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Huang HL, Chao YP, Kuo CY, Sung YL, Shyu YIL, Hsu WC. Development of a Dementia Case Management Information System App: Mixed Methods Study. JMIR Aging 2024; 7:e56549. [PMID: 39312770 PMCID: PMC11459097 DOI: 10.2196/56549] [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: 01/19/2024] [Revised: 07/22/2024] [Accepted: 07/28/2024] [Indexed: 09/25/2024] Open
Abstract
BACKGROUND Case managers for persons with dementia not only coordinate patient care but also provide family caregivers with educational material and available support services. Taiwan uses a government-based information system for monitoring the provision of health care services. Unfortunately, scheduling patient care and providing information to family caregivers continues to be paper-based, which results in a duplication of patient assessments, complicates scheduling of follow-ups, and hinders communication with caregivers, which limits the ability of case managers to provide cohesive, quality care. OBJECTIVE This multiphase study aimed to develop an electronic information system for dementia care case managers based on their perceived case management needs and what they would like included in an electronic health care app. METHODS Case managers were recruited to participate (N=63) by purposive sampling from 28 facilities representing two types of community-based dementia care centers in Taiwan. A dementia case management information system (DCMIS) app was developed in four phases. Phase 1 assessed what should be included in the app by analyzing qualitative face-to-face or internet-based interviews with 33 case managers. Phase 2 formulated a framework for the app to support case managers based on key categories identified in phase 1. During phase 3, a multidisciplinary team of information technology engineers and dementia care experts developed the DCMIS app: hardware and software components were selected, including platforms for messaging, data management, and security. The app was designed to eventually interface with a family caregiver app. Phase 4 involved pilot-testing the DCMIS app with a second group of managers (n=30); feedback was provided via face-to-face interviews about their user experience. RESULTS Findings from interviews in phase 1 indicated the DCMIS framework should include unified databases for patient reminder follow-up scheduling, support services, a health education module, and shared recordkeeping to facilitate teamwork, networking, and communication. The DCMIS app was built on the LINE (LY Corporation) messaging platform, which is the mobile app most widely used in Taiwan. An open-source database management system allows secure entry and storage of user information and patient data. Case managers had easy access to educational materials on dementia and caregiving for persons living with dementia that could be provided to caregivers. Interviews with case managers following pilot testing indicated that the DCMIS app facilitated the completion of tasks and management responsibilities. Some case managers thought it would be helpful to have a DCMIS desktop computer system rather than a mobile app. CONCLUSIONS Based on pilot testing, the DCMIS app could reduce the growing challenges of high caseloads faced by case managers of persons with dementia, which could improve continuity of care. These findings will serve as a reference when the system is fully developed and integrated with the electronic health care system in Taiwan.
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Affiliation(s)
- Huei-Ling Huang
- Department of Gerontology and Health Care Management, College of Nursing, Chang Gung University of Science and Technology, Taoyuan City, Taiwan
- Dementia Center, Department of Neurology, Taoyuan Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Geriatric and Long-Term Care Research Center, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Yi-Ping Chao
- Department of Computer Science and Information Engineering, Chang Gung University, Taoyuan, Taiwan
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Chun-Yu Kuo
- Department of Gerontology and Health Care Management, College of Nursing, Chang Gung University of Science and Technology, Taoyuan City, Taiwan
| | - Ya-Li Sung
- Department of Gerontology and Health Care Management, College of Nursing, Chang Gung University of Science and Technology, Taoyuan City, Taiwan
| | - Yea-Ing L Shyu
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Wen-Chuin Hsu
- Dementia Center, Department of Neurology, Taoyuan Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Urbano-Mairena J, De Los Ríos-Calonge J, Postigo-Mota S, Carvajal-Gil J, Silveira-Saraiva ES, Guerra-Bustamante J, Muñoz-Bermejo L. Benefits Perceived by Caregivers of Patients with Alzheimer's Disease on Physical and Emotional Health in an Interdisciplinary Program: A Qualitative Study. Healthcare (Basel) 2024; 12:1414. [PMID: 39057557 PMCID: PMC11275445 DOI: 10.3390/healthcare12141414] [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] [Received: 05/10/2024] [Revised: 07/01/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024] Open
Abstract
Alzheimer's disease is the most common type of dementia, severely affecting the families and caregivers who live with those affected. The aim was to explore the physical, psychological, and behavioral benefits for caregivers of people with Alzheimer's disease. Fifteen semi-structured interviews were conducted with informal Alzheimer's caregivers upon completion of the program. Following a discussion on the topics, categories, and codes among the researchers, a consensus was reached to obtain the final themes and categories. Three main categories were obtained: (1) perceived benefits by the participants; (2) applicability of the knowledge; and (3) proposals for improvement. Participants expressed having perceived improvements in their ability to manage emotions and cope with the situation created by the disease, physical capacity, and in their relationships. In this sense, the application of the contents addressed during the intervention became a fundamental tool for the participants' daily lives. This study showed how an interdisciplinary intervention with psychological sessions, health education, and physical activities could be beneficial for improving both the physical and mental health of caregivers.
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Affiliation(s)
- Javier Urbano-Mairena
- Social Impact and Innovation in Health (InHEALTH) Research Group, University Centre of Mérida, University of Extremadura, 06800 Mérida, Spain;
| | - Javier De Los Ríos-Calonge
- Department of Sport Sciences, Sports Research Centre, Miguel Hernández University of Elche, 03202 Elche, Spain;
| | - Salvador Postigo-Mota
- Farmacogenética de Enfermedades Psiquiátricas, Faculty of Medicine, University of Extremadura, 06006 Badajoz, Spain;
| | - Julián Carvajal-Gil
- Social Impact and Innovation in Health (InHEALTH) Research Group, University Centre of Mérida, University of Extremadura, 06800 Mérida, Spain;
| | | | - Joan Guerra-Bustamante
- Physical and Health Literacy and Health-Related Quality of Life (PHYQOL) Research Group, Faculty of Sport Sciences, University of Extremadura, 10003 Cáceres, Spain;
| | - Laura Muñoz-Bermejo
- Social Impact and Innovation in Health (InHEALTH) Research Group, University Centre of Mérida, University of Extremadura, 06800 Mérida, Spain;
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Huang HL, Shyu YIL, Hsu WC, Liao YT, Huang HL, Hsieh SH. Effectiveness of a health education program for people with dementia and their family caregivers: An intervention by nurse practitioners. Arch Psychiatr Nurs 2024; 50:147-159. [PMID: 38789227 DOI: 10.1016/j.apnu.2024.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 01/17/2024] [Accepted: 03/17/2024] [Indexed: 05/26/2024]
Abstract
PURPOSE This study assesses the effectiveness of a health education program on caregiving outcomes for people with dementia and their families. METHODS This quasi-experimental study involved 250 people with dementia and their family caregivers. Behavioral problems in people with dementia were assessed using the Chinese version of the Cohen-Mansfield Agitation Inventory-community form. Family caregiver outcomes were measured using the Agitation Management Self-Efficacy Scale, Caregiver Preparedness Scale, Competence Scale, and Community Resource Awareness and Utilization Assessment. RESULTS Following the intervention, the experimental group demonstrated significant improvements in terms of self-efficacy, preparedness, competence, and awareness and utilization of community resources among family caregivers. Additionally, the experimental group exhibited lower levels of behavioral problems among people with dementia. CONCLUSIONS This study helped improve caregiving outcomes for people with dementia and their family caregivers. Therefore, outpatient healthcare providers can utilize these findings to enhance care for this population.
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Affiliation(s)
- Huei-Ling Huang
- Department of Gerontology and Health Care Management, College of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan; Geriatric and Long-Term Care Research Center, Chang Gung University of Science and Technology, Taoyuan, Taiwan; Department of Nursing, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan; Dementia Center, Department of Neurology, Taoyuan Chang Gung Memorial Hospital, Taoyuan, Taiwan.
| | - Yea-Ing L Shyu
- Dementia Center, Department of Neurology, Taoyuan Chang Gung Memorial Hospital, Taoyuan, Taiwan; School of Nursing, Chang Gung University, Taoyuan, Taiwan; Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Wen-Chuin Hsu
- Dementia Center, Department of Neurology, Taoyuan Chang Gung Memorial Hospital, Taoyuan, Taiwan; School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yen-Ting Liao
- Department of Gerontology and Health Care Management, College of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Hsiu-Li Huang
- Department of Long-Term Care, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Shu-Hua Hsieh
- Dementia Center, Department of Neurology, Taoyuan Chang Gung Memorial Hospital, Taoyuan, Taiwan
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The Effects of Aerobic and Resistance Exercises on the Cognitive and Physical Function of Persons with Mild Dementia: A Randomized Controlled Trial Protocol. Healthcare (Basel) 2023; 11:healthcare11050677. [PMID: 36900682 PMCID: PMC10000686 DOI: 10.3390/healthcare11050677] [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: 11/29/2022] [Revised: 02/21/2023] [Accepted: 02/23/2023] [Indexed: 03/02/2023] Open
Abstract
Dementia causes deterioration in cognitive and physical functions. The scope of this study is to investigate the effect of different exercise programs on cognitive functions and functionality of persons suffering from mild Alzheimer's disease (AD) by generating information on the exercise types and their parameters. A randomized controlled trial (RCT) will be performed involving aerobic and resistance exercise interventions, taking place both at the sample collection center and at home. Participants will be randomly divided into two different intervention groups and a control group. All groups will be assessed twice; once at baseline and once after 12 weeks. The primary outcome shall comprise the effect of exercise programs on cognitive functions using cognitive testing, such as Addenbrooke's Cognitive Examination-Revisited (ACE-R), Mini Mental State Examination (MMSE), Trail Making Test A-Β (TMT A-B), and Digit Span Test (DST): Digit Span Forward (DSF) and Digit Span Backward (DSB). The effect on functionality will be assessed using the Senior Fitness Test (SFT), Berg Balance Scale (BBS), and Instrumental Activities of Daily Living Scale (IADL) questionnaire. Secondary outcomes include the effect of exercise on depression using the Geriatric Depression Scale-15 (GDS-15), on physical activity using the International Physical Activity Questionnaire (IPAQ), as well as the participants' compliance with the intervention. This study will investigate the possible effect of intervention of different exercise types and the comparison between them. Exercise forms a low-cost and reduced-risk intervention.
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Dementia-Specific Nursing Care Competencies for Nursing Education and Long-Term Care Practice. Nurs Clin North Am 2022; 57:217-232. [DOI: 10.1016/j.cnur.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Jin X, Tamiya N, Uda K, Yasunaga H. The impact of additional payments on functional decline among long-term care health facility residents in Japan. Age Ageing 2021; 50:2055-2062. [PMID: 34120174 PMCID: PMC8581374 DOI: 10.1093/ageing/afab121] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Indexed: 11/13/2022] Open
Abstract
Background Additional payment approach has been one of the most important incentives in long-term care (LTC) systems for the past 20 years in Japan. Objective To estimate the effect of additional payments on functional decline in long-term care health facility (LTCHF) residents of Japan. Design A 24-month retrospective cohort study. Setting and subjects Residents aged ≥65 years who were newly admitted to LTCHFs in the 2014 fiscal year. Methods National LTC claims data were linked to the survey of institutions and establishments for LTC. Competing risk regression was performed with functional decline as the primary outcome, and additional payments as exposure, controlling for individual and facility characteristics. The level of LTC needs certified in the LTC insurance system was applied as a proxy of functional ability. Death, hospitalisation, discharge to home and transfer to other LTC facilities were treated as competing events. Individual- and facility-level additional payments were presented as binary variables: being reimbursed or not during the follow-up period. Results At baseline, 146,311 residents from 3,724 LTCHFs were included. The vast majority of additional payments were associated with a lower risk of functional decline at follow-up. At the individual level, additional payment for pre/post admission instructions had the strongest association with a lower risk of functional decline. Despite this, only 8% of residents were reimbursed for this additional payment. At the facility level, residents in LTCHFs with additional payments for support for home-life resumption and nutritional management were associated with a decreased risk of functional decline. Conclusions The results of our study may be of particular interest to policymakers in monitoring and evaluating additional payment approaches and provide insight into improving quality of care.
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Affiliation(s)
- Xueying Jin
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba city, Ibaraki Prefecture, Japan
- Health Services Research & Development Center, University of Tsukuba, Tsukuba city, Ibaraki Prefecture, Japan
| | - Nanako Tamiya
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba city, Ibaraki Prefecture, Japan
- Health Services Research & Development Center, University of Tsukuba, Tsukuba city, Ibaraki Prefecture, Japan
| | - Kazuaki Uda
- Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, University of Tokyo, Tokyo City, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, University of Tokyo, Tokyo City, Japan
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Duru Aşiret G, Kütmeç Yılmaz C, Sayın Kasar K. Investigation of the effects of interventions made according to the Progressively Lowered Stress Threshold Model on the care outcomes of Alzheimer patients and their families: a randomized clinical trial. Psychogeriatrics 2021; 21:738-748. [PMID: 34233376 DOI: 10.1111/psyg.12734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 05/25/2021] [Accepted: 06/07/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND One of the non-pharmacological methods used to reduce behavioural problems of Alzheimer's patients and the negative emotions accordingly experienced by caregivers consists of interventions performed according to the Progressively Lowered Stress Threshold (PLST) model. METHODS This randomized controlled study aimed to determine the effect of interventions performed according to PLST on the care burden, care satisfaction, and life satisfaction of caregivers of middle and advanced stage Alzheimer's disease patients, and on the neuropsychiatric symptoms and agitation levels of these patients. The research was conducted with a total of 29 caregivers divided into intervention (15) and control (14) groups. Data were collected using an Introductory Information Form, plus the Standardised Mini-Mental State Examination, Neuropsychiatric Inventory, Cohen-Mansfield Agitation Inventory, Carer's Assessment of Satisfaction Index, and Life Satisfaction Scale. Three home visits were made to the caregivers by the researchers in the first, second, and twelfth weeks of the intervention. During the home visits, face-to-face training was given as necessary to the individual caring for problems identified in the nursing care plan according to PLST. RESULTS As a result of the PLST training, there was a decrease in the behavioural problems of Alzheimer's patients, along with a decrease in the care burden of the caregivers and an increase in their care satisfaction. When the scale total scores of the individuals in the intervention and control groups were compared, it was found that only caregivers' care satisfaction increased at a statistically significant level (P < 0.05). CONCLUSION At the end of the training given according to PLST, it was found that behavioural problems of Alzheimer's patients and the care burden of caregivers had decreased, and the care satisfaction of caregivers increased. It is recommended that Alzheimer's patients and their caregivers be given training and interventions according to PLST.
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Affiliation(s)
- Güler Duru Aşiret
- Faculty of Health Sciences, Nursing Department, Aksaray University, Aksaray, Turkey
| | - Cemile Kütmeç Yılmaz
- Faculty of Health Sciences, Nursing Department, Aksaray University, Aksaray, Turkey
| | - Kadriye Sayın Kasar
- Faculty of Health Sciences, Nursing Department, Aksaray University, Aksaray, Turkey
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Clarkson P, Challis D, Hughes J, Roe B, Davies L, Russell I, Orrell M, Poland F, Jolley D, Kapur N, Robinson C, Chester H, Davies S, Sutcliffe C, Peconi J, Pitts R, Fegan G, Islam S, Gillan V, Entwistle C, Beresford R, Abendstern M, Giebel C, Ahmed S, Jasper R, Usman A, Malik B, Hayhurst K. Components, impacts and costs of dementia home support: a research programme including the DESCANT RCT. PROGRAMME GRANTS FOR APPLIED RESEARCH 2021. [DOI: 10.3310/pgfar09060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background
Over half of people with dementia live at home. We know little about what home support could be clinically effective or cost-effective in enabling them to live well.
Objectives
We aimed to (1) review evidence for components of home support, identify their presence in the literature and in services in England, and develop an appropriate economic model; (2) develop and test a practical memory support package in early-stage dementia, test the clinical effectiveness and cost-effectiveness of routine home support in later-stage dementia and design a toolkit based on this evidence; and (3) elicit the preferences of staff, carers and people with dementia for home support inputs and packages, and evaluate the cost-effectiveness of these approaches in early- and later-stage dementia.
Design
We undertook (1) an evidence synthesis, national surveys on the NHS and social care and an economic review; (2) a multicentre pragmatic randomised trial [Dementia Early Stage Cognitive Aids New Trial (DESCANT)] to estimate the clinical effectiveness and cost-effectiveness of providing memory aids and guidance to people with early-stage dementia (the DESCANT intervention), alongside process evaluation and qualitative analysis, an observational study of existing care packages in later-stage dementia along with qualitative analysis, and toolkit development to summarise this evidence; and (3) consultation with experts, staff and carers to explore the balance between informal and paid home support using case vignettes, discrete choice experiments to explore the preferences of people with dementia and carers between home support packages in early- and later-stage dementia, and cost–utility analysis building on trial and observational study.
Setting
The national surveys described Community Mental Health Teams, memory clinics and social care services across England. Recruitment to the trial was through memory services in nine NHS trusts in England and one health board in Wales. Recruitment to the observational study was through social services in 17 local authorities in England. Recruitment for the vignette and preference studies was through memory services, community centres and carers’ organisations.
Participants
People aged > 50 years with dementia within 1 year of first attendance at a memory clinic were eligible for the trial. People aged > 60 years with later-stage dementia within 3 months of a review of care needs were eligible for the observational study. We recruited staff, carers and people with dementia for the vignette and preference studies. All participants had to give written informed consent.
Main outcome measures
The trial and observational study used the Bristol Activities of Daily Living Scale as the primary outcome and also measured quality of life, capability, cognition, general psychological health and carers’ sense of competence.
Methods
Owing to the heterogeneity of interventions, methods and outcome measures, our evidence and economic reviews both used narrative synthesis. The main source of economic studies was the NHS Economic Evaluation Database. We analysed the trial and observational study by linear mixed models. We analysed the trial by ‘treatment allocated’ and used propensity scores to minimise confounding in the observational study.
Results
Our reviews and surveys identified several home support approaches of potential benefit. In early-stage dementia, the DESCANT trial had 468 randomised participants (234 intervention participants and 234 control participants), with 347 participants analysed. We found no significant effect at the primary end point of 6 months of the DESCANT intervention on any of several participant outcome measures. The primary outcome was the Bristol Activities of Daily Living Scale, for which scores range from 0 to 60, with higher scores showing greater dependence. After adjustment for differences at baseline, the mean difference was 0.38, slightly but not significantly favouring the comparator group receiving treatment as usual. The 95% confidence interval ran from –0.89 to 1.65 (p = 0.56). There was no evidence that more intensive care packages in later-stage dementia were more effective than basic care. However, formal home care appeared to help keep people at home. Staff recommended informal care that cost 88% of formal care, but for informal carers this ratio was only 62%. People with dementia preferred social and recreational activities, and carers preferred respite care and regular home care. The DESCANT intervention is probably not cost-effective in early-stage dementia, and intensive care packages are probably not cost-effective in later-stage dementia. From the perspective of the third sector, intermediate intensity packages were cheaper but less effective. Certain elements may be driving these results, notably reduced use of carers’ groups.
Limitations
Our chosen outcome measures may not reflect subtle outcomes valued by people with dementia.
Conclusions
Several approaches preferred by people with dementia and their carers have potential. However, memory aids aiming to affect daily living activities in early-stage dementia or intensive packages compared with basic care in later-stage dementia were not clinically effective or cost-effective.
Future work
Further work needs to identify what people with dementia and their carers prefer and develop more sensitive outcome measures.
Study registration
Current Controlled Trials ISRCTN12591717. The evidence synthesis is registered as PROSPERO CRD42014008890.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 9, No. 6. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Paul Clarkson
- Social Care and Society, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - David Challis
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Jane Hughes
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Brenda Roe
- Evidence-based Practice Research Centre, Edge Hill University, Ormskirk, UK
| | - Linda Davies
- Health Economics Research Team, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Ian Russell
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Martin Orrell
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Fiona Poland
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - David Jolley
- Social Care and Society, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Narinder Kapur
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Catherine Robinson
- Social Care and Society, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Helen Chester
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Sue Davies
- Social Care and Society, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Caroline Sutcliffe
- Social Care and Society, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Julie Peconi
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Rosa Pitts
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Greg Fegan
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Saiful Islam
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Vincent Gillan
- Social Care and Society, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Charlotte Entwistle
- Social Care and Society, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Rebecca Beresford
- Social Care and Society, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Michele Abendstern
- Social Care and Society, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Clarissa Giebel
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
| | - Saima Ahmed
- Social Care and Society, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Rowan Jasper
- Social Policy Research Unit, University of York, York, UK
| | - Adeela Usman
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Baber Malik
- Social Care and Society, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Karen Hayhurst
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
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Isaac V, Kuot A, Hamiduzzaman M, Strivens E, Greenhill J. The outcomes of a person-centered, non-pharmacological intervention in reducing agitation in residents with dementia in Australian rural nursing homes. BMC Geriatr 2021; 21:193. [PMID: 33743597 PMCID: PMC7980426 DOI: 10.1186/s12877-021-02151-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 03/11/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND There is limited best- practice evidence to address behavioral and psychiatric symptoms for those with dementia in Australian rural nursing homes. This study aims to evaluate the outcomes of a person-centered, non-pharmacological dementia care model, 'Harmony in the Bush', based on the Progressively Lowered Stress Threshold principles and person-centered music in rural Australia. METHODS A quasi-experimental (nonrandomized, pre-post) intervention study was conducted in five rural nursing homes in Queensland and South Australia. Seventy-four residents with dementia participated in this intervention study, which yielded a sample power of 80%. Eighty-seven staff completed the Caregiver Stress Inventory at pre-post four-weeks of intervention. Staff training workshops focused on the theory of the Progressively Lowered Stress Threshold principles and delivery of person-centered care plan with integrated music intervention. We used reported changes in agitation of the residents, measured using Cohen- Mansfield Agitation Inventory, and staff's caregiving stress, using Caregivers Stress Inventory. This study adheres to the CONSORT guidelines. RESULTS Mean age of residents with dementia was 82.4 (7.7) years and 69% were females. The mean age of admission was 80.1(8.4) years. Baseline measures indicated that 32.7% had mild- severe pain and 30.5% reported mild-severe sadness. The results showed statistically significant decline in aggressive behaviors, physically non-aggressive behaviors, verbally agitated behavior and hiding and hoarding. There was similar reduction in staff stress in the domains of aggressive behaviors, inappropriate behaviors, resident safety, and resource deficiency. CONCLUSIONS The Harmony in the Bush model is effective in reducing agitation among dementia residents with significant reduction in staff stress levels in nursing homes in rural Australia. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry (ANZCTR) on 20/2/2018 (Registration No: ACTRN12618000263291p). https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374458.
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Affiliation(s)
- Vivian Isaac
- Rural and Remote Health South Australia, College of Medicine and Public Health, Flinders University, Po Box 852, Ral Ral Avenue, Renmark, SA, 5341, Australia.
| | - Abraham Kuot
- Rural and Remote Health South Australia, College of Medicine and Public Health, Flinders University, Po Box 852, Ral Ral Avenue, Renmark, SA, 5341, Australia
| | - Mohammad Hamiduzzaman
- Rural and Remote Health South Australia, College of Medicine and Public Health, Flinders University, Po Box 852, Ral Ral Avenue, Renmark, SA, 5341, Australia
| | - Edward Strivens
- James Cook University & Clinical Director, Older Persons Health Services, Cairns and Hinterland Hospital and Health Service, Cairns, Queensland, 4870, Australia
| | - Jennene Greenhill
- Rural and Remote Health South Australia, College of Medicine and Public Health, Flinders University, Po Box 852, Ral Ral Avenue, Renmark, SA, 5341, Australia
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Khan TS, Hirschman KB, McHugh MD, Naylor MD. Self-efficacy of family caregivers of older adults with cognitive impairment: A concept analysis. Nurs Forum 2021; 56:112-126. [PMID: 32888197 PMCID: PMC8549654 DOI: 10.1111/nuf.12499] [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: 12/19/2019] [Revised: 07/01/2020] [Accepted: 08/13/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Research demonstrates that increased self-efficacy can help family caregivers of older adults with Alzheimer's and other types of cognitive impairment experience lower burden and depressive symptom severity. AIMS The purpose of this concept analysis is to address fundamental gaps in the understanding of self-efficacy in family caregivers of older adults with cognitive impairment, including updating the 26-year-old concept analysis with a contemporary definition. METHODS This study utilizes Walker and Avant's (2019) concept analysis method, an eight-step iterative process that helps to clarify ambiguous concepts. A literature review was conducted from July 1993 through March 2019 using PubMed/MEDLINE, Scopus, CINAHL, and Embase. Inclusion criteria encompassed peer-reviewed research articles and review articles that included family caregivers of older adults with cognitive impairment. RESULTS Eight defining attributes of this concept are identified. The revised definition of self-efficacy in this population is a family caregiver's confidence in their ability to: manage behaviors and other caregiving stresses, control upsetting thoughts, acquire medical information, manage medical issues, obtain self-care, access community supports, assist with activities of daily living and other care, and maintain a good relationship with a relative, friend, or neighbor of an older adult with cognitive impairment. CONCLUSION This paper utilizes over a quarter-century of research to build on the original analysis by Mowat and Spence Laschinger (1994) and update the concept's definition. This analysis should provide researchers with a clearer understanding of this concept and a renewed emphasis on the importance of targeting interventions to improve self-efficacy in this vulnerable caregiving population.
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Affiliation(s)
- Tarik S. Khan
- School of Nursing, New Courtland Center for Transitions and Health, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Karen B. Hirschman
- School of Nursing, New Courtland Center for Transitions and Health, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Matthew D. McHugh
- School of Nursing, Center for Health Outcomes and Policy Research, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mary D. Naylor
- School of Nursing, New Courtland Center for Transitions and Health, University of Pennsylvania, Philadelphia, Pennsylvania
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Ma KPK, Saw A. An international systematic review of dementia caregiving interventions for Chinese families. Int J Geriatr Psychiatry 2020; 35:1263-1284. [PMID: 32964577 DOI: 10.1002/gps.5400] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 07/26/2020] [Accepted: 08/08/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Older Asians and Chinese are among the least studied populations in the dementia caregiving literature. This review seeks to critically synthesize the literature on intervention characteristics, components and tailoring strategies for dementia family caregivers in Chinese communities globally. METHODS Five electronic databases (PsychINFO, PubMed, CINAHL, ScienceDirect and Google Scholar) were searched for articles published between 1980 and July 2018. The protocol of this review was registered with PROSPERO (CRD42019132800). RESULTS Twenty-nine unique interventions across 39 papers met inclusion criteria. Results from descriptive and thematic syntheses revealed that most interventions were psychoeducational, CBT-based, multicomponent, structured, and less than a year in duration. Disease education, management of behavioral and psychological symptoms of dementia, stress coping techniques, and referral to community resources were frequently included in interventions. Community-, culture- and language-focused strategies were used to tailor interventions. The most common tailoring strategies were: (a) using community networks and media for outreach and recruitment; (b) making translations and language adaptations to the intervention materials; and (c) focusing on trust and therapeutic alliance. Most interventions produced desired outcomes, particularly reducing caregiver burden and increasing self-efficacy. CONCLUSIONS To our knowledge, this is the first review to date that systematically synthesized the characteristics and tailoring of dementia caregiving interventions for Chinese families globally. Current findings suggest that most interventions are effective, although many only superficially address Chinese culture. Future research should incorporate Chinese values and cross-cultural challenges into caregiving interventions for deep-level adaptations that could potentially be more effective to engage and support Chinese caregivers.
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Affiliation(s)
- Kris Pui Kwan Ma
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Anne Saw
- Department of Psychology, DePaul University, Chicago, Illinois, USA
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12
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Tonga JB, Eilertsen DE, Solem IKL, Arnevik EA, Korsnes MS, Ulstein ID. Effect of Self-Efficacy on Quality of Life in People With Mild Cognitive Impairment and Mild Dementia: The Mediating Roles of Depression and Anxiety. Am J Alzheimers Dis Other Demen 2020; 35:1533317519885264. [PMID: 31916847 PMCID: PMC10623983 DOI: 10.1177/1533317519885264] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To examine the mediating effects of depression and anxiety in the relationship between self-efficacy and quality of life among people with mild cognitive impairment (MCI) or mild dementia. METHOD A total of 196 patients diagnosed with MCI or dementia due to Alzheimer disease completed structured measures of self-efficacy, quality of life, and depressive and anxiety symptoms. We examined direct and mediated effects by fitting structural equation models to data. RESULTS Our analyses supported that the effects of self-efficacy on quality of life may be partially mediated by depression and anxiety. Both anxiety and depression had significant mediating effects, with depression showing a stronger effect. CONCLUSION These results suggest that increased self-efficacy may have a positive effect on quality of life in people with MCI or dementia-partly by reducing depression and anxiety. These findings may have important practical implications for tailoring therapeutic interventions.
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Affiliation(s)
- Johanne B. Tonga
- Department of Old Age Psychiatry, Oslo University Hospital, Gaustad, Norway
- Norwegian Health Association, Oslo, Norway
- Institute of Psychology, University of Oslo, Norway
| | | | - Ingrid K. Ledel Solem
- Center for Shared Decision Making and Collaborative Care Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Espen A. Arnevik
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Maria S. Korsnes
- Department of Old Age Psychiatry, Oslo University Hospital, Gaustad, Norway
- Institute of Psychology, University of Oslo, Norway
| | - Ingun D. Ulstein
- Department of Geriatric Medicine, Oslo University Hospital, Ullevål, Norway
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13
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Borji M, Mousavimoghadam SR, Salimi E, Otaghi M, Azizi Y. The Impact of Spiritual Care Education on Anxiety in Family Caregivers of Patients with Heart Failure. JOURNAL OF RELIGION AND HEALTH 2019; 58:1961-1969. [PMID: 30406492 DOI: 10.1007/s10943-018-0689-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Heart failure (HF) has been emerging as a general health problem over recent decades. Spiritual care is a type of support service provided to patients suffering from HF. Spiritual care intervention in nursing is a unique aspect of care, which cannot be replaced by psychosocial care. Considering the importance of anxiety for caregivers of patients with HF, the present study aimed to examine the effect of spiritual intervention on anxiety in caregivers of patients with HF in Ilam, Iran. This research is a semi-experimental study, 71 caregivers of patients with HF were randomly assigned to experimental group (n = 34) and control (n = 37) group. Beck Anxiety Inventory, which consisted of 21 items and scored based on a 4-point Likert scale ranging from zero to three, was employed to collect data. The scores range from zero to 63 with the higher scores indicating the higher level of anxiety. The experimental group received spiritual intervention over six 45-minute sessions in a period of 2 weeks (14 days; three times a week; every other day). Data were analyzed using descriptive and inferential statistics run in the SPSS software version 16. The result showed a difference between the level of anxiety in two groups after the intervention (P = 0.001). Anxiety level in the experimental group three weeks after intervention (27.88 ± 7.10) was significant in comparison with before intervention (45.06 ± 5.79) (P = 0.001). According to the results, the spiritual intervention reduced the anxiety level in the caregivers of patients with HF. Nurses are recommended to provide such necessary training to caregivers in order to provide the grounds for reducing their anxiety.
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Affiliation(s)
- Milad Borji
- Department of Nursing, Faculty of Nursing and Midwifery, Kermanshah University of Medical Science, Kermanshah, Islamic Republic of Iran
- Nursing and Midwifery School, Students Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Islamic Republic of Iran
| | | | - Ebrahim Salimi
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Islamic Republic of Iran
| | - Masoumeh Otaghi
- Department of Nursing, Faculty of Nursing and Midwifery, Ilam University of Medical Science, Ilam, Islamic Republic of Iran
| | - Yosof Azizi
- Student Research Committee, Ilam University of Medical Sciences, Ilam, Islamic Republic of Iran.
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Hinton L, Tran D, Nguyen TN, Ho J, Gitlin L. Interventions to support family caregivers of people living with dementia in high, middle and low-income countries in Asia: a scoping review. BMJ Glob Health 2019; 4:e001830. [PMID: 31798992 PMCID: PMC6861057 DOI: 10.1136/bmjgh-2019-001830] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 09/25/2019] [Accepted: 09/28/2019] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Despite increasing numbers of persons living with Alzheimer's disease and Alzheimer's-related dementias (AD/ADRD) in Asia, particularly in low-income countries (LIC) and middle-income countries (MIC), surprisingly little is known about the current state of the evidence for family caregiver interventions. The objectives of this scoping review were to: (1) describe the evidence for efficacy of family dementia-caregiver psychosocial interventions in Asian countries, (2) compare evidence across LIC, MIC, and high-income countries (HIC), and (3) characterise cultural adaptions to interventions developed outside Asia. METHODS The inclusion criteria included: (1) conducted in Asia (2) included an intervention delivered to a family caregiver of a person living with AD/ADRD, (3) reported quantitative outcomes for the family caregiver and (4) published in a peer-reviewed journal with full text available in English. RESULTS Thirty intervention trials were identified meeting inclusion criteria and all reported statistically significant (p<0.05) improvement in one or more caregiver outcomes. Interventions usually included multiple components. The most frequently reported outcomes (ie, by ≥20% of studies) were caregiver depression, burden, quality of life and self-efficacy. Overall, 26 (87%) of the studies were conducted in HIC in Asia, primarily in Hong Kong SAR-China and Taiwan, and only 4 (13%) in LIC and MIC in Asia. Seven studies (23%) used interventions developed in USA and several described cultural adaptations. CONCLUSION This scoping review found substantial evidence, particularly from high-income Asian countries, that a wide range of interventions improve AD/ADRD family caregiver outcomes. However, critical knowledge gaps exist, particularly for LIC and MIC in Asia, where the number of persons with dementia is numerically largest and projected to increase dramatically in coming decades. The field could also benefit from more detailed descriptions of the process and types of cultural adaptations to interventions.
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Affiliation(s)
- Ladson Hinton
- Department of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine, Sacramento, California, USA
| | - Duyen Tran
- University of California Davis, Davis, California, USA
| | | | - Janis Ho
- Touro University California, Vallejo, California, USA
| | - Laura Gitlin
- College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA
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15
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Keszycki RM, Fisher DW, Dong H. The Hyperactivity-Impulsivity-Irritiability-Disinhibition-Aggression-Agitation Domain in Alzheimer's Disease: Current Management and Future Directions. Front Pharmacol 2019; 10:1109. [PMID: 31611794 PMCID: PMC6777414 DOI: 10.3389/fphar.2019.01109] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 08/29/2019] [Indexed: 12/14/2022] Open
Abstract
Behavioral and psychological symptoms of dementia (BPSD) afflict the vast majority of patients with dementia, especially those with Alzheimer's disease (AD). In clinical settings, patients with BPSD most often do not present with just one symptom. Rather, clusters of symptoms commonly co-occur and can, thus, be grouped into behavioral domains that may ultimately be the result of disruptions in overarching neural circuits. One major BPSD domain routinely identified across patients with AD is the hyperactivity-impulsivity-irritiability-disinhibition-aggression-agitation (HIDA) domain. The HIDA domain represents one of the most difficult sets of symptoms to manage in AD and accounts for much of the burden for caregivers and hospital staff. Although many studies recommend non-pharmacological treatments for HIDA domain symptoms as first-line, they demonstrate little consensus as to what these treatments should be and are often difficult to implement clinically. Certain symptoms within the HIDA domain also do not respond adequately to these treatments, putting patients at risk and necessitating adjunct pharmacological intervention. In this review, we summarize the current literature regarding non-pharmacological and pharmacological interventions for the HIDA domain and provide suggestions for improving treatment. As epigenetic changes due to both aging and AD cause dysfunction in drug-targeted receptors, we propose that HIDA domain treatments could be enhanced by adjunct strategies that modify these epigenetic alterations and, thus, increase efficacy and reduce side effects. To improve the implementation of non-pharmacological approaches in clinical settings, we suggest that issues regarding inadequate resources and guidance for implementation should be addressed. Finally, we propose that increased monitoring of symptom and treatment progression via novel sensor technology and the "DICE" (describe, investigate, create, and evaluate) approach may enhance both pharmacological and non-pharmacological interventions for the HIDA domain.
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Affiliation(s)
- Rachel M. Keszycki
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Daniel W. Fisher
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Department of Psychiatry and Behavioral Sciences, University of Washington Medical Center, Seattle, WA, United States
| | - Hongxin Dong
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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16
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Merrilees JJ, Bernstein A, Dulaney S, Heunis J, Walker R, Rah E, Choi J, Gawlas K, Carroll S, Ong P, Feuer J, Braley T, Clark AM, Lee K, Chiong W, Bonasera SJ, Miller BL, Possin KL. The Care Ecosystem: Promoting self-efficacy among dementia family caregivers. DEMENTIA 2018; 19:1955-1973. [PMID: 30497302 DOI: 10.1177/1471301218814121] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To illustrate specific psychosocial interventions aimed at improving self-efficacy among family caregivers enrolled in the Care Ecosystem, a model of navigated care designed to support persons with dementia and their primary caregivers. Enrolled family caregivers work with unlicensed care team navigators who are trained in dementia care and provide information, linkages to community resources, and emotional support by phone and email. METHOD We conducted focus groups and interviews with the care team navigators to identify the approaches they used to target caregiver self-efficacy. We assessed mean self-efficacy scores in a sample of 780 family caregivers and selected three exemplary cases in which the caregivers had low self-efficacy scores at baseline with significantly higher scores after six months of participation in the Care Ecosystem intervention. RESULTS Multiple psychosocial strategies were utilized by care team navigators working with patients with dementia and their family caregivers. Using thematic coding we identified three categories of Care Team Navigator intervention: emotional, informational, and instrumental support. These are consistent with a psychosocial approach to building self-efficacy. DISCUSSION Self-efficacy represents a family caregiver's knowledge and preparedness in managing the challenges of care. Psychosocial support shows benefit in improving caregiver self-efficacy that in turn, may positively influence caregiver health and well-being. The findings in this manuscript demonstrate how a model of navigated care can positively impact self-efficacy among dementia family caregivers.
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Affiliation(s)
- Jennifer J Merrilees
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, CA, USA
| | - Alissa Bernstein
- Philip R. Lee Institute for Health Policy Studies; Global Brain Health Institute, University of California, San Francisco, CA, USA
| | - Sarah Dulaney
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, CA, USA
| | - Julia Heunis
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, CA, USA
| | - Reilly Walker
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, CA, USA
| | - Esther Rah
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, CA, USA
| | - Jeff Choi
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, CA, USA
| | - Katherine Gawlas
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, CA, USA
| | - Savannah Carroll
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, CA, USA
| | - Paulina Ong
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, CA, USA
| | - Julie Feuer
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, CA, USA
| | - Tamara Braley
- Division of Geriatrics, Department of Internal Medicine, Home Instead Center for Successful Aging, Omaha, NE, USA
| | - Amy M Clark
- Division of Geriatrics, Department of Internal Medicine, Home Instead Center for Successful Aging, Omaha, NE, USA
| | - Kirby Lee
- Department of Clinical Pharmacy, University of California, San Francisco, CA, USA
| | - Winston Chiong
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, CA, USA
| | - Stephen J Bonasera
- Division of Geriatrics, Department of Internal Medicine, Home Instead Center for Successful Aging, Omaha, NE, USA
| | - Bruce L Miller
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, CA, USA
| | - Katherine L Possin
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, CA, USA
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17
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Wu B, Petrovsky DV, Wang J, Xu H, Zhu Z, McConnell ES, Corrazzini KN. Dementia caregiver interventions in Chinese people: A systematic review. J Adv Nurs 2018; 75:528-542. [DOI: 10.1111/jan.13865] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 08/07/2018] [Accepted: 09/04/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Bei Wu
- New York University Rory Meyers College of Nursing; New York New York
- New York University NYU Aging Incubator; New York New York
- Hartford Institute for Geriatric Nursing; New York University Rory Meyers College of Nursing; New York New York
| | | | - Jing Wang
- Duke University School of Nursing; Durham North Carolina
- Duke Global Health Institute; Durham North Carolina
| | - Hanzhang Xu
- Duke University School of Nursing; Durham North Carolina
- Department Community and Family Medicine; Duke University School of Medicine; Durham North Carolina
| | - Zheng Zhu
- School of Nursing; Fudan University; Shanghai China
- Fudan University Centre for Evidence-based Nursing: A Joanna Briggs Institute Centre of Excellence; Shanghai China
| | - Eleanor S. McConnell
- Duke University School of Nursing; Durham North Carolina
- Durham VA Geriatric Research; Education and Clinical Center (GRECC); Durham North Carolina
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18
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Jütten LH, Mark RE, Wicherts JM, Sitskoorn MM. The Effectiveness of Psychosocial and Behavioral Interventions for Informal Dementia Caregivers: Meta-Analyses and Meta-Regressions. J Alzheimers Dis 2018; 66:149-172. [DOI: 10.3233/jad-180508] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Linda Helena Jütten
- Department of Cognitive Neuropsychology, Tilburg University, Tilburg, The Netherlands
| | - Ruth Elaine Mark
- Department of Cognitive Neuropsychology, Tilburg University, Tilburg, The Netherlands
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19
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Huang HL, Shyu YIL, Hsu WC. Agitated behaviors among elderly people with dementia living in their home in Taiwan. Clin Interv Aging 2018; 13:1193-1199. [PMID: 29988711 PMCID: PMC6029592 DOI: 10.2147/cia.s160243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background/aims Limited research has been conducted on agitated behavior in Taiwan and dementia among community-dwelling elderly. Therefore, this study focused on community elderly with dementia and a factor analysis of an inventory of their agitated behaviors was conducted. Patients and methods Participants (N=221) completed the Chinese Cohen-Mansfield Agitation Inventory, community form. Item analysis and exploratory factor analysis assessed reliability, validity, and the underlying factor structure. Results Five factors were extracted and accounted for 44.53% of the total variance. This study classified agitated behaviors into 5 main subtypes: physically agitated behaviors, destructive behaviors, verbally agitated behaviors, handling things behavior, and aggressive behaviors. Conclusion The results indicate that differences in the agitated behavior of elderly with dementia exist with respect to cultural background and setting. This novel research and its findings serve as a reference for assessing the agitated behaviors of elderly with dementia living in their homes. Applications may exist for other countries with Chinese/Taiwanese populations.
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Affiliation(s)
- Huei-Ling Huang
- Department of Gerontological Care and Management, Chang Gung University of Science and Technology, Taoyuan, Taiwan, .,Nursing Department, Taoyuan Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yea-Ing L Shyu
- Department of Gerontological Care and Management, Chang Gung University of Science and Technology, Taoyuan, Taiwan, .,School of Nursing, College of Medicine & Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan, .,Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, .,Department of Nursing, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan,
| | - Wen-Chuin Hsu
- Chang Gung Dementia Center, Department of Neurology, Chang Gung University and Memorial Hospital, Taoyuan, Taiwan
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20
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Yennurajalingam S, Kang DH, Hwu WJ, Padhye NS, Masino C, Dibaj SS, Liu DD, Williams JL, Lu Z, Bruera E. Cranial Electrotherapy Stimulation for the Management of Depression, Anxiety, Sleep Disturbance, and Pain in Patients With Advanced Cancer: A Preliminary Study. J Pain Symptom Manage 2018; 55:198-206. [PMID: 28870799 DOI: 10.1016/j.jpainsymman.2017.08.027] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 08/22/2017] [Accepted: 08/23/2017] [Indexed: 10/18/2022]
Abstract
CONTEXT Cranial electrotherapy stimulation (CES) is a safe modulation of brain activity for treating depression, anxiety, insomnia, and pain. However, there are no published studies in patients with advanced cancer (ACPs). OBJECTIVES The aim of the study was to determine the feasibility and preliminary efficacy of a four-week CES intervention on depression, anxiety, sleep disturbance, and pain scores. Concurrent salivary biomarker studies were conducted. METHODS In this one group open label pre- and post-intervention study with a four-week CES intervention, ACPs with one or more of four moderate intensity (≥3/10) Edmonton Symptom Assessment Scale (ESAS) symptoms (depression, anxiety, sleep disturbance, and pain) were eligible. Adherence (0%-100%), satisfaction rates (0-10), and safety were assessed. ESAS, Hospital Anxiety and Depression Scale (HADS), Pittsburgh Sleep Quality Index, Brief Pain Inventory, and salivary levels (cortisol, alpha amylase, C-reactive protein, and interleukin-1β, and interleukin-6) were assessed from baseline to Week 4. RESULTS Thirty-three of 36 patients (92%) completed the CES. Median (interquartile range) adherence CES use and satisfaction scores were 93% (89-100) and 10% (9-10), respectively, and the adherence criteria was met in the study. CES use was safe (no Grade 3 or higher adverse events). HADS anxiety (P < 0.001), HADS depression (P = 0.024), ESAS anxiety (P = 0.001), ESAS depression (P = 0.025), Brief Pain Inventory pain (P = 0.013), Pittsburgh Sleep Quality Index daytime dysfunction (P = 0.002), and medication use (P = 0.006) scores improved after four-week CES treatment. CONCLUSION In this preliminary study, we found that the use of CES was safe and feasible in ACP. The use of CES was associated with significant improvement of depression, anxiety, pain, and sleep scores. These findings support further studies of CES in ACP for symptom control.
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Affiliation(s)
- Sriram Yennurajalingam
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
| | - Duck-Hee Kang
- Center for Nursing Research, University of Texas School of Nursing, Houston, Texas, USA
| | - Wen-Jen Hwu
- Department of Melanoma Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nikhil S Padhye
- Center for Nursing Research, University of Texas School of Nursing, Houston, Texas, USA
| | - Charles Masino
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Seyedeh S Dibaj
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Diane D Liu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Janet L Williams
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Zhanni Lu
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Clarkson P, Hughes J, Roe B, Giebel CM, Jolley D, Poland F, Abendstern M, Chester H, Challis D. Systematic review: Effective home support in dementia care, components and impacts - Stage 2, effectiveness of home support interventions. J Adv Nurs 2017; 74:507-527. [DOI: 10.1111/jan.13460] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2017] [Indexed: 01/20/2023]
Affiliation(s)
- Paul Clarkson
- Personal Social Services Research Unit; Division of Population Health; Health Services Research and Primary Care; School of Health Sciences; Faculty of Biology, Medicine and Health; University of Manchester; Manchester Academic Health Science Centre; Manchester UK
| | - Jane Hughes
- Personal Social Services Research Unit; Division of Population Health; Health Services Research and Primary Care; School of Health Sciences; Faculty of Biology, Medicine and Health; University of Manchester; Manchester Academic Health Science Centre; Manchester UK
| | - Brenda Roe
- Faculty of Health & Social Care; Evidence-based Practice Research Centre; Edge Hill University; Ormskirk UK
| | - Clarissa M. Giebel
- Personal Social Services Research Unit; Division of Population Health; Health Services Research and Primary Care; School of Health Sciences; Faculty of Biology, Medicine and Health; University of Manchester; Manchester Academic Health Science Centre; Manchester UK
| | - David Jolley
- Personal Social Services Research Unit; Division of Population Health; Health Services Research and Primary Care; School of Health Sciences; Faculty of Biology, Medicine and Health; University of Manchester; Manchester Academic Health Science Centre; Manchester UK
| | - Fiona Poland
- School of Health Sciences; University of East Anglia; Norwich UK
| | - Michele Abendstern
- Personal Social Services Research Unit; Division of Population Health; Health Services Research and Primary Care; School of Health Sciences; Faculty of Biology, Medicine and Health; University of Manchester; Manchester Academic Health Science Centre; Manchester UK
| | - Helen Chester
- Personal Social Services Research Unit; Division of Population Health; Health Services Research and Primary Care; School of Health Sciences; Faculty of Biology, Medicine and Health; University of Manchester; Manchester Academic Health Science Centre; Manchester UK
| | - David Challis
- Personal Social Services Research Unit; Division of Population Health; Health Services Research and Primary Care; School of Health Sciences; Faculty of Biology, Medicine and Health; University of Manchester; Manchester Academic Health Science Centre; Manchester UK
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22
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Pope N, Giger J, Lee J, Ely G. Predicting personal self-care in informal caregivers. SOCIAL WORK IN HEALTH CARE 2017; 56:822-839. [PMID: 28715255 DOI: 10.1080/00981389.2017.1344755] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Caregiver research often focuses on negative health outcomes, yet little is known about the self-care practices of caregivers. The present study investigates self-care practices among family caregivers and the relationships between personal self-care, perceived stress, and other health variables. Data were collected from informal caregivers through self-administered Internet and paper surveys that included the Medical Outcomes Study Short Form 36-item Health Survey, Perceived Stress Scale, and Self-Care Practices Scale. Personal self-care was most strongly associated with emotional well-being, pain, perceived stress, and general health. The relevance of study findings to strengthening family caregiver programs and future research is discussed.
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Affiliation(s)
- Natalie Pope
- a College of Social Work , The University of Kentucky , Lexington , Kentucky , USA
| | - Jarod Giger
- a College of Social Work , The University of Kentucky , Lexington , Kentucky , USA
| | - Jacquelyn Lee
- b School of Social Work at UNC-WIlmington , University of North Carolina Wilmington , Wilmington , North Carolina , USA
| | - Gretchen Ely
- c School of Social Work , The State University of New York , Buffalo , New York , USA
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Boyacıoğlu NE, Kutlu Y. The Effectiveness of Psychoeducational Interventions in Reducing the Care Burden of Family Members Caring for the Elderly in Turkey: A Randomized Controlled Study. Arch Psychiatr Nurs 2017; 31:183-189. [PMID: 28359431 DOI: 10.1016/j.apnu.2016.09.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 09/19/2016] [Accepted: 09/20/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To examine the effectiveness of psychoeducational intervention that is based on the McGill Model of Nursing in reducing the burden of caregivers and improving self-efficacy and adaptive coping in people who provide care for the older person. METHODS This study was conducted using a pre- and post-test control group and repeated measures experimental design in a family health center service area located in Istanbul. This study was conducted with 33 caregivers in each group. The data were collected using the questionnaire form, the Zarit Burden Interview, the General Self-Efficacy Scale and the Cognitive Emotion Regulation Questionnaire. RESULTS According to the findings of the study, the post-test Zarit Burden Interview points of the intervention group trained for according to McGill Model of Nursing will decrease compared with the control group after the intervention hypothesis was accepted; the post-test General Self-Efficacy Scale and adaptive subscales of the Cognitive Emotion Regulation Questionnaire scores will increase after the intervention hypothesis was also accepted. CONCLUSION It was found that the psychoeducational intervention based on the McGill Nursing Model was efficient.
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Affiliation(s)
| | - Yasemin Kutlu
- Istanbul University, Florence Nightingale Nursing Faculty, Mental Health and Psychiatric Nursing Department.
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Abraha I, Rimland JM, Trotta FM, Dell'Aquila G, Cruz-Jentoft A, Petrovic M, Gudmundsson A, Soiza R, O'Mahony D, Guaita A, Cherubini A. Systematic review of systematic reviews of non-pharmacological interventions to treat behavioural disturbances in older patients with dementia. The SENATOR-OnTop series. BMJ Open 2017; 7:e012759. [PMID: 28302633 PMCID: PMC5372076 DOI: 10.1136/bmjopen-2016-012759] [Citation(s) in RCA: 234] [Impact Index Per Article: 33.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 09/05/2016] [Accepted: 10/04/2016] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To provide an overview of non-pharmacological interventions for behavioural and psychological symptoms in dementia (BPSD). DESIGN Systematic overview of reviews. DATA SOURCES PubMed, EMBASE, Cochrane Database of Systematic Reviews, CINAHL and PsycINFO (2009-March 2015). ELIGIBILITY CRITERIA Systematic reviews (SRs) that included at least one comparative study evaluating any non-pharmacological intervention, to treat BPSD. DATA EXTRACTION Eligible studies were selected and data extracted independently by 2 reviewers.The AMSTAR checklist was used to assess the quality of the SRs. DATA ANALYSIS Extracted data were synthesised using a narrative approach. RESULTS 38 SRs and 129 primary studies were identified, comprising the following categories of non-pharmacological interventions: (1) sensory stimulation interventions (25 SRs, 66 primary studies) that encompassed: shiatsu and acupressure, aromatherapy, massage/touch therapy, light therapy, sensory garden and horticultural activities, music/dance therapy, dance therapy, snoezelen multisensory stimulation therapy, transcutaneous electrical nerve stimulation; (2) cognitive/emotion-oriented interventions (13 SRs; 26 primary studies) that included cognitive stimulation, reminiscence therapy, validation therapy, simulated presence therapy; (3) behaviour management techniques (6 SRs; 22 primary studies); (4) Multicomponent interventions (3 SR; four primary studies); (5) other therapies (5 SRs, 15 primary studies) comprising exercise therapy, animal-assisted therapy, special care unit and dining room environment-based interventions. CONCLUSIONS A large number of non-pharmacological interventions for BPSD were identified. The majority of the studies had great variation in how the same type of intervention was defined and applied, the follow-up duration, the type of outcome measured, usually with modest sample size. Overall, music therapy and behavioural management techniques were effective for reducing BPSD.
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Affiliation(s)
- Iosief Abraha
- Geriatrics and Geriatric Emergency Care, Italian National Research Center on Aging (IRCCS-INRCA), Ancona, Italy
| | - Joseph M Rimland
- Geriatrics and Geriatric Emergency Care, Italian National Research Center on Aging (IRCCS-INRCA), Ancona, Italy
| | - Fabiana Mirella Trotta
- Geriatrics and Geriatric Emergency Care, Italian National Research Center on Aging (IRCCS-INRCA), Ancona, Italy
| | - Giuseppina Dell'Aquila
- Geriatrics and Geriatric Emergency Care, Italian National Research Center on Aging (IRCCS-INRCA), Ancona, Italy
| | | | - Mirko Petrovic
- Department of Internal Medicine (Geriatrics), Ghent University,Ghent, Belgium
| | | | - Roy Soiza
- Department of Medicine for the Elderly, Woodend Hospital, Aberdeen, UK
| | - Denis O'Mahony
- Department of Medicine, University College Cork, Cork, Ireland
| | | | - Antonio Cherubini
- Geriatrics and Geriatric Emergency Care, Italian National Research Center on Aging (IRCCS-INRCA), Ancona, Italy
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Di Rosa M, Fabbietti P, Corsonello A, Fusco S, Sganga F, Volpato S, Ruggiero C, Onder G, Lattanzio F. Does being assisted by care workers affect antipsychotics prescription among older people discharged from hospital? Geriatr Gerontol Int 2016; 17:1707-1713. [PMID: 27862784 DOI: 10.1111/ggi.12931] [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: 06/08/2016] [Revised: 08/04/2016] [Accepted: 09/20/2016] [Indexed: 11/28/2022]
Abstract
AIM Several factors can affect antipsychotic prescriptions, among which, caregivers. However, whether being assisted by a care worker might increase the rate of antipsychotic prescriptions at discharge from acute care hospital has not been previously investigated. We aimed to investigate whether being assisted by a care worker is associated with increased use of antipsychotics among older patients discharged from acute care hospitals. METHODS The present series consisted of 928 patients not taking antipsychotics at admission in seven acute care wards of geriatric medicine in Italy (mean age 80.8 ± 7.2 years, 54.9% women). The outcome of the study was defined as receiving an antipsychotic prescription at discharge. Patients were grouped according to their living conditions as follows: (i) living alone; (ii) living only with care worker; (iii) living with care worker and family members; and (iv) living only with family members. The association between study variables and antipsychotic prescription at discharge was investigated by logistic regression analysis. RESULTS After adjusting for potential confounders, being assisted by care workers was significantly associated with the outcome (OR 2.64, 95% CI 1.21-5.75). Diagnosis of dementia (OR 2.73, 95% CI 1.65-4.51), instrumental activities of daily living limitations (OR 1.12, 95% CI 1.05-1.21) and delirium during stay (OR 3.87, 95% CI 2.01-7.47) also qualified as independent correlates of antipsychotic prescription at discharge. CONCLUSIONS Being assisted by care workers could increase the likelihood of receiving antipsychotics at discharge from acute care hospitals. Geriatr Gerontol Int 2017; 17: 1707-1713.
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Affiliation(s)
- Mirko Di Rosa
- Laboratory of Studies and Research in Biostatistics, National Institute of Health and Science on Aging (INRCA), Ancona, Italy
| | - Paolo Fabbietti
- Laboratory of Studies and Research in Biostatistics, National Institute of Health and Science on Aging (INRCA), Ancona, Italy
| | - Andrea Corsonello
- Unit of Geriatric Pharmacoepidemiology, Italian National Research Center on Aging (INRCA), Cosenza, Italy
| | - Sergio Fusco
- Unit of Geriatric Pharmacoepidemiology, Italian National Research Center on Aging (INRCA), Cosenza, Italy
| | - Federica Sganga
- Department of Gerontology, Neuroscience and Orthopedics, Catholic University of Sacread Hearth, Rome, Italy
| | - Stefano Volpato
- Section of Internal and Cardiorespiratory Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Carmelinda Ruggiero
- Section of Gerontology and Geriatrics, Department of Medicine, University of Perugia, Perugia, Italy
| | - Graziano Onder
- Department of Gerontology, Neuroscience and Orthopedics, Catholic University of Sacread Hearth, Rome, Italy
| | - Fabrizia Lattanzio
- Scientific Direction, Italian National Research Center on Aging (INRCA), Cosenza, Italy
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Robinson KM, Crawford TN, Buckwalter KC, Casey DA. Outcomes of a Two-Component Intervention on Behavioral Symptoms in Persons With Dementia and Symptom Response in Their Caregivers. J Appl Gerontol 2016; 37:570-594. [DOI: 10.1177/0733464816677549] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose: This study evaluated the longitudinal influence of an individualized evidence-based psychoeducational intervention for caregivers on frequency of behavioral symptoms in persons with dementia (PWD) and caregiver reaction to these symptoms. The intervention included information about the disease process using Progressively Lowered Stress Threshold (PLST) content and a family meeting based on Mittelman’s New York University Intervention. Method: A quasi-experimental study design was implemented. The Revised Memory and Behavior Problems Checklist was administered to N = 127 caregiver/care recipient dyads at baseline, 6, 12, and 18 months follow-up. All caregivers were enrolled in the intervention at baseline and followed over 18 months. Linear mixed models were developed to evaluate effects on frequency of behavioral symptoms in PWD and caregiver response. Results: The most frequently occurring behavior was memory problems, although depressive behaviors produced the most negative caregiver responses. Between baseline and 6-month follow-up, there was a significant decrease in frequency of behavioral symptoms. Overall, there was a significant decrease in caregiver’s reaction to behavioral symptoms from baseline to 18-month follow-up.
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Kuo LM, Huang HL, Liang J, Kwok YT, Hsu WC, Su PL, Shyu YIL. A randomized controlled trial of a home-based training programme to decrease depression in family caregivers of persons with dementia. J Adv Nurs 2016; 73:585-598. [PMID: 27653753 DOI: 10.1111/jan.13157] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2016] [Indexed: 12/22/2022]
Abstract
AIMS The aim of this study was to explore distinct trajectories of caregivers' depressive symptoms and the effects of a training programme on these trajectories over 18 months after the programme. BACKGROUND Overall effects of caregiver-training programmes on family caregivers' depressive symptoms have been reported, but few studies explored distinct courses of changes in caregivers' depressive symptoms and followed up intervention effects on these distinct courses. DESIGN Randomized clinical trial. METHODS Family caregivers (n = 116) were randomly assigned into experimental (n = 57) and control (n = 59) groups. The experimental group received the training programme with telephone consultation and the control group received written educational materials and social telephone follow-ups. Caregivers' depressive symptoms were assessed from June 2009 - March 2012 by self-completed questionnaires before, at 2 weeks and 3, 6, 12 and 18 months after the intervention. Groups of individual trajectories were distinguished using group-based trajectory modelling. RESULTS Caregivers' depressive symptoms fell into three stable trajectories: non-depressed, mildly blue and depressed. After controlling for covariates, caregivers who received the caregiver-training programme were less likely than those who did not experience persistent depressive symptoms (b = -1·92, odds ratio = 0·15, P < 0·05). CONCLUSION Depressive symptoms of family caregivers of persons with dementia were relatively stable and followed three distinct courses: non-depressed, mildly blue and depressed. Therefore, caregivers' depressive symptoms should be assessed as early as possible. Caregivers in the experimental group had a lower probability of persistent depressive symptoms than caregivers in the control group. Therefore, this training programme can be used by healthcare providers for persons with dementia and their caregivers. TRIAL REGISTRATION NUMBER NCT02667951.
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Affiliation(s)
- Li-Min Kuo
- School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Huei-Ling Huang
- Department of Gerontological Care and Management, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Jersey Liang
- School of Public Health and Institute of Gerontology, University of Michigan, Ann Arbor, Michigan, USA
| | - Yam-Ting Kwok
- Division of Neurology, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - Wen-Chuin Hsu
- Dementia Center, Department of Neurology, Chang Gung University and Memorial Hospital, Taoyuan, Taiwan
| | - Pei-Ling Su
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yea-Ing L Shyu
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Traumatological Division, Department of Orthopedics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Kuo LM, Huang HL, Hsu WC, Wang YT, Shyu YIL. Home-based caregiver training: Benefits differ by care receivers' dementia diagnosis. Geriatr Nurs 2016; 37:376-384. [DOI: 10.1016/j.gerinurse.2016.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 05/09/2016] [Accepted: 05/16/2016] [Indexed: 11/28/2022]
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Yu DSF. Effects of a Health and Social Collaborative Case Management Model on Health Outcomes of Family Caregivers of Frail Older Adults: Preliminary Data from a Pilot Randomized Controlled Trial. J Am Geriatr Soc 2016; 64:2144-2148. [PMID: 27550619 DOI: 10.1111/jgs.14259] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Family caregiving is an important form of informal care provided to frail, community-dwelling older adults. This article describes a health and social collaborative case management (HSC-CM) model that aims to optimize the support given to caregivers of frail elderly adults. The model was characterized by a comprehensive assessment to identify the caregiver's needs; a case management approach to provide integrated, coordinated, continued care; and multidisciplinary group-based education customized to the caregiver's individualized needs. A pilot study using a randomized controlled trial study design was conducted to evaluate the effects of the HSC-CM on caregiver burden and health-related quality of life of family caregivers of frail elderly adults. Sixty family caregivers (mean age 61.3 ± 15.5) of frail older adults recruited from a community center for elderly adults in Hong Kong were randomly assigned to receive a 16-week HSC-CM intervention or usual care. Case managers who conducted a comprehensive assessment of the care dyads to identify caregiver needs using a case management approach to optimize care coordination and continuity led the HSC-CM. These case managers served as liaisons for multidisciplinary efforts to provide group-based education according to caregiver needs. Family caregivers who participated in the HSC-CM had significantly greater improvement on the Caregiver Burden Index (p = .03) and on the Medical Outcomes Study 36-item Short-Form Survey subscales, including vitality (p = .049), social role functioning (p = .047), and general well-being (p = .049). This study provides preliminary evidence indicating that client-centered care, a case management approach, and multidisciplinary support are crucial to an effective caregiving support initiative. A full-scale study is required to validate these findings.
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Affiliation(s)
- Doris S F Yu
- Nethersole School of Nursing, Chinese University of Hong Kong, Hong Kong City, Hong Kong.
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Abstract
This article describes the concept of self-management and how it is being promoted. This is followed by a consideration of why dementia has been largely set aside. Illustrations of how people with early dementia might be enabled to participate are given and the requirements that will help to make this a reality are postulated. These include early disclosure of the diagnosis, support with the consequences of disclosure, a focus upon the needs of the person with dementia, identification of specific interventions that might facilitate self-management, meeting needs for professional education and support and a whole systems approach towards treatment and care. The results of a scoping review of the evidence is given, with an extra factor of meeting needs for lay and patient education being identified in addition to those elements originally postulated. The implications of policy neglect combined with a patchy evidence base and unrecognized service innovations are discussed.
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Lee M, Yoon E, Kropf NP. Factors Affecting Burden of South Koreans Providing Care to Disabled Older Family Members. Int J Aging Hum Dev 2016; 64:245-62. [PMID: 17503688 DOI: 10.2190/c4u5-078n-r83l-p1mn] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study examined the determinants of caregiving burden among South Koreans who care for their disabled older family members. A sample of 1,000 primary caregivers taken from the Comprehensive Study for Elderly Welfare Policy in Seoul, South Korea was analyzed. Independent variables included the demographic characteristics of caregivers and care recipients, the severity of cognitive impairment among care recipients, care recipients' functional abilities, financial adequacy and caregivers' degree of social support. Hierarchical regression was used to predict the levels of caregivers' burden. Similar to western care providers, South Korean caregivers who were in poor health and who had little informal social support, inadequate financial resources and more weekly caregiving hours were more likely to experience intense caregiving burden. Burden was also positively related to the functional and cognitive disabilities of care recipients. The results of this study indicate that certain aspects of caregiving are unique to South Koreans. Daughters-in-law were the most common caregiver within the sample which indicates that South Korean eldercare is non-consanguineous. Identifying predictors of South Korean caregivers' burden promotes a more comprehensive understanding of cultural experiences in caring for older adults.
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Affiliation(s)
- Minhong Lee
- Department of Social Welfare, Dong-Eui University, Busan, South Korea.
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Söylemez BA, Küçükgüçlü Ö, Buckwalter KC. Application of the Progressively Lowered Stress Threshold Model with Community-Based Caregivers: A Randomized Controlled Trial. J Gerontol Nurs 2016; 42:44-54. [DOI: 10.3928/00989134-20160406-01] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 03/15/2016] [Indexed: 12/23/2022]
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Tang WK, Chan CYJ. Effects of psychosocial interventions on self-efficacy of dementia caregivers: a literature review. Int J Geriatr Psychiatry 2016; 31:475-93. [PMID: 26352192 DOI: 10.1002/gps.4352] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 07/20/2015] [Accepted: 08/03/2015] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Self-efficacy plays an important role in mediating stressors and physical and psychological outcomes in dementia caregiving. OBJECTIVES This literature review aims to identify, summarize, and critically appraise current evidence on the psychosocial interventions used for enhancing the self-efficacy of caregivers of patients with dementia (PWD). METHODS A database search from two major web gateways was conducted to identify relevant research articles with an intervention for caregivers of patients with any type of dementia that included self-efficacy as an outcome measure. RESULTS A total of 14 studies met the criteria. The key findings and characteristics of the interventions were summarized and analyzed. The results showed that caregivers' self-efficacy and other aspects could be improved by psychosocial interventions. CONCLUSION The efficacy of the interventions for self-efficacy and other outcomes for caregivers and PWD were explored. Recommendations on the effects and significance of various psychosocial interventions for caregivers of PWD in enhancing self-efficacy were discussed.
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Affiliation(s)
- Wai Kit Tang
- Castle Peak Hospital, Tuen Mun, Hong Kong.,The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong
| | - Chung Yan Joanne Chan
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong
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Steffen AM, Gant JR. A telehealth behavioral coaching intervention for neurocognitive disorder family carers. Int J Geriatr Psychiatry 2016; 31:195-203. [PMID: 26077904 PMCID: PMC4744782 DOI: 10.1002/gps.4312] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 05/06/2015] [Accepted: 05/07/2015] [Indexed: 12/23/2022]
Abstract
OBJECTIVES This study examined the differential impact of two telehealth programs for women caring for an older adult with a neurocognitive disorder. Outcomes examined were depressive symptoms, upset following disruptive behaviors, anxious and angry mood states, and caregiving self-efficacy. METHODS Women cohabitating with a family member diagnosed with a neurocognitive disorder were assigned via random allocation to either of the following: (1) a 14-week behavioral intervention using video instructional materials, workbook and telephone coaching in behavioral management, pleasant events scheduling, and relaxation or (2) a basic education guide and telephone support comparison condition. Telephone assessments were conducted by interviewers blind to treatment condition at pre-intervention, post-intervention, and 6 months following intervention. RESULTS For those providing in-home care at post-treatment, depressive symptoms, upset following disruptive behaviors, and negative mood states were statistically lower in the behavioral coaching condition than in the basic education and support condition. Reliable change index analyses for Beck Depression Inventory II scores favored the behavioral coaching condition. Caregiving self-efficacy scores for obtaining respite and for managing patient behavioral disturbances were significantly higher in the coaching condition. Effect sizes were moderate but not maintained at the 6-month follow-up. CONCLUSIONS This study provides some initial evidence for the efficacy of a telehealth behavioral coaching intervention compared with basic education and telephone support. Carers' abilities to maintain strategy use during progressive disorders such as Alzheimer's disease likely require longer intervention contact than provided in the current study. Dementia carers, including those living in rural areas, can benefit from accessible and empirically supported interventions that can be easily disseminated across distances at modest cost.
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Affiliation(s)
- Ann M. Steffen
- Department of Psychological SciencesUniversity of Missouri–St. LouisSt. LouisMOUSA
| | - Judith R. Gant
- Department of Psychological SciencesUniversity of Missouri–St. LouisSt. LouisMOUSA
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Kuo LM, Huang HL, Hsu WC, Shyu YIL. Health-related quality of life and self-efficacy of managing behavior problems for family caregivers of vascular dementia and Alzheimer's disease patients. Dement Geriatr Cogn Disord 2015; 38:310-20. [PMID: 25011490 DOI: 10.1159/000360414] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/07/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Little is known about the differences in patients' behavioral problems and health outcomes of family caregivers of patients with vascular dementia (VaD) and Alzheimer's disease (AD). METHODS A secondary analysis of baseline data on a subsample of caregiver-dementia patient dyads in a randomized clinical trial. RESULTS Family caregivers of VaD patients reported higher self-efficacy than caregivers of AD patients in handling verbally nonaggressive and verbally aggressive behaviors. Caregivers of VaD patients had poorer health-related quality of life (HRQoL) than caregivers of AD patients considering role disability due to physical health problems, bodily pain, social function, and physical component summary. Greater self-efficacy was associated with better mental health-related outcomes for family caregivers of VaD patients, and better self-care ability of VaD patients was associated with better caregiver mental health-related outcomes. Caring for a patient with more severe dementia predicted poor physical health-related outcomes in role disability due to physical health problems, but better overall mental health (mental component summary) for caregivers. CONCLUSION This study is the first to examine and compare the behavioral problems of AD and VaD patients in a Chinese population, along with their family caregivers' self-efficacy and health outcomes. Family caregivers of patients with VaD might warrant specific attention to their HRQoL, with interventions developed to enhance their self-efficacy.
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Affiliation(s)
- Li-Min Kuo
- School of Nursing, Hsin Sheng College of Medical Care and Management, Longtan, Taiwan, ROC
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Huang HL, Shyu YIL, Chen MC, Huang CC, Kuo HC, Chen ST, Hsu WC. Family caregivers' role implementation at different stages of dementia. Clin Interv Aging 2015; 10:135-46. [PMID: 25584022 PMCID: PMC4289485 DOI: 10.2147/cia.s60574] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The purpose of this study was to explore family caregivers' role-implementation experiences at different stages of dementia. PATIENTS AND METHODS For this cross-sectional, exploratory study, 176 dyads of family caregivers and their community-dwelling elderly relatives with dementia were recruited from the neurological clinics of a medical center in Taiwan. The Family Caregiving Inventory was used to assess family caregivers for caregiving activities, role strain, role preparation, and help from others at different stages of care receivers' dementia. RESULTS Family caregivers' caregiving activities were related to patients' stages of dementia. For patients with mild dementia, caregivers provided more assistance in transportation and housekeeping. In addition to these two activities, family caregivers of patients with moderate dementia provided more assistance with mobility and protection. For patients with severe dementia, family caregivers provided more assistance with personal care, mobility and protection, transportation, and housekeeping. Overall, family caregivers reported having some preparation to provide care; the most difficult caregiving activity was identified as managing behavioral problems. CONCLUSION This study's results provide a knowledge base for designing dementia stage-specific interventions in clinical practice and developing community-based, long-term care systems for families of patients with dementia.
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Affiliation(s)
- Huei-Ling Huang
- Department of Gerontological Care and Management, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Yea-Ing L Shyu
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan ; Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Min-Chi Chen
- Department of Public Health and Biostatistics Consulting Center, Chang Gung University, Taoyuan, Taiwan
| | - Chin-Chang Huang
- Department of Neurology, Chang Gung Memorial Hospital, Taoyuan, Taiwan ; School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hung-Chou Kuo
- Department of Neurology, Chang Gung Memorial Hospital, Taoyuan, Taiwan ; School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Sien-Tsong Chen
- Department of Neurology, Chang Gung Memorial Hospital, Taoyuan, Taiwan ; School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wen-Chuin Hsu
- School of Medicine, Chang Gung University, Taoyuan, Taiwan ; Chang Gung Dementia Center, Taoyuan, Taiwan
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Livingston G, Kelly L, Lewis-Holmes E, Baio G, Morris S, Patel N, Omar RZ, Katona C, Cooper C. Non-pharmacological interventions for agitation in dementia: systematic review of randomised controlled trials. Br J Psychiatry 2014; 205:436-42. [PMID: 25452601 DOI: 10.1192/bjp.bp.113.141119] [Citation(s) in RCA: 234] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Agitation in dementia is common, persistent and distressing and can lead to care breakdown. Medication is often ineffective and harmful. AIMS To systematically review randomised controlled trial evidence regarding non-pharmacological interventions. Method We reviewed 33 studies fitting predetermined criteria, assessed their validity and calculated standardised effect sizes (SES). RESULTS Person-centred care, communication skills training and adapted dementia care mapping decreased symptomatic and severe agitation in care homes immediately (SES range 0.3-1.8) and for up to 6 months afterwards (SES range 0.2-2.2). Activities and music therapy by protocol (SES range 0.5-0.6) decreased overall agitation and sensory intervention decreased clinically significant agitation immediately. Aromatherapy and light therapy did not demonstrate efficacy. CONCLUSIONS There are evidence-based strategies for care homes. Future interventions should focus on consistent and long-term implementation through staff training. Further research is needed for people living in their own homes.
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Affiliation(s)
- Gill Livingston
- Gill Livingston, MD, Lynsey Kelly, BSc, Elanor Lewis-Holmes, BSc, Unit of Mental Health Sciences, Gianluca Baio, PhD, Departments of Statistical Science and PRIMENT Clinical Trials Unit, Stephen Morris, PhD, Nishma Patel, MSc, Department of Applied Health Research, Rumana Z. Omar, PhD, Departments of Statistical Science and PRIMENT Clinical Trials Unit, Cornelius Katona, MD, Claudia Cooper, PhD, Unit of Mental Health Sciences, University College London, UK
| | - Lynsey Kelly
- Gill Livingston, MD, Lynsey Kelly, BSc, Elanor Lewis-Holmes, BSc, Unit of Mental Health Sciences, Gianluca Baio, PhD, Departments of Statistical Science and PRIMENT Clinical Trials Unit, Stephen Morris, PhD, Nishma Patel, MSc, Department of Applied Health Research, Rumana Z. Omar, PhD, Departments of Statistical Science and PRIMENT Clinical Trials Unit, Cornelius Katona, MD, Claudia Cooper, PhD, Unit of Mental Health Sciences, University College London, UK
| | - Elanor Lewis-Holmes
- Gill Livingston, MD, Lynsey Kelly, BSc, Elanor Lewis-Holmes, BSc, Unit of Mental Health Sciences, Gianluca Baio, PhD, Departments of Statistical Science and PRIMENT Clinical Trials Unit, Stephen Morris, PhD, Nishma Patel, MSc, Department of Applied Health Research, Rumana Z. Omar, PhD, Departments of Statistical Science and PRIMENT Clinical Trials Unit, Cornelius Katona, MD, Claudia Cooper, PhD, Unit of Mental Health Sciences, University College London, UK
| | - Gianluca Baio
- Gill Livingston, MD, Lynsey Kelly, BSc, Elanor Lewis-Holmes, BSc, Unit of Mental Health Sciences, Gianluca Baio, PhD, Departments of Statistical Science and PRIMENT Clinical Trials Unit, Stephen Morris, PhD, Nishma Patel, MSc, Department of Applied Health Research, Rumana Z. Omar, PhD, Departments of Statistical Science and PRIMENT Clinical Trials Unit, Cornelius Katona, MD, Claudia Cooper, PhD, Unit of Mental Health Sciences, University College London, UK
| | - Stephen Morris
- Gill Livingston, MD, Lynsey Kelly, BSc, Elanor Lewis-Holmes, BSc, Unit of Mental Health Sciences, Gianluca Baio, PhD, Departments of Statistical Science and PRIMENT Clinical Trials Unit, Stephen Morris, PhD, Nishma Patel, MSc, Department of Applied Health Research, Rumana Z. Omar, PhD, Departments of Statistical Science and PRIMENT Clinical Trials Unit, Cornelius Katona, MD, Claudia Cooper, PhD, Unit of Mental Health Sciences, University College London, UK
| | - Nishma Patel
- Gill Livingston, MD, Lynsey Kelly, BSc, Elanor Lewis-Holmes, BSc, Unit of Mental Health Sciences, Gianluca Baio, PhD, Departments of Statistical Science and PRIMENT Clinical Trials Unit, Stephen Morris, PhD, Nishma Patel, MSc, Department of Applied Health Research, Rumana Z. Omar, PhD, Departments of Statistical Science and PRIMENT Clinical Trials Unit, Cornelius Katona, MD, Claudia Cooper, PhD, Unit of Mental Health Sciences, University College London, UK
| | - Rumana Z Omar
- Gill Livingston, MD, Lynsey Kelly, BSc, Elanor Lewis-Holmes, BSc, Unit of Mental Health Sciences, Gianluca Baio, PhD, Departments of Statistical Science and PRIMENT Clinical Trials Unit, Stephen Morris, PhD, Nishma Patel, MSc, Department of Applied Health Research, Rumana Z. Omar, PhD, Departments of Statistical Science and PRIMENT Clinical Trials Unit, Cornelius Katona, MD, Claudia Cooper, PhD, Unit of Mental Health Sciences, University College London, UK
| | - Cornelius Katona
- Gill Livingston, MD, Lynsey Kelly, BSc, Elanor Lewis-Holmes, BSc, Unit of Mental Health Sciences, Gianluca Baio, PhD, Departments of Statistical Science and PRIMENT Clinical Trials Unit, Stephen Morris, PhD, Nishma Patel, MSc, Department of Applied Health Research, Rumana Z. Omar, PhD, Departments of Statistical Science and PRIMENT Clinical Trials Unit, Cornelius Katona, MD, Claudia Cooper, PhD, Unit of Mental Health Sciences, University College London, UK
| | - Claudia Cooper
- Gill Livingston, MD, Lynsey Kelly, BSc, Elanor Lewis-Holmes, BSc, Unit of Mental Health Sciences, Gianluca Baio, PhD, Departments of Statistical Science and PRIMENT Clinical Trials Unit, Stephen Morris, PhD, Nishma Patel, MSc, Department of Applied Health Research, Rumana Z. Omar, PhD, Departments of Statistical Science and PRIMENT Clinical Trials Unit, Cornelius Katona, MD, Claudia Cooper, PhD, Unit of Mental Health Sciences, University College London, UK
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Delgadillo J, Moreea O, Outhwaite-Luke H, Dace T, Nicholls B, Ramseyer G, Dale V. Confidence in the face of risk: the Risk Assessment and Management Self-Efficacy Study (RAMSES). PSYCHIATRIC BULLETIN 2014; 38:58-65. [PMID: 25237500 PMCID: PMC4115406 DOI: 10.1192/pb.bp.112.040394] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 04/19/2013] [Accepted: 07/10/2013] [Indexed: 11/30/2022]
Abstract
Aims and method To evaluate a comprehensive risk management programme. A Risk Assessment and Management Self-Efficacy Scale (RAMSES) was used to evaluate the impact of a clinical guideline and training course. Fifty-three psychological therapists were randomly allocated to training v. waiting list in a controlled, delayed-intervention design. Differences in mean self-efficacy scores between groups were examined using analysis of covariance (ANCOVA). Results The RAMSES measure had adequate factor structure, internal consistency and construct validity. When adjusting for baseline scores and cluster design, the group exposed to training had a higher mean self-efficacy score than controls. Mean differences between groups were not significant after the control group received training, nor at 6 months’ follow-up. Clinical implications Exposure to training and clinical guidelines can improve self-efficacy in risk assessment and management. An important advance put forward by this study is the specification of areas of competence in risk assessment and management, which can be measured using a psychometrically sound tool.
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Affiliation(s)
- Jaime Delgadillo
- Primary Care Mental Health Service, Leeds Community Healthcare NHS Trust
| | - Omar Moreea
- Primary Care Mental Health Service, Leeds Community Healthcare NHS Trust
| | | | - Toby Dace
- Primary Care Mental Health Service, Leeds Community Healthcare NHS Trust
| | - Brenda Nicholls
- Primary Care Mental Health Service, Leeds Community Healthcare NHS Trust
| | - Georgina Ramseyer
- Primary Care Mental Health Service, Leeds Community Healthcare NHS Trust
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Huang HL, Kuo LM, Chen YS, Liang J, Huang HL, Chiu YC, Chen ST, Sun Y, Hsu WC, Shyu YIL. A home-based training program improves caregivers' skills and dementia patients' aggressive behaviors: a randomized controlled trial. Am J Geriatr Psychiatry 2013; 21:1060-70. [PMID: 23933422 DOI: 10.1016/j.jagp.2012.09.009] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Revised: 08/28/2012] [Accepted: 09/26/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate the effects of an individualized, home-based caregiver-training program for caregivers of elderly patients with dementia and behavioral problems. METHODS Using a randomized clinical trial in the neurologic clinics of two hospitals and a community care management center in northern Taiwan, we tested an individualized home-based caregiver-training program for managing behavioral problems, with referrals to community services and telephone consultation. Participants were patients with dementia and their caregivers (N = 129): 63 in the intervention group and 66 in the control group. The control group received only written instructions and social telephone follow-ups. Behavioral problems of elderly dementia patients were assessed by the Chinese version of the Cohen-Mansfield Agitation Inventory, community form. Family caregivers' outcomes were measured by the Agitation Management Self-efficacy Scale and the Preparedness and Competence Scales. These instruments were administered before the program and 2 weeks, 3 months, and 6 months afterward. RESULTS Family caregivers who received the individualized home-based training program had better preparedness (t = 2.72, df = 127, p <0.01), competence (t = 4.77, df = 126, p <0.001), and overall self-efficacy (t = 3.81, df = 127, p <0.001) at 3 months than those in the control group. Moreover, the growth rate by treatment interaction effect was significant for caregiver competence (t = 2.25, df = 127, p <0.05) and overall self-efficacy for managing behavioral problems (t = 2.16, df = 127, p <0.05). The probability of physically aggressive behavior for patients in the intervention group decreased from 0.27 to 0.12. CONCLUSION Our individualized home-based caregiver-training program improved caregivers' preparedness, competence, and self-efficacy for managing problematic behaviors and decreased physical aggressiveness of elderly patients with dementia.
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Affiliation(s)
- Huei-Ling Huang
- Department of Gerontological Care and Management, Chang Gung University of Science and Technology, Taoyuan, Taiwan
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Greene MC, Zhang J, Li J, Desai M, Kershaw T. Mental health and social support among HIV-positive injection drug users and their caregivers in China. AIDS Behav 2013; 17:1775-84. [PMID: 23283579 DOI: 10.1007/s10461-012-0396-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The burden of HIV/AIDS in China is due to injection drug use. Non-clinical caregivers provide much of the care for HIV patients but are often not included in HIV care or research. The objective of this study is to examine the relationships between the caregiver context and mental health of HIV-positive injection drug users and their caregivers. We interviewed 96 patient-caregiver dyads using quantitative methods. A conceptual model was developed as a framework for multivariate linear regression modeling. The strongest predictor of poor patient mental health was lack of social support, which was largely determined by the caregiver's stigma towards HIV/AIDS and caregiver burden. Patient disability and caregiver burden were the primary predictors of poor caregiver mental health. The interrelated nature of caregiver and patient mental health supports the inclusion of caregiver health into the patient's HIV/AIDS treatment to maximize support provision and health for the patient and caregiver.
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Kuo LM, Huang HL, Huang HL, Liang J, Chiu YC, Chen ST, Kwok YT, Hsu WC, Shyu YIL. A home-based training program improves Taiwanese family caregivers' quality of life and decreases their risk for depression: a randomized controlled trial. Int J Geriatr Psychiatry 2013; 28:504-13. [PMID: 22778053 DOI: 10.1002/gps.3853] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Accepted: 06/08/2012] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Little is known about the longitudinal effects of training programs on family caregivers' health-related quality of life (HRQoL) and depressive symptoms over time. Therefore, the purpose of this study was to examine the effects of a home-based caregiver training program on HRQoL and depressive symptoms for family caregivers of older persons with dementia. METHODS Outcomes (caregivers' HRQoL and depressive symptoms) were assessed before the training program (baseline), and at 2 weeks, 3 months, and 6 months afterwards. HRQoL was measured using the Medical Outcomes Study 36-item Short Form Survey, Taiwan version. Depressive symptoms were measured using the Chinese version Center for Epidemiologic Studies Depression Scale. RESULTS Family caregivers who received the individualized home-based training program had better health outcomes in bodily pain (b = 12.37, p < 0.013), role disability due to emotional problems (b = 17.74, p < 0.013), vitality (b = 12.40, p < 0.001), better mental summary score (b = 5.14, p < 0.003), and decreased risk for depression (odds ratio = 0.15, confidence interval = 0.04-0.65, p < 0.013) than those in the control group during the 6 months following the training program. CONCLUSION Our home-based caregiver training program improved caregivers' HRQoL, especially role limitations due to emotional problems, and decreased their risk for depression.
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Affiliation(s)
- Li-Min Kuo
- School of Nursing, Hsin Sheng College of Medical Care and Management, Taoyuan, Taiwan
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Semiatin AM, O'Connor MK. The relationship between self-efficacy and positive aspects of caregiving in Alzheimer's disease caregivers. Aging Ment Health 2012; 16:683-8. [PMID: 22360626 DOI: 10.1080/13607863.2011.651437] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Positive aspects of the caregiving experience may buffer caregivers from the many negative psychological and physical consequences of caregiving. Understanding what factors relate to the recognition of positive aspects of caregiving is important for the enhancement of caregiver well-being. Self-efficacy is a potentially modifiable psychological construct that has been associated with positive thinking, improved control of negative affect, and enhanced motivation. METHODS This study examined the relationship between positive aspects of caregiving and self-efficacy among 57 family members caring for a loved one with Alzheimer's disease. Participant data was gathered through individual interviews conducted as a part of a larger randomized controlled trial of a caregiver intervention. RESULTS We found that self-efficacy accounted for a significant percentage of the variance in positive aspects of caregiving after controlling for other factors commonly associated with positive aspects of caregiving including caregiver demographics, care recipient neuropsychiatric symptoms, and caregiver depression. CONCLUSIONS Our results suggest that high self-efficacy relates to caregivers' perception of positive aspects of the caregiving experience.
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Affiliation(s)
- Alicia M Semiatin
- Department of Clinical Psychology, Massachusetts School of Professional Psychology, Boston, USA
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Parker D, Mills S, Abbey J. Effectiveness of interventions that assist caregivers to support people with dementia living in the community: a systematic review. INT J EVID-BASED HEA 2012; 6:137-72. [PMID: 21631819 DOI: 10.1111/j.1744-1609.2008.00090.x] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Objectives The objective of this review was to assess the effectiveness of interventions that assist caregivers to provide support for people living with dementia in the community. Inclusion criteria Types of participants Adult caregivers who provide support for people with dementia living in the community (non-institutional care). Types of interventions Interventions designed to support caregivers in their role such as skills training, education to assist in caring for a person living with dementia and support groups/programs. Interventions of formal approaches to care designed to support caregivers in their role, care planning, case management and specially designated members of the healthcare team - for example dementia nurse specialist or volunteers trained in caring for someone with dementia. Types of studies This review considered any meta-analyses, systematic reviews, randomised control trials, quasi-experimental studies, cohort studies, case control studies and observational studies without control groups that addressed the effectiveness of interventions that assist caregivers to provide support for people living with dementia in the community. Search strategy The search sought to identify published studies from 2000 to 2005 through the use of electronic databases. Only studies in English were considered for inclusion. The initial search was conducted of the databases, CINAHL, MEDLINE and PsychINFO using search strategies adapted from the Cochrane Dementia and Cognitive Improvement Group. A second more extensive search was then conducted using the appropriate Medical Subject Headings (MeSH) and keywords for other available databases. Finally, hand searching of reference lists of articles retrieved and of core dementia, geriatric and psycho geriatric journals was undertaken. Assessment of quality Methodological quality of each of the articles was assessed by two independent reviewers using appraisal checklist developed by the Joanna Briggs Institute and based on the work of the Cochrane Collaboration and Centre for Reviews and Dissemination. Data collection and analysis Standardised mean differences or weighted mean differences and their 95% confidence intervals were calculated for each included study reported in the meta-analysis. Results from comparable groups of studies were pooled in statistical meta-analysis using Review Manager Software from the Cochrane Collaboration. Heterogeneity between combined studies was tested using standard chi-square test. Where statistical pooling was not appropriate or possible, the findings are summarised in narrative form. Results A comprehensive search of relevant databases, hand searching and cross referencing found 685 articles that were assessed for relevance to the review. Eighty-five papers appeared to meet the inclusion criteria based on title and abstract, and the full paper was retrieved. Of the 85 full papers reviewed, 40 were accepted for inclusion, three were systematic reviews, three were meta-analysis, and the remaining 34 were randomised controlled trials. For the randomised controlled trials that were able to be included in a meta-analysis, standardised mean differences or weighted mean differences and their 95% confidence intervals were calculated for each. Results from comparable groups of studies were pooled in statistical meta-analysis using Review Manager Software and heterogeneity between combined studies was assessed by using the chi-square test. Where statistical pooling was not appropriate or possible, the findings are summarised in narrative form. The results are discussed in two main sections. Firstly it was possible to assess the effectiveness of different types of caregiver interventions on the outcome categories of depression, health, subjective well-being, self-efficacy and burden. Secondly, results are reported by main outcome category. For each of these sections, meta-analysis was conducted where it was possible; otherwise, a narrative summary describes the findings. Effectiveness of intervention type Four categories of intervention were included in the review - psycho-educational, support, multi-component and other. Psycho-educational Thirteen studies used psycho-educational interventions, and all but one showed positive results across a range of outcomes. Eight studies were entered in a meta-analysis. No significant impact of psycho-educational interventions was found for the outcome categories of subjective well-being, self-efficacy or health. However, small but significant results were found for the categories of depression and burden. Support Seven studies discussed support only interventions and two of these showed significant results. These two studies were suitable for meta-analysis and demonstrated a small but significant improvement on caregiver burden. Multi-component Twelve of the studies report multi-component interventions and 10 of these report significant outcomes across a broad range of outcome measures including self-efficacy, depression, subjective well-being and burden. Unfortunately because of the heterogeneity of study designs and outcome measures, no meta-analysis was possible. Other interventions Other interventions included the use of exercise or nutrition which resulted in improvements in psychological distress and health benefits. Case management and a computer aided support intervention provided mixed results. One cognitive behavioural therapy study reported a reduction in anxiety and positive impacts on patient behaviour. Effectiveness of interventions using specific outcome categories In addition to analysis by type of intervention it was possible to analyse results based on some outcome categories that were used across the studies. In particular the impact of interventions on caregiver depression was available for meta-analysis from eight studies. This indicated that multi-component and psycho-educational interventions showed a small but significant positive effect on caregiver depression. Five studies using the outcome category of caregiver burden were entered into a meta-analysis and findings indicated that there were no significant effects of any of interventions. No meta-analysis was possible for the outcome categories of health, self-efficacy or subjective well-being. Implications for practice From this review there is evidence to support the use of well-designed psycho-educational or multi-component interventions for caregivers of people with dementia who live in the community. Factors that appear to positively contribute to effective interventions are those which: • Provide opportunities within the intervention for the person with dementia as well as the caregiver to be involved • Encourage active participation in educational interventions for caregivers • Offer individualised programs rather than group sessions • Provide information on an ongoing basis, with specific information about services and coaching regarding their new role • Target the care recipient particularly by reduction in behaviours Factors which do not appear to have benefit in interventions are those which: • Simply refer caregivers to support groups • Only provide self help materials • Only offer peer support.
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Affiliation(s)
- Deborah Parker
- University of Queensland/Blue Care Research and Practice Development Centre, (Formally of the Dementia Collaborative Research Centre), Queensland University of Technology, Kelvin Grove, Brisbane, Queensland, Australia
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Wang YN, Shyu YIL, Tsai WC, Yang PS, Yao G. Exploring conflict between caregiving and work for caregivers of elders with dementia: a cross-sectional, correlational study. J Adv Nurs 2012; 69:1051-62. [DOI: 10.1111/j.1365-2648.2012.06092.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2012] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Wen-Che Tsai
- Department of Psychiatry; National Taiwan University Hospital; Taipei; Taiwan
| | - Pei-Shan Yang
- Department of Social Work; National Taiwan University; Taipei; Taiwan
| | - Grace Yao
- Department of Psychology; National Taiwan University; Taipei; Taiwan
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Moniz Cook ED, Swift K, James I, Malouf R, De Vugt M, Verhey F. Functional analysis-based interventions for challenging behaviour in dementia. Cochrane Database Syst Rev 2012:CD006929. [PMID: 22336826 DOI: 10.1002/14651858.cd006929.pub2] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Functional analysis (FA) for the management of challenging behaviour is a promising behavioural intervention that involves exploring the meaning or purpose of an individual's behaviour. It extends the 'ABC' approach of behavioural analysis, to overcome the restriction of having to derive a single explanatory hypothesis for the person's behaviour. It is seen as a first line alternative to traditional pharmacological management for agitation and aggression. FA typically requires the therapist to develop and evaluate hypotheses-driven strategies that aid family and staff caregivers to reduce or resolve a person's distress and its associated behavioural manifestations. OBJECTIVES To assess the effects of functional analysis-based interventions for people with dementia (and their caregivers) living in their own home or in other settings. SEARCH METHODS We searched ALOIS: the Cochrane Dementia and Cognitive Improvement Group's Specialized Register on 3 March 2011 using the terms: FA, behaviour (intervention, management, modification), BPSD, psychosocial and Dementia. SELECTION CRITERIA Randomised controlled trials (RCTs) with reported behavioural outcomes that could be associated with functional analysis for the management of challenging behaviour in dementia. DATA COLLECTION AND ANALYSIS Four reviewers selected trials for inclusion. Two reviewers worked independently to extract data and assess trial quality, including bias. Meta-analyses for reported incidence, frequency, severity of care recipient challenging behaviour and mood (primary outcomes) and caregiver reaction, burden and mood were performed. Details of adverse effects were noted. MAIN RESULTS Eighteen trials are included in the review. The majority were in family care settings. For fourteen studies, FA was just one aspect of a broad multi-component programme of care. Assessing the effect of FA was compromised by ill-defined protocols for the duration of component parts of these programmes (i.e. frequency of the intervention or actual time spent). Therefore, establishing the real effect of the FA component was not possible.Overall, positive effects were noted at post-intervention for the frequency of reported challenging behaviour (but not for incidence or severity) and for caregiver reaction (but not burden or depression). These effects were not seen at follow-up. AUTHORS' CONCLUSIONS The delivery of FA has been incorporated within wide ranging multi-component programmes and study designs have varied according to setting - i.e. family care, care homes and hospital, with surprisingly few studies located in care homes. Our findings suggest potential beneficial effects of multi-component interventions, which utilise FA. Whilst functional analysis for challenging behaviour in dementia care shows promise, it is too early to draw conclusions about its efficacy.
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Affiliation(s)
- Esme D Moniz Cook
- Clinical Psychology & Ageing, Institute of Rehabilitation,University of Hull, Hull,UK.
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Van Mierlo LD, Meiland FJM, Van der Roest HG, Dröes RM. Personalised caregiver support: effectiveness of psychosocial interventions in subgroups of caregivers of people with dementia. Int J Geriatr Psychiatry 2012; 27:1-14. [PMID: 21520288 DOI: 10.1002/gps.2694] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Accepted: 01/04/2011] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Insight into the characteristics of caregivers for whom psychosocial interventions are effective is important for care practice. Until now no systematic reviews were conducted into the effectiveness of psychosocial interventions for caregiver subgroups. METHODS To gain insight into this relationship between caregiver subgroups and intervention outcomes, a first review study was done. This study reviews the personal characteristics of caregivers of people with dementia for whom psychosocial interventions were effective. RESULTS Electronic databases and key articles were searched for reviews on psychosocial interventions for caregivers studies published between January 1990 and February 2008. Based on these reviews, twenty-six studies met the inclusion criteria (i.e. having positive outcomes described in subgroups). Most positive effects were found in caregivers of people with a diagnosis of 'dementia not otherwise specified' and in the subgroup of female caregivers. Examples of outcomes were decreased depression and improved self-efficacy. CONCLUSIONS This study gives a first overview of successful psychosocial interventions in subgroups of caregivers of people with dementia. It makes clear that until now, relatively little research has been done into subgroups of these caregivers. It also suggests that more research is needed to better understand which psychosocial interventions are effective for specific subgroups of caregivers of people with dementia.
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Affiliation(s)
- Lisa D Van Mierlo
- VU University Medical Center, Department of Psychiatry, Alzheimer Center, EMGO Institute for Health and Care Research, Valeriusplein 9, 1075 BG Amsterdam, the Netherlands
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Ishii S, Streim JE, Saliba D. A Conceptual Framework for Rejection of Care Behaviors: Review of Literature and Analysis of Role of Dementia Severity. J Am Med Dir Assoc 2012; 13:11-23.e1-2. [DOI: 10.1016/j.jamda.2010.11.004] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Revised: 10/31/2010] [Accepted: 11/05/2010] [Indexed: 10/18/2022]
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Ho SY, Lai HL, Jeng SY, Tang CW, Sung HC, Chen PW. The effects of researcher-composed music at mealtime on agitation in nursing home residents with dementia. Arch Psychiatr Nurs 2011; 25:e49-55. [PMID: 22114806 DOI: 10.1016/j.apnu.2011.08.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Revised: 06/28/2011] [Accepted: 08/08/2011] [Indexed: 11/24/2022]
Abstract
This study examined the effects of music at mealtimes on agitation in 22 nursing home residents with dementia. We used a pretest-posttest research design. We played researcher-composed music to residents at each of two mealtimes daily over a consecutive 4-week period. We observed and recorded agitation 24 hours daily for the 4-week period and the following 2-week period. Results revealed a significant decline in mean agitation scores. A cumulative dose effect and a short-term linger effect were observed. Findings suggest that soothing music may be beneficial in managing agitation in nursing home residents with dementia.
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Affiliation(s)
- Shu-Yuan Ho
- Taipei Veterans General Hospital Su-Ao Branch, Taiwan, R.O.C
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Thinnes A, Padilla R. Effect of educational and supportive strategies on the ability of caregivers of people with dementia to maintain participation in that role. Am J Occup Ther 2011; 65:541-9. [PMID: 22026322 DOI: 10.5014/ajot.2011.002634] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
A systematic review of evidence of the effectiveness of educational and supportive strategies for enabling caregivers of people with Alzheimer's disease (AD) or related dementias to maintain participation in that role was conducted as part of the American Occupational Therapy Association's Evidence-Based Literature Review Project. Forty-three articles met inclusion criteria. Results suggest that interventions that jointly engage people with AD and their caregivers in education and training in the home setting are more successful than strategies that focus solely on people with AD. Greater carryover is noted when education and training are implemented at the time that the caregiver identifies concerns. Interventions should provide caregivers with problem solving, technical skills, support, simple home modification strategies, and referral to community resources. Interventions mediated by technology have a positive effect on the caregiver and are especially important for those who live in rural areas.
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Affiliation(s)
- Andrea Thinnes
- Department of Occupational Therapy, School of Pharmacy and Health Professions, Creighton University, Omaha, NE 68178, USA
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Kilbourn KM, Costenaro A, Madore S, Deroche K, Anderson D, Keech T, Kutner JS. Feasibility of a telephone-based counseling program for informal caregivers of hospice patients. J Palliat Med 2011; 14:1200-5. [PMID: 21966991 DOI: 10.1089/jpm.2011.0186] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Informal caregivers of hospice patients experience multiple stressors that can negatively impact physical, psychological, and emotional health. The Caregiver Life Line (CaLL) study was a one-group, intervention-only feasibility study of a telephone cognitive-behavioral stress-management intervention consisting of 10 to 12 weekly telephone counseling calls designed specifically for informal caregivers of home-based hospice patients. METHODS Caregivers, who were recruited via seven participating hospices, were assessed at baseline, 3, and 6 months. Psychosocial measures included depression, perceived stress, benefit finding, social support, and quality of life (QoL). Process evaluation was also conducted at 6 months. RESULTS Of the 25 participants, 19 completed the 12-week intervention. The mean age was 60.3 years; 91% were female and 70% married. Forty-eight percent were caring for a spouse; 51% were caring for a parent or other family member. Participating caregivers and hospice staff reported high levels of satisfaction with the intervention. Although the small sample size and lack of a control group limit our ability to assess the efficacy of the intervention, psychosocial outcomes changed in the expected direction and participants reported high levels of self-efficacy regarding their ability to implement the adaptive coping skills. Interestingly, we observed a decrease in physical QoL across the three time points. CONCLUSIONS This pilot study demonstrated that the CaLL intervention is feasible and acceptable to informal hospice caregivers. This report describes important lessons learned from the pilot study with the intention of informing future intervention studies with this population.
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