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Haverfield MC, De Leon G, Johnson A, Jackson VL, Basu G, Dodge J. Transforming the discharge conversation through support and structure: A scoping review. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2024; 6:100203. [PMID: 39022593 PMCID: PMC467064 DOI: 10.1016/j.ijnsa.2024.100203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 04/19/2024] [Accepted: 04/28/2024] [Indexed: 07/20/2024] Open
Abstract
Background System level demands and interpersonal barriers can disrupt nurse delivery of high-quality information at discharge, which can contribute to a lack of caregiver preparedness to manage care of the patient and ultimately affect patient health. Objective To synthesize evidence on effective nurse communication with informal caregivers during hospital discharge of adult patients with cognitive decline or Alzheimer's disease and related dementia. Design A scoping review of inpatient nurse communication with informal caregivers. Methods Collected research (published between 2011 and 2023) from three databases (MEDLINE, PsycINFO, and CINAHL), along with a separate search for gray literature (N = 18), to extract and synthesize recommended communication practices evidenced to improve the nurse care experience and support caregiver activation and preparedness. Results Extraction synthesis of strategies resulted in two themes with corresponding sub-themes: Support (Information exchange, Space and time to determine preparedness, and Positive reinforcement of caregiver efforts) and Structure (Setting shared expectations, Informational resources, and Standardization). Conclusions We offer practical recommendations for both interpersonal and policy level facilitation of nurse delivery of high-quality information at discharge to caregivers of patients with serious illness.
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Affiliation(s)
- Marie C. Haverfield
- Department of Communication Studies, San José State University, CA, United States
| | - Gisselle De Leon
- Department of Communication Studies, San José State University, CA, United States
| | - Angelica Johnson
- Department of Communication Studies, San José State University, CA, United States
| | - Victoria L. Jackson
- Betty Irene Moore School of Nursing, University of California, Davis, CA, United States
| | - Geetali Basu
- Dr. Martin Luther King Junior Library, San José State University, CA, United States
| | - Jane Dodge
- Dr. Martin Luther King Junior Library, San José State University, CA, United States
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Davis ER, Aggar C, Bissett M. Nonpharmacological tactile activity interventions for reducing behavioural and psychological symptoms of dementia in the acute hospital setting: An integrative review. J Clin Nurs 2023; 32:7970-7978. [PMID: 37795921 DOI: 10.1111/jocn.16891] [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: 03/10/2023] [Revised: 08/13/2023] [Accepted: 09/13/2023] [Indexed: 10/06/2023]
Abstract
AIM To review existing research on nonpharmacological tactile activity interventions for reducing behavioural and psychological symptoms of dementia in the acute hospital setting. BACKGROUND When people living with dementia are admitted to hospital, they often experience an exacerbation of behavioural and psychological symptoms of dementia. Pharmacological interventions are often used to manage behavioural and psychological symptoms of dementia despite the low success rate and the heightened risk of morbidity and mortality. Low-cost alternatives that are implementable at the bedside are nonpharmacological interventions such as tactile activity interventions. DESIGN An integrative review of the literature. METHODS Four databases were searched using the PRISMA framework to guide the search and screening. Eligible studies were identified and the quality of each was evaluated using the Mixed Method Appraisal Tool. Thematic analysis was conducted to identify and analyse key themes across all articles. The PRISMA checklist was used to evaluate the current study. RESULTS Seven studies examined the use of tactile activity interventions to reduce the behavioural and psychological symptoms of dementia and the barriers and facilitators to implementation. CONCLUSION There is limited evidence exploring tactile activity interventions for reducing behavioural and psychological symptoms of dementia in acute hospital settings. Individualised approaches in combination with staffing expertise appear central to implementation. RELEVANCE TO CLINICAL PRACTICE Acute hospital settings can result in increased behavioural and psychological symptoms of dementia which can be distressing for patients and family and challenging for nursing staff. Tactile activity interventions may offer a low resource bedside option to support people with dementia in acute health settings. PATIENT OR PUBLIC CONTRIBUTION No direct patient or public contribution to the review.
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Affiliation(s)
- Erin Rachel Davis
- Southern Cross University, Southern Cross Drive, Bilinga, Queensland, Australia
- Northern NSW Local Health District, Lismore, New South Wales, Australia
| | - Christina Aggar
- Southern Cross University, Southern Cross Drive, Bilinga, Queensland, Australia
- Northern NSW Local Health District, Lismore, New South Wales, Australia
| | - Michelle Bissett
- Southern Cross University, Southern Cross Drive, Bilinga, Queensland, Australia
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Abstract
BACKGROUND AND OBJECTIVES People living with dementia have historically been excluded from qualitative research and their voices ignored due to the perception that a person with dementia is not able to express their opinions, preferences and feelings. Research institutions and organizations have contributed by adopting a paternalistic posture of overprotection. Furthermore, traditional research methods have proven to be exclusionary towards this group. The objective of this paper is to address the issue of inclusion of people with dementia in research and provide an evidence-based framework for dementia researchers based on the five principles of human rights: Participation, Accountability, Non-discrimination and equality, Empowerment and Legality (PANEL). DESIGN This paper adapts the PANEL principles to the research context, and uses evidence from the literature to create a framework for qualitative research in people with dementia. This new framework aims to guide dementia researchers in designing studies around the needs of people with dementia, to improve involvement and participation, facilitate research development and maximize research outcomes. RESULTS A checklist is presented with questions related to the five PANEL principles. These questions cover ethical, methodological and legal issues that researchers may need to consider while developing qualitative research for people with dementia. CONCLUSIONS The proposed checklist offers a series of questions and considerations to facilitate the development of qualitative research in patients with dementia. It is inspired by current human rights work of recognized dementia researchers and organizations who have been directly involved in policy development. Future studies need to explore its utility in improving participation, facilitating ethics approvals and ensuring that outcomes are relevant to people with dementia.
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García-Sanjuán S, Esteve-Ríos A, Fernández-Alcántara M, Valero-Soriano M. Experience of Operating Room Health Care Providers in the Management of Patients With Dementia. Res Gerontol Nurs 2023; 16:125-133. [PMID: 36881009 DOI: 10.3928/19404921-20230301-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
The management of hospitalized patients with dementia is more complicated compared to patients without dementia, specifically in the surgery ward. The aim of the current study was to explore the experiences of operating room health care providers in the management of patients with dementia. A descriptive qualitative study was designed. Twenty semi-structured interviews were conducted with surgical professionals. Content analysis was performed. Four main themes emerged: Communication Issues, Experience-Based Protocol, Emotions, and Perceived Needs. Health care providers in a surgical ward face numerous challenges when attending to patients with dementia and tend to use strategies based on their own experience due to lack of specific action protocols. Therefore, specific training of the surgical team and protocols are needed to ensure quality care. [Research in Gerontological Nursing, xx(x), xx-xx.].
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Anantapong K, Sampson EL, Davies N. A shared decision-making model about care for people with severe dementia: A qualitative study based on nutrition and hydration decisions in acute hospitals. Int J Geriatr Psychiatry 2023; 38:e5884. [PMID: 36750227 PMCID: PMC10108087 DOI: 10.1002/gps.5884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 01/24/2023] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To understand the decision-making processes regarding eating and drinking for hospital patients with severe dementia and use this data to modify a decision-making model about care for people with severe dementia. METHODS From January to May 2021, qualitative semi-structured interviews were conducted with 29 family carers and hospital staff in England who cared for people with severe dementia during hospital admissions. Interviews were transcribed verbatim and analysed using codebook thematic analysis. RESULTS We demonstrated a modified decision-making model consisting of six stages of the decision-making process: (i) identify a decision to be made; (ii) exchange information and recognise emotions; (iii) clarify values and preferences of all involved; (iv) consider feasibility of each choice; (v) share preferred choice and make a final decision; and (vi) deliver the decision, monitor outcomes and renegotiation. From this study, decision-making needed to be shared among all people involved and address holistic needs and personal values of people with dementia and family carers. However, hospital staff often made assumptions about the persons' ability to eat and drink without adequate consultation with family carers. The process was impacted by ward culture, professional practice, and legal framework, which might overlook cultural and personal beliefs of the persons and families. Treatment escalation plans could help inform stepwise treatments, create realistic expectations, and guide future decisions. CONCLUSIONS Our decision-making model provides clear stages of decision-making processes and can be used to guide clinical practice and policy around care decisions for eating and drinking, which is often poorly supported.
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Affiliation(s)
- Kanthee Anantapong
- Marie Curie Palliative Care Research DepartmentUCL Division of PsychiatryUniversity College LondonLondonUK
- Department of PsychiatryFaculty of MedicinePrince of Songkla UniversityHat YaiThailand
| | - Elizabeth L. Sampson
- Marie Curie Palliative Care Research DepartmentUCL Division of PsychiatryUniversity College LondonLondonUK
- Department of Psychological MedicineRoyal London HospitalEast London NHS Foundation TrustLondonUK
| | - Nathan Davies
- Marie Curie Palliative Care Research DepartmentUCL Division of PsychiatryUniversity College LondonLondonUK
- Centre for Ageing Population StudiesResearch Department of Primary Care and Population HealthUniversity College LondonLondonUK
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Waters CJ. Supporting person-centred dementia care following the COVID-19 pandemic. Nurs Stand 2023; 38:37-41. [PMID: 36317537 DOI: 10.7748/ns.2022.e11876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2022] [Indexed: 11/07/2022]
Abstract
In recent years, nurses have experienced increased workplace pressures in part due to the coronavirus disease 2019 (COVID-19) pandemic, which exacerbated challenges in the delivery of person-centred dementia care. This article examines how people with dementia were affected by the COVID-19 pandemic, as well as exploring the ongoing effects on nurses and the care they provide for people with dementia. The author discusses the importance of dementia awareness and education for nurses that supports them to promote the needs of people with the condition. The article also outlines how nurse leaders can promote person-centred care for people with dementia through reflection and clinical supervision.
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Anantapong K, Davies N, Sampson EL. Communication between the multidisciplinary team and families regarding nutrition and hydration for people with severe dementia in acute hospitals: a qualitative study. Age Ageing 2022; 51:6834151. [PMID: 36434801 PMCID: PMC9701106 DOI: 10.1093/ageing/afac230] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND When a person with severe dementia is in hospital and has eating and drinking difficulties, communication between the multidisciplinary team and families can be challenging and lead to suboptimal care. OBJECTIVE To gain in-depth understanding about the experiences, views and needs of family carers and hospital staff, regarding communication and conversations about nutrition and hydration, for hospital patients with severe dementia. DESIGN Qualitative semi-structured interview study. SETTING Acute hospital in England. METHODS From January to May 2021, semi-structured interviews were conducted with 29 family carers and hospital staff. Interviews were transcribed verbatim and analysed using reflexive thematic methods. RESULTS Four overarching themes were developed: (i) prerequisites to initiating communication about eating and drinking; (ii) communication aiming to develop agreed care plans; (iii) difficulty discussing palliative and end-of-life care; and (iv) needs of information and plans about future eating and drinking difficulties. Families tended to wait for hospital staff to initiate discussions but usually experienced frustration with delays and repeated conversations with different staff. Some staff felt unprepared to manage these conversations and found it challenging to work across the multidisciplinary team. During discharge processes, key information and care plans about eating and drinking were not regularly passed on to people involved to avoid unnecessary readmissions. CONCLUSIONS In acute hospitals, family carers and hospital staff can have disjointed communications and conversations about nutrition and hydration for persons with severe dementia. Timely reassurance, ongoing discussions and clear information sharing will support communication between those involved.
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Affiliation(s)
| | - Nathan Davies
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK,Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Elizabeth L Sampson
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK,Department of Psychological Medicine, Royal London Hospital, East London NHS Foundation Trust, London, UK
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Abbott RA, Rogers M, Lourida I, Green C, Ball S, Hemsley A, Cheeseman D, Clare L, Moore D, Hussey C, Coxon G, Llewellyn DJ, Naldrett T, Thompson Coon J. New horizons for caring for people with dementia in hospital: the DEMENTIA CARE pointers for service change. Age Ageing 2022; 51:6691373. [PMID: 36057987 PMCID: PMC9441201 DOI: 10.1093/ageing/afac190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Indexed: 01/27/2023] Open
Abstract
Approximately two-thirds of hospital admissions are older adults and almost half of these are likely to have some form of dementia. People with dementia are not only at an increased risk of adverse outcomes once admitted, but the unfamiliar environment and routinised practices of the wards and acute care can be particularly challenging for them, heightening their confusion, agitation and distress further impacting the ability to optimise their care. It is well established that a person-centred care approach helps alleviate some of the unfamiliar stress but how to embed this in the acute-care setting remains a challenge. In this article, we highlight the challenges that have been recognised in this area and put forward a set of evidence-based 'pointers for service change' to help organisations in the delivery of person-centred care. The DEMENTIA CARE pointers cover areas of: dementia awareness and understanding, education and training, modelling of person-centred care by clinical leaders, adapting the environment, teamwork (not being alone), taking the time to 'get to know', information sharing, access to necessary resources, communication, involving family (ask family), raising the profile of dementia care, and engaging volunteers. The pointers extend previous guidance, by recognising the importance of ward cultures that prioritise dementia care and institutional support that actively seeks to raise the profile of dementia care. The pointers provide a range of simple to more complex actions or areas for hospitals to help implement person-centred care approaches; however, embedding them within the organisational cultures of hospitals is the next challenge.
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Affiliation(s)
- Rebecca A Abbott
- Address correspondence to: Dr Rebecca Abbott, Evidence Synthesis Team, NIHR ARC South West Peninsula (PenARC), University of Exeter Medical School, College of Medicine and Health, St Luke’s Campus, University of Exeter, Exeter EX1 2LU, UK.
| | - Morwenna Rogers
- Evidence Synthesis Team, NIHR ARC South West Peninsula (PenARC), University of Exeter Medical School, College of Medicine and Health, St Luke’s Campus, University of Exeter, Exeter EX1 2LU, UK
| | - Ilianna Lourida
- Evidence Synthesis Team, NIHR ARC South West Peninsula (PenARC), University of Exeter Medical School, College of Medicine and Health, St Luke’s Campus, University of Exeter, Exeter EX1 2LU, UK,Mental Health Research Group, University of Exeter Medical School, St Luke’s Campus, University of Exeter, Exeter EX1 2LU, UK
| | - Colin Green
- Health Economics Group, University of Exeter Medical School, St Luke’s Campus, University of Exeter, Exeter EX1 2LU, UK
| | - Susan Ball
- Health Statistics Group, PenARC, University of Exeter Medical School, College of Medicine and Health, St Luke’s Campus, University of Exeter, Exeter EX1 2LU, UK
| | - Anthony Hemsley
- Royal Devon and Exeter NHS Foundation Trust, Exeter EX2 5DW, UK
| | | | - Linda Clare
- Centre for Research in Aging and Cognitive Health, PenARC, University of Exeter Medical School, St Luke’s Campus, University of Exeter, Exeter EX1 2LU, UK
| | - Darren Moore
- Graduate School of Education, College of Social Sciences and International Studies, St Luke’s Campus, University of Exeter, Exeter EX1 2LU, UK
| | | | - George Coxon
- Pottles Court Care Home, Days-Pottles Lane, Exminster, Summercourt Care Home, Teignmouth, Exeter EX6 8DG, UK
| | - David J Llewellyn
- Mental Health Research Group, University of Exeter Medical School, St Luke’s Campus, University of Exeter, Exeter EX1 2LU, UK,The Alan Turing Institute, London, UK
| | | | - Jo Thompson Coon
- Evidence Synthesis Team, NIHR ARC South West Peninsula (PenARC), University of Exeter Medical School, College of Medicine and Health, St Luke’s Campus, University of Exeter, Exeter EX1 2LU, UK
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Supporting families of patients with dementia at end-of-life in hospital. Collegian 2022. [DOI: 10.1016/j.colegn.2021.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Feasibility of a two-part person-centred care initiative for people living with dementia in acute hospitals: A mixed methods study. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2021. [DOI: 10.1016/j.ijnsa.2021.100040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Virdun C, Luckett T, Davidson PM, Lorenz K, Phillips J. Generating key practice points that enable optimal palliative care in acute hospitals: Results from the OPAL project's mid-point meta-inference. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2021. [DOI: 10.1016/j.ijnsa.2021.100035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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Greskötter JM. [Relatives of patients with dementia as a link and mediator in acute care hospitals]. Z Gerontol Geriatr 2021; 54:651-658. [PMID: 33877443 PMCID: PMC8551104 DOI: 10.1007/s00391-021-01892-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 03/22/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND The needs of patients with dementia can hardly be met in an organization- and process-oriented acute care hospital. In order to create a successful interaction between patients and hospital staff, the importance of relatives as a link and mediator is considered. OBJECTIVE From publications on similar topics, it is deduced which conditions relatives need in order to be able to act as a link and mediator. MATERIAL AND METHODS A systematic search was conducted in the databases of Medline (PubMed), Cochrane, CINAHL, and GeroLit. RESULTS From the available literature, the reasons for the accompaniment by relatives can be outlined, their activities in the acute care hospital can be described and hindering and supporting factors can be presented. CONCLUSION Relatives already act as a link and mediator between patients with dementia and hospital staff. In doing so they act as advocates for the patient and are available to the professionals as experts and advisors. To accomplish this task, there are conditions that support or hinder the mediation activity.
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Affiliation(s)
- Jasmin M Greskötter
- Department für Pflegewissenschaft, Universität Witten/Herdecke, Witten, Deutschland.
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Jimoh OF, Ryan H, Killett A, Shiggins C, Langdon PE, Heywood R, Bunning K. A systematic review and narrative synthesis of the research provisions under the Mental Capacity Act (2005) in England and Wales: Recruitment of adults with capacity and communication difficulties. PLoS One 2021; 16:e0256697. [PMID: 34469482 PMCID: PMC8409627 DOI: 10.1371/journal.pone.0256697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 07/13/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The Mental Capacity Act (MCA, 2005) and its accompanying Code of Practice (2007), govern research participation for adults with capacity and communication difficulties in England and Wales. We conducted a systematic review and narrative synthesis to investigate the application of these provisions from 2007 to 2019. METHODS AND FINDINGS We included studies with mental capacity in their criteria, involving participants aged 16 years and above, with capacity-affecting conditions and conducted in England and Wales after the implementation of the MCA. Clinical trials of medicines were excluded. We searched seven databases: Academic Search Complete, ASSIA, MEDLINE, CINAHL, PsycArticles, PsycINFO and Science Direct. We used narrative synthesis to report our results. Our review follows Preferred Reporting Items for Systematic Reviews and is registered on PROSPERO, CRD42020195652. 28 studies of various research designs met our eligibility criteria: 14 (50.0%) were quantitative, 12 (42.9%) qualitative and 2 (7.1%) mixed methods. Included participants were adults with intellectual disabilities (n = 12), dementia (n = 9), mental health disorders (n = 2), autism (n = 3) and aphasia after stroke (n = 2). We found no studies involving adults with acquired brain injury. Diverse strategies were used in the recruitment of adults with capacity and communication difficulties with seven studies excluding individuals deemed to lack capacity. CONCLUSIONS We found relatively few studies including adults with capacity and communication difficulties with existing regulations interpreted variably. Limited use of consultees and exclusions on the basis of capacity and communication difficulties indicate that this group continue to be under-represented in research. If health and social interventions are to be effective for this population, they need to be included in primary research. The use of strategic adaptations and accommodations during the recruitment process, may serve to support their inclusion.
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Affiliation(s)
- Oluseyi Florence Jimoh
- School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
| | - Hayley Ryan
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
| | - Anne Killett
- School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
| | - Ciara Shiggins
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne Victoria, Australia
| | - Peter E. Langdon
- Centre for Educational Development, Appraisal and Research, New Education Building, Westwood Campus, University of Warwick, Coventry, United Kingdom
| | - Rob Heywood
- School of Law, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
| | - Karen Bunning
- School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
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Consequences of visiting restrictions during the COVID-19 pandemic: An integrative review. Int J Nurs Stud 2021; 121:104000. [PMID: 34242976 PMCID: PMC8196532 DOI: 10.1016/j.ijnurstu.2021.104000] [Citation(s) in RCA: 161] [Impact Index Per Article: 53.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 05/17/2021] [Accepted: 06/05/2021] [Indexed: 12/18/2022]
Abstract
Background During the COVID-19 pandemic, visiting restrictions of different extents have been implemented. However, despite the long history of visiting restrictions in health care systems, little is known about their effects. Objectives This review sought to explore the consequences of visitor restrictions in health care services during the COVID-19 pandemic. Methods A systematic, integrative review was conducted in accordance with the PRISMA guidelines, based on a systematic search in PubMed, CHINAL full plus, Web of Science, PsychInfo, Scopus and the Cochrane Library. Results A total of 17 scientific papers covering intensive care, pediatric care, general medical care, hospital care, palliative care and nursing home settings were included. Although appreciation for the technical solutions enabling remote meetings was reported, visiting restrictions had several consequences, mainly negative, for the patient's health, the health and wellbeing of family members and the provision of care. Among physical health consequences, reduced nutrition intake, decreased activities of daily living and increased physical pain and symptoms were reported. Among mental health consequences for the patient, loneliness, depressive symptoms, agitation, aggression, reduced cognitive ability and overall dissatisfaction were observed. For family members, worry, anxiety and uncertainty occurred, and they reported an increased need for information from care providers. Family members of neonatal intensive care unit patients reported less bonding with their child and family relation disturbances due to the restrictions. For care providers, visiting restrictions added the burdens of ethical dilemmas, learning new technical means to enable social interaction and an increased demand for communication with families and providing social support to both family members and patients. Conclusions When implementing visiting restrictions in health care services, decision makers and nurses need to be aware of their potential negative effects and adapt the provision of care to compensate for such effects. Nurses in all sectors should be aware that visiting restrictions may affect patients, families, and health care services for longer than the actual pandemic. Since the level of evidence regarding effect from visiting restrictions is low, further studies is strongly needed.
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Tutton E, Saletti-Cuesta L, Langstaff D, Wright J, Grant R, Willett K. Patient and informal carer experience of hip fracture: a qualitative study using interviews and observation in acute orthopaedic trauma. BMJ Open 2021; 11:e042040. [PMID: 33542042 PMCID: PMC7925874 DOI: 10.1136/bmjopen-2020-042040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES The time taken for older people to recover from hip fracture can be extensive. The aim of this study was to gain an understanding of patient and informal carer experience of recovery in the early stage, while in acute care. DESIGN A phenomenological (lived experience) approach was used to guide the design of the study. Interviews and observation took place between March 2016 and December 2016 in acute care. SETTING Trauma wards in a National Health Service Foundation Trust in the South West of England. PARTICIPANTS A purposive sample of 25 patients were interviewed and observation taking 52 hours was undertaken with 13 patients and 12 staff. 11 patients had memory loss, 2 patients chose to take part in an interview and observation. The age range was 63-91 years (median 83), 10 were men. A purposive sample of 25 informal carers were also interviewed, the age range was 42-95 years (mean 64), 11 were men. RESULTS The results identified how participants moved forward together after injury by sharing the journey. This was conveyed through three themes: (1) sustaining relationships while experiencing strong emotions and actively helping, (2) becoming aware of uncertainty about the future and working through possible outcomes, (3) being changed, visibly looking different, not being able to walk, and enduring indignity and pain. CONCLUSION This study identified the experience of patients and informal carers as they shared the journey during a challenging life transition. Strategies that support well-being and enable successful negotiation of the emotional and practical challenges of acute care may help with longer term recovery. Research should focus on developing interventions that promote well-being during this transition to help provide the foundation for patients and carers to live fulfilled lives.
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Affiliation(s)
- Elizabeth Tutton
- Kadoorie, Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Trauma and Major Trauma Centre, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | - Lorena Saletti-Cuesta
- Culture and Society Research and Study Centre, National Scientific and Technical Research Council, Cordoba, Argentina
| | - Debbie Langstaff
- Trauma and Major Trauma Centre, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | - Julie Wright
- Trauma and Major Trauma Centre, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | - Richard Grant
- Patient and Public Involvement Partner, Kadoorie, Oxford Trauma and Emergency Care, University of Oxford, Oxford, UK
| | - Keith Willett
- Kadoorie, Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Gwernan-Jones R, Lourida I, Abbott RA, Rogers M, Green C, Ball S, Hemsley A, Cheeseman D, Clare L, Moore D, Burton J, Lawrence S, Rogers M, Hussey C, Coxon G, Llewellyn DJ, Naldrett T, Thompson Coon J. Understanding and improving experiences of care in hospital for people living with dementia, their carers and staff: three systematic reviews. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Being in hospital can be particularly confusing and challenging not only for people living with dementia, but also for their carers and the staff who care for them. Improving the experience of care for people living with dementia in hospital has been recognised as a priority.
Objectives
To understand the experience of care in hospital for people living with dementia, their carers and the staff who care for them and to assess what we know about improving the experience of care.
Review methods
We undertook three systematic reviews: (1) the experience of care in hospital, (2) the experience of interventions to improve care in hospital and (3) the effectiveness and cost-effectiveness of interventions to improve the experience of care. Reviews 1 and 2 sought primary qualitative studies and were analysed using meta-ethnography. Review 3 sought comparative studies and economic evaluations of interventions to improve experience of care. An interweaving approach to overarching synthesis was used to integrate the findings across the reviews.
Data sources
Sixteen electronic databases were searched. Forwards and backwards citation chasing, author contact and grey literature searches were undertaken. Screening of title and abstracts and full texts was performed by two reviewers independently. A quality appraisal of all included studies was undertaken.
Results
Sixty-three studies (reported in 82 papers) were included in review 1, 14 studies (reported in 16 papers) were included in review 2, and 25 studies (reported in 26 papers) were included in review 3. A synthesis of review 1 studies found that when staff were delivering more person-centred care, people living with dementia, carers and staff all experienced this as better care. The line of argument, which represents the conceptual findings as a whole, was that ‘a change of hospital culture is needed before person-centred care can become routine’. From reviews 2 and 3, there was some evidence of improvements in experience of care from activities, staff training, added capacity and inclusion of carers. In consultation with internal and external stakeholders, the findings from the three reviews and overarching synthesis were developed into 12 DEMENTIA CARE pointers for service change: key institutional and environmental practices and processes that could help improve experience of care for people living with dementia in hospital.
Limitations
Few of the studies explored experience from the perspectives of people living with dementia. The measurement of experience of care across the studies was not consistent. Methodological variability and the small number of intervention studies limited the ability to draw conclusions on effectiveness.
Conclusions
The evidence suggests that, to improve the experience of care in hospital for people living with dementia, a transformation of organisational and ward cultures is needed that supports person-centred care and values the status of dementia care. Changes need to cut across hierarchies and training systems to facilitate working patterns and interactions that enable both physical and emotional care of people living with dementia in hospital. Future research needs to identify how such changes can be implemented, and how they can be maintained in the long term. To do this, well-designed controlled studies with improved reporting of methods and intervention details to elevate the quality of available evidence and facilitate comparisons across different interventions are required.
Study registration
This study is registered as PROSPERO CRD42018086013.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 43. See the NIHR Journals Library website for further project information. Additional funding was provided by the NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula.
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Affiliation(s)
- Ruth Gwernan-Jones
- Evidence Synthesis Team, PenCLAHRC, University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Ilianna Lourida
- Evidence Synthesis Team, PenCLAHRC, University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Rebecca A Abbott
- Evidence Synthesis Team, PenCLAHRC, University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Morwenna Rogers
- Evidence Synthesis Team, PenCLAHRC, University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Colin Green
- Health Economics Group, University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Susan Ball
- Health Statistics Group, PenCLAHRC, University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
| | | | | | - Linda Clare
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Darren Moore
- Graduate School of Education, College of Social Sciences and International Studies, University of Exeter, Exeter, UK
| | - Julia Burton
- Alzheimer’s Society Research Network Volunteers, c/o University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Sue Lawrence
- Alzheimer’s Society Research Network Volunteers, c/o University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
| | | | | | | | - David J Llewellyn
- Mental Health Research Group, University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
- The Alan Turing Institute, London, UK
| | | | - Jo Thompson Coon
- Evidence Synthesis Team, PenCLAHRC, University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
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17
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Wu Q, Qian S, Deng C, Yu P. Understanding Interactions Between Caregivers and Care Recipients in Person-Centered Dementia Care: A Rapid Review. Clin Interv Aging 2020; 15:1637-1647. [PMID: 32982198 PMCID: PMC7500833 DOI: 10.2147/cia.s255454] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 08/05/2020] [Indexed: 11/23/2022] Open
Abstract
Background Good interactions are essential in caring for people with dementia. There is a lack of knowledge about interaction approaches used by caregivers in person-centered dementia care. This study aimed to understand interactions in person-centered dementia care. Methods A search for relevant publications was undertaken in 2020 on two electronic databases, MEDLINE with full text and CINAHL Plus with full text. This was supplemented by manual searching of the reference lists of relevant articles. Inclusion and exclusion criteria were applied to determine the relevance of the articles. Data extraction included publication year, country, study setting, aim, design, definition of person-centered dementia care, elements of person-centered dementia care and interaction approaches used by caregivers. A Donabedian quality framework was used to group the elements of person-centered dementia care into three categories: structure, process and outcome. Results A total of 25 articles were included in the review, all from developed countries. A conceptual framework was developed for the delivery of person-centered dementia care. It includes the organizational structure, ie, management and resources, a competent workforce and physical environment; the dementia care process, ie, respectful interaction underpinned by good knowledge about the care recipients in a calm, peaceful environment; and care outcome, ie, the social, psychological, and physical well-being of the care recipients. Interaction approaches used by caregivers in providing person-centered dementia care were classified according to the six purposes of interaction: to know and understand the care recipient, to keep the person happy and satisfied, to make the person feel safe and secure, to calm the person, to support self-identity, and to guide the person in conducting daily activities. Conclusion The delivery of person-centered dementia care needs to consider organizational structure, the dementia care process, and care outcome which together foster a positive environment for meaningful interactions between caregivers and care recipients. The identified interaction approaches could be used by dementia care trainers to develop training materials.
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Affiliation(s)
- Qiujuan Wu
- Oncology Department, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Siyu Qian
- Centre for Digital Transformation, School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, NSW 2522, Australia.,Drug and Alcohol Service, Illawarra Shoalhaven Local Health District, Wollongong, NSW, 2500, Australia
| | - Chao Deng
- Illawarra Health and Medical Research Institute, Wollongong, NSW 2500, Australia.,School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, 2522, Australia
| | - Ping Yu
- Centre for Digital Transformation, School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, NSW 2522, Australia.,Illawarra Health and Medical Research Institute, Wollongong, NSW 2500, Australia
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18
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Navigating cancer treatment and care when living with comorbid dementia: an ethnographic study. Support Care Cancer 2020; 29:2571-2579. [PMID: 32955656 PMCID: PMC7981315 DOI: 10.1007/s00520-020-05735-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 09/01/2020] [Indexed: 11/08/2022]
Abstract
Objectives The risks of developing cancer and dementia increase as we age; however, this comorbidity remains relatively under-researched. This study reports on the challenges that people affected by comorbid cancer and dementia face when navigating engagement with cancer treatment within secondary care. Materials and methods An ethnographic study recruiting 17 people with cancer and dementia, 22 relatives and 19 oncology staff in two UK National Health Service Trusts. Observations (46 h) and informal conversations were conducted during oncology appointments involving people with dementia. Semi-structured interviews (n = 37) with people living with cancer and dementia, their relatives and staff working in various roles across oncology services were also carried out. Data were analysed using ethnographically informed thematic analysis. Results People with cancer and dementia experienced challenges across three areas of navigating cancer treatment and care: navigating through multiple services, appointments and layers of often complex information; repeatedly navigating transport to and from hospital; and navigating non-dementia-friendly hospital outpatient environments alongside the cognitive problems associated with dementia. Conclusions Dementia impacts patients’ abilities to navigate the many practical aspects of attending hospital for cancer treatment and care. This study indicates the importance of addressing ways to improve the experience of travelling to and from the hospital, alongside extending the ongoing efforts to develop ‘dementia-friendly’ hospital in-patient areas and practices, to outpatient departments. Such steps will serve to improve hospital-based cancer treatment and care and more broadly outpatient appointment experiences for people with dementia and their families.
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19
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Røsvik J, Rokstad AMM. What are the needs of people with dementia in acute hospital settings, and what interventions are made to meet these needs? A systematic integrative review of the literature. BMC Health Serv Res 2020; 20:723. [PMID: 32767987 PMCID: PMC7412803 DOI: 10.1186/s12913-020-05618-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 08/02/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Research aiming to improve the hospital experience for patients with dementia and their informal carers is strongly recommended. The present review aimed to describe the research on interventions to meet the needs of people with dementia in acute hospital settings regarding physical environment, organization of care, and staff knowledge of dementia and competence in person-centred care. An integrative review design was applied. We searched for studies in PubMed, Ovid Medline, Cinahl, Embase, Swemed+, and Cochrane databases using the Mixed Methods Appraisal Tool (MMAT) for quality evaluation. Twenty-seven articles were included, describing the perspectives of people with dementia, informal carers, and professional carers. The MMAT score ranged from two to four. Twelve studies described needs and experiences, mostly using a qualitative design. Common themes and results were synthesized. The studies identified a need to enhance staff competence regarding dementia and person-centred care. Fifteen studies described interventions: two were qualitative; three used mixed method, and 10 were quantitative, of which two were randomized controlled trials and eight were observational studies. Five types of interventions were identified. Three types could positively impact staff knowledge about dementia and person-centred care. One type was experienced as positive regarding organisation of care for patients with dementia. None of the intervention studies found evidence for effects on the identified needs regarding physical environment. CONCLUSION The included studies suggest that staff need more knowledge regarding dementia and person-centred dementia care and that training interventions implemented to enhance staff competence had promising results. However, there is a need for research on the needs of patients with dementia in acute hospital settings regarding physical environment and effect of design elements. There is also a scarcity of intervention studies focusing on the effect of models of care that support the psychosocial needs of patients with dementia.
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Affiliation(s)
- Janne Røsvik
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway. .,Department of Geriatric Medicine, Oslo University Hospital-Ullevål, Oslo, Norway.
| | - Anne Marie Mork Rokstad
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Faculty of Health Sciences and Social Care, Molde University College, Molde, Norway
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20
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Gwernan-Jones R, Abbott R, Lourida I, Rogers M, Green C, Ball S, Hemsley A, Cheeseman D, Clare L, Moore DA, Hussey C, Coxon G, Llewellyn DJ, Naldrett T, Thompson Coon J. The experiences of hospital staff who provide care for people living with dementia: A systematic review and synthesis of qualitative studies. Int J Older People Nurs 2020; 15:e12325. [PMID: 32412167 DOI: 10.1111/opn.12325] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/30/2020] [Accepted: 04/14/2020] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To systematically review and synthesise qualitative data from studies exploring the experiences of hospital staff who care for people living with dementia (Plwd). BACKGROUND In hospital, the number of Plwd continues to rise; however, their experiences of care remain problematic. Negative experiences of care are likely to contribute to poorer mental and physical health outcomes for Plwd while in hospital and after discharge. Experiences of the hospital staff who care for Plwd can also be poor or unrewarding. It is important to understand the experiences of staff in order to improve staff well-being and ultimately the experience of care for Plwd while in hospital. DESIGN Systematic review and evidence synthesis of qualitative research. DATA SOURCES We searched 16 electronic databases in March 2018 and completed forward and backward citation chasing. METHODS Eligible studies explored the experiences of paid and unpaid staff providing care in hospital for Plwd. Study selection was undertaken independently by two reviewers, and quality appraisal was conducted. We prioritised included studies according to richness of text, methodological rigour and conceptual contribution. We adopted approaches of meta-ethnography to analyse study findings, creating a conceptual model to represent the line of argument. FINDINGS Forty-five studies reported in 58 papers met the inclusion criteria, and of these, we prioritised 19 studies reported in 24 papers. The line of argument was that Institutions can improve staff experiences of care for Plwd by fostering person-centred care (PCC). PCC aligned with staff perceptions of 'good care'; however, staff often felt prevented from providing PCC because of care cultures that prioritised tasks, routines and physical health. Staff experienced conflict over the care they wanted to give versus the care they were able to give, and this caused moral distress. When staff were able to provide PCC, this increased experiences of job satisfaction and emotional well-being. CONCLUSIONS Person-centred care not only has the potential to improve the experience of care for Plwd and their carers, but can also improve the experiences of hospital staff caring for Plwd. However, without institutional-level changes, hospital staff are often unable to provide PCC even when they have the experience and knowledge to do so. IMPLICATIONS FOR PRACTICE Institutional-level areas for change include the following: training; performance indicators and ward cultures that prioritise psychological needs alongside physical needs; adequate staffing levels; inclusive approaches to carers; physical environments that promote familiarisation, social interaction and occupation; systems of documentation about individual needs of Plwd; and cultures of sharing knowledge across hierarchies.
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Affiliation(s)
- Ruth Gwernan-Jones
- Evidence Synthesis Team, PenCLAHRC, University of Exeter Medical School, St Luke's Campus, University of Exeter, Exeter, UK
| | - Rebecca Abbott
- Evidence Synthesis Team, PenCLAHRC, University of Exeter Medical School, St Luke's Campus, University of Exeter, Exeter, UK
| | - Ilianna Lourida
- Evidence Synthesis Team, PenCLAHRC, University of Exeter Medical School, St Luke's Campus, University of Exeter, Exeter, UK
| | - Morwenna Rogers
- Evidence Synthesis Team, PenCLAHRC, University of Exeter Medical School, St Luke's Campus, University of Exeter, Exeter, UK
| | - Colin Green
- Health Economics Group, University of Exeter Medical School, St Luke's Campus, University of Exeter, Exeter, UK
| | - Susan Ball
- Health Statistics Group, PenCLAHRC, College of Medicine and Health, University of Exeter Medical School, St Luke's Campus, University of Exeter, Exeter, UK
| | | | | | - Linda Clare
- Centre for Research in Aging and Cognitive Health, University of Exeter Medical School, St Luke's Campus, University of Exeter, Exeter, UK
| | - Darren A Moore
- Graduate School of Education, College of Social Sciences and International Studies, St Luke's Campus, University of Exeter, Exeter, UK
| | | | | | - David J Llewellyn
- Mental Health Research Group, University of Exeter Medical School, St Luke's Campus, University of Exeter, Exeter, UK.,The Alan Turing Institute, London, UK
| | | | - Jo Thompson Coon
- Evidence Synthesis Team, PenCLAHRC, University of Exeter Medical School, St Luke's Campus, University of Exeter, Exeter, UK
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