Aplicación del modelo Balance of Care en la toma de decisiones acerca del mejor cuidado para las personas con demencia

Care of older people with Cognitive Impairment or Dementia Hospitalized in Traumatology Units (CARExDEM): a quasi-experiment

BACKGROUND

In our context, as in other European countries, care of patients with cognitive disorders or dementia still represents a major challenge in hospital settings. Thus, there is a need to ensure quality and continuity of care, avoiding preventable readmissions, which involve an increase in public expenses. Healthcare professionals need to acquire the necessary knowledge and skills to care for hospitalized patients with cognitive disorders and dementia.

METHODS

A quasi-experimental design with repeated observations, taken at baseline, post-intervention, and at one and three months post-intervention, in people hospitalized with cognitive disorders or dementia. The study will be carried out in four general hospitals in Spain and will include 430 PwD and their caregivers. The intervention was previously developed using the Balance of Care methodology where nurses, physicians, social workers and informal caregivers identified the best practices for this specific care situation. We aim to personalize the intervention, as recommended in the literature. The study has an innovative approach that includes new technologies and previous scientific evidence. Valid, reliable instruments will be used to measure the intervention outcomes. Quality of care and comorbidity will be analyzed based on the use of restraints and psychotropic medication, pain control, falls, functional capacity and days of hospitalization. Continuity of care will be measured based on post-discharge emergency hospital visits, visits to specialists, cost, and inter-sectorial communication among healthcare professionals and informal caregivers. Statistical analysis will be performed to analyze the effect of the intervention on quality of care, comorbidity and continuity of care for patients with dementia.

DISCUSSION

Our aim is to helping healthcare professionals to improve the management of cognitive disorders or dementia care during hospitalization and the quality of care, comorbidity and continuity of care in patients with dementia and their informal caregivers. Moving towards dementia-friendly environments is vital to achieving the optimum care outcomes.

TRIAL REGISTRATION

Registered in Clinical Trials. ClinicalTrials.gov Identifier: NCT04048980 retrospectively registered on the 6th August 2019. https://clinicaltrials.gov/ Protocol Record HCB/2017/0499.

SPONSOR

Hospital Clinic Barcelona.

Suitability of Social Services for the Older Persons: Analysis of Degree of Fit between Needs and Services

Increased life expectancy coupled with decreased birth rates has led to a notable aging of the population. In the social care sector, resources for the older persons should be allocated by means of objective instruments that ensure an appropriate fit between older people's needs and the characteristics of the services. This paper analyzes the appropriacy of actual assignments of resources in a sample of 632 older users of social services, evaluating the degree of fit between these assignments and those made by a Decision Making Model (DMM) which is strictly based on an objective assessment of user's needs and characteristics. The results indicate that biopsychosocial variables included as predictors in the DMM are appropriate for ensuring that the needs of the older persons are met and resources are optimized. However, the current assignments of users to services cannot be explained by relying solely on these variables, suggesting that the allocation of users to services may be conditioned by factors that are different from those covered by the DMM.

Effectiveness of a psychoeducational intervention for caregivers of People With Dementia with regard to burden, anxiety and depression: A systematic review

AIM

To assess the effectiveness of psychoeducational interventions with respect to burden, anxiety and depression in family caregivers of People With Dementia living at home.

BACKGROUND

In dementia, the family assumes the role of main caregiver, maintaining the patient in a good state of health. Nevertheless, burden, anxiety and depression may have negative repercussions in caregivers. Therefore, professional supports through psychoeducational programmes are recommended as interventions for improving caregivers' health.

DESIGN

A quantitative systematic review.

DATA SOURCES

Electronic searches were performed in CINAHL/AMED/CENTRAL/Web of Science/LILACS/PUBMED from January 2005-August 2018.

REVIEW METHODS

The review was conducted using the JADAD scale to assess bias risk and the quality of the randomized controlled trials (RCTs) and the CONSORT instrument to assess study quality report. The extracted data were reviewed by independent reviewer pairs. The review was reported using PRISMA.

RESULTS

A total of 18 RCTs met inclusion criteria. Seven were classified as Technology-based Interventions and 11 as Group-based Interventions.

CONCLUSION

Psychoeducational interventions for caregivers allow them to increase their knowledge of the illness, develop problem-solving skills and facilitate social support. Technology-based Interventions significantly affect burden while Group-based Interventions affect anxiety, depression, insomnia and burden and quality of life and self-efficacy.

IMPACT

Research findings can be used to classify caregivers in future interventions according to illness stage to obtain more precise results.