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Louis-Delsoin C, Ruiz-Rodrigo A, Rousseau J. Understanding the home environment of older adults living with dementia: A scoping review of assessment tools. Home Health Care Serv Q 2024; 43:54-86. [PMID: 38146743 DOI: 10.1080/01621424.2023.2290708] [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: 12/27/2023]
Abstract
Rigorous assessments to better understand the person-environment interaction are essential to comprehend how neurocognitive disorders influence in-home functioning of older people living with dementia. No recent synthesis identifies validated instruments targeting the human (e.g. caregivers) and nonhuman (e.g. objects) elements of the home environment interacting with this population and used with the perspective of aging in place. Consequently, following Arksey and O'Malley's (2005) scoping review method, 2,182 articles were identified in six databases and in gray literature. Two reviewers independently selected 23 relevant articles describing 19 validated assessment tools targeting elements of the home interacting with older people with dementia, namely: nonhuman environment (n = 13), human environment (n = 3), and person-environment interaction (n = 3). This overview highlights the scarcity of tools addressing the human environment and the person-environment interaction to foster sustainable at-home living for older people with neurocognitive disorders, demonstrating the need to incorporate new evidence-based, holistic methods into dementia home care.
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Affiliation(s)
- Cindy Louis-Delsoin
- School of rehabilitation, Faculty of medicine, Université de Montréal, Montreal, Quebec, Canada
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Quebec, Canada
| | - Alicia Ruiz-Rodrigo
- School of rehabilitation, Faculty of medicine, Université de Montréal, Montreal, Quebec, Canada
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Quebec, Canada
| | - Jacqueline Rousseau
- School of rehabilitation, Faculty of medicine, Université de Montréal, Montreal, Quebec, Canada
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Quebec, Canada
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Chen D, Jutkowitz E, Gross AL. Statistical harmonization of everyday functioning and dementia-related behavioral measures across nine surveys and trials. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2023; 15:e12412. [PMID: 36935763 PMCID: PMC10017408 DOI: 10.1002/dad2.12412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/13/2023] [Accepted: 02/07/2023] [Indexed: 03/18/2023]
Abstract
Introduction Efforts to harmonize measures of everyday function and dementia-related behaviors are needed to synthesize across studies in dementia research. There have been some psychometric attempts to harmonize everyday function for secondary analysis, but far less for dementia-related behaviors. Methods Statistical co-calibration was performed to generate factor scores representing everyday function and dementia-related behaviors for participants with dementia. We evaluated convergent criterion validity of factor scores and mapped the scores onto established clinical instruments. Results Factor analyses of included items fit well to available data. Harmonized factors showed expected associations with the Global Clinical Dementia Rating (CDR) score, with greater impairment (higher Global CDR score) corresponding to higher (more severe) levels on factor scores. Discussion We used large, well-characterized samples to derive harmonized factors representing everyday functions and dementia-related behaviors. These harmonized factors can be used to tackle questions about dementia phenotypes which require either large samples or unique subpopulations.
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Affiliation(s)
- Diefei Chen
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Johns Hopkins University Center on Aging and HealthBaltimoreMarylandUSA
| | - Eric Jutkowitz
- Department of Health Services, Policy & PracticeBrown University School of Public HealthProvidenceRhode IslandUSA
- Center of Innovation in Long Term Services and SupportsProvidence VA Medical CenterProvidenceRhode IslandUSA
- Evidence Synthesis Program CenterProvidence VA Medical CenterProvidenceRhode IslandUSA
| | - Alden L. Gross
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Johns Hopkins University Center on Aging and HealthBaltimoreMarylandUSA
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Jayakody S, Arambepola C. Determinants of quality of life among people with dementia: evidence from a South Asian population. BMC Geriatr 2022; 22:745. [PMID: 36096721 PMCID: PMC9469587 DOI: 10.1186/s12877-022-03443-3] [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: 05/27/2022] [Accepted: 09/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dementia has become a public health priority along with population aging worldwide. Owing to its chronic progressive nature in the absence of a cure, maintaining the best possible quality of life (QOL) has become the desired outcome for people with dementia (PWD). AIM The current study aimed to determine the factors associated with 'good QOL' in people with dementia in the Sri Lankan setting. METHODS An unmatched case-control study was conducted to identify the factors associated with 'good QoL. Cases in the study included dementia patients having 'good' QOL, whereas controls were those having 'poor' or 'average' QOL. Both cases and controls were selected from the same patient base at a premier tertiary care state hospital in Colombo District, Sri Lanka. They were identified using the validated DEMQOL (Dementia Specific Quality of Life) tool, adhering to strict eligibility criteria. An interviewer-administered questionnaire was used to assess the associated factors. Bivariate analysis followed by logistic regression modelling determined the associated factors for 'good QOL' adjusted for confounders using odds ratio (OR) and 95% confidence interval (CI). RESULTS The study sample consisted of 64 cases and 208 controls. After adjusting for confounders, education up to GCE O/Level and above (OR = 4.02; 95% CI = 2.97, 12.0), ever employed (OR = 3.21; 95% CI = 1.59, 11.06), good social functioning (OR = 4.14; 95% CI = 3.39, 16.46), mild functional impairment (OR = 1.77; 95% CI = 1.13, 9.67), little or no caregiver burden (OR = 2.96; 95% CI = 1.86, 10.94), absence of apathy (OR = 2.22; 95% CI = 1.27, 12.48) and absence of irritability (OR = 2.17; 95% CI = 1.72, 10.34) were found to be significantly associated with 'good QOL'. 60% of the variance of 'good' QOL among PWD was explained by the factors in the final model. CONCLUSIONS AND RECOMMENDATIONS: The identified determinants of 'good QOL' clearly show how the QOL improvement interventions need to be planned. Accordingly, such programmes should be primarily focused on strategies to improve PWDs' ADL (Activities of Daily living), reduce and manage neuropsychiatric symptoms effectively and to promote activities enhancing social functioning, and plan programmes to address caregiver burden.
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Affiliation(s)
- Surangi Jayakody
- Department of Community Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka.
| | - Carukshi Arambepola
- Department of Community Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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Relationship between parental history of dementia, motor-cognitive and executive function performance in African American women. J Neurol Sci 2022; 439:120305. [DOI: 10.1016/j.jns.2022.120305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 04/19/2022] [Accepted: 05/28/2022] [Indexed: 11/23/2022]
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Exploring the contribution of housing adaptations in supporting everyday life for people with dementia: a scoping review. AGEING & SOCIETY 2021. [DOI: 10.1017/s0144686x21001367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Abstract
The primary aim of this scoping review was to explore the contribution of housing adaptations to supporting everyday life for people with dementia living at home in the community. The study adopted a scoping review methodology which was guided by the Joanna Briggs Institute Reviewers Manual. Four review questions were developed which subsequently informed the inclusion criteria and search terms. Eight databases were searched resulting in 2,339 records, with 13 papers being included in the review. Evidence from the review found that the most common adaptations were recommended and/or implemented to compensate for a person's physical limitations and for safety reasons, rather than adaptations to support activities of daily living for a person with dementia. Support to implement adaptations was provided by a range of professionals coupled with ‘trial and error’ approaches adopted by the person themselves, and these were seen as key enablers. Barriers to implementing and using adaptations were fourfold: (a) access to information, (b) knowing when to make changes, (c) carer resistance, and (d) the unsuitability of the home. It would appear that housing adaptations have a positive impact on both the person with dementia and the carer (where one is present), with some adaptations having a relatively sustained impact and being particularly effective if implemented early in the lived trajectory of dementia.
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Chen D, Jutkowitz E, Iosepovici SL, Lin JC, Gross AL. Pre-statistical harmonization of behavrioal instruments across eight surveys and trials. BMC Med Res Methodol 2021; 21:227. [PMID: 34689753 PMCID: PMC8543796 DOI: 10.1186/s12874-021-01431-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 10/08/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Data harmonization is a powerful method to equilibrate items in measures that evaluate the same underlying construct. There are multiple measures to evaluate dementia related behavioral symptoms. Pre-statistical harmonization of behavioral instruments in dementia research is the first step to develop a statistical crosswalk between measures. Studies that conduct pre-statistical harmonization of behavioral instruments rarely document their methods in a structured, reproducible manner. This is a crucial step which entails careful review, documentation and scrutiny of source data to ensure sufficient comparability between items prior to data pooling. Here, we document the pre-statistical harmonization of items measuring behavioral and psychological symptoms among people with dementia. We provide a box of recommended procedure for future studies. METHODS We identified behavioral instruments that are used in clinical practice, a national survey, and randomized trials of dementia care interventions. We rigorously reviewed question content and scoring procedures to establish sufficient comparability across items as well as item quality prior to data pooling. Additionally, we standardized coding to Stata-readable format, which allowed us to automate approaches to identify potential cross-study differences in items and low-quality items. To ensure reasonable model fit for statistical co-calibration, we estimated two-parameter logistic Item Response Theory models within each of the eight studies. RESULTS We identified 59 items from 11 behavioral instruments across the eight datasets. We found considerable cross-study heterogeneity in administration and coding procedures for items that measure the same attribute. Discrepancies existed in terms of directionality and quantification of behavioral symptoms for even seemingly comparable items. We resolved item response heterogeneity, missingness and skewness, conditional dependency prior to estimation of item response theory models for statistical co-calibration. We used several rigorous data transformation procedures to address these issues, including re-coding and truncation. CONCLUSIONS This study highlights the importance of each aspect involved in the pre-statistical harmonization process of behavioral instruments. We provide guidelines and recommendations for how future research may detect and account for similar issues in pooling behavioral and related instruments.
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Affiliation(s)
- Diefei Chen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States, 2024 E. Monument Street, Baltimore, MD 21205 USA
| | - Eric Jutkowitz
- Health Services, Policy & Practice, Brown School of Public Health, Providence, RI USA
- Center of Innovation in Long Term Services and Supports, Providence VA Medical Center, Providence, RI USA
| | - Skylar L. Iosepovici
- Health Services, Policy & Practice, Brown School of Public Health, Providence, RI USA
| | - John C. Lin
- Health Services, Policy & Practice, Brown School of Public Health, Providence, RI USA
| | - Alden L. Gross
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States, 2024 E. Monument Street, Baltimore, MD 21205 USA
- Johns Hopkins University Center on Aging and Health, Baltimore, MD USA
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Wang W, Lu Z. Influences of Physical Environmental Cues on People With Dementia: A Scoping Review. J Appl Gerontol 2021; 41:1209-1221. [PMID: 34689638 DOI: 10.1177/07334648211050376] [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: 11/15/2022] Open
Abstract
Physical environmental cues can provide important support to people with dementia (PwD). Compared to interventions involving construction, some cues can be achieved more easily, with less expense, and with fewer disruptions to PwD's daily lives. This review aims to examine existing empirical evidence about the impacts of cues on PwD's behaviors. We adopted the PRISMA scoping review approach and identified 32 articles. The results show visual cues have been frequently studied. The signage facilitates PwD's wayfinding. Concealed doors (e.g., concealing doorknobs) effectively prevent exit attempts. PwD also eat better with tableware of higher-contrasting colors or good lighting conditions. Clearer toilet signage results in better continence. Applying cues properly contributes to improving PwD's well-being and decreasing the burden for caregivers. However, knowledge gaps still exist in the impacts of other sensory cues (e.g., tactile, olfactory, and auditory), which require further research.
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Affiliation(s)
- Wenjin Wang
- Department of Architecture, Texas A&M University, College Station, TX, USA
| | - Zhipeng Lu
- Department of Architecture, Texas A&M University, College Station, TX, USA
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Isaia G, Brunetti E, Presta R, Salone B, Carignano G, Sappa M, Fonte G, Raspo S, Lauria G, Riccardini F, Lupia E, Bo M. Prevalence, determinants and practical implications of inappropriate hospitalizations in older subjects: A prospective observational study. Eur J Intern Med 2021; 90:89-95. [PMID: 33947625 DOI: 10.1016/j.ejim.2021.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 04/02/2021] [Accepted: 04/09/2021] [Indexed: 11/30/2022]
Abstract
In a context of high demand for hospital services among older people, we aimed to assess the rate and determinants of inappropriate hospitalizations of older patients, and to what extent they were associated with inappropriate hospital stay. This prospective observational multicentre study evaluated a random sample of consecutive patients aged ≥ 70 years accessing the Emergency Department (ED) of two Italian tertiary hospitals. A standardized comprehensive geriatric assessment was carried out in each patient, including the Blaylock Risk Assessment Screen Scale (BRASS) for identification of patients at risk of difficult discharge. Inappropriate hospitalization was defined by the ED physician when patients did not necessitate hospital-provided procedures but was due to social reasons or lack of an alternative care-setting. Among 1877 patients (median age 80.7 years, 50.1% male), with a high prevalence of functional dependence and social isolation (around 30% and 25%, respectively), 767 (40.9%) were hospitalized. Incidence of inappropriate hospitalization was 14.6% (95% CI 12.1%-17.1%) and was associated with moderate-high risk of difficult discharge at BRASS (OR = 1.98, 95% CI 1.16-3.39, p = 0.013) and the presence of dementia with behavioural disorders (OR = 1.79, 95% CI 1.10-2.91, p = 0.020). Compared with patients appropriately admitted, inappropriate hospitalizations had shorter length of hospital stay but accounted for 1059/9154 days of stay (11.6%). Inappropriate hospitalizations occurred in less than 15% of cases, mainly accounted for by patients no longer manageable at home, but contributed to the greatest proportion of inappropriate hospital stay. These findings highlight the need of implementing appropriate home-care services and ensuring rapid access to suitable care-facilities for community-dwelling frail older patients.
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Affiliation(s)
- Gianluca Isaia
- Section of Geriatrics, Department of Medical Sciences, AOU Città della Salute e della Scienza - Molinette, Turin, Italy
| | - Enrico Brunetti
- Section of Geriatrics, Department of Medical Sciences, AOU Città della Salute e della Scienza - Molinette, Turin, Italy
| | - Roberto Presta
- Section of Geriatrics, Department of Medical Sciences, AOU Città della Salute e della Scienza - Molinette, Turin, Italy.
| | - Bianca Salone
- Section of Geriatrics, Department of Medical Sciences, AOU Città della Salute e della Scienza - Molinette, Turin, Italy
| | - Giulia Carignano
- Section of Geriatrics, Department of Medical Sciences, AOU Città della Salute e della Scienza - Molinette, Turin, Italy; Section of Geriatrics, AO Santa Croce e Carle, Cuneo, Italy
| | - Matteo Sappa
- Section of Geriatrics, Department of Medical Sciences, AOU Città della Salute e della Scienza - Molinette, Turin, Italy; Section of Geriatrics, AO Santa Croce e Carle, Cuneo, Italy
| | - Gianfranco Fonte
- Section of Geriatrics, Department of Medical Sciences, AOU Città della Salute e della Scienza - Molinette, Turin, Italy
| | - Silvio Raspo
- Section of Geriatrics, AO Santa Croce e Carle, Cuneo, Italy
| | - Giuseppe Lauria
- Emergency Medicine Department, AO Santa Croce e Carle, Cuneo, Italy
| | - Franco Riccardini
- Emergency Medicine Department, Department of Medical Sciences, AOU Città della Salute e della Scienza - Molinette, Turin, Italy
| | - Enrico Lupia
- Emergency Medicine Department, Department of Medical Sciences, AOU Città della Salute e della Scienza - Molinette, Turin, Italy
| | - Mario Bo
- Section of Geriatrics, Department of Medical Sciences, AOU Città della Salute e della Scienza - Molinette, Turin, Italy
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Wranker LS, Elmståhl S, Cecilia F. The Health of Older Family Caregivers - A 6-Year Follow-up. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2021; 64:190-207. [PMID: 33155521 DOI: 10.1080/01634372.2020.1843098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 10/19/2020] [Accepted: 10/24/2020] [Indexed: 06/11/2023]
Abstract
It is unclear whether caregiving has an impact on the physical, mental and functional health of older caregivers. This study aimed to describe physical, mental and functional health in relation to family caregiving in old age (60+) over a six-year period. The study comprised 2,294 randomly selected individuals (60-96 years) from the Swedish National Study on Aging and Care, who answered the question on whether they were caregivers and who were followed up six years later. The prevalence of family caregivers was 13.1% and the incidence was 12.4%. Four tracks (T) were identified; T1) Family caregiver both at baseline and follow-up (n = 74), T2) Family caregiver at baseline but not at follow-up (n = 226), T3) non-caregiver at baseline but family caregiver at follow-up (n = 218), T4) non-caregiver both at baseline and follow-up (1,776). Only non-caregivers (T4) reported a decline in mental health, p < .036. Worries about health increased significantly in T2 and T4. The prevalence of caregivers was 13.1% with a high turnover. There are differences between family caregivers and non-caregivers in deterioration in physical and mental health as well as physical function over a six-year period.
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Affiliation(s)
- Lena Sandin Wranker
- Department of Clinical Sciences, Division of Geriatric Medicine, Lund University , Lund, Sweden
- Centre for Ageing and Health, AGECAP, University of Gothenburg , Gothenburg, Sweden
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg , Gothenburg, Sweden
| | - Sölve Elmståhl
- Department of Clinical Sciences, Division of Geriatric Medicine, Lund University , Lund, Sweden
| | - Fagerström Cecilia
- Department of research and development, Blekinge Center of Competence , Karlskrona, Sweden
- Department of Health and Caring Science, Linnaeus University , Kalmar, Sweden
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Richardson K, Savva GM, Boyd PJ, Aldus C, Maidment I, Pakpahan E, Loke YK, Arthur A, Steel N, Ballard C, Howard R, Fox C. Non-benzodiazepine hypnotic use for sleep disturbance in people aged over 55 years living with dementia: a series of cohort studies. Health Technol Assess 2021; 25:1-202. [PMID: 33410736 PMCID: PMC7812417 DOI: 10.3310/hta25010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Sleep disturbance affects around 60% of people living with dementia and can negatively affect their quality of life and that of their carers. Hypnotic Z-drugs (zolpidem, zopiclone and zaleplon) are commonly used to treat insomnia, but their safety and efficacy have not been evaluated for people living with dementia. OBJECTIVES To estimate the benefits and harms of Z-drugs in people living with dementia with sleep disturbance. DESIGN A series of observational cohort studies using existing data from (1) primary care linked to hospital admission data and (2) clinical cohort studies of people living with dementia. DATA SOURCES Primary care study - Clinical Practice Research Datalink linked to Hospital Episode Statistics and Office for National Statistics mortality data. Clinical cohort studies - the Resource Use and Disease Course in Dementia - Nursing Homes (REDIC) study, National Alzheimer's Coordinating Centre (NACC) clinical data set and the Improving Well-being and Health for People with Dementia (WHELD) in nursing homes randomised controlled trial. SETTING Primary care study - 371 primary care practices in England. Clinical cohort studies - 47 nursing homes in Norway, 34 Alzheimer's disease centres in the USA and 69 care homes in England. PARTICIPANTS Primary care study - NHS England primary care patients diagnosed with dementia and aged > 55 years, with sleep disturbance or prescribed Z-drugs or low-dose tricyclic antidepressants, followed over 2 years. Clinical cohort studies - people living with dementia consenting to participate, followed over 3 years, 12 years and 9 months, for REDIC, NACC and WHELD, respectively. INTERVENTIONS The primary exposure was prescription or use of Z-drugs. Secondary exposures included prescription or use of benzodiazepines, low-dose tricyclic antidepressants and antipsychotics. MAIN OUTCOME MEASURES Falls, fractures, infection, stroke, venous thromboembolism, mortality, cognitive function and quality of life. There were insufficient data to investigate sleep disturbance. RESULTS The primary care study and combined clinical cohort studies included 6809 and 18,659 people living with dementia, with 3089 and 914 taking Z-drugs, respectively. New Z-drug use was associated with a greater risk of fractures (hazard ratio 1.40, 95% confidence interval 1.01 to 1.94), with risk increasing with greater cumulative dose (p = 0.002). The hazard ratio for Z-drug use and hip fracture was 1.59 (95% confidence interval 1.00 to 2.53) and for mortality was 1.34 (95% confidence interval 1.10 to 1.64). No excess risks of falls, infections, stroke or venous thromboembolism were detected. Z-drug use also did not have an impact on cognition, neuropsychiatric symptoms, disability or quality of life. LIMITATIONS Primary care study - possible residual confounding because of difficulties in identifying patients with sleep disturbance and by dementia severity. Clinical cohort studies - the small numbers of people living with dementia taking Z-drugs and outcomes not necessarily being measured before Z-drug initiation restricted analyses. CONCLUSIONS We observed a dose-dependent increase in fracture risk, but no other harms, with Z-drug use in dementia. However, multiple outcomes were examined, increasing the risk of false-positive findings. The mortality association was unlikely to be causal. Further research is needed to confirm the increased fracture risk. Decisions to prescribe Z-drugs may need to consider the risk of fractures, balanced against the impact of improved sleep for people living with dementia and that of their carers. Our findings suggest that when Z-drugs are prescribed, falls prevention strategies may be needed, and that the prescription should be regularly reviewed. FUTURE WORK More research is needed on safe and effective management strategies for sleep disturbance in people living with dementia. STUDY REGISTRATION This study is registered as European Union electronic Register of Post-Authorisation Studies (EU PAS) 18006. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 1. See the NIHR Journals Library website for further project information.
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Affiliation(s)
| | - George M Savva
- School of Health Sciences, University of East Anglia, Norwich, UK
- Quadram Institute, Norwich, UK
| | - Penelope J Boyd
- School of Health Sciences, University of East Anglia, Norwich, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Clare Aldus
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Ian Maidment
- School of Life and Health Sciences, Aston University, Birmingham, UK
| | - Eduwin Pakpahan
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Yoon K Loke
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Antony Arthur
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Nicholas Steel
- Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - Robert Howard
- Division of Psychiatry, University College London, London, UK
| | - Chris Fox
- Norwich Medical School, University of East Anglia, Norwich, UK
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11
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Richardson K, Loke YK, Fox C, Maidment I, Howard R, Steel N, Arthur A, Boyd PJ, Aldus C, Ballard C, Savva GM. Adverse effects of Z-drugs for sleep disturbance in people living with dementia: a population-based cohort study. BMC Med 2020; 18:351. [PMID: 33228664 PMCID: PMC7683259 DOI: 10.1186/s12916-020-01821-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 10/20/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Sleep disturbance is common in dementia and often treated with Z-drugs (zopiclone, zaleplon, and zolpidem). While some observational studies suggest that Z-drugs are associated with adverse events such as falls and fracture risks in older people, this has not been studied in dementia. METHODS We used data from 27,090 patients diagnosed with dementia between January 2000 and March 2016 from the Clinical Practice Research Datalink linked to Hospital Episodes Statistics data in England. We compared adverse events for 3532 patients newly prescribed Z-drugs by time-varying dosage to (1) 1833 non-sedative-users with sleep disturbance; (2) 10,214 non-sedative-users with proximal GP consultation matched on age, sex, and antipsychotic use; and (3) 5172 patients newly prescribed benzodiazepines. We defined higher dose Z-drugs and benzodiazepines as prescriptions equivalent to ≥ 7.5 mg zopiclone or > 5 mg diazepam daily. Cox regression was used to estimate hazard ratios (HRs) for incident fracture, hip fracture, fall, mortality, acute bacterial infection, ischaemic stroke/transient ischaemic attack, and venous thromboembolism over a 2-year follow-up, adjusted for demographic- and health-related covariates. RESULTS The mean (SD) age of patients was 83 (7.7) years, and 16,802 (62%) were women. Of 3532 patients prescribed Z-drugs, 584 (17%) were initiated at higher doses. For patients prescribed higher dose Z-drugs relative to non-users with sleep disturbance, the HRs (95% confidence interval) for fractures, hip fractures, falls, and ischaemic stroke were 1.67 (1.13-2.46), 1.96 (1.16-3.31), 1.33 (1.06-1.66), and 1.88 (1.14-3.10), respectively. We observed similar associations when compared to non-sedative-users with proximal GP consultation. Minimal or inconsistent excess risks were observed at ≤ 3.75 mg zopiclone or equivalent daily, and for mortality, infection, and venous thromboembolism. We observed no differences in adverse events for Z-drugs compared to benzodiazepines, except lower mortality rates with Z-drugs (HR [95% confidence interval] of 0.73 [0.64-0.83]). CONCLUSIONS Higher dose Z-drug use in dementia is associated with increased fracture and stroke risks, similar or greater to that for higher dose benzodiazepines. Higher dose Z-drugs should be avoided, if possible, in people living with dementia, and non-pharmacological alternatives preferentially considered. Prescriptions for higher dose Z-drugs in dementia should be regularly reviewed. TRIAL REGISTRATION ENCePP e-register of studies, EUPAS18006.
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Affiliation(s)
- Kathryn Richardson
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK.
| | - Yoon K Loke
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Chris Fox
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Ian Maidment
- School of Life and Health Sciences, Aston University, Birmingham, B4 7ET, UK
| | - Robert Howard
- Division of Psychiatry, UCL Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Nicholas Steel
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Antony Arthur
- School of Health Sciences, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Penelope J Boyd
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Clare Aldus
- School of Health Sciences, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Clive Ballard
- Medical School, University of Exeter, Exeter, EX1 2LU, UK
| | - George M Savva
- School of Health Sciences, University of East Anglia, Norwich, NR4 7TJ, UK.,Quadram Institute Bioscience, Norwich Research Park, Norwich, NR4 7UQ, UK
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12
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Evans CRD, Kovach CR. The Association Between Physiological Sources of Pain and Sleep Quality in Older Adults With and Without Dementia. Res Gerontol Nurs 2020; 13:297-308. [PMID: 33034650 DOI: 10.3928/19404921-20201002-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 04/21/2020] [Indexed: 11/20/2022]
Abstract
The association of musculoskeletal pain, respiratory distress, gastrointestinal discomfort, and genitourinary pain to sleep quality in 89 persons with and without dementia was examined in the current exploratory, cross-sectional, observational quantitative design. Sources of pain were recorded, with 37.1% of the sample reporting urinary retention, 30.3% reporting genitourinary discomfort, and 53.9% reporting gastrointestinal discomfort. Mild scores of musculoskeletal pain and respiratory discomfort were elicited in >75% of the sample. An actigraph was used to measure sleep variables. Findings from this research illustrated dementia, gender, pillow use, respiratory distress, and urinary retention were statistically significantly associated with nighttime sleep quality. Results suggest comprehensive assessments of pain and sleep for older adults with and without dementia are needed. Developing and testing interventions that address factors contributing to sleep quality may improve outcomes. [Research in Gerontological Nursing, 13(6), 297-308.].
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13
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Marx F, Rétfalvi D. People with Dementia as Active Participants in Studies Related to the Built Environment: A Systematic Review. JOURNAL OF AGING AND ENVIRONMENT 2020. [DOI: 10.1080/26892618.2020.1793440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Fernanda Marx
- Marcel Breuer Doctoral School, Faculty of Engineering and Information Technology, University of Pécs, Pécs, Hungary
| | - Donát Rétfalvi
- Faculty of Engineering and Information Technology, University of Pécs, Pécs, Hungary
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14
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Quinn C, Nelis SM, Martyr A, Morris RG, Victor C, Clare L. Caregiver influences on 'living well' for people with dementia: Findings from the IDEAL study. Aging Ment Health 2020; 24:1505-1513. [PMID: 31104475 DOI: 10.1080/13607863.2019.1602590] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Objectives: The capability to 'live well' in people with dementia can be influenced by many factors, including those related to the experiences of their informal caregiver. How caregivers experience their own role can affect not only their well-being but also the way they provide care and hence the experience of the person with dementia. The aim of this study is to identify the potential impact of the caregiver's perception of the caregiving experience on how people with mild to moderate dementia self-rate their QoL, well-being and satisfaction with life.Method: This study utilised time-point 1 data from 1283 informal caregiver and the 1283 people with dementia whom they provide care from the IDEAL cohort study. Multivariate modelling was used to investigate the associations between measures related to the caregiver's perception of the caregiving experience (caregiving stress, perceived social restrictions, caregiving competence, positive aspects of caregiving, and coping) and the self-ratings of QoL, satisfaction with life, and well-being by the person with dementia.Results: Lower QoL ratings by the person with dementia were associated with high caregiver stress (-1.98; 95% CI: -2.89, -1.07), high perceived social restrictions (-2.04; 95% CI: -2.94, -1.14) and low caregiving competence (-2.01; 95% CI: -2.95, -1.06). Similar associations were found for satisfaction with life and wellbeing. Positive aspects of caregiving and coping were not associated with outcomes for the person with dementia.Conclusion: The findings indicate that how the caregiver experiences caregiving can affect the person with dementia. This finding reinforces the importance of providing support to caregivers.
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Affiliation(s)
- Catherine Quinn
- Centre of Applied Dementia Studies, University of Bradford, Bradford, UK.,REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School and College of Life and Environmental Sciences, Exeter, UK
| | - Sharon M Nelis
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School and College of Life and Environmental Sciences, Exeter, UK
| | - Anthony Martyr
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School and College of Life and Environmental Sciences, Exeter, UK
| | - Robin G Morris
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Christina Victor
- Department of Clinical Sciences, College of Health and Life Sciences, Brunel University London, London, UK
| | - Linda Clare
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School and College of Life and Environmental Sciences, Exeter, UK
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15
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Leidi-Maimone B, Notter-Bielser ML, Laouadi MH, Perrin S, Métraux H, Damian D, Chavan CF, Nsir M, Cibelli G, Tâche MJ, Montandon ML, Ghika J, Démonet JF, Dürst AV, Guevara AB. How non-drug interventions affect the quality of life of patients suffering from progressive cognitive decline and their main caregiver. Aging (Albany NY) 2020; 12:10754-10771. [PMID: 32516129 PMCID: PMC7346059 DOI: 10.18632/aging.103291] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 04/27/2020] [Indexed: 11/25/2022]
Abstract
Background: In the absence of cure for age-related neurodegenerative diseases, non-drug interventions (NDIs) represent useful options. Quality of life (QOL) is a multidimensional concept progressively affected by cognitive decline. How single or multiple NDIs impact QOL is unknown. Results: We found no significant effect of multiple over single NDI on QOL. Socio-demographic variables influenced patients’ (age, gender, caregivers’ occupational status, management of patients’ financial affairs) and caregivers’ (gender, occupational status, patients’ severity of cognitive decline) QOL. When dyads interrupted interventions after 6 months, their QOL was lower and caregivers’ anxiety, depression and physical symptoms were higher at the end of the study. Conclusions: While the type and number of interventions do not appear to be critical, the continuity of adapted interventions in the long-term might be important for maintaining QOL of patients and caregivers. Methods: This is a multicenter (7 Swiss Memory Clinics), quasi-experimental, one-year follow-up study including 148 subjects (mild cognitive impairment or mild dementia patients and their caregivers). Primary outcome was the effect of multiple vs single NDIs on QOL. Secondary outcome included NDIs effect on patients’ cognitive impairment and functional autonomy, caregivers’ burden, severity of patients’ neuropsychiatric symptoms and dyads’ anxiety and depression.
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Affiliation(s)
| | | | - Marie-Hélène Laouadi
- Leenaards Memory Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Sarah Perrin
- Leenaards Memory Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Service of Old Age Psychiatry, Department of Psychiatry (SUPAA), Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Hélène Métraux
- Vaud Association for Help and Home Care (AVASAD, Association Vaudoise d'Aide et de Soins à Domicile), Lausanne, Switzerland
| | - Daniel Damian
- Leenaards Memory Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Camille F Chavan
- Memory Center of the Neuropsychology and Aphasiology Unit, Fribourg Hospital (HFR), Fribourg, Switzerland
| | - Mélanie Nsir
- Nord Broye Memory Center, Montagny-près-Yverdon, Switzerland
| | | | | | - Marie-Louise Montandon
- Memory Center of the Geneva University Hospitals (HUG), Geneva, Switzerland.,CU ROMENS, Switzerland
| | - Joseph Ghika
- Valais Hospital Memory Center, Sierre, Switzerland
| | - Jean-François Démonet
- Leenaards Memory Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,CU ROMENS, Switzerland
| | - Anne-Véronique Dürst
- Service of Geriatric Medicine and Geriatric Rehabilitation, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Andrea Brioschi Guevara
- Leenaards Memory Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,CU ROMENS, Switzerland
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16
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Cognitive and neuropsychological examination of the elderly. HANDBOOK OF CLINICAL NEUROLOGY 2020. [PMID: 31753159 DOI: 10.1016/b978-0-12-804766-8.00006-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
Neuropsychological assessment plays a prominent role in the evaluation and care of patients with neurodegenerative diseases throughout the dynamic course of disease. As a biomarker of disease, neuropsychological measurement can distinguish normal from pathologic aging processes. Further, neuropsychological data can help distinguish and classify underlying pathologies in dementing diseases, augmenting imaging and biofluid markers in this area. Neuropsychological data can predict increased or reduced risk for dementia conferred by multiple factors, and describe disease trajectory in affected individuals. Cognitive evaluation can also estimate and address functional outcomes that are most important to patients and their loved ones and that are clinically relevant to diagnostic staging. In informing intervention and patient care needs, areas of cognitive weakness highlight targets for support/intervention, while areas of cognitive strength can be capitalized upon to modify the clinical course of disease. These functions can be accomplished through the complementary use of brief screening tools and comprehensive test batteries. However, for neuropsychological data to serve these functions, it is critical to understand neuropsychological test properties and nondisease factors that can account for variance in test performance. This chapter concludes with directions for future research.
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17
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Mengelers AMHJ, Bleijlevens MHC, Verbeek H, Moermans VRA, Capezuti E, Hamers JPH. Prevention and reduction of involuntary treatment at home: A feasibility study of the PRITAH intervention. Geriatr Nurs 2020; 41:536-543. [PMID: 32139030 DOI: 10.1016/j.gerinurse.2020.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 02/12/2020] [Accepted: 02/13/2020] [Indexed: 10/24/2022]
Abstract
Sometimes care is provided to a cognitively impaired person against the person's will, referred to as involuntary treatment. We developed the PRITAH intervention, aimed at prevention and reduction of involuntary treatment at home. PRITAH consists of a policy discouraging involuntary treatment, workshops, coaching by a specialized nurse and alternative interventions. A feasibility study was conducted including 30 professional caregivers. Feasibility was assessed by attendance lists (reach), a logbook (dose delivered and fidelity), evaluation questionnaires and focus group interviews (dose received, satisfaction & barriers). The workshops and coach were positively evaluated and the average attendance rate was 73%. Participants gained more awareness and knowledge and received practical tips and advice to prevent involuntary treatment. Implementation of the intervention was feasible with minor deviations from protocol. Recommendations for improvement included more emphasis on involvement of family caregivers and general practitioners and development of an extensive guideline to comply with the policy.
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Affiliation(s)
- Angela M H J Mengelers
- Department of Health Services Research, CAPHRI, Maastricht University, Maastricht, the Netherlands.
| | - Michel H C Bleijlevens
- Department of Health Services Research, CAPHRI, Maastricht University, Maastricht, the Netherlands.
| | - Hilde Verbeek
- Department of Health Services Research, CAPHRI, Maastricht University, Maastricht, the Netherlands.
| | - Vincent R A Moermans
- Department of Health Services Research, CAPHRI, Maastricht University, Maastricht, the Netherlands; Department of Nursing, White Yellow Cross Limburg, Genk, Belgium.
| | - Elizabeth Capezuti
- Hunter College and the Graduate Center of City University of New York, New York, United States.
| | - Jan P H Hamers
- Department of Health Services Research, CAPHRI, Maastricht University, Maastricht, the Netherlands.
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18
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Yang Z, Fu Y. Physical Attributes of Housing and Elderly Health: A New Dynamic Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4961. [PMID: 31817683 PMCID: PMC6950626 DOI: 10.3390/ijerph16244961] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 11/24/2019] [Accepted: 12/04/2019] [Indexed: 11/24/2022]
Abstract
Maintaining health and improving the quality of life of the elderly is extremely challenging in an aging society. In this study, the relationship between housing and the independence and functional capabilities of the elderly is examined, and the effect of housing conditions on health improvements and their economic benefits for the elderly in terms of medical expenditures are assessed. The study is based on the Chinese Health and Retirement Longitudinal Study (CHARLS), which was conducted in 2011 and 2013. Two indices that measure housing conditions and the health status of the elderly were run through regression and state-transition models. Housing was found to have a positive relationship with the health of the elderly, and the improvement of housing conditions could significantly change health status and decrease medical expenditures. The importance of maintaining the health of the elderly through housing adaptations and the economic benefits of housing interventions are highlighted, as these can contribute to both public health and housing adaption subsidy policies.
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Affiliation(s)
- Zan Yang
- Hang Lung Center for Real Estate, Department of Construction Management, Tsinghua University, Beijing 100084, China;
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19
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Unmet needs in community-living persons with dementia are common, often non-medical and related to patient and caregiver characteristics. Int Psychogeriatr 2019; 31:1643-1654. [PMID: 30714564 PMCID: PMC6679825 DOI: 10.1017/s1041610218002296] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Understanding which characteristics of persons with dementia (PWD) and their caregivers are associated with unmet needs can inform strategies to address those needs. Our purpose was to determine the percentage of PWD having unmet needs and significant correlates of unmet needs in PWD. DESIGN Cross-sectional data were analyzed using bivariate and hierarchical multiple linear regression analyses. SETTING Participants lived in the greater Baltimore, Maryland and Washington DC suburban area. PARTICIPANTS A sample of 646 community-living PWD and their informal caregivers participated in an in-home assessment of dementia-related needs. MEASUREMENTS Unmet needs were identified using the Johns Hopkins Dementia Care Needs Assessment. Correlates of unmet needs were determined using demographic, socioeconomic, clinical, functional and quality of life characteristics of the PWD and their caregivers. RESULTS PWD had a mean of 10.6 (±4.8) unmet needs out of 43 items (24.8%). Unmet needs were most common in Home/Personal Safety (97.4%), General Health Care (83.1%), and Daily Activities (73.2%) domains. Higher unmet needs were significantly related to non-white race, lower education, higher cognitive function, more neuropsychiatric symptoms, lower quality of life in PWD, and having caregivers with lower education or who spent fewer hours/week with the PWD. CONCLUSIONS Unmet needs are common in community-living PWD, and most are non-medical. Home-based dementia care can identify and address PWD's unmet needs by focusing on care recipients and caregivers to enable PWD to remain safely at home.
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20
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Larochette C, Wawrziczny E, Papo D, Pasquier F, Antoine P. An acceptance, role transition, and couple dynamics-based program for caregivers: A qualitative study of the experience of spouses of persons with young-onset dementia. DEMENTIA 2019; 19:2714-2731. [DOI: 10.1177/1471301219854643] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective In this study, we assessed a support program based on acceptance, role transition, and couple dynamics for spouses of people with young-onset dementia. The qualitative feedback from the caregivers’ experience is analyzed. The goal was to explore how this home-based support program is perceived and to appraise the impact of the different approaches that were offered. Design A thematic analysis was conducted on the answers to the end-of-session questionnaires and the follow-up semistructured interviews. Results Five themes emerged from the analyses. They highlighted caregivers’ ability to overcome their emotional struggle as well as the control of their loved one’s behaviors. The results also showed the possibility for caregivers to access new ways to support their loved ones and to maintain the quality of their relationship. Conclusion These findings represent preliminary evidence of this program’s efficacy for caregivers.
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Affiliation(s)
| | | | - David Papo
- Laboratory SCALab UMR CNRS 9193, University of Lille, France; Labex Distalz—Development of Innovative Strategies for a Transdisciplinary approach to ALZheimer’s disease, France
| | | | - Pascal Antoine
- Laboratory SCALab UMR CNRS 9193, University of Lille, France; Labex Distalz—Development of Innovative Strategies for a Transdisciplinary approach to ALZheimer’s disease, France
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21
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Holle D, Müller-Widmer R, Reuther S, Rosier-Segschneider U, Graf R, Roes M, Halek M. Process evaluation of the context, reach and recruitment of participants and delivery of dementia-specific case conferences (WELCOME-IdA) in nursing homes (FallDem): a mixed-methods study. Trials 2019; 20:45. [PMID: 30642387 PMCID: PMC6332590 DOI: 10.1186/s13063-018-3147-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 12/17/2018] [Indexed: 11/10/2022] Open
Abstract
Background A system of dementia-specific case conferences (WELCOME-IdA) was evaluated using a stepped-wedge design in six nursing homes (NHs) to enable nursing staff to analyse properly the behavioural and psychological symptoms (BPSD) of residents with dementia. A process evaluation of the context, the recruitment and target populations reached (residents and nursing staff) and the delivery of the intervention and implementation strategy was carried out to explore the lack of effectiveness of WELCOME-IdA on the residents’ prevalence of BPSD. Methods This study was part of a larger process evaluation using a mixed-methods design. Standardised questionnaires, semi-structured interviews, attendance lists, standardised protocols and written self-reports were used to collect the data. The quantitative data were analysed by calculating descriptive statistics. The qualitative interviews were analysed using deductive content analysis and the self-reports were analysed using a documentary analysis. Results None of the NHs had prior experience with dementia-specific case conferences on a specific concept related to BPSD. The number of residents for whom a dementia-specific case conference was held was lower than expected. The number of nursing staff reached was high, although as defined in the study protocol, core nursing teams continuously participating in all components of the intervention were not established throughout the study. An analysis of the delivery of the intervention showed a reduction in the frequency of dementia-specific case conferences and deviations in the process structure and role structure of WELCOME-IdA. The strategy used to facilitate the implementation of WELCOME-IdA was mostly followed. An analysis of the recruitment of residents indicated that the variation in which residents were included in the study sample was high and that the intended sample size required to achieve a power >80% was not reached. Conclusion An analysis of the process evaluation data indicated that there were inaccuracies in the implementation of WELCOME-IdA and there were methodological limitations within the design of the effectiveness trial, both of which could explain the lack of effectiveness of WELCOME-IdA. To optimise the process structure of WELCOME-IdA, an assessment of BPSD and a pre-selection of possible domains for the behavioural analysis could be conducted prior to a dementia-specific case conference. Trial registration ISRCTN20203855. Registered on 10 July 2013.
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Affiliation(s)
- Daniela Holle
- German Center for Neurodegenerative Diseases (DZNE), Stockumer Str. 12, 58453, Witten, Germany. .,Faculty of Health, University of Witten/Herdecke, Alfred-Herrhausen-Straße 50, 58455, Witten, Germany.
| | - Rene Müller-Widmer
- German Center for Neurodegenerative Diseases (DZNE), Stockumer Str. 12, 58453, Witten, Germany.,Faculty of Health, University of Witten/Herdecke, Alfred-Herrhausen-Straße 50, 58455, Witten, Germany
| | - Sven Reuther
- German Center for Neurodegenerative Diseases (DZNE), Stockumer Str. 12, 58453, Witten, Germany.,Faculty of Health, University of Witten/Herdecke, Alfred-Herrhausen-Straße 50, 58455, Witten, Germany
| | - Ute Rosier-Segschneider
- German Center for Neurodegenerative Diseases (DZNE), Stockumer Str. 12, 58453, Witten, Germany.,Faculty of Health, University of Witten/Herdecke, Alfred-Herrhausen-Straße 50, 58455, Witten, Germany
| | - Rabea Graf
- German Center for Neurodegenerative Diseases (DZNE), Stockumer Str. 12, 58453, Witten, Germany
| | - Martina Roes
- German Center for Neurodegenerative Diseases (DZNE), Stockumer Str. 12, 58453, Witten, Germany.,Faculty of Health, University of Witten/Herdecke, Alfred-Herrhausen-Straße 50, 58455, Witten, Germany
| | - Margareta Halek
- German Center for Neurodegenerative Diseases (DZNE), Stockumer Str. 12, 58453, Witten, Germany.,Faculty of Health, University of Witten/Herdecke, Alfred-Herrhausen-Straße 50, 58455, Witten, Germany
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22
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Blanchet R, Edwards N. A need to improve the assessment of environmental hazards for falls on stairs and in bathrooms: results of a scoping review. BMC Geriatr 2018; 18:272. [PMID: 30413144 PMCID: PMC6234792 DOI: 10.1186/s12877-018-0958-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 10/19/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Falls occurring on stairs or in bathrooms are associated with a high risk of injuries among older adults. Home environmental assessments are frequently used to guide fall-prevention interventions. The aims of this review were to describe how, where, by whom, and for whom environmental hazard checklists are used, and to examine the characteristics of environmental hazard assessment checklists with specific attention to features of bathrooms and stairs/steps assessed in them. METHODS Studies published before January 5, 2018, were identified using several databases. Publications reporting the use and/or evaluation of environmental hazard checklists were eligible if they assessed bathrooms or stairs/steps in homes of older adults (≥65 years). Content analysis was conducted on publications that provided a complete list of specific environmental hazards assessed. Checklist items related to bathrooms and stairs/steps were extracted and categorized as structural or non-structural and as objective or subjective. RESULTS 1119 studies were appraised. A pool of 136 published articles and 4 checklists from the grey literature were included in this scoping review. Content analysis was conducted on 42 unique checklists. There was no widely used checklist and no obvious consensus definition of either environmental hazards overall or of single hazards listed in checklists. Checklists varied greatly with respect to what rooms were assessed, whether or not outdoor stair/steps hazards were assessed, and how responses were coded. Few checklists examined person-environment fit. The majority of checklists were not oriented towards structural hazards in bathrooms. Although the majority of checklists assessing stair/steps hazards evaluated structural hazards, most features assessed were not related to the construction geometry of stairs/steps. Objective features of bathrooms and stairs/steps that would deem them safe were rarely specified. Rather, adequacy of their characteristics was mostly subjectively determined by the evaluator with little or no guidance or training. CONCLUSION The lack of standard definitions and objective criteria for assessing environmental hazards for falls is limiting meaningful cross-study comparisons and slowing advances in this field. To inform population health interventions aimed at preventing falls, such as building code regulations or municipal housing by-laws, it is essential to include objectively-assessed structural hazards in environmental checklists.
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Affiliation(s)
- Rosanne Blanchet
- School of Nursing, University of Ottawa, 1 Stewart Street, Room 212, Ottawa, ON K1H 8M5 Canada
| | - Nancy Edwards
- School of Nursing, University of Ottawa, 1 Stewart Street, Room 205, Ottawa, ON K1H 8M5 Canada
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23
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Holle D, Halek M, Holle B, Pinkert C. Individualized formulation-led interventions for analyzing and managing challenging behavior of people with dementia - an integrative review. Aging Ment Health 2017; 21:1229-1247. [PMID: 27809556 DOI: 10.1080/13607863.2016.1247429] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Individualized formulation-led interventions offer a promising approach for analyzing and managing challenging behaviors in people with dementia. Little is known about which individualized formulation-led interventions exist and what effects these interventions have on people with dementia and their caregivers. Therefore, the review aims to describe and examine existing interventions and to review their evidence. METHODS An integrative review of individualized formulation-led interventions for managing challenging behavior in people with dementia was conducted. PUBMED, PsycINFO [EBSCO] and CINAHL [EBSCO] databases were searched between February and April 2014 using key terms related to dementia, challenging behavior and individualized formulation- led interventions. The literature search was limited to German and English publications published from 1995. No limitations were placed on the type of paper, type of study design and stage of disease or setting. 37 relevant papers that met the inclusion criteria were included in this review. RESULTS The literature review provided 14 different individualized formulation-led interventions. The effects on people with dementia were diverse, as only half of the studies showed a significant reduction in behaviors compared with the control group. Family caregivers felt less upset about the challenging behavior and more confident in their ability to manage the behavior. CONCLUSION There is a clear need for further research on individualized formulation-led interventions. The results of this review have the potential for developing interventions and for designing methodological robust evaluation studies that take into account the effectiveness of individualized formulation-led interventions on patient and caregiver outcomes.
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Affiliation(s)
- Daniela Holle
- a German Center for Neurodegenerative Diseases (DZNE) , Witten , Germany.,b School of Nursing Science , Witten/ Herdecke University , Witten , Germany
| | - Margareta Halek
- a German Center for Neurodegenerative Diseases (DZNE) , Witten , Germany.,b School of Nursing Science , Witten/ Herdecke University , Witten , Germany
| | - Bernhard Holle
- a German Center for Neurodegenerative Diseases (DZNE) , Witten , Germany.,b School of Nursing Science , Witten/ Herdecke University , Witten , Germany
| | - Christiane Pinkert
- a German Center for Neurodegenerative Diseases (DZNE) , Witten , Germany
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24
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Samus QM, Black BS, Bovenkamp D, Buckley M, Callahan C, Davis K, Gitlin LN, Hodgson N, Johnston D, Kales HC, Karel M, Kenney JJ, Ling SM, Panchal M, Reuland M, Willink A, Lyketsos CG. Home is where the future is: The BrightFocus Foundation consensus panel on dementia care. Alzheimers Dement 2017; 14:104-114. [PMID: 29161539 DOI: 10.1016/j.jalz.2017.10.006] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 10/13/2017] [Accepted: 10/15/2017] [Indexed: 02/07/2023]
Abstract
INTRODUCTION A national consensus panel was convened to develop recommendations on future directions for home-based dementia care (HBDC). METHODS The panel summarized advantages and challenges of shifting to HBDC as the nexus of care and developed consensus-based recommendations. RESULTS The panel developed five core recommendations: (1) HBDC should be considered the nexus of new dementia models, from diagnosis to end of life in dementia; (2) new payment models are needed to support HBDC and reward integration of care; (3) a diverse new workforce that spans the care continuum should be prepared urgently; (4) new technologies to promote communication, monitoring/safety, and symptoms management must be tested, integrated, and deployed; and (5) targeted dissemination efforts for HBDC must be employed. DISCUSSION HBDC represents a promising paradigm shift to improve care for those living with dementia and their family caregivers: these recommendations provide a framework to chart a course forward for HBDC.
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Affiliation(s)
- Quincy M Samus
- Department of Psychiatry, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
| | - Betty Smith Black
- Department of Psychiatry, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | | | | | - Christopher Callahan
- Department of Medicine, Indiana University School of Medicine, Center for Aging Research, Indianapolis, IN, USA
| | - Karen Davis
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Laura N Gitlin
- Department of Community Public Health, Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Nancy Hodgson
- Department of Gerontology, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Deirdre Johnston
- Department of Psychiatry, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Helen C Kales
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA; Department of Veterans Affairs, HSR&D Center for Clinical Management Research, Washington, DC, USA
| | - Michele Karel
- Veterans Administration Central Office, Washington, DC, USA
| | - John Jay Kenney
- Aging & Disability Services, Montgomery Department of Health & Human Services, Rockville, MD, USA
| | - Shari M Ling
- Center for Clinical Standards and Quality, Centers for Medicare and Medicaid Services, Baltimore, MD, USA
| | - Maï Panchal
- Fondation Vaincre Alzheimer, Paris, France; Alzheimer Forschung Initiative, Düsseldorf, Germany; Alzheimer Nederland, Amersfoort, Amersfoort, The Netherlands
| | - Melissa Reuland
- Department of Psychiatry, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Amber Willink
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Constantine G Lyketsos
- Department of Psychiatry, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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Armstrong NM, Gitlin LN, Parisi JM, Carlson MC, Rebok GW, Gross AL. E pluribus unum: Harmonization of physical functioning across intervention studies of middle-aged and older adults. PLoS One 2017; 12:e0181746. [PMID: 28753644 PMCID: PMC5533461 DOI: 10.1371/journal.pone.0181746] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 07/06/2017] [Indexed: 11/23/2022] Open
Abstract
Common scales for physical functioning are not directly comparable without harmonization techniques, complicating attempts to pool data across studies. Our aim was to provide a standardized metric for physical functioning in adults based on basic and instrumental activities of daily living scaled to NIH PROMIS norms. We provide an item bank to compare the difficulty of various physical functioning activities. We used item response theory methods to place 232 basic and instrumental activities of daily living questions, administered across eight intervention studies of middle-aged and older adults (N = 2,556), on a common metric. We compared the scale’s precision to an average z-score of items and evaluated criterion validity based on objective measures of physical functioning and Fried’s frailty criteria. Model-estimated item thresholds were widely distributed across the range of physical functioning. From test information plots, the lowest precision in each dataset was 0.80. Using power calculations, the sample size needed to detect 25% physical functional decline with 80% power based on the physical functioning factor was less than half of what would be needed using an average z-score. The physical functioning factor correlated in expected directions with objective measurements from the Timed Up and Go task, tandem balance, gait speed, chair stands, grip strength, and frailty status. Item-level harmonization enables direct comparison of physical functioning measures across existing and potentially future studies and across levels of function using a nationally representative metric. We identified key thresholds of physical functioning items in an item bank to facilitate clinical and epidemiologic decision-making.
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Affiliation(s)
- Nicole M Armstrong
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.,Johns Hopkins University Center on Aging and Health, Baltimore, Maryland, United States of America
| | - Laura N Gitlin
- Division of Geriatrics and Gerontology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America.,Center for Innovative Care in Aging, Johns Hopkins School of Nursing, Baltimore, Maryland, United States of America
| | - Jeanine M Parisi
- Center for Innovative Care in Aging, Johns Hopkins School of Nursing, Baltimore, Maryland, United States of America.,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Michelle C Carlson
- Johns Hopkins University Center on Aging and Health, Baltimore, Maryland, United States of America.,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - George W Rebok
- Johns Hopkins University Center on Aging and Health, Baltimore, Maryland, United States of America.,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Alden L Gross
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.,Johns Hopkins University Center on Aging and Health, Baltimore, Maryland, United States of America
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26
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Piersol CV, Herge EA, Copolillo AE, Leiby BE, Gitlin LN. Psychometric Properties of the Functional Capacity Card Sort for Caregivers of People With Dementia. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2016; 36:126-33. [DOI: 10.1177/1539449216666063] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Caregiver appraisal influences care decisions and may place the person with dementia at risk. The Functional Capacity Card Sort (FCCS) was developed to determine caregiver appraisal. The objective of this study was to examine FCCS psychometric properties and utility, using data from a cross-sectional study ( N = 86). The FCCS had moderately positive association (convergent validity) with a related activities of daily living (ADL) index ( r = .43, p < .0001), weak negative association (discriminant validity) with an unrelated neuropsychiatric symptom index ( r = −.14, p = .16), and strong caregiver agreement (interrater reliability) in ranking cards from high to low function, Kendall’s W(5, 72) = 0.83, p = .0001. When compared with occupational therapy assessment, the FCCS distinguished caregiver concordant estimation (17%), underestimation (22%), and overestimation (61%) of function. The FCCS is a valid and reliable tool used in conjunction with formal assessment to identify caregiver over- or underestimation, which has implications for patient safety and caregiver education.
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Affiliation(s)
- Catherine Verrier Piersol
- Department of Occupational Therapy, Jefferson College of Health Professions, Thomas Jefferson University, Philadelphia, PA, USA
| | - E. Adel Herge
- Department of Occupational Therapy, Jefferson College of Health Professions, Thomas Jefferson University, Philadelphia, PA, USA
| | - Albert E. Copolillo
- Department of Occupational Therapy, School of Allied Health Professions, Virginia Commonwealth University, Richmond, VA, USA
| | - Benjamin E. Leiby
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Laura N. Gitlin
- Center for Innovative Care in Aging, School of Nursing, Johns Hopkins University, Baltimore, MD, USA
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27
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Cho HY, MacLachlan M, Clarke M, Mannan H. Accessible Home Environments for People with Functional Limitations: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:E826. [PMID: 27548194 PMCID: PMC4997512 DOI: 10.3390/ijerph13080826] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 08/05/2016] [Accepted: 08/09/2016] [Indexed: 11/17/2022]
Abstract
The aim of this review is to evaluate the health and social effects of accessible home environments for people with functional limitations, in order to provide evidence to promote well-informed decision making for policy guideline development and choices about public health interventions. MEDLINE and nine other electronic databases were searched between December 2014 and January 2015, for articles published since 2004. All study types were included in this review. Two reviewers independently screened 12,544 record titles or titles and abstracts based on our pre-defined eligibility criteria. We identified 94 articles as potentially eligible; and assessed their full text. Included studies were critically appraised using the Mixed Method Appraisal Tool, version 2011. Fourteen studies were included in the review. We did not identify any meta-analysis or systematic review directly relevant to the question for this systematic review. A narrative approach was used to synthesise the findings of the included studies due to methodological and statistical heterogeneity. Results suggest that certain interventions to enhance the accessibility of homes can have positive health and social effects. Home environments that lack accessibility modifications appropriate to the needs of their users are likely to result in people with physical impairments becoming disabled at home.
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Affiliation(s)
- Hea Young Cho
- Centre for Global Health, Trinity College Dublin, 7-9 Leinster Street South, Dublin 2, Ireland.
- School of Psychology, Trinity College Dublin, College Green, Dublin 2, Ireland.
| | - Malcolm MacLachlan
- Centre for Global Health, Trinity College Dublin, 7-9 Leinster Street South, Dublin 2, Ireland.
- School of Psychology, Trinity College Dublin, College Green, Dublin 2, Ireland.
- Centre for Rehabilitation Studies, Stellenbosch University, Private Bag X1, Matieland, Stellenbosch 7602, South Africa.
- Olomouc University Social Health Institute, Palacky University Olomouc, Olomouc 77111, Czech Republic.
| | - Michael Clarke
- Northern Ireland Network for Trials Methodology Research, Centre for Public Health, Queen's University Belfast, Belfast BT126BA, UK.
| | - Hasheem Mannan
- School of Nursing, Midwifery & Health Systems, University College Dublin, Belfield, Dublin 4, Ireland.
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28
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Naylor MD, Hirschman KB, Hanlon AL, Abbott KM, Bowles KH, Foust J, Shah S, Zubritsky C. Factors Associated With Changes in Perceived Quality of Life Among Elderly Recipients of Long-Term Services and Supports. J Am Med Dir Assoc 2015; 17:44-52. [PMID: 26412018 DOI: 10.1016/j.jamda.2015.07.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 07/29/2015] [Accepted: 07/31/2015] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Advance knowledge about changes in multiple dimensions of health related quality of life (HRQoL) among older adults receiving long-term services and supports (LTSS) over time and across settings. DESIGN A prospective, observational, longitudinal cohort design. SETTING Nursing homes (NHs), assisted living facilities (ALFs), community. PARTICIPANTS A total of 470 older adults who were first-time recipients of LTSS. MEASUREMENT Single-item quality-of-life measure assessed every 3 months over 2 years. HRQoL domains of emotional status, functional status, and social support were measured using standardized instruments. RESULTS Multivariable mixed effects model with time varying covariates revealed that quality-of-life ratings decreased over time (P < .001). Quality-of-life ratings were higher among enrollees with fewer depressive symptoms (P < .001), higher general physical function (P < .001), enhanced emotional well-being (P < .001), and greater social support (P = .004). Ratings also were higher among those with increased deficits in activities of daily living (P = .02). Ratings were highest among enrollees who received LTSS from ALFs, followed by NHs, then home and community-based services (H&CBS), but only findings between ALFs and H&CBS were statistically significant (P < .001). Finally, ratings tended to decrease over time among enrollees with greater cognitive impairment and increase over time among enrollees with less cognitive impairment (P < .001). CONCLUSIONS Findings advance knowledge regarding what is arguably the most important outcome of elderly LTSS recipients: quality of life. Understanding associations between multiple HRQoL domains and quality of life over time and directly from LTSS recipients represents a critical step in enhancing care processes and outcomes of this vulnerable population.
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Affiliation(s)
- Mary D Naylor
- NewCourtland Center for Transitions and Health; University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania.
| | - Karen B Hirschman
- NewCourtland Center for Transitions and Health; University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | - Alexandra L Hanlon
- NewCourtland Center for Transitions and Health; University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | - Katherine M Abbott
- Miami University, Department of Sociology and Gerontology, Scripps Research Center, Oxford, OH
| | - Kathryn H Bowles
- NewCourtland Center for Transitions and Health; University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | - Janice Foust
- College of Nursing and Health Sciences, University of Massachusetts - Boston, Boston, MA
| | - Shivani Shah
- Center for Home Care Policy and Research, Visiting Nurse Service of New York, New York, NY
| | - Cynthia Zubritsky
- University of Pennsylvania School of Medicine, Department of Psychiatry, Philadelphia, PA
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29
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Gomez-Gallego M, Gomez-Garcia J, Ato-Lozano E. Addressing the bias problem in the assessment of the quality of life of patients with dementia: determinants of the accuracy and precision of the proxy ratings. J Nutr Health Aging 2015; 19:365-72. [PMID: 25732223 DOI: 10.1007/s12603-014-0564-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES We aimed to examine the discrepancy between patients and caregivers' ratings of quality of life in terms of accuracy and precision, and identify factors associated with it, in order to facilitate the use of this scale as dementia progresses. DESIGN Cross-sectional analytic study. SETTING Day care centres. PARTICIPANTS Community-living patients with Alzheimer's disease in early or moderate stage and their principal caregivers. MEASUREMENTS PARTICIPANTS rated patients' quality of life using DEMQOL. The discrepancy was assessed using the individual difference score and the residuals for each domain of DEMQOL. The scores on Mini-Mental State Examination, Geriatric Depression Scale, Neuropsychiatric Inventory, Clinical Insight Rating Scale, Cumulative Illness Rating Scale, Health Utilities Index Mark 3 and Zarit Burden Interview were considered as possible predictors of the discrepancy. RESULTS A total of 276 subjects participated in the study (138 patients with Alzheimer's disease and their caregivers). Discrepancy measured by individual difference score was lower than that measured by the residuals. Burden and mood-related symptoms explained the positive differences and residuals, while pain, self-perceived depression and cognition determined the negative ones. CONCLUSIONS Differences exist between patients and caregivers' perceptions about subjective states. The evaluations of each informant seem to be influenced by their own emotional state and the inner experience of the effects of the disease. Caregivers' ratings on DEMQOL could be useful to monitor the efficacy of any treatment whenever burden is low and patients have no great physical or emotional suffering.
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Affiliation(s)
- M Gomez-Gallego
- Maria Gomez-Gallego, Campus de Los Jerónimos, 30107 Murcia, Telephone: (+34) 968 27 88 00,
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Hodgson N, Gitlin LN, Huang J. The influence of sleep disruption and pain perception on indicators of quality of life in individuals living with dementia at home. Geriatr Nurs 2014; 35:394-8. [PMID: 25193739 PMCID: PMC4416487 DOI: 10.1016/j.gerinurse.2014.08.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This cross-sectional study evaluated the influence of sleep quality and pain perceptions on different dimensions of quality of life in community-dwelling persons with dementia. Evaluations of pain were collected using Visual Analog Scale (VAS), sleep disruption using Pittsburg Sleep Quality Index (PSQI) items, and quality of life indicators using the DemQOL-Proxy in 88 persons with dementia and their family caregivers. Lower overall quality of life was associated with the presence of pain and symptoms of sleep disruption when controlling for mental status, age, and number of health conditions. Pain and sleep symptoms were differentially associated with different aspects of QoL. As symptoms negatively impact quality of life but are modifiable, better clinical procedures are needed to prevent and also identify and treat symptoms of pain and sleep disturbance in community-dwelling persons with dementia.
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Affiliation(s)
- Nancy Hodgson
- Corresponding Author: Assistant Professor, Johns Hopkins University, School of Nursing, 525 Wolfe Street, Suite, 422 Baltimore, MD, 21205; voice 443-287-4503;
| | - Laura N. Gitlin
- Director, The Johns Hopkins University School of Nursing Center for Innovative Care in Aging, 525 Wolfe Street, Suite 316, Baltimore, MD, 21205; voice: 410-955-7539; Fax: 410-614-6873
| | - Jin Huang
- Biostatistician, Center on Aging and Health, Johns Hopkins University, School of Public Health 511 N. Washington Street, Baltimore, MD, 21205
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