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Wang S, Leung SHI, Xu X, Liu M, Wang P, Zhang W, Moyle W. Influences of Social Disengagement and Depressive Symptoms on Sleep Disturbance in Dementia Caregiving Dyads: A Nationally Representative Study. J Am Med Dir Assoc 2024:105197. [PMID: 39127457 DOI: 10.1016/j.jamda.2024.105197] [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: 08/23/2023] [Revised: 06/28/2024] [Accepted: 07/05/2024] [Indexed: 08/12/2024]
Abstract
OBJECTIVES To examine the influence of social disengagement and depressive symptoms on sleep disturbance among dementia caregiving dyads and the actor-partner interdependence nature of these influences. DESIGN Actor-partner interdependence model through structural equation modeling for dyadic analyses. SETTING AND PARTICIPANTS A total of 310 dyads of older adults with dementia and their care partners from 2 national representative studies in the United States, the National Health and Aging Trends Study (NHATS) and its companion study, the National Study of Caregiving (NSOC). METHODS Data from the NHATS Round 11 and NSOC IV were analyzed using descriptive statistics, Pearson correlation analysis, and the actor-partner interdependence model. Structural equation modeling was used to assess the mediation effects of depressive symptoms within the actor-partner interdependence models. RESULTS In the model of caregivers, social disengagement had a direct impact on sleep disturbance (β = 0.49, P < .001) and an indirect impact through depressive symptoms (β = 0.25, P < .001). In the model of older adults with dementia, social disengagement only had an indirect effect on sleep disturbance through depressive symptoms. In models examining partner effects, caregivers' social disengagement directly influenced their care partners' depressive symptoms (β = 0.20, P = .019), which subsequently affected caregivers' sleep disturbance (β = 0.17, P < .001). Social disengagement (β = 0.17, P = .001) and depressive symptoms (β = 0.17, P < .001) in older adults with dementia directly impacted their caregivers' sleep disturbance. Depressive symptoms of older adults with dementia served as multiple mediators linking one member's social disengagement to both their own and partner's sleep. CONCLUSIONS AND IMPLICATIONS This study represents one of the first attempts to investigate the influencing mechanism of sleep disturbances among older adults with dementia and their informal caregivers through a dyadic perspective. The sleep disturbance of caregivers may be directly influenced by the social disengagement and depressive symptoms exhibited by both members of the dyad, whereas the sleep disturbance experienced by older adults with dementia can only be indirectly influenced by the dyad's social disengagement via their own depressive symptoms. Dyadic social activities targeting depressive symptoms could be designed to address sleep disturbances in dementia caregiving dyads.
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Affiliation(s)
- Shanshan Wang
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China.
| | - Sze Him Isaac Leung
- Department of Statistics, The Chinese University of Hong Kong, Sha Tin, Hong Kong SAR, China
| | - Xinyi Xu
- School of Nursing, Hebei Medical University, Hebei, China
| | - Minhui Liu
- School of Nursing, Ningxia Medical University, Ningxia, China
| | - Peng Wang
- School of Nursing and Health, Zhengzhou University, Henan, China; School of Nursing, Xinxiang Medical University, Henan, China
| | - Weihong Zhang
- School of Nursing and Health, Zhengzhou University, Henan, China
| | - Wendy Moyle
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
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Lee JE, Nemmers NL, Svec J, Cho J. Caregiving Appraisals and Emotional Valence: Moderating Effects of Activity Participation. Res Aging 2024:1640275241263770. [PMID: 39028310 DOI: 10.1177/01640275241263770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
The present study examines the extent to which a two-factor model of affect explains how caregiving appraisals experienced by caregivers influence their own well-being. We used data from three waves of Nation Study of Caregiving (NSOC) to conduct latent growth curve models with the time-varying predictors to investigate the effect of between-person (BP) and within-person (WP) caregiving appraisals on positive and negative affect. Furthermore, we simultaneously modeled WP differences in activity participation and affective experience with multilevel modeling. Then, we tested the moderating effect of activity participation in the association between WP caregiving appraisals and emotional valence. We found that BP and WP caregiving negative appraisal also contribute to caregiver positive affect similar to that of negative affect. Time-varying effects of negative appraisals and emotional valence are consistent with the two-factor model. Future longitudinal investigations could target WP and BP activity participation to alleviate caregiving cognitive appraisal among caregivers.
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Affiliation(s)
| | | | | | - Jinmyoung Cho
- Saint Louis University School of Medicine, Saint Louis, MO, USA
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Chan HM, Ho KHM, Pang RCK, Chan HYL. Strategies and factors to enhance active participation of family caregivers of people with dementia in psychoeducation: A scoping review. DEMENTIA 2024; 23:272-291. [PMID: 38091474 DOI: 10.1177/14713012231220231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
Psychoeducation with an active participation component is effective in facilitating family caregivers of people living with dementia to learn about the disease and gain relevant caregiving skills. However, research into the best strategies to promote active participation has received little attention, and the factors hindering active participation are also unknown. Therefore, the nine-stage framework of the Joanna Briggs Institute methodology for scoping reviews was adopted to map and identify information about the active participation of family caregivers of people living with dementia in psychoeducation. The search criteria focused on identifying primary research studies and grey literature relevant to psychoeducation with active participation that had the family caregivers of community dwelling people living with dementia as the target population. Two reviewers independently screened and selected items from the literature. Content analysis was conducted to thematically synthesise strategies mentioned in 29 articles published from 2011 and 2021. Content analysis revealed six strategies that promoted active participation: (1) the involvement of interventionist and qualifications; (2) the teaching and learning methods used to conduct psychoeducation with active participation; (3) tailoring the contents and formats to the experiences, preferences, and resources of the caregivers; (4) collaborating with caregivers; (5) facilitating sharing and support between peers; and (6) providing experiential learning opportunities. Two factors hindering active caregiver participation were negative caregiver emotions and cultural taboos. This review offers ideas for evidence-based practices that can be used by health and social care providers when planning psychoeducation with active participation for the family caregivers of people living with dementia.
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Affiliation(s)
- Hoi Man Chan
- The Nethersole School of NursingThe Chinese University of Hong Kong, Hong Kong, China
| | - Ken Hok Man Ho
- The Nethersole School of NursingThe Chinese University of Hong Kong, Hong Kong, China
| | | | - Helen Yue Lai Chan
- The Nethersole School of NursingThe Chinese University of Hong Kong, Hong Kong, China
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Blomberg O, Svedin F, Farrand P, Brantnell A, von Essen L, Patriksson Karlsson J, Åberg AC, Woodford J. Adaptation of a guided low-intensity behavioral activation intervention for people with dementia in Sweden: a qualitative study exploring the needs and preferences of key stakeholders. BMC Geriatr 2024; 24:113. [PMID: 38291349 PMCID: PMC10826011 DOI: 10.1186/s12877-023-04606-6] [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: 09/01/2023] [Accepted: 12/15/2023] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Despite depression being prevalent in people with dementia, contributing to negative health outcomes and placing increased burden on individuals and family members, access to psychological interventions is limited. A potential solution is guided low-intensity behavioral activation, supported by informal caregivers and guided by healthcare professionals. However, it is necessary to adapt interventions to meet the needs and preferences of key stakeholders to enhance acceptability and relevance. Study objectives were to: (1) explore needs and preferences concerning the content and delivery model of the guided low-intensity behavioral activation intervention; and (2) adapt the intervention to ensure cultural appropriateness, relevancy, and acceptability to people with dementia and their caregivers in Sweden. METHODS Semi-structured interviews and focus group discussions were conducted with key stakeholders, including healthcare professionals (n = 18), community stakeholders (n = 7), people with dementia (n = 8), and informal caregivers (n = 19). A draft of the written low-intensity behavioral activation intervention and a description of the proposed intervention delivery model were provided to participants. Open-ended questions explored the perceived relevance of the intervention, alongside needs and preferences concerning content and delivery. A manifest content analysis approach was adopted. RESULTS Content analysis resulted in three categories: Content, Delivery procedures, and Illness trajectory. Results highlighted a need to consider the intervention Content via increased cultural adaptation to the Swedish context, and increasing the inclusiveness of intervention content. Delivery procedures were identified as needing to be flexible given the unpredictable nature of caring for people with dementia, with the provision of additional guidance to informal caregivers supporting the intervention. Illness trajectory was viewed as essential to consider, with the intervention regarded as suitable for those early in the dementia trajectory, alongside a need to reduce workbook text to minimize burden given dementia symptomology. CONCLUSIONS The intervention and proposed delivery model were generally well received by all stakeholders. We were able to identify key adaptations to enhance cultural appropriateness, relevancy, and acceptability for a currently neglected population. Results will inform a feasibility study to explore the feasibility and acceptability of the intervention and study procedures to inform the design of a future superiority randomized controlled trial. TRIAL REGISTRATION/PROTOCOL Not applicable.
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Affiliation(s)
- Oscar Blomberg
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Dag Hammarskjölds väg 14B, Uppsala, 751 85, Sweden
| | - Frida Svedin
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Dag Hammarskjölds väg 14B, Uppsala, 751 85, Sweden
| | - Paul Farrand
- Clinical Psychology, Education, Development and Research (CEDAR), Psychology, University of Exeter, Perry Road, EX4 4QG, Devon, UK
| | - Anders Brantnell
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Dag Hammarskjölds väg 14B, Uppsala, 751 85, Sweden
- Industrial Engineering and Management, Department of Civil and Industrial Engineering, Uppsala University, Uppsala, 751 21, Sweden
| | - Louise von Essen
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Dag Hammarskjölds väg 14B, Uppsala, 751 85, Sweden
| | - Johanna Patriksson Karlsson
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Dag Hammarskjölds väg 14B, Uppsala, 751 85, Sweden
| | - Anna Cristina Åberg
- Department of Medical Science, School of Health and Welfare, Dalarna University, Falun, 791 88, Sweden
- Clinical Geriatrics, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, 751 22, Sweden
| | - Joanne Woodford
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Dag Hammarskjölds väg 14B, Uppsala, 751 85, Sweden.
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Taylor JO, Child CE, Sharma RK, Asirot MG, Miller LM, Turner AM. Supportive care decision-making processes of persons with dementia and their caregivers. DEMENTIA 2023; 22:1695-1717. [PMID: 37656956 PMCID: PMC10688994 DOI: 10.1177/14713012231193139] [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] [Indexed: 09/03/2023]
Abstract
Little is known about the decision-making processes around seeking more supportive care for dementia. Persons with dementia are often left out of decision-making regarding seeking more supportive care as their dementia progresses. This paper provides a description of findings from the Decision-making in Alzheimer's Research project (DMAR) investigating the process of decision-making about transitions to more supportive care. We conducted 61 qualitative interviews with two stakeholder groups: 24 persons with dementia, and 37 informal caregivers to explore supportive care decisions and associated decision-making factors from the perspectives of persons with dementia and their caregivers. We identified four main decisions that persons with dementia and their informal caregivers played a role in: (1) sharing household responsibilities; (2) limiting routine daily activities; (3) bringing in formal support; and (4) moving to a care facility. Based on our findings we developed a schematized roadmap of decision-making that we used to guide the discussion of our findings. Four crosscutting themes emerged from our analysis: unknowns and uncertainties, maintaining life as you know it, there's no place like home and resource constraints. These results will be incorporated into the development of instruments whose goal is to identify preferences of persons with dementia and their caregivers, in order to include persons with dementia in care decisions even as their dementia progresses.
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Affiliation(s)
- Jean O Taylor
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, USA
| | - Claire E Child
- Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, WA, USA
| | - Rashmi K Sharma
- Division of General Internal Medicine, School of Medicine, University of Washington, Seattle, WA, USA
| | - Mary Grace Asirot
- Department of Neurology, School of Medicine, University of Washington, Seattle, WA, USA
| | | | - Anne M Turner
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, USA
- Department of Biomedical Informatics and Medical Education, School of Medicine, University of Washington, Seattle, WA, USA
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Zhang S, Gao Q, Pan L, Miao X, Yang M, Sun Y, Wang Z. Effectiveness of dyadic sensory art therapies for People with dementia and their caregivers:A systematic review and meta-analysis. Geriatr Nurs 2023; 54:118-128. [PMID: 37782974 DOI: 10.1016/j.gerinurse.2023.09.002] [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: 06/15/2023] [Revised: 08/31/2023] [Accepted: 09/01/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND The need for dyadic intervention is enhanced with increasing numbers of older adults with dementia. Studies have shown that sensory art therapies are essential for dementia patients and their caregivers. The effects of dyadic sensory art therapies for people with dementia and their caregivers require further exploration. OBJECTIVES This review aimed to assess the efficacy of dyadic sensory art therapies on neuropsychiatric symptoms and mental function for dementia patients, caregiver burden and psychological state for caregivers, dyad relationship quality for dyads, and evaluate the potential effects of dyadic sensory art therapies on quality of life for both dementia patients and caregivers. METHODS An electronic literature search of the PubMed, EMBASE, CINAHL, Web of Science, Cochrane Library, PsycINFO and three Chinese databases (CNKI, Wanfang and CBM) was conducted up to November 2022. Two reviewers (SZ and QG) worked independently to identify relevant studies. Risk of bias was assessed by the Cochrane's and Joanna Briggs Institute's tool. Meta-analyses were conducted using RevMan software 5.4. RESULTS This systematic review included 15 studies (7 RCTs and 8 quasi-experimental studies). The meta-analysis showed that dyadic sensory art therapies significantly ameliorated neuropsychiatric symptoms (SMD = -0.90, 95% CI -1.61 to -0.20, P = .01), caregiver burden (SMD = -0.75; 95% CI -1.03 to -0.47; P < .001). No significant improvements were found in caregiver depression and quality of life for both patients and caregivers. CONCLUSIONS Dyadic sensory art therapies are generally effective at ameliorating neuropsychiatric symptoms, and caregiver burden. Future studies are encouraged to design large-scale randomized controlled trials with high-quality study to examine and confirm the effectiveness of dyadic sensory art therapies for these dyads composed of dementia patients and their caregivers. TRIAL REGISTRATION PROSPERO CRD 42023393577; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023393577.
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Affiliation(s)
- Shuang Zhang
- Department of Neurology, Henan Provincial People's Hospital, Henan Provincial Key Medicine Laboratory of Nursing, Zhengzhou University People's Hospital, Zhengzhou, China; Henan Evidence-based Nursing Centre: A JBI Affiliated Group, The University of Adelaide, Zhengzhou, China
| | - Qiaoqiao Gao
- Henan Evidence-based Nursing Centre: A JBI Affiliated Group, The University of Adelaide, Zhengzhou, China; Department of Infectious Diseases, Henan Provincial People's Hospital, Henan Provincial Key Medicine Laboratory of Nursing, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Liniu Pan
- School of Nursing, Zhengzhou Health Vocational College, Zhengzhou, China
| | - Xiaohui Miao
- Department of Neurology, Henan Provincial People's Hospital, Henan Provincial Key Medicine Laboratory of Nursing, Zhengzhou University People's Hospital, Zhengzhou, China; Henan Evidence-based Nursing Centre: A JBI Affiliated Group, The University of Adelaide, Zhengzhou, China
| | - Mengli Yang
- Department of Neurology, Henan Provincial People's Hospital, Henan Provincial Key Medicine Laboratory of Nursing, Zhengzhou University People's Hospital, Zhengzhou, China; Henan Evidence-based Nursing Centre: A JBI Affiliated Group, The University of Adelaide, Zhengzhou, China
| | - Yue Sun
- School of Nursing, Peking University, Beijing, China; Peking University Health Science Centre for Evidence-Based Nursing, Beijing, China
| | - Zhiwen Wang
- School of Nursing, Peking University, Beijing, China; Peking University Health Science Centre for Evidence-Based Nursing, Beijing, China.
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Miranda A, Rubovits E, Mudar R, Leung V, Raj M. Where are caregivers in the clinical trial? Evaluation of caregiver responsibilities in Alzheimer's disease and related dementias clinical trials. Alzheimers Dement 2023; 19:5316-5322. [PMID: 37594028 DOI: 10.1002/alz.13418] [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: 04/26/2023] [Revised: 06/20/2023] [Accepted: 07/12/2023] [Indexed: 08/19/2023]
Abstract
INTRODUCTION Family caregivers of persons with Alzheimer's disease and related dementias (ADRD) have significant responsibilities within health care. They may identify relevant clinical trials and support decision-making about their relative's participation. The objectives of this study were to (a) evaluate the responsibilities of caregivers related to their relative's participation in ADRD clinical trials and (b) examine how these responsibilities are communicated on clinicaltrials.gov. METHODS We reviewed ADRD clinical trials completed between 1990 and 2021 using clinicaltrials.gov. RESULTS Less than half of clinical trial study information pages included caregiver responsibilities. Nine caregiver responsibilities were provided among those with information (e.g., giving consent, caregiver training and education, monitoring patient's response to intervention, communicating with study team). DISCUSSION ADRD clinical trial study information pages should consistently include caregiver responsibilities to help caregivers better prepare for trial responsibilities. This enhanced engagement with caregivers could also facilitate recruitment and retention, including participants from diverse communities. HIGHLIGHTS Alzheimer's disease and related dementias (ADRD) clinical trial study information does not consistently include caregiver responsibilities. Caregiver responsibilities in clinical trials span communication, monitoring, and transportation. Robust information provision to caregivers could support participant recruitment and retention. Meaningfully engaging caregivers could support recruitment of diverse participants.
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Affiliation(s)
- Armando Miranda
- College of Applied Health Sciences, University of Illinois Urbana Champaign, Champaign, Illinois, USA
| | - Eve Rubovits
- College of Applied Health Sciences, University of Illinois Urbana Champaign, Champaign, Illinois, USA
| | - Raksha Mudar
- College of Applied Health Sciences, University of Illinois Urbana Champaign, Champaign, Illinois, USA
| | - Vania Leung
- Division of Geriatrics, University of Illinois Chicago, Chicago, Illinois, USA
| | - Minakshi Raj
- College of Applied Health Sciences, University of Illinois Urbana Champaign, Champaign, Illinois, USA
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Roddy MK, El-Rifai M, LeStourgeon L, Aikens JE, Wolever RQ, Greevy RA, Mayberry LS. Prerandomization withdrawals from a Type 2 diabetes self-care support intervention trial are associated with lack of available support person coparticipant. Chronic Illn 2023:17423953231203734. [PMID: 37750180 PMCID: PMC10963338 DOI: 10.1177/17423953231203734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
OBJECTIVES Dyadic interventions, involving two persons with a preexisting close relationship, offer the opportunity to activate support persons (SPs) to improve health for adults with chronic conditions. Requiring SP coparticipation can challenge recruitment and bias samples; however, the associations between voluntary SP coparticipation and recruitment outcomes across patient characteristics are unknown. METHODS The Family/Friend Activation to Motivate Self-care 2.0 randomized controlled trial (RCT) enrolled adults with Type 2 diabetes (T2D) from an academic health system. Participants were asked-but not required-to invite an SP to coenroll. Using data from the electronic health record we sought to describe RCT enrollment in the setting of voluntary SP coparticipation. RESULTS In a diverse sample of adults with (T2D) (48% female, 44% minoritized race/ethnicity), most participants (91%) invited SPs and (89%) enrolled with SPs. However, prerandomization withdrawal was significantly higher among participants who did not have consenting SPs than those who did. Females were less likely to invite SPs than males and more Black PWD were prerandomization withdrawals than randomized. DISCUSSION Voluntary SP coenrollment may benefit recruitment for dyadic sampling; however, more research is needed to understand if these methods systematically bias sampling and to prevent these unintended biases.
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Affiliation(s)
- McKenzie K. Roddy
- VA Quality Scholars Program, VA Tennessee Valley Healthcare System, Nashville, TN, USA
- Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Merna El-Rifai
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lauren LeStourgeon
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - James E. Aikens
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Ruth Q. Wolever
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Robert A. Greevy
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lindsay S. Mayberry
- Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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Ho KHM, Yang C, Ng MSN, Tao A, Chan HYL. Loneliness at end-of-life: A scoping review. J Clin Nurs 2023; 32:6179-6195. [PMID: 37149735 DOI: 10.1111/jocn.16748] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 03/14/2023] [Accepted: 04/20/2023] [Indexed: 05/08/2023]
Abstract
AIMS AND OBJECTIVES To map and synthesise the literature on loneliness at end-of-life and identify key knowledge gaps in loneliness research. BACKGROUND Declined health conditions, reduced social engagement, loss of social roles, and fear of death may lead to loneliness at end-of-life. However, systematic information about loneliness at end-of-life is scant. METHODS This scoping review followed the methodology proposed by Arksey and O'Malley. Nine electronic databases were searched from January 2001 to July 2022. Studies about loneliness at end-of-life were included. Two review authors independently screened and selected relevant studies and performed the data charting. The PAGER framework was employed to collate, summarise and report the results. The PRISMA-ScR checklist was included. RESULTS A total of 23 studies were included in this review (12 qualitative, 10 quantitative, and one mixed-methods design). There was not reliable data about the prevalence of loneliness among adults at end-of-life internationally. Three or 20-item UCLA loneliness scale was frequently used to measure loneliness. Factors predisposed adults at end-of-life to loneliness included passive and active withdrawal from social networks, inability to share emotions and to be understood, and inadequate support on spirituality. Four strategies were identified to alleviate loneliness, yet none have been substantiated in clinical trials. Interventions facilitating spirituality, social interactions and connectedness seem effective in alleviating loneliness. CONCLUSIONS This is the first scoping review on loneliness at end-of-life, synthesising evidence from qualitative, quantitative, and mixed-methods studies. Loneliness among adults at end-of-life is under-investigated and there is a prominent need to address existential loneliness at end-of-life. RELEVANCE TO CLINICAL PRACTICE All nurses should proactively assess loneliness or perceived social isolation for clients with life-limiting conditions, regardless of social networks. Collaborative efforts (e.g., medical-social collaborations) to promote self-worthiness, social engagement and connectedness with significant others and social networks are needed. PATIENT OR PUBLIC CONTRIBUTION No patient or public involvement.
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Affiliation(s)
- Ken Hok Man Ho
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong
| | - Chen Yang
- School of Nursing, Sun Yat-Sen University, Guangzhou, China
| | - Marques Shek Nam Ng
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong
| | - An Tao
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong
| | - Helen Yue Lai Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong
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Yeung CCY, Ho KHM, Chan HYL. A dyadic advance care planning intervention for people with early-stage dementia and their family caregivers in a community care setting: a feasibility trial. BMC Geriatr 2023; 23:115. [PMID: 36859250 PMCID: PMC9979490 DOI: 10.1186/s12877-023-03815-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 02/09/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Advance care planning (ACP) is highly relevant for people with early-stage dementia to communicate their care preferences for serious illness conditions with their family caregivers before they become mentally incapacitated. METHODS A multi-centre, quasi-experimental study was conducted to test the feasibility and acceptability of a theory-guided, dyadic ACP intervention ('Have a Say' programme) among participants with early-stage dementia-family caregiver dyads. The feasibility of the trial design, intervention procedures, subject recruitment and retention, and study instruments were assessed. Study outcomes were measured at baseline (T0), immediately after the intervention (T1), and at 1 month (T2) and 3 months post-intervention (T3). Acceptability of the intervention was determined by the satisfaction score, completion rate and qualitative interviews as process evaluation with a purposive sample of participants and ACP facilitators. Generalised estimating equations were performed to examine differential changes between groups over time, with covariates adjusted. RESULTS Subject recruitment from five elderly community centres yielded a recruitment rate of 60% and resulted in 36 client-caregiver dyads. The intervention was acceptable to the dyads, with a mean satisfaction score of 4.4 out of 5 and completion rate of 94.4%. The attrition rates at T1, T2, and T3 were 8.3%, 13.9%, and 19.4%, respectively. The intervention group reported a significantly greater improvement in the readiness for ACP at T1, self-efficacy for ACP at T3, and dyadic concordance on end-of-life care preferences at all time points than the control group, but not on depressive symptoms. Family caregivers in the intervention group reported a significantly higher caregiving burden at T2 than the control group. The qualitative findings revealed that triadic involvement of and trusting relationships among the dyads and ACP facilitators, and documentation of clients' views are the programme strengths, while the structured format and discussion about medical issues posed implementation challenges. CONCLUSIONS This ACP intervention and trial design were feasible and acceptable to the dyads. Several refinements were identified, including adding a nurse-led group-based session for information giving, allowing flexibility in arrangement, and adding measure of ACP engagement of family caregivers. A rigorous trial to test the effects of the ACP intervention is warranted. TRIAL REGISTRATION Retrospectively registered on 14/08/2020 at clinicaltrials.gov (Identifier: NCT04513106).
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Affiliation(s)
- Cheryl Chi-Yan Yeung
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, 6-8/F, Esther Lee Building, Shatin, Hong Kong SAR, China
| | - Ken Hok-Man Ho
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, 6-8/F, Esther Lee Building, Shatin, Hong Kong SAR, China
| | - Helen Yue-Lai Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, 6-8/F, Esther Lee Building, Shatin, Hong Kong SAR, China.
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Ho KHM, Hung MSY, Zhang Y, Bai X, Cheung DSK, Chow MCM, Lee PH, Chien WT. The perceived relationship quality with migrant domestic workers is correlated with a lower level of loneliness among community-dwelling older adults: A cross-sectional study. Arch Gerontol Geriatr 2023; 109:104952. [PMID: 36753937 DOI: 10.1016/j.archger.2023.104952] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/29/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023]
Abstract
PURPOSE To explore older adults' perceived relationship quality with migrant domestic workers (MDWs) and examine the correlation between older adult/MDW (O-M) relationship quality and loneliness of community-dwelling older adults. MATERIALS AND METHODS In this cross-sectional study, older adults living with MDWs were conveniently recruited from neighbourhood elderly centers in Hong Kong. Loneliness and O-M relationship quality were assessed by the 6-item De Jong Gierveld Loneliness Scale and the mutuality scale, respectively. Older adults' demographic and functional characteristics, and MDW's nationality, spoken language and years of service in the dyad were also collected. Hierarchical multiple regression analyses were conducted to examine the contributions of 1) demographic variables and functional status, 2) MDW characteristics, 3) perceived social network and 4) perceived O-M relationship quality on loneliness. RESULTS The 178 participants [mean age 83.44 (SD 7.05 years); 155 (87.1%) women and 23 men (22.9%)] were socially lonely (1.07 ± 1.15) and close to being lonely overall (1.90 ± 1.68), and emotionally (0.84 ± 0.97). The mean O-M relationship quality was poor (1.42 ± 0.79), which was significantly correlated with overall (β= -0.33, 95% CI: -0.65 to -0.01, P value = 0.045), and social (β= -0.24, 95% CI: -0.46 to -0.01, P value = 0.04) loneliness, but not significantly correlated to emotional loneliness. CONCLUSION Better perceived O-M relationship quality is correlated with a lower level of loneliness among older adults. Strategies to improve O-M relationship quality may alleviate loneliness among older adults.
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Affiliation(s)
- Ken H M Ho
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.
| | - Maria S Y Hung
- School of Health Sciences, Caritas Institute of Higher Education, Tseung Kwan O, New Territories, Hong Kong
| | - Youjuan Zhang
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Xue Bai
- Department of Applied Social Sciences, Faculty of Health and Social Sciences, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Daphne S K Cheung
- School of Nursing, Faculty of Health and Social Sciences, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Meyrick C M Chow
- School of Health Sciences, Caritas Institute of Higher Education, Tseung Kwan O, New Territories, Hong Kong
| | - Paul H Lee
- Southampton Clinical Trials Unit, University of Southampton, United Kingdoms
| | - Wai Tong Chien
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
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12
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Song D, Liu Y, Lai CKY, Li Y. Effects of dyadic-based physical activity intervention on cancer-related fatigue among cancer survivors: A scoping review. Front Psychol 2023; 14:1102019. [PMID: 36777230 PMCID: PMC9909825 DOI: 10.3389/fpsyg.2023.1102019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 01/05/2023] [Indexed: 01/27/2023] Open
Abstract
Objective Cancer-related fatigue is one of the most common adverse reactions to cancer survivors, which has a significant impact on the daily life. As a traumatic event, cancer not only brings great physical and mental harm to patients, but also poses a threat to the physical and psychological health of caregivers. Current studies have shown that physical activity improves cancer-related fatigue in cancer survivors. And studies have suggested that dyadic interventions are more effective in improving patient outcomes and may also provide some benefits to caregivers. But the literature on the effects of dyadic-based physical activity on improving cancer-related fatigue has not been synthesized. This scoping review described the scope and impact of studies on cancer-related fatigue with dyadic-based physical activity interventions. Methods Six databases which is PubMed, Cochrane Library, Web of Science, Embase, CINAHL and Medline were searched for all studies of dyadic-based physical activity interventions with outcome measures including cancer-related fatigue published since the inception of the databases through May 2022. The search strategy was developed based on PICO principles. Results This article includes 6 pre and post-test designs and 2 randomized controlled trial design. The majority of participants were survivors with breast and lung cancer. The overall results showed that the effectiveness of dyadic-based physical activity interventions in improving cancer-related fatigue was unsatisfactory. Conclusions This scoping review suggests that current dyadic-based physical activity interventions are not well-researched among cancer survivors. In the future, more high-quality studies with more sophisticated and rigorous interventions are needed.
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Affiliation(s)
- Dongyu Song
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Yuzhou Liu
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Claudia K. Y. Lai
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China,School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Yuli Li
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China,*Correspondence: Yuli Li ✉
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13
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Ho KHM, Wilson IM, Wong JY, McKenna L, Reisenhofer S, Efendi F, Smith GD. Overlooked by nurses: A scoping review on health stressors, problems and coping of migrant domestic workers. Nurs Open 2022; 10:1166-1179. [PMID: 36181249 PMCID: PMC9912437 DOI: 10.1002/nop2.1391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 08/16/2022] [Accepted: 09/14/2022] [Indexed: 11/06/2022] Open
Abstract
AIM The first scoping review is to map and synthesize the stressors, problems and coping strategies surrounding the health issues of migrant domestic workers. DESIGN Scoping review using Arksey and O'Malley's five-stage framework. METHODS Ten electronic databases were systematically searched by keywords for literature published between January 1995 and December 2019. Data were extracted into tables and collated and summarized into themes for presentation. RESULTS Twenty-seven reports were included in the final review. Analysis revealed that stressors to health included abuse, poor health service accessibility, ongoing financial hardship despite demanding working conditions and social isolation. Physical and mental health problems were identified for which migrant domestic workers largely depended on social networks and religion to cope with stressors and health problems. Training para-professional peer leaders of migrant domestic workers by community nurses and including them in interprofessional teams is a possible way for nurses to promote their health and well-being.
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Affiliation(s)
- Ken Hok Man Ho
- Nethersole School of Nursing, Faculty of MedicineThe Chinese University of Hong KongHong KongHong Kong SAR
| | - Ingrid M. Wilson
- Health and Social Services ClusterSingapore Institute of TechnologySingaporeSingapore
| | - Janet Yuen‐Ha Wong
- School of Nursing & Health StudiesHong Kong Metropolitan UniversityHong KongHong Kong SAR
| | - Lisa McKenna
- School of Nursing and MidwiferyLa Trobe UniversityMelbourneVictoriaAustralia
| | - Sonia Reisenhofer
- Community Wellbeing & PartnershipsBairnsdale Regional Health ServiceBairnsdaleVictoriaAustralia
| | - Ferry Efendi
- Faculty of NursingUniversitas AirlanggaSurabayaIndonesia
| | - Graeme D. Smith
- School of Health SciencesCaritas Institute of Higher EducationHong KongHong Kong SAR
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14
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Cheung DSK, Wang SS, Li Y, Ho KHM, Kwok RKH, Mo SH, Bressington D. Sensory-based interventions for the immediate de-escalation of agitation in people with dementia: A systematic review. Aging Ment Health 2022:1-12. [PMID: 36073320 DOI: 10.1080/13607863.2022.2116404] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Objectives: Sensory-based interventions are commonly used to reduce the occurrence of agitation in people with dementia over extended periods. However, the evidence regarding their immediate de-escalation effects is unclear. The objectives of this systematic review are to (a) identify which sensory-based interventions have been used for de-escalating agitation and (b) examine the immediate effects of these interventions on de-escalating agitation in people with dementia.Methods: A systematic review was performed in accordance with PRISMA guidelines. Data sources were identified by searching Embase, Medline, PsycINFO, and CINAHL for publications up to 2 March 2022. The de-escalating agitation effect had to be measured during the intervention or within 15 min after commencing the treatment. Only randomized controlled trials or quasi-experimental studies published in English were included.Results: Nine studies met the inclusion criteria: two randomized controlled trials, one cross-over study, and six quasi-experimental studies. All were conducted in Western countries, involving a total of 246 participants. Music-related interventions were investigated in seven studies, and a positive effect on de-escalating agitation was found, with no side-effects. All of the studies had methodological limitations, including a single group design, blinding, an insufficient sample size, and imprecisely reported results.Conclusion: There is a profound dearth of rigorous studies examining the immediate agitation de-escalating effects of sensory-based interventions on people with dementia. However, the limited evidence on music-related interventions is encouraging. More rigorous research is recommended to confirm the effects.
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Affiliation(s)
| | - Shan Shan Wang
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Yan Li
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Ken Hok Man Ho
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Ma Liu Shui, Hong Kong
| | - Robin Ka Ho Kwok
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Siu Hong Mo
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Daniel Bressington
- College of Nursing and Midwifery, Charles Darwin University, Casuarina, Northern Territory, Australia
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15
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Cheung DSK, Ho LYW, Chan LCK, Kwok RKH, Lai CKY. A Home-Based Dyadic Music-with-Movement Intervention for People with Dementia and Caregivers: A Hybrid Type 2 Cluster-Randomized Effectiveness-Implementation Design. Clin Interv Aging 2022; 17:1199-1216. [PMID: 35978943 PMCID: PMC9377350 DOI: 10.2147/cia.s370661] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 07/28/2022] [Indexed: 11/23/2022] Open
Abstract
Background Integrating evidence-based music-with-movement into routine practices for people with dementia requires effective implementation strategies. The objectives of this study were to evaluate the clinical efficacy of the intervention and to examine the effectiveness of the implementation strategies in promoting home-based adoption. Methods This was a cluster randomized controlled trial adopting a clinical effectiveness-implementation hybrid design. The 12-week music-with-movement intervention aims to promote the well-being of people with dementia and their caregivers. Clinical outcomes were assessed to evaluate the efficacy of the intervention. These included the symptoms of anxiety and depression of people with dementia; caregivers' perception of their stress and the positive aspects of caregiving; and the quality of the dyadic relationship. Caregivers, staff, and volunteers were interviewed and objective figures on reach and adoption were collected to reflect the outcomes of the implementation. Results Compared to the waitlist control, there was a significant reduction in the anxiety and the symptoms of depression of those in the intervention group. There was also a significant reduction in the perceived stress level of the caregivers. Six focus group interviews were conducted. The intervention and the appropriateness of the implementation strategies were perceived positively by the dyad participants, the staff of the centres, and volunteers. Of the collaborating centres, 57% continued to use the intervention and, after six months, served six times more people than were recruited in this study. Over half of the participating families continued to use the intervention for at least six more months. Conclusion Music-with-movement interventions showed promise for improving the well-being of people with dementia and their caregivers. Effective strategies facilitated the implementation process, such as integrating communication technology to provide instant support and involving volunteers in engaging the collaborating centres and families. This study sheds light on perceptions of the intervention, and on its scalability for a broader population. Trial Registration NCT03575026, Registered 2 July 2018.
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Affiliation(s)
- Daphne Sze Ki Cheung
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong Special Administrative Region, People’s Republic of China,Correspondence: Daphne Sze Ki Cheung, School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong Special Administrative Region, People’s Republic of China, Tel +852 2766 4534, Email ;
| | - Lily Yuen Wah Ho
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong Special Administrative Region, People’s Republic of China
| | - Liliane Chui King Chan
- Ho Cheung Shuk Yuen Charitable Foundation, Hong Kong Special Administrative Region, People’s Republic of China
| | - Robin Ka Ho Kwok
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong Special Administrative Region, People’s Republic of China
| | - Claudia Kam Yuk Lai
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong Special Administrative Region, People’s Republic of China
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Yin Y, Wei Z. Effect of Nursing Intervention on Coronary CT Angiography in Elderly Patients. SCANNING 2022; 2022:3663285. [PMID: 35822159 PMCID: PMC9225874 DOI: 10.1155/2022/3663285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 05/20/2022] [Accepted: 05/27/2022] [Indexed: 06/15/2023]
Abstract
To investigate the clinical benefits of coronary CT angiography in older adults. The results of this trial were 110 patients who underwent CT angiography (selected from 20 March 2016 to 20 March 2017). Use computer group mode. The control group received health care, including 50 patients, and the control group received usual care, including 60 patients. Then, the best and best image quality, time-consuming analysis, and satisfaction were compared between the two groups. The experimental results showed that the best and best image quality (83.00%), examination time (5.72 ± 1.81) minutes, and patient satisfaction (100.00%) of the experimental group were better than those of the control group (P < 0.05). Targeted healthcare for patients undergoing coronary CT angiography can improve the patient's ability to receive a diagnosis with a consistent attitude, reduce work hours, reduce adverse factors, and improve patient satisfaction with care.
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Affiliation(s)
- Yajuan Yin
- School of Nursing Science, Guangxi University of Science and Technology, Liuzhou, Guangxi 545006, China
- Guangxi University of Science and Technology Second Hospital, Liuzhou, Guangxi 545006, China
| | - Zhongting Wei
- School of Nursing Science, Guangxi University of Science and Technology, Liuzhou, Guangxi 545006, China
- Guangxi University of Science and Technology Second Hospital, Liuzhou, Guangxi 545006, China
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He J, Wang J, Zhong H, Guan C. The Effectiveness of Multi-Component Interventions on the Positive and Negative Aspects of Well-Being among Informal Caregivers of People with Dementia: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19126973. [PMID: 35742220 PMCID: PMC9222573 DOI: 10.3390/ijerph19126973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/02/2022] [Accepted: 06/04/2022] [Indexed: 11/16/2022]
Abstract
The present review aims to examine whether multi-component interventions for informal caregivers of people with dementia are effective on positive and negative aspects of caregiver well-being. Eleven databases were searched from inception to 8 March 2021. Only randomized controlled trials reporting the effectiveness of multi-component intervention on positive and negative aspects of caregiver well-being were eligible. Endnote X7 (Thomson ResearchSoft, Stanford, CA, USA) was used for study selection and version 5.1.0 of Cochrane Collaboration’s tool (Cochrane, London, UK) was applied for quality assessment. Review Manager (Revman) Version 5.3 (Cochrane, London, UK) was used for the meta-analysis, and if statistical synthesis was inappropriate, only narrative analysis was performed. A total of 31 RCTs with 3939 participants were included. Meta-analyses showed small to moderate effects on subjective well-being, depression, and burden of caregivers, and a moderate to high effect on caregiver anxiety. Due to insufficient data and vast heterogeneity, meta-analysis was not performed for other outcomes, such as resilience, competence, and empathy. This review suggests that individualized multi-component interventions for caregivers may be one of the ways to promote their well-being. Further research is needed to explore the impact of rigorously designed and personalized multi-component interventions on informal caregivers, especially on more positive indicators, as well as its long-term effects and sustainability.
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Affiliation(s)
- Jinjie He
- Faculty of Nursing, Health Science Center, Xi’an Jiaotong University, #76 Yanta West Road, Xi’an 710061, China; (J.H.); (C.G.)
| | - Jing Wang
- Faculty of Nursing, Health Science Center, Xi’an Jiaotong University, #76 Yanta West Road, Xi’an 710061, China; (J.H.); (C.G.)
- Correspondence: ; Tel.: +86-29-8265-7015
| | - Hongmei Zhong
- Department of Nursing, School of Medicine, Shihezi University, Shihezi 832002, China;
| | - Chengguo Guan
- Faculty of Nursing, Health Science Center, Xi’an Jiaotong University, #76 Yanta West Road, Xi’an 710061, China; (J.H.); (C.G.)
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Ho KY, Cheung PM, Cheng TW, Suen WY, Ho HY, Cheung DSK. Virtual Reality Intervention for Managing Apathy in People With Cognitive Impairment: Systematic Review. JMIR Aging 2022; 5:e35224. [PMID: 35544317 PMCID: PMC9133981 DOI: 10.2196/35224] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 04/08/2022] [Accepted: 04/13/2022] [Indexed: 11/25/2022] Open
Abstract
Background Apathy is common in people with cognitive impairment. It leads to different consequences, such as more severe cognitive deficits, rapid functional decline, and decreased quality of life. Virtual reality (VR) interventions are increasingly being used to manage apathy in individuals with cognitive impairment. However, reports of VR interventions are scattered across studies, which has hindered the development and use of the interventions. Objective This study aimed to systematically review existing evidence on the use of VR interventions for managing apathy in people with cognitive impairment with regard to the effectiveness, contents, and implementation of the interventions. Methods The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. The PubMed, Embase, CINAHL, and PsycINFO databases were systematically searched for experimental studies published up to March 13, 2022, that reported the effects of VR interventions on apathy in older adults with cognitive impairment. Hand searching and citation chasing were conducted. The results of the included studies were synthesized by using a narrative synthesis. Their quality was appraised by using the Effective Public Health Practice Project quality assessment tool. However, because the VR interventions varied in duration, content, and implementation across studies, a meta-analysis was not conducted. Results A total of 22 studies were identified from the databases, of which 6 (27%) met the inclusion criteria. Of these 6 studies, 2 (33%) were randomized controlled trials, 1 (17%) was a controlled clinical trial, and 3 (50%) were quasi-experimental studies. Individual studies showed significant improvement in apathy and yielded within-group medium to large effect sizes. The level of immersion ranged from low to high. Minor adverse effects were reported. The VR content mostly included natural scenes, followed by city views and game-based activities. A background soundtrack was often used with natural scenes. Most (5/6, 83%) of the studies were conducted in a residential care setting and were implemented by health care professionals or researchers. Safety precautions were taken in most (5/6, 83%) of the studies. Conclusions Although preliminary evidence shows that VR interventions may be effective and feasible for alleviating apathy in people with cognitive impairment, the methodological limitations in the included studies make it difficult to reach a firm conclusion on these points. The implementation of the interventions was highlighted and discussed. More rigorous studies are encouraged. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42021268289; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021268289
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Affiliation(s)
- Ka Ying Ho
- School of Nursing, The Hong Kong Polytechinc University, Hong Kong, Hong Kong
| | - Po Mang Cheung
- School of Nursing, The Hong Kong Polytechinc University, Hong Kong, Hong Kong
| | - Tap Wing Cheng
- School of Nursing, The Hong Kong Polytechinc University, Hong Kong, Hong Kong
| | - Wing Yin Suen
- School of Nursing, The Hong Kong Polytechinc University, Hong Kong, Hong Kong
| | - Hiu Ying Ho
- School of Nursing, The Hong Kong Polytechinc University, Hong Kong, Hong Kong
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