Work, University of Michigan, USA
| | - Ki Woong Kim
- Department of Neuropsychiatry, 65462Seoul National University Bundang Hospital; Department of Psychiatry, College of Medicine, Seoul National University; Department of Brain and Cognitive Science, College of Natural Sciences, Seoul National University, Seoul, Korea
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36
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Leven NV, de Lange J, van der Ploeg ES, Pot AM. Working mechanisms of dyadic, psychosocial, activating interventions for people with dementia and informal caregivers: a qualitative study. Clin Interv Aging 2018; 13:1847-1857. [PMID: 30310270 PMCID: PMC6166763 DOI: 10.2147/cia.s160363] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background People living with dementia (PWD) and their informal caregivers often report difficulties in maintaining their usual activities. Several dyadic, psychosocial, activating interventions were developed to create insight into how to cope with limitations in a practical way and to increase skills for maintaining personal activities. Effects of these interventions varied so far. More knowledge on the working mechanisms of activating interventions might help to increase their impact. This study will provide more insights into the working mechanisms of three dyadic, psychosocial, activating interventions as the participating PWD, caregivers, and coaches perceived them during the interventions. Participants and methods We used a qualitative design with semi-structured interviews of 34 dyads that included 27 PWD, 34 caregivers, and 19 coaches. The data were analyzed with the constant comparative method. Results Many PWD and caregivers found capacity-building approaches beneficial. We identified “empowerment” as the core theme. Three working mechanisms explained why the interventions were perceived as having a beneficial impact: 1) enabling activities without providing false hope; 2) exploring the most important personal activity needs of the PWD and caregivers; and 3) a solution-focused approach to adapt, test, and practice activities. An individualized approach contributed to positive change. Conclusion For the overarching working mechanism empowerment, expertise in the field of dementia and psychological skills of coaches seem to be important. Assessing the needs, capacities, and limitations of both the PWD and the caregivers to take part in activities seems to be key, as well as the communication about it and the skills to teach a solution-focused approach. Studies on the impact of psychosocial and activating interventions might benefit from considering outcome measures directed at empowerment, along with aspects such as hope and belief in one’s own capacities versus traditional outcome measures as mood, burden, or quality of life.
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Affiliation(s)
- Netta Van't Leven
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands,
| | - Jacomine de Lange
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands,
| | - Eva S van der Ploeg
- Department of Public Health & Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Anne Margriet Pot
- Department of Clinical Psychology, Vrije Universiteit, Amsterdam, the Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
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Teixidó-Planas J, Tarrats Velasco L, Arias Suárez N, Cosculluela Mas A. Sobrecarga de los cuidadores de pacientes de diálisis peritoneal. Validación de cuestionario y baremos. Nefrologia 2018; 38:535-544. [DOI: 10.1016/j.nefro.2018.02.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 01/14/2018] [Accepted: 02/25/2018] [Indexed: 11/29/2022] Open
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Bennett HQ, Norton S, Bunn F, Robinson L, Rait G, Goodman C, Brayne C, Matthews FE. The impact of dementia on service use by individuals with a comorbid health condition: a comparison of two cross-sectional analyses conducted approximately 10 years apart. BMC Med 2018; 16:114. [PMID: 30037332 PMCID: PMC6056993 DOI: 10.1186/s12916-018-1105-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 06/20/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The presence of concomitant medical conditions in people with dementia is common. Dementia may be related to differential use of health, social and informal care. METHODS Data from two large UK population-based studies (CFAS I & II) of adults aged 65 years and older were analysed using logistic regression for binary outcomes and Poisson regression for count outcomes to look at differences in non-dementia service use by those with dementia and a health condition in comparison to those with the health condition alone. RESULTS A total of 1619 individuals from CFAS I and 3805 individuals from CFAS II over the age of 75 years were included in this analysis. The presence of dementia and either stroke, diabetes or visual impairment tended to increase the likelihood of a range of different services being used over having any of the health conditions alone. There has been a shift to the use of unpaid care over time. There is now increased use of unpaid care from friends and family by those with dementia and another health condition in comparison to the health condition alone. CONCLUSIONS Either due to the decrease in care home spaces or affordability, people with dementia are now relying on unpaid care more than people with other long-term health conditions.
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Affiliation(s)
- Holly Q Bennett
- Cambridge Institute of Public Health, Forvie Site, Robinson Way, Cambridge, CB2 0SR, UK
| | - Sam Norton
- Institute of Psychiatry, Psychology & Neuroscience, 16 De Crespigny Park King's College London, London, SE5 8AF, UK
| | - Frances Bunn
- Centre for Research in Public Health and Community Care, University of Hertfordshire, College Lane, Hatfield, Hertfordshire, AL10 9AB, UK
| | - Louise Robinson
- Newcastle University Institute for Ageing and Institute for Health & Society, Newcastle University, Newcastle Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Greta Rait
- Research Department of Primary Care and Population Health, UCL Medical School (Royal Free Campus), Rowland Hill Street, London, NW3 2PF, UK
| | - Claire Goodman
- Centre for Research in Public Health and Community Care, University of Hertfordshire, College Lane, Hatfield, Hertfordshire, AL10 9AB, UK
| | - Carol Brayne
- Cambridge Institute of Public Health, Forvie Site, Robinson Way, Cambridge, CB2 0SR, UK
| | - Fiona E Matthews
- Newcastle University Institute for Ageing and Institute for Health & Society, Newcastle University, Newcastle Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK.
- MRC Biostatistics Unit Cambridge Institute of Public Health, Forvie Site, Robinson Way, Cambridge Biomedical Campus, Cambridge, CB2 0SR, UK.
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Brooker D, Evans S, Evans S, Bray J, Saibene FL, Scorolli C, Szcześniak D, d'Arma A, Urbańska KM, Atkinson T, Farina E, Rymaszewska J, Chattat R, Henderson C, Rehill A, Hendriks I, Meiland F, Dröes RM. Evaluation of the implementation of the Meeting Centres Support Program in Italy, Poland, and the UK; exploration of the effects on people with dementia. Int J Geriatr Psychiatry 2018. [PMID: 29513909 DOI: 10.1002/gps.4865] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES MEETINGDEM investigated whether the Dutch Meeting Centres Support Programme (MCSP) could be implemented in Italy, Poland, and the UK with comparable benefits. This paper reports on the impact on people living with dementia attending pilot Meeting Centres in the 3 countries. METHODS Nine pilot Meeting Centres (MCs) participated (Italy-5, Poland-2, UK-2). Effectiveness of MCSP was compared with Usual Care (UC) on outcomes measuring behavioural and psychological symptoms (NPI), depression (CSDD), and quality of life (DQoL, QOL-AD), analysed by ANCOVAs in a 6-month pre-test/post-test controlled trial. RESULTS Pre/post data were collected for 85 people with dementia and 93 carers (MCSP) and 74 people with dementia /carer dyads' receiving UC. MCSP showed significant positive effects for DQoL [Self-esteem (F = 4.8, P = 0.03); Positive Affect (F = 14.93, P < 0.00); Feelings of Belonging (F = 7.77, P = 0.01)] with medium and large effect sizes. Higher attendance levels correlated with greater neuropsychiatric symptom reduction (rho = 0.24, P = 0.03) and a greater increase in feelings of support (rho = 0.36, P = 0.001). CONCLUSIONS MCSPs showed significant wellbeing and health benefits compared with UC, building on the evidence of effectiveness from the Netherlands. In addition to the previously reported successful implementation of MCSP in Italy, Poland, and the UK, these findings suggest that further international dissemination of MCSP is recommended.
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Affiliation(s)
- Dawn Brooker
- Association for Dementia Studies, University of Worcester, Worcester, UK
| | - Simon Evans
- Association for Dementia Studies, University of Worcester, Worcester, UK
| | - Shirley Evans
- Association for Dementia Studies, University of Worcester, Worcester, UK
| | - Jennifer Bray
- Association for Dementia Studies, University of Worcester, Worcester, UK
| | | | - Claudia Scorolli
- Department of Psychology, University of Bologna (UNIBO), Bologna, Italy
| | - Dorota Szcześniak
- Uniwersytet Medyczny im Piastow Slaskich we Wroclawiu, Wroclaw, Dolnoslaskie, Poland
| | | | - Katarzyna M Urbańska
- Uniwersytet Medyczny im Piastow Slaskich we Wroclawiu, Wroclaw, Dolnoslaskie, Poland
| | - Teresa Atkinson
- Association for Dementia Studies, University of Worcester, Worcester, UK
| | | | - Joanna Rymaszewska
- Uniwersytet Medyczny im Piastow Slaskich we Wroclawiu, Wroclaw, Dolnoslaskie, Poland
| | - Rabih Chattat
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Catherine Henderson
- PSSRU, Health Policy, London School of Economics and Political Science, London, UK
| | - Amritpal Rehill
- PSSRU, Health Policy, London School of Economics and Political Science, London, UK
| | - Iris Hendriks
- Department of Psychiatry, VU University Medical center/Amsterdam Public Health Research Institute, Netherlands
| | - Franka Meiland
- Department of Psychiatry and Department of General Practice and Elderly Care Medicine VU University Medical center/ Amsterdam Public Health Research Institute, Netherlands
| | - Rose-Marie Dröes
- Department of Psychiatry, VU University Medical center/Amsterdam Public Health Research Institute, Netherlands
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Stockwell-Smith G, Moyle W, Kellett U. The impact of early psychosocial intervention on self-efficacy of care recipient/carer dyads living with early-stage dementia-A mixed-methods study. J Adv Nurs 2018; 74:2167-2180. [PMID: 29754408 DOI: 10.1111/jan.13710] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 03/02/2018] [Accepted: 04/09/2018] [Indexed: 11/29/2022]
Abstract
AIM To evaluate the effect of a targeted community-based psychosocial intervention on self-efficacy outcomes for care recipient/carer dyads living with early-stage dementia. BACKGROUND There is increasing interest in the role of self-efficacy and self-management structures in determining positive outcomes for people with dementia. The assumption is that care recipient/carer dyads who receive early support to identify and adjust to dementia-related changes will cope better in the long term. DESIGN An explanatory sequential mixed-method design was employed. Primarily quantitative with qualitative data providing a supportive secondary role to expand on and illuminate the quantitative findings. METHODS Eighty-eight dyads were recruited and allocated on a regional basis to an intervention or control group. Intervention group dyads received the Early Diagnosis Dyadic Intervention. Control group dyads received two information manuals. Quantitative data were collected at three time points. Qualitative data were collected via evaluation questionnaires and semistructured interviews. RESULTS Intervention structure, content, and delivery were acceptable to the dyads but few quantitative self-efficacy findings reached statistical significance. Improvements in self-efficacy were evident in the postintervention evaluation qualitative responses where dyads expressed greater confidence in identifying and accessing community support. CONCLUSION There is an urgent need for effective psychosocial interventions to help reduce the impact of dementia symptoms on patients, carers, and society. This study makes an important contribution to our understanding of the capacity of psychosocial interventions to improve self-efficacy outcomes for care recipient/carer dyads with early-stage dementia while also illustrating the challenges associated with measuring self-efficacy in the early stages of the condition.
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Affiliation(s)
- Gillian Stockwell-Smith
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Southport, Queensland, Australia
| | - Wendy Moyle
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Southport, Queensland, Australia
| | - Ursula Kellett
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Southport, Queensland, Australia
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Facilitators and barriers to adaptive implementation of the Meeting Centers Support Program (MCSP) in three European countries; the process evaluation within the MEETINGDEM study. Int Psychogeriatr 2018; 30:527-537. [PMID: 29145912 DOI: 10.1017/s1041610217001922] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
UNLABELLED ABSTRACTBackground:In the MEETINGDEM project, the Meeting Centers Support Program (MCSP) was adaptively implemented and evaluated in three European countries: Italy, Poland, and the United Kingdom. The aim of this study was to investigate overall and country-specific facilitators and barriers to the implementation of MCSP in these European countries. METHODS A qualitative multiple case study design was used. Based on the theoretical model of adaptive implementation, a checklist was composed of potential facilitators and barriers to the implementation of MCSP. This checklist was administered among stakeholders involved in the implementation of MCSP to trace the experienced facilitators and barriers. Twenty-eight checklists were completed. RESULTS Main similarities between countries were related to the presence of suitable staff, management, and a project manager, and the fact that the MCSP is attuned to needs and wishes of people with dementia and informal caregivers. Main differences between countries were related to: communication with potential referrers, setting up an inter-organizational collaboration network, receiving support of national organizations, having clear discharge criteria for the MCSP and continuous PR in the region. CONCLUSION The results of this study provide insight into generic and country specific factors that can influence the implementation of MCSP in different European countries. This study informs further implementation and dissemination of MCSP in Europe and may also serve as an example for the dissemination and implementation of other effective psychosocial support interventions for people with dementia and their informal caregivers across and beyond Europe.
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Chung PYF, Ellis-Hill C, Coleman P. Supporting activity engagement by family carers at home: maintenance of agency and personhood in dementia. Int J Qual Stud Health Well-being 2017; 12:1267316. [PMID: 28452609 PMCID: PMC5328354 DOI: 10.1080/17482631.2016.1267316] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/29/2016] [Indexed: 11/13/2022] Open
Abstract
An explorative paper to describe how family carers, through the caregiving journey, reaffirm and promote the agency of people with dementia. Agency is an important concept in dementia care and is crucial to the promotion of wellbeing and the delivery of person-centred care. This article is based on one of the key findings of a study that explored family carers' experiences of engaging their relatives in daily activities in domestic settings. Following research governance and ethical approval, 30 in-depth interviews (initial and follow-up) were carried out with 15 resident-carers of people with dementia who were recruited via local community mental health teams. Then five focus groups were conducted with 21 participants accessed through carers support groups. Interviews and focus groups were transcribed, coded and analysed using a grounded theory method. Findings showed the process in which family carers encouraged and sustained a sense of autonomy and control (agency) in their relative's daily activities. Key strategies used by carers included: being non-judgemental; facilitating a sense of worth; taking calculated risks; maintaining the continuity of their relative's identity; enhancing a sense of connection with their relative's role and identity using enjoyable activities; preventing inactivity and attending to the bodily source of the agency. Lack of support for carers could ultimately pose a risk to the maintenance of the agency of people with dementia. This study provides a deeper insight into the process used by home carers to support the agency of people with dementia. This is essential if practitioners are to identify and develop more realistic intervention strategies and to work in effective partnership with family carers. The implications for the creation of dementia-friendly communities are discussed.
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Affiliation(s)
- Pat Yin Fan Chung
- Occuaptional Therapy Pathway, School of Allied Health Professions, Canterbury Christ Church University, Canterbury, UK
| | - Caroline Ellis-Hill
- Faculty of Health and Social Sciences, Bournemouth University, Canterbury, UK
| | - Peter Coleman
- Faculty of Social & Human Sciences, University of Southampton, Southampton, UK
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Bielsten T, Hellström I. An extended review of couple-centred interventions in dementia: Exploring the what and why - Part B. DEMENTIA 2017; 18:2450-2473. [PMID: 29105499 DOI: 10.1177/1471301217737653] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This scoping review is an extended version of a narrative review of couple-centred interventions in dementia shared in part A and the previous publication in this edition. The rationale for expanding study A emerged through the fact that most dyadic interventions have samples consisting of a majority of couples. The exclusion of interventions with samples of mixed relationships in part A therefore contributed to a narrow picture of joint dyadic interventions for couples in which one partner has a dementia. The aim of this second review is to explore the ‘what’ (types of interventions) and the ‘why’ (objectives and outcome measures) of dyadic interventions in which sample consists of a majority of couples/spouses and in which people with dementia and caregivers jointly participate. Method A five-step framework for scoping reviews guided the procedure. Searches were performed in Academic Search Premier, CINAHL, PsycINFO, PubMed, Scopus, and Web of Science. Results Twenty-one studies with various types of psychosocial interventions were included. The main outcome measure for people with dementia was related to cognitive function, respectively caregiver burden and depression for caregivers. Conclusions The findings of this extended review of joint dyadic interventions in dementia are in line with the findings of part A regarding the negative approach of outcomes, lack of a genuine dyadic approach, lack of tailored support, neglect of interpersonal issues and the overlook of the views of people with dementia. This review also recognises that measures of caregiver burden, as well as relationship quality should be considered in samples of mixed relationships due to the different significance of burden and relationship quality for a spouse as opposed to an adult child or friend.
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Affiliation(s)
- Therése Bielsten
- Department of Social and Welfare Studies, Linkopings universitet Institutionen for samhalls- och valfardsstudier, Linköping University, Sweden
| | - Ingrid Hellström
- Department of Social and Welfare Studies, Linkopings universitet Institutionen for samhalls- och valfardsstudier, Linköping University, Sweden; Department of Health Care Science, Ersta Sköndal Bräcke University College, Sweden
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O'Connor CM, Clemson L, Brodaty H, Low LF, Jeon YH, Gitlin LN, Piguet O, Mioshi E. The tailored activity program (TAP) to address behavioral disturbances in frontotemporal dementia: a feasibility and pilot study. Disabil Rehabil 2017; 41:299-310. [PMID: 29034719 DOI: 10.1080/09638288.2017.1387614] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE To explore the feasibility of implementing the Tailored Activity Program with a cohort of people with frontotemporal dementia and their carers (dyads). METHODS The Tailored Activity Program is an occupational therapy based intervention that involves working collaboratively with family carers and prescribes personalized activities for behavioral management in people with dementia. Twenty dyads randomized into the study (Tailored Activity Program: n = 9; Control: n = 11) were assessed at baseline and 4-months. Qualitative analyzes evaluated feasibility and acceptability of the program for the frontotemporal dementia cohort, and quantitative analyzes (linear mixed model analyzes, Spearman's rho correlations) measured the impact of the program on the dyads. RESULTS The Tailored Activity Program was an acceptable intervention for the frontotemporal dementia dyads. Qualitative analyses identified five themes: "carer perceived benefits", "carer readiness to change", "strategies used by carer to engage person with dementia", "barriers to the Tailored Activity Program uptake/implementation", and "person with dementia engagement". Quantitative outcomes showed an overall reduction of behavioral symptoms (F18.34 = 8.073, p = 0.011) and maintenance of functional performance in the person with dementia (F18.03 = 0.375, p = 0.548). CONCLUSIONS This study demonstrates the potential for using an activity-based intervention such as the Tailored Activity Program in frontotemporal dementia. Service providers should recognize that while people with frontotemporal dementia present with challenging issues, tailored therapies may support their function and reduce their behavioral symptoms. Implications for rehabilitation The Tailored Activity Program is an occupational therapy based intervention that involves prescribing personalized activities for behavioral management in dementia. The Tailored Activity Program is an acceptable and feasible intervention approach to address some of the unique behavioral and functional impairments inherent in frontotemporal dementia.
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Affiliation(s)
- Claire M O'Connor
- a Ageing, Work & Health Research Unit, Faculty of Health Sciences , University of Sydney , Sydney , Australia.,b Centre of Excellence in Population Ageing Research , University of Sydney , Sydney , Australia
| | - Lindy Clemson
- a Ageing, Work & Health Research Unit, Faculty of Health Sciences , University of Sydney , Sydney , Australia.,b Centre of Excellence in Population Ageing Research , University of Sydney , Sydney , Australia
| | - Henry Brodaty
- c Dementia Collaborative Research Centre and Centre for Healthy Brain Ageing (CHeBA) , University of New South Wales , Sydney , Australia
| | - Lee-Fay Low
- a Ageing, Work & Health Research Unit, Faculty of Health Sciences , University of Sydney , Sydney , Australia
| | - Yun-Hee Jeon
- d Sydney Nursing School , University of Sydney , Sydney , Australia
| | - Laura N Gitlin
- e Center for Innovative Care in Aging , Johns Hopkins University , Baltimore , MD , USA
| | - Olivier Piguet
- f Brain and Mind Centre , Sydney , Australia.,g Neuroscience Research Australia , Sydney , Australia.,h ARC Centre of Excellence in Cognition and its Disorders , University of New South Wales , Sydney , Australia
| | - Eneida Mioshi
- i School of Health Sciences , University of East Anglia , Norwich , UK
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Fakolade A, Lamarre J, Latimer-Cheung A, Parsons T, Morrow SA, Finlayson M. Understanding leisure-time physical activity: Voices of people with MS who have moderate-to-severe disability and their family caregivers. Health Expect 2017; 21:181-191. [PMID: 28722772 PMCID: PMC5750693 DOI: 10.1111/hex.12600] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2017] [Indexed: 01/25/2023] Open
Abstract
Background Physical activity (PA) is beneficial for all people, yet people affected by multiple sclerosis (MS) find regular PA challenging. These people may include individuals with the disease who have moderate‐to‐severe disability and their family caregivers. For researchers and clinicians to effectively promote PA among caregiver/care‐recipient dyads with moderate‐to‐severe MS, a comprehensive understanding of the shared PA experiences of these dyads would be beneficial. Objective We explored shared experiences of caregiver/care‐recipient dyads affected by moderate‐to‐severe MS about PA and directions for intervention. Methods Six focus groups with 23 people with moderate‐to‐severe MS and 12 family caregivers were conducted. Data were analysed using a constant comparative approach. Results Three major themes emerged as follows: (i) PA is a continuum, (ii) cycle of disengagement and (iii) cycle of adjustment. The first theme captured the dyads understanding that PA falls along a continuum ranging from highly structured to unstructured activities. Cycle of disengagement captured the experiences of dyads engaging in little or no PA. These dyads perceived internal and external issues as drivers of the cycle of disengagement, while availability of supportive programmes and services or people helped the dyads to break out of the cycle. When the cycle of disengagement was broken, the dyads described moving towards the cycle of adjustment, where they were able to learn skills and take action to incorporate PA into daily routines. Conclusion This research highlights the need to adopt an integrative approach that acknowledges the caregiver/care‐recipient dyad with moderate‐to‐severe MS as a focus for PA intervention.
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Affiliation(s)
- Afolasade Fakolade
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | - Julie Lamarre
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | - Amy Latimer-Cheung
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada
| | - Trisha Parsons
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | - Sarah A Morrow
- Multiple Sclerosis Clinic, University Hospital-London Health Services, London, ON, Canada
| | - Marcia Finlayson
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
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Vandepitte S, Van Den Noortgate N, Putman K, Verhaeghe S, Faes K, Annemans L. Effectiveness of Supporting Informal Caregivers of People with Dementia: A Systematic Review of Randomized and Non-Randomized Controlled Trials. J Alzheimers Dis 2017; 52:929-65. [PMID: 27079704 DOI: 10.3233/jad-151011] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Dementia is known as a major public health problem affecting both patients and caregivers, and placing a high financial strain upon society. In community-dwelling patients, it is important to support informal caregivers in order to help them sustain their demanding role. Previous reviews about effectiveness of such supporting strategies often included a small number of studies, focused only on particular supportive types, particular outcomes, or solely on caregivers. OBJECTIVE A general systematic review was conducted investigating effectiveness of different supportive strategies on at least the well-being of the caregiver or the care-recipient. METHODS A systematic literature search was conducted in Web of Science and PubMed. An adapted version of the Downs and Black (1998) checklist was used to assess methodological quality. A new classification was developed to group different types of caregiver support. RESULTS Fifty-three papers met the inclusion criteria. Although 87% of the interventions were to some extent effective, methods and findings were rather inconsistent. Psychoeducational interventions generally lead to positive outcomes for caregivers, and delay permanent institutionalization of care-recipients. Cognitive behavioral therapy decreases dysfunctional thoughts among caregivers. Occupational therapy decreases behavioral problems among patients and improves self-efficacy of caregivers. In general, those interventions tailored on individual level generate better outcomes. Comparative research on respite care was very rare. CONCLUSIONS Despite methodological inconsistency, supporting caregivers appears to be an effective strategy often improving well-being of caregiver or care-recipient and resulting in additional benefits for society. However, there is a need for more research on the (cost)-effectiveness of respite care.
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Affiliation(s)
- Sophie Vandepitte
- Faculty of Medicine and Health Sciences, Department of Public Health, Ghent University, Belgium
| | - Nele Van Den Noortgate
- Faculty of Medicine and Health Sciences, Department of Internal Medicine, Ghent University, Brussels, Belgium
| | - Koen Putman
- Faculty of Medicine and Pharmacy, Department of Medical Sociology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Sofie Verhaeghe
- Faculty of Medicine and Health Sciences, Department of Public Health, Ghent University, Belgium
| | - Kristof Faes
- Faculty of Medicine and Health Sciences, Department of Public Health, Ghent University, Belgium
| | - Lieven Annemans
- Faculty of Medicine and Health Sciences, Department of Public Health, Ghent University, Belgium
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Dröes RM, Meiland FJM, Evans S, Brooker D, Farina E, Szcześniak D, Van Mierlo LD, Orrell M, Rymaszewska J, Chattat R. Comparison of the adaptive implementation and evaluation of the Meeting Centers Support Program for people with dementia and their family carers in Europe; study protocol of the MEETINGDEM project. BMC Geriatr 2017; 17:79. [PMID: 28376895 PMCID: PMC5381019 DOI: 10.1186/s12877-017-0472-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 03/31/2017] [Indexed: 11/17/2022] Open
Abstract
Background The MEETINGDEM study aims to implement and evaluate an innovative, inclusive, approach to supporting community dwelling people with mild to moderate dementia and their family carers, called the Meeting Centers Support Program (MCSP), in three countries in the European Union (EU): Italy, Poland and United Kingdom. Demonstrated benefits of this person-centered approach, developed in The Netherlands, include high user satisfaction, reduced behavioral and mood problems, delayed admission to residential care, lower levels of caregiving-related stress, higher carer competence, and improved collaboration between care and welfare organizations. Methods The project will be carried out over a 36 month period. Project partners in the three countries will utilize, and adapt, strategies and tools developed in the Netherlands. In Phase One (month 1-18) activities will focus on establishing an initiative group of relevant organizations and user representatives in each country, exploring pathways to care and potential facilitators and barriers to implementing the program, and developing country specific implementation plans and materials. In Phase Two (month 19‑36) training will be provided to organizations and staff, after which the meeting centers will be established and evaluated for impact on behavior, mood and quality of life of people with dementia and carers, cost-effectiveness, changes in service use, user satisfaction and implementation process. Discussion An overall evaluation will draw together findings from the three countries to develop recommendations for successful implementation of MCSP across the EU. If the Meeting Centers approach can be widely implemented, this could lead to major improvements in dementia care across Europe and beyond. Trial registration The trial was retrospectively registered in May 2016: trial number: NTR5936.
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Affiliation(s)
- R M Dröes
- Department of Psychiatry, VU University medical center/GGZinGeest, Postbox 74077, 1070 BB, Amsterdam, The Netherlands.
| | - F J M Meiland
- Department of Psychiatry, VU University medical center/GGZinGeest, Postbox 74077, 1070 BB, Amsterdam, The Netherlands
| | - S Evans
- Association for Dementia Studies, University of Worcester, Henwick Grove, Worcester, WR26AJ, UK
| | - D Brooker
- Association for Dementia Studies, University of Worcester, Henwick Grove, Worcester, WR26AJ, UK
| | - E Farina
- Santa Maria Nascente IRCCS Clinical Research Center, Don Carlo Gnocchi Foundation, Via Alfonso Capecelatro 66, 20148, Milan, Italy
| | - D Szcześniak
- Department of Psychiatry, Wroclaw Medical University, Pasteura 10, 50-367, Wroclaw, Poland
| | - L D Van Mierlo
- Department of Psychiatry, VU University medical center/GGZinGeest, Postbox 74077, 1070 BB, Amsterdam, The Netherlands
| | - M Orrell
- Institute of Mental Health, University of Nottingham, Triumph Road, Nottingham, NG7 2TU, UK
| | - J Rymaszewska
- Department of Psychiatry, Wroclaw Medical University, Pasteura 10, 50-367, Wroclaw, Poland
| | - R Chattat
- Department of Psychology, University of Bologna, Viale Berti Pichat 5, Bologna, Italy
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Keeping the person with dementia and the informal caregiver together: a systematic review of psychosocial interventions. Int Psychogeriatr 2017; 29:583-593. [PMID: 27890029 DOI: 10.1017/s1041610216002106] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Social support, relationships, and closeness are emphasized as important by both people with dementia and their informal caregivers. Psychosocial interventions might be helpful to reinforce the relationship between a person with dementia and his or her informal caregiver. Therefore, this review explores what types of psychosocial interventions have been provided for people with dementia and their informal caregivers together, and the effectiveness of these interventions. METHODS PubMed, PsychInfo, Cinahl, and references of key papers were searched for studies describing a psychosocial intervention for people with dementia and their informal caregivers together. Psychosocial interventions were defined as focusing primarily on psychological or social factors. RESULTS A total of seven publications describing six studies were identified as eligible for inclusion in this review. Interventions ranged in focus from skills training to viewing/making art. The methodology of the studies varied, especially regarding the outcome measures used. The results of individual studies were mixed. A narrative synthesis of the included studies is given. CONCLUSION Although caregiving dyads emphasize the importance of their relationship, this is mostly not taken into consideration in the design and effect evaluations of the interventions. Improved research is needed on this subject, which focuses on people with dementia living in the community and those living in nursing homes.
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Alshammari SA, Alzahrani AA, Alabduljabbar KA, Aldaghri AA, Alhusainy YA, Khan MA, Alshuwaier RA, Kariz IN. The burden perceived by informal caregivers of the elderly in Saudi Arabia. J Family Community Med 2017; 24:145-150. [PMID: 28932158 PMCID: PMC5596626 DOI: 10.4103/jfcm.jfcm_117_16] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES: The objective of this study was to discover the characteristics of informal caregivers of elderly patients; to determine the socioeconomic, psychological, and physical consequences facing informal caregivers; and to measure their burdens and needs. MATERIALS AND METHODS: This study was a cross-sectional survey of informal caregivers of elderly patients. Participants were recruited from different hospitals and primary care clinics in Riyadh, Saudi Arabia. For an intended sample size of 384 caregivers, a multistage sampling was used. A self-administered questionnaire was used to collect data. Data analysis included student's t-test and ANOVA to test for statistical significance. RESULTS: The study included 315 caregivers of elderly patients. Over half of the elderly patients were female (55.9%) and over 70 years old (65.7%); about 31% had chronic diseases or disabilities, which represented the majority of health problems reported by the elderly population. Most of the caregivers were family members (87.9%), young (43.8%), female (52.7%), unemployed (54.6%), and unmarried (58.1%). Most caregivers suffered from musculoskeletal problems (78.1%). The mean Zarit Burden Interview score was 31.3, which indicated a moderate burden. More than half of caregivers requested blood pressure (55.6%) and blood sugar measuring devices (53%). Three quarters (74.9%) of the caregivers wanted educational training to cope with emergencies. Most caregivers expressed a need for frequent healthcare for themselves (58.4%) and a home health visit service (72.9%) to support them in the care of their elderly. CONCLUSIONS AND RECOMMENDATIONS: Mobilization of resources in locations where these carers of the elderly live are greatly needed. In addition, health authorities should provide devices and essential training to manage the common problems and emergencies that informal caregivers have to deal with. Moreover, caregivers need follow-up supervision by a home visit team. Further studies are required to guide the implementation of the above advice.
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Affiliation(s)
- Sulaiman A Alshammari
- Research Chair of Health Education and Health Promotion, Department of Family Community Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah A Alzahrani
- Research Chair of Health Education and Health Promotion, Department of Family Community Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Khaled A Alabduljabbar
- Research Chair of Health Education and Health Promotion, Department of Family Community Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdulaziz A Aldaghri
- Research Chair of Health Education and Health Promotion, Department of Family Community Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Yazeed A Alhusainy
- Research Chair of Health Education and Health Promotion, Department of Family Community Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed A Khan
- Research Chair of Health Education and Health Promotion, Department of Family Community Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Rakan A Alshuwaier
- Research Chair of Health Education and Health Promotion, Department of Family Community Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ismail N Kariz
- Research Chair of Health Education and Health Promotion, Department of Family Community Medicine, King Saud University, Riyadh, Saudi Arabia
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Abstract
BACKGROUND There are many systematic reviews and meta-analyses (SRs) of interventions for family caregivers of persons with Alzheimer's disease or a related dementia. A challenge when synthesizing the efficacy of dementia caregiver interventions is the potential discrepancy in how they are categorized. The objective of this study was to systematically examine inconsistencies in how dementia caregiver interventions are classified. METHODS We searched Ovid Medline®, Ovid PsycINFO®, Ovid Embase®, and the Cochrane Library to identify previous SRs published and indexed in bibliographic databases through January 2015. Following a graphical network analysis, open-coding of classification definitions was conducted. A descriptive analysis was then completed to examine classification consistency of individual interventions across SR grouping labels. RESULTS Twenty-three SRs were identified. A graphical network analysis revealed a significant amount of overlap in individual studies included across SRs, but stark differences in how reviews labeled or categorized them. The qualitative content analysis identified seven themes; one of these, content of the intervention, was used to compare classification consistency. When subjecting the classification of interventions to descriptive empirical analysis, extensive inconsistency was apparent. CONCLUSIONS The substantial inconsistency in how dementia caregiver interventions are classified across SRs has hindered the science and practice of dementia caregiver interventions. Specifically, accurate reporting of intervention components and SRs would allow for more precise assessments of efficacy as well as a fuller determination of how caregiver interventions can best yield benefits for caregivers and persons with dementia.
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