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Takechi H, Yoshino H, Suzuki M, Maeda A, Suzumura S, Kamiya E. Characteristics of Changes in Caregiver Burden during Follow-up at a Memory Clinic: A Retrospective Cohort Study. J Alzheimers Dis Rep 2024; 8:151-162. [PMID: 38405344 PMCID: PMC10894603 DOI: 10.3233/adr-230069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 12/26/2023] [Indexed: 02/27/2024] Open
Abstract
Background Because dementia is a long-term condition, the appropriate involvement of health-care professionals is considered important. However, little is known about the factors associated with changes in family caregiver burden. Objective To clarify changes in family caregiver burden and associated factors during follow-up at a memory clinic. Methods A retrospective cohort study was conducted, enrolling 495 pairs of patients with dementia or mild cognitive impairment and their family caregivers. A total of 120 pairs completed the second evaluation. The caregiver burden was assessed using the Zarit Burden Interview (ZBI). Data at the initial visit and after an average follow-up of about 2 years were compared and analyzed. Results At initial visit, the patients' mean age, Mini-Mental State Examination (MMSE) and ZBI scores were 78.6±5.6 years, 23.3±3.5, and 22.6±16.7, respectively. At follow-up, MMSE scores decreased (21.4±4.5, p < 0.001), but ZBI scores remained similar (22.5±13.6). When the difference in ZBI scores between the two time points was defined as ΔZBI, and the related factors were analyzed by multiple regression analysis, ZBI scores at the initial visit, start of psychotropic drug, and decrease of neuropsychiatric symptoms were identified as significant factors (p < 0.001, p = 0.003, p < 0.001, respectively). A significant negative correlation was found between ZBI scores at the initial visit and ΔZBI (r = -0.588, p < 0.001). Conclusions These findings suggest the importance of assessing changes in the burden experienced by family caregivers during the disease follow-up.
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Affiliation(s)
- Hajime Takechi
- Department of Geriatrics and Cognitive Disorders, School of Medicine, Fujita Health University, Aichi, Japan
| | - Hiroshi Yoshino
- Department of Geriatrics and Cognitive Disorders, School of Medicine, Fujita Health University, Aichi, Japan
| | - Megumi Suzuki
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Aichi, Japan
| | - Akiko Maeda
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Aichi, Japan
| | - Shota Suzumura
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Aichi, Japan
| | - Eiko Kamiya
- Department of Geriatrics and Cognitive Disorders, School of Medicine, Fujita Health University, Aichi, Japan
- Graduate School of Health Sciences, Fujita Health University, Aichi, Japan
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2
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Colclough C, Miles E, Rusted J, Perach R, Hicks B, Dixon J, Dangoor M, Gridley K, Birks Y, Donaghy P, Mcardle R, Moseley E, Sondh HK, Banerjee S. Emotion-focused dyadic coping styles used by family carers of people with dementia during the COVID-19 pandemic. DEMENTIA 2023:14713012231173812. [PMID: 37147119 PMCID: PMC10164090 DOI: 10.1177/14713012231173812] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Emotional wellbeing of family carers and people with dementia is associated with not only how each individual copes with stress and conflict, but also by how they cope together. Finding ways to positively cope together was particularly important during COVID-19 lockdown restrictions, when other avenues of emotional support were less available. We explored how carers experienced and used emotion-focused dyadic coping styles during the COVID-19 pandemic. In-depth qualitative interviews were conducted during the pandemic with 42 family carers, supplemented by quality of life scores collected both pre- and during the pandemic and household status. Abductive thematic analysis identified five styles of emotion-focused dyadic coping: common, supportive, hostile, disengaged avoidance and protective. The COVID-19 pandemic left many dyads unsupported. While many carers adapted, reporting increases in quality of life and enjoying the extra time with the person with dementia, others experienced dyadic conflict and reductions in quality of life. This variation was associated with dyadic coping styles, including challenges in using 'positive' styles and the protective use of 'negative' disengaged avoidance in the right situations. Dyadic coping styles also differed as a function of whether the dyad lived together. As many people with dementia are supported by an informal carer, considering how they cope together could help us to better support them. We make suggestions for dyadic interventions tailored by co-residency status that could help dyads identify and communicate coping needs, reconnect following avoidance coping, and replenish their coping resources through social support.
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Affiliation(s)
| | - Eleanor Miles
- School of Psychology, University of Sussex, Brighton, UK
| | | | - Rotem Perach
- School of Social Sciences, University of Westminster, London, UK
| | - Ben Hicks
- Brighton and Sussex Medical School, Brighton, UK
- University of Sussex, Brighton, UK
| | - Josie Dixon
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Margaret Dangoor
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Kate Gridley
- Social Policy Research Unit, University of York, York, UK
| | - Yvonne Birks
- Social Policy Research Unit, University of York, York, UK
| | - Paul Donaghy
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Riona Mcardle
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Elen Moseley
- South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Sube Banerjee
- Faculty of Health, University of Plymouth, Plymouth, UK
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3
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Balzaretti PL, Reano A, Canonico S, Aurucci ML, Ricotti A, Pili FG, Monacelli F, Vallino D. A geriatric re-evaluation clinic is associated with fewer unplanned returns in the Emergency Department: an observational case-control study. Eur Geriatr Med 2023; 14:123-129. [PMID: 36471122 PMCID: PMC9734542 DOI: 10.1007/s41999-022-00726-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE The increasing share of older adults is associated with heavier Emergency Health Services utilization. In this context, a significant problem is the rate of unplanned revisits of geriatric patients after discharge from the Emergency Department (ED). We aimed to evaluate whether the referral to a dedicated Geriatric Revaluation Clinic (GRC) after discharge from the ED is associated with fewer early unplanned returns. METHODS We conducted an observational, retrospective, case-control study comparing patients 65 years or older evaluated in a GRC after an ED visit and a control group of same age subjects accessing the ED during the study period and discharged with one of the ICD-9-CM diagnoses used for the cases, for whom defined post-ED assessment was not arranged. The intervention at the GRC consisted of a comprehensive geriatric evaluation. We calculated unadjusted and adjusted OR for unplanned ED revisits within 30 days from ED discharge using two logistic regression models including the variables with statistically significant differences among study groups at univariate analysis. RESULTS During the study period, 121 eligible patients were evaluated at the GRC and were matched to 242 subjects included in the control group. The median age of the study population was 85 years. The adjusted OR for unplanned return after ED discharge and unplanned hospital admission after ED discharge were 0.44 (CI 0.20-0.89) and 0.52 (CI 95% 0.18-1.74), respectively. CONCLUSIONS In a population of older patients discharged from the ED, the referral to a GRC is associated with fewer early unplanned revisits.
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Affiliation(s)
- P L Balzaretti
- Emergency Department, Azienda Ospedaliera "Ordine Mauriziano", Turin, Italy.
| | - A Reano
- Emergency Department, Azienda Ospedaliera "Ordine Mauriziano", Turin, Italy
| | - S Canonico
- Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, Italy
| | - M L Aurucci
- Emergency Department, Azienda Ospedaliera "Ordine Mauriziano", Turin, Italy
| | - A Ricotti
- Emergency Department, Azienda Ospedaliera "Ordine Mauriziano", Turin, Italy
| | - F G Pili
- Emergency Department, Azienda Ospedaliera "Ordine Mauriziano", Turin, Italy
| | - F Monacelli
- Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, Italy
| | - D Vallino
- Emergency Department, Azienda Ospedaliera "Ordine Mauriziano", Turin, Italy
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4
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Moberg C, Grundberg Å, Konradsen H, Kallström AP, Leung AY, Kabir ZN. Meeting own needs and supporting ability to care: Family caregivers' and health care professionals' perspectives on professional support provided through a potential mobile application. DEMENTIA 2022; 21:1120-1134. [PMID: 35300535 DOI: 10.1177/14713012211065313] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND A majority of persons with dementia in Sweden live in their own homes and are often cared for by family members. Caring for a family member may be a positive experience. It may, however, also be a negative experience as symptoms like disturbing behavior and delusions may be difficult to encounter. The burden of being a family caregiver has been shown to affect the caregivers' quality of life. OBJECTIVE To explore stakeholders' perspectives on a potential mobile application through which family caregivers could be supported by healthcare professionals in caring for a person with dementia living at home. METHOD Eight individual interviews with family caregivers and a focus group with eight healthcare professionals specialized in dementia care were analyzed using content analysis method. RESULTS The findings suggest that a mobile application can support family caregivers to meet their own needs in terms of finding structure in everyday life, how to get information and support in their own pace, and how to care for themselves. The findings also suggest the necessity of accessing relevant contact networks to be supported in the ability to care for a family member with dementia. CONCLUSION Healthcare and social services mediated support provided through user-friendly mobile application has the potential to support family caregivers both in taking care of a person with dementia and caring for themselves. Moreover, it is important that the information provided to family caregivers is personalized according to the needs of the family caregivers as the family member's dementia advances.
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Affiliation(s)
- Cecilia Moberg
- Department of Neurobiology, Care Sciences and Society, NVS, 27106Karolinska Institutet, Stockholm, Sweden
| | - Åke Grundberg
- Department of Learning, Informatics, Management and Ethics, LIME, 27106Karolinska Institutet, Stockholm, Sweden
| | - Hanne Konradsen
- Department of Neurobiology, Care Sciences and Society, NVS, Karolinska Institutet, Stockholm, Sweden; Faculty of Health and Medical Sciences, Department of Clinical Medicine, 4321University of Copenhagen, Kobenhavn, Denmark; Department of Gastroenterology, Herley and Gentofte Hospital, Copenhagen, Denmark
| | - Ana Paula Kallström
- Department of Neurobiology, Care Sciences and Society, NVS, 27106Karolinska Institutet, Stockholm, Sweden
| | - Angela Ym Leung
- Centre for Gerontological Nursing, School of Nursing, 105806The Hong Kong Polytechnic University of Hong Kong, China
| | - Zarina N Kabir
- Department of Neurobiology, Care Sciences and Society, NVS, 27106Karolinska Institutet, Stockholm, Sweden
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5
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van den Kieboom R, Snaphaan L, Mark R, Bongers I. The Trajectory of Caregiver Burden and Risk Factors in Dementia Progression: A Systematic Review. J Alzheimers Dis 2021; 77:1107-1115. [PMID: 32804093 PMCID: PMC7683084 DOI: 10.3233/jad-200647] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Caring for patients with dementia at home is often a long-term process, in which the independence of the patient declines, and more responsibility and supervision time is required from the informal caregiver. Objective: In order to minimize and reduce caregiver burden, it is important to explore its trajectory and the accompanying risk factors as dementia progresses; the objective of this systematic review. Methods: PRISMA guidelines were followed in this systematic review. Three databases, PubMed, PsycINFO, and EMbase, were systematically searched in November 2019 using specific keywords. Results: 1,506 hits emerged during the systematic search but only eleven articles actually met the inclusion criteria for this review. The trajectory of caregiver burden is highly variable and depends on multiple factors. Important risk factors included: patients’ behavioral and neuropsychiatric symptoms, and their decline in functioning in (I)ADL; the caregiver’s age, gender, and physical and mental health; and, within the dyads (patient/caregiver), cohabitation and kinship. Conclusion: There is no one-size-fits-all for predicting how caregiver burden will change over time, but specific factors (like being a spouse and increased behavioral impairment and decline in functional status in the patient) may heighten the risk. Other factors, not yet comprehensively included in the published studies, might also prove to be important risk factors. Future research in the field of reducing caregiver burden is recommended to integrate the patient, caregiver, and context characteristics in the trajectory of caregiver burden, and to assess more clearly the phase of the dementia progression and use of external resources.
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Affiliation(s)
- Robin van den Kieboom
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands.,Research Unit Evidence Based Management of Innovation, Mental Health Care Institute Eindhoven, Eindhoven, Netherlands
| | - Liselore Snaphaan
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands.,Research Unit Evidence Based Management of Innovation, Mental Health Care Institute Eindhoven, Eindhoven, Netherlands
| | - Ruth Mark
- Department of Cognitive Neuropsychology, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
| | - Inge Bongers
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands.,Research Unit Evidence Based Management of Innovation, Mental Health Care Institute Eindhoven, Eindhoven, Netherlands
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7
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Dombestein H, Norheim A, Aase K. Caring for home-dwelling parents with dementia: A qualitative study of adult-child caregivers' motivation. Nurs Open 2020; 7:1954-1965. [PMID: 33072381 PMCID: PMC7544851 DOI: 10.1002/nop2.587] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/25/2020] [Accepted: 07/06/2020] [Indexed: 12/15/2022] Open
Abstract
Aim To explore adult children's motivation in caregiving for their home-dwelling parents with dementia. Design Qualitative design with a phenomenological approach. Methods Semi-structured individual interviews with 21 adult sons and daughters who were caregivers for a parent with dementia. Data were analysed using systematic text condensation. Results Inspired by self-determination theory, three categories were identified in the empirical data representing the main motivational drivers for adult-child caregivers: relatedness (to the parent with dementia, the parent's spouse, other persons), competence (in handling dementia, in the parent's need) and autonomy (freedom of choice, innate values and tasks). Caregivers report relatedness as their key motivational driver.These results imply that nurses and other health professionals should value the importance of relatedness when interacting with dementia caregivers and establish belonging support structures. Further research should generate more knowledge of the positive motivational drivers, including interventions to improve relatedness, competence and autonomy.
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Affiliation(s)
- Heidi Dombestein
- Centre for Resilience in HealthcareFaculty of Health SciencesUniversity of StavangerStavangerNorway
| | - Anne Norheim
- Department of Caring and EthicsFaculty of Health SciencesUniversity of StavangerStavangerNorway
| | - Karina Aase
- Centre for Resilience in HealthcareFaculty of Health SciencesUniversity of StavangerStavangerNorway
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8
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van Wyk NC. Care for carers: A concept analysis of support for carers of ill relatives. Nurs Forum 2020; 56:202-207. [PMID: 33125730 DOI: 10.1111/nuf.12520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/04/2020] [Accepted: 10/09/2020] [Indexed: 11/28/2022]
Abstract
The aim of the study is to clarify the concept "care for carers," and enhance our understanding of caring for carers of ill relatives. Healthcare professionals often refer to "care for carers" when discussing methods to support the carers of ill family relatives. These carers do not always receive the support they need. A literature search of electronic databases and search engines, using the keywords carer, caregiver, caring for the carer, caring for the caregiver was done. Peer-reviewed research articles published between 2014 and 2019 and written in the English language were analyzed. Following retrieval, research articles were analyzed to describe the uses, attributes, antecedents, consequences, and empirical referents of the concept "care for carers." Research articles describing borderline, related, contrary, and illegitimate examples were included. "Care for carers" addresses the unique support needs of those taking care of ill family members. Carers may derive a sense of empowerment from receiving individualized and proactively rendered support. Carers should be supported to develop control over their circumstances, to find meaning in their caring, to become resilient when experiencing challenges, and to confirm their identity as carers of their ill relatives.
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Affiliation(s)
- Neltjie C van Wyk
- Department of Nursing Science, University of Pretoria, Pretoria, South Africa
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9
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Pike J, Picking R, Cunningham S. Robot companion cats for people at home with dementia: A qualitative case study on companotics. DEMENTIA 2020; 20:1300-1318. [PMID: 32668978 DOI: 10.1177/1471301220932780] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The use of robot companion pets for people in care homes has been extensively studied. The results are largely positive and suggest that they are valuable in enhancing wellbeing, communication and behavioural aspects. However, there has been little research in people's own homes, possibly due to the cost and complexity of some of the robot pets currently available. As dementia affects people in different ways, this study explores the effects of a robot cat for people in their own homes, without specifically investigating the effects on a particular symptom. We utilised a case study design to investigate the proposition that various factors influence the impact of a robot cat on the person living with dementia and their carer, including acceptability of the robot pet and acceptance of dementia and its symptoms. The qualitative analysis explores the similarities and differences within the data which were gathered during interviews with people with dementia and their families. This analysis revealed four themes: Distraction, Communication, Acceptance and rejection, and Connecting with the cat and connecting with others. These themes were synthesised into two overarching themes: the effect of the cat on mood and behaviour, and The interaction with the cat. We present the acceptability and impact of the robot cat on symptoms of dementia, with data presented across and within the group of participants. Our analysis suggests that benefits of the robot pet were evident, and although this was a small-scale study, where they were accepted, robot pets provided positive outcomes for the participants and their families.
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Affiliation(s)
- Joanne Pike
- Faculty of Social and Life Sciences, Wrexham Glyndŵr University, UK
| | - Richard Picking
- Faculty of Arts, Science and Technology, Wrexham Glyndŵr University, UK
| | - Stuart Cunningham
- Centre for Advanced Computational Science, Manchester Metropolitan University, UK
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10
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Terum TM, Testad I, Rongve A, Aarsland D, Svendsboe E, Andersen JR. The association between specific neuropsychiatric disturbances in people with Alzheimer's disease and dementia with Lewy bodies and carer distress. Int J Geriatr Psychiatry 2019; 34:1421-1428. [PMID: 31050041 DOI: 10.1002/gps.5134] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 04/12/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Neuropsychiatric symptoms (NPSs) are identified as important care-recipient variables in terms of the impact on carer distress. The aim of this study was to determine whether specific neuropsychiatric disturbances in people with Alzheimer disease (AD) and dementia with Lewy bodies (DLB) differentially impact carer distress. METHODS This was a cross-sectional study of people diagnosed with AD and DLB and their primary carers. The Relatives' Stress Scale (RSS) was used to assess the level of reported distress in carers, and the Neuropsychiatric Inventory (NPI) was used to assess NPSs. The effect of NPSs on carer distress was analyzed using correlation analysis and partial least squares regression. RESULTS This study included 159 participants diagnosed with AD (n = 97) and DLB (n = 62) and their primary carers (spouses and adult children). The majority of people diagnosed with dementia were women (64.2%), with a mean age of 75.9 years (SD, 7.4) and a mean Mini-Mental State Examination (MMSE) score of 23.5 (SD, 2.9). The main analysis identified apathy as the most important NPS contributing to carer distress. Compared with AD, the explained variance in the DLB group was higher (r2 = 37.3 vs r2 = 53.7). In addition, more NPSs were considered clinically important in the DLB group. CONCLUSION The findings of this study identify apathy as the most important NPS contributing to carer distress among carers of people with AD and DLB. These findings help us identify the support needs of families dealing with dementia.
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Affiliation(s)
- Toril Marie Terum
- Faculty of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, Norway.,Centre for Age-related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Center of Health Research, Førde Hospital Trust, Førde, Norway
| | - Ingelin Testad
- Centre for Age-related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway.,University of Exeter Medical School, St Luke's Campus, University of Exeter, Exeter, UK.,Department of Old Age Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Arvid Rongve
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Research and Innovation, Helse Fonna, Haugesund, Norway
| | - Dag Aarsland
- Centre for Age-related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway.,Department of Old Age Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Ellen Svendsboe
- Centre for Age-related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway.,Faculty of Health and Caring Sciences, Western Norway University of Applied Sciences, Stord, Norway
| | - John Roger Andersen
- Faculty of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, Norway.,Center of Health Research, Førde Hospital Trust, Førde, Norway
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