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Zhu X, Chen S, He M, Dong Y, Fang S, Atigu Y, Sun J. Life experience and identity of spousal caregivers of people with dementia: A qualitative systematic review. Int J Nurs Stud 2024; 154:104757. [PMID: 38552470 DOI: 10.1016/j.ijnurstu.2024.104757] [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: 08/12/2023] [Revised: 03/07/2024] [Accepted: 03/11/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND The number of people with dementia is on the rise worldwide, and dementia care has become the focus of global health services. People with dementia are primarily cared for by informal caregivers, with spouses seen as a particularly vulnerable group. Focusing on the spousal caregiving experience and having a good caregiver identity contributes to group bonding and enhanced social support. OBJECTIVE To explore the dynamic changes that occur in the caregiving experience of spouse caregivers and explicate the identity of spouses during this process alongside its causes. DESIGN A qualitative systematic review. DATA SOURCE The following eight electronic databases were searched: PubMed, Web of Science (Core Collection), The Cochrane Library, Embase, CINAHL and CNKI, WanFang and Vip. REVIEW METHODS The Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) and Joanna Briggs Institute Reviewer's Manual criteria were used to report the results. Study screening and data extraction were conducted independently by two reviewers, and quality was assessed using the Joanna Briggs Institute's Qualitative Research Standard Assessment tool. Data synthesis was performed using thematic analysis. RESULTS A total of 15 studies were included and synthesized into three analytical themes: (1) attitudes and emotions toward dementia, (2) emotional ups and downs in dementia care, and (3) who am "I". In binary care, patience and marital responsibilities are identified as facilitators, while care burden and social isolation are identified as hindrances. In addition, gender differences were identified as influencers of identity. CONCLUSIONS In this review, spouse identity of people with dementia is complex and affects caregiving experience together with dementia cognition. Disease cognition, caregiving burden and social isolation are identified. Interventions for barriers are suggested to enhance social support.
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Affiliation(s)
- Xiangning Zhu
- School of Nursing, Jilin University, No.965 Xinjiang Street, Changchun 130021, Jilin, People's Republic of China
| | - Si Chen
- The First Bethune Hospital of Jilin University, No.126 Xinmin Street, Changchun 130021, Jilin, People's Republic of China
| | - Meng He
- School of Nursing, Jilin University, No.965 Xinjiang Street, Changchun 130021, Jilin, People's Republic of China
| | - Yueyang Dong
- School of Nursing, Jilin University, No.965 Xinjiang Street, Changchun 130021, Jilin, People's Republic of China
| | - Shuyan Fang
- School of Nursing, Jilin University, No.965 Xinjiang Street, Changchun 130021, Jilin, People's Republic of China
| | - Yiming Atigu
- School of Nursing, Jilin University, No.965 Xinjiang Street, Changchun 130021, Jilin, People's Republic of China
| | - Jiao Sun
- School of Nursing, Jilin University, No.965 Xinjiang Street, Changchun 130021, Jilin, People's Republic of China.
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2024 Alzheimer's disease facts and figures. Alzheimers Dement 2024; 20:3708-3821. [PMID: 38689398 PMCID: PMC11095490 DOI: 10.1002/alz.13809] [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: 05/02/2024]
Abstract
This article describes the public health impact of Alzheimer's disease (AD), including prevalence and incidence, mortality and morbidity, use and costs of care and the ramifications of AD for family caregivers, the dementia workforce and society. The Special Report discusses the larger health care system for older adults with cognitive issues, focusing on the role of caregivers and non-physician health care professionals. An estimated 6.9 million Americans age 65 and older are living with Alzheimer's dementia today. This number could grow to 13.8 million by 2060, barring the development of medical breakthroughs to prevent or cure AD. Official AD death certificates recorded 119,399 deaths from AD in 2021. In 2020 and 2021, when COVID-19 entered the ranks of the top ten causes of death, Alzheimer's was the seventh-leading cause of death in the United States. Official counts for more recent years are still being compiled. Alzheimer's remains the fifth-leading cause of death among Americans age 65 and older. Between 2000 and 2021, deaths from stroke, heart disease and HIV decreased, whereas reported deaths from AD increased more than 140%. More than 11 million family members and other unpaid caregivers provided an estimated 18.4 billion hours of care to people with Alzheimer's or other dementias in 2023. These figures reflect a decline in the number of caregivers compared with a decade earlier, as well as an increase in the amount of care provided by each remaining caregiver. Unpaid dementia caregiving was valued at $346.6 billion in 2023. Its costs, however, extend to unpaid caregivers' increased risk for emotional distress and negative mental and physical health outcomes. Members of the paid health care and broader community-based workforce are involved in diagnosing, treating and caring for people with dementia. However, the United States faces growing shortages across different segments of the dementia care workforce due to a combination of factors, including the absolute increase in the number of people living with dementia. Therefore, targeted programs and care delivery models will be needed to attract, better train and effectively deploy health care and community-based workers to provide dementia care. Average per-person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are almost three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 22 times as great. Total payments in 2024 for health care, long-term care and hospice services for people age 65 and older with dementia are estimated to be $360 billion. The Special Report investigates how caregivers of older adults with cognitive issues interact with the health care system and examines the role non-physician health care professionals play in facilitating clinical care and access to community-based services and supports. It includes surveys of caregivers and health care workers, focusing on their experiences, challenges, awareness and perceptions of dementia care navigation.
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Gimm G, Layman S, Inoue M, Ihara ES, Pantleay H, Tompkins CJ. Mason Caregivers Aiming for Resilience, Empowerment, and Support Study: Assessing Family Caregiver Burden Post-Intervention. J Appl Gerontol 2024:7334648241243173. [PMID: 38607327 DOI: 10.1177/07334648241243173] [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: 04/13/2024] Open
Abstract
Background: Family caregivers of older adults living with dementia are known to experience higher burden levels. Methods: This empirical study conducted a sub-group analysis of burden levels of 97 family caregivers by the dementia severity of care recipients. Family caregivers were assessed before and after the 9-week Stress-Busting Program for Family CaregiversTM (SBP). Results: Family caregivers of older adults living with severe dementia had the highest baseline Zarit Burden Interview (ZBI) score of 27.7 which decreased to 25.0 (p < .05); family caregivers of those living with moderate dementia had a baseline ZBI score of 24.3 which decreased to 20.4 (p < .01); and family caregivers of those living with mild dementia had the lowest baseline ZBI score of 21.0, which decreased to 18.0 (p < .01). Conclusion: The SBP intervention was associated with a 15% reduction in burden scores for family caregivers of older adults living with dementia.
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Affiliation(s)
- Gilbert Gimm
- Department of Health Administration and Policy, George Mason University, Fairfax, VA, USA
| | - Shannon Layman
- Department of Social Work, George Mason University, Fairfax, VA, USA
| | - Megumi Inoue
- Department of Social Work, George Mason University, Fairfax, VA, USA
| | - Emily S Ihara
- Department of Social Work, George Mason University, Fairfax, VA, USA
| | - Harveen Pantleay
- Department of Social Work, George Mason University, Fairfax, VA, USA
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Nandi A, Counts N, Bröker J, Malik S, Chen S, Han R, Klusty J, Seligman B, Tortorice D, Vigo D, Bloom DE. Cost of care for Alzheimer's disease and related dementias in the United States: 2016 to 2060. NPJ AGING 2024; 10:13. [PMID: 38331952 PMCID: PMC10853249 DOI: 10.1038/s41514-024-00136-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/09/2024] [Indexed: 02/10/2024]
Abstract
Medical and long-term care for Alzheimer's disease and related dementias (ADRDs) can impose a large economic burden on individuals and societies. We estimated the per capita cost of ADRDs care in the in the United States in 2016 and projected future aggregate care costs during 2020-2060. Based on a previously published methodology, we used U.S. Health and Retirement Survey (2010-2016) longitudinal data to estimate formal and informal care costs. In 2016, the estimated per patient cost of formal care was $28,078 (95% confidence interval [CI]: $25,893-$30,433), and informal care cost valued in terms of replacement cost and forgone wages was $36,667 ($34,025-$39,473) and $15,792 ($12,980-$18,713), respectively. Aggregate formal care cost and formal plus informal care cost using replacement cost and forgone wage methods were $196 billion (95% uncertainty range [UR]: $179-$213 billion), $450 billion ($424-$478 billion), and $305 billion ($278-$333 billion), respectively, in 2020. These were projected to increase to $1.4 trillion ($837 billion-$2.2 trillion), $3.3 trillion ($1.9-$5.1 trillion), and $2.2 trillion ($1.3-$3.5 trillion), respectively, in 2060.
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Affiliation(s)
- Arindam Nandi
- The Population Council, 1 Dag Hammarskjold Plaza, New York, NY, 10017, USA.
- One Health Trust, Washington, DC, USA.
| | - Nathaniel Counts
- Office of the Commissioner of Health & Mental Hygiene for the City of New York, New York, NY, USA
| | | | | | - Simiao Chen
- University of Heidelberg, Heidelberg, Germany
| | - Rachael Han
- Department of Molecular and Cellular Biology and The Center for Brain Science, Harvard University, Cambridge, MA, USA
| | | | - Benjamin Seligman
- Division of Geriatric Medicine, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Geriatrics Research, Education, and Clinical Center, Greater Los Angeles VA Health Care System, Los Angeles, CA, USA
| | | | - Daniel Vigo
- University of British Columbia, Vancouver, BC, V6T 1Z4, Canada
| | - David E Bloom
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Appel L, Appel E, Kisonas E, Lewis-Fung S, Pardini S, Rosenberg J, Appel J, Smith C. Evaluating the Impact of Virtual Reality on the Behavioral and Psychological Symptoms of Dementia and Quality of Life of Inpatients With Dementia in Acute Care: Randomized Controlled Trial (VRCT). J Med Internet Res 2024; 26:e51758. [PMID: 38289666 PMCID: PMC10865216 DOI: 10.2196/51758] [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: 08/11/2023] [Revised: 11/07/2023] [Accepted: 11/27/2023] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Virtual reality (VR) is increasingly considered a valuable therapeutic tool for people with dementia. However, rigorous studies are still needed to evaluate its impact on behavioral and psychological symptoms of dementia (BPSDs) and quality of life (QoL) across care settings. OBJECTIVE The primary aim of this study was to evaluate the impact of VR therapy on managing BPSDs, falls, length of stay, and QoL in inpatients with dementia admitted to an acute care hospital. The secondary aim was to evaluate the intervention's feasibility in terms of acceptability, safety, and patient experience. METHODS A prospective, open-label, mixed methods, randomized controlled clinical trial was conducted between April 2019 and March 2020. A total of 69 participants (aged ≥65 years with a diagnosis of dementia and who did not meet the exclusion criteria) were randomly assigned to either the control (n=35, 51%) or VR (n=34, 49%) arm. Participants in the experimental (VR) arm were visited by a researcher and watched 360° VR films on a head-mounted display for up to 20 minutes every 1 to 3 days, whereas individuals in the control arm received standard of care. Instances of daily BPSDs and falls were collected from nurses' daily notes. QoL was measured through semistructured interviews and the Quality of Life in Late-Stage Dementia scale. Structured observations and semistructured interviews were used to measure treatment feasibility. The primary outcomes were analyzed at a 95% significance level based on the intention-to-treat method. RESULTS VR therapy had a statistically significant effect on reducing aggressiveness (ie, physical aggression and loud vociferation; P=.01). Substantial impact of VR therapy was not found for other BPSDs (eg, apathy), falls, length of stay, or QoL as measured using the Quality of Life in Late-Stage Dementia scale. The average VR therapy session lasted 6.8 (SD 6.6; range 0-20) minutes, and the intervention was overall an acceptable and enjoyable experience for participants. No adverse events occurred as a result of VR therapy. CONCLUSIONS Immersive VR therapy appears to have an effect on aggressive behaviors in patients with dementia in acute care. Although the randomized controlled trial was stopped before reaching the intended sample size owing to COVID-19 restrictions, trends in the results are promising. We suggest conducting future trials with larger samples and, in some cases, more sensitive data collection instruments. TRIAL REGISTRATION ClinicalTrials.gov NCT03941119; https://clinicaltrials.gov/study/NCT03941119. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/22406.
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Affiliation(s)
- Lora Appel
- School of Health Policy and Management, Faculty of Health, York Universtiy, Toronto, ON, Canada
- OpenLab, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Michael Garron Hospital, Toronto, ON, Canada
| | - Eva Appel
- OpenLab, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Erika Kisonas
- OpenLab, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Samantha Lewis-Fung
- OpenLab, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | | | | | - Julian Appel
- Ted Rogers School of Management, Toronto Metropolitan University, Toronto, ON, Canada
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Mendoza-Jiménez MJ, van Exel J, Brouwer W. On spillovers in economic evaluations: definition, mapping review and research agenda. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2024:10.1007/s10198-023-01658-8. [PMID: 38261132 DOI: 10.1007/s10198-023-01658-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 12/05/2023] [Indexed: 01/24/2024]
Abstract
An important issue in economic evaluations is determining whether all relevant impacts are considered, given the perspective chosen for the analysis. Acknowledging that patients are not isolated individuals has important implications in this context. Increasingly, the term "spillovers" is used to label consequences of health interventions on others. However, a clear definition of spillovers is lacking, and as a result, the scope of the concept remains unclear. In this study, we aim to clarify the concept of spillovers by proposing a definition applicable in health economic evaluations. To illustrate the implications of this definition, we highlight the diversity of potential spillovers through an expanded impact inventory and conduct a mapping review that outlines the evidence base for the different types of spillovers. In the context of economic evaluations of health interventions, we define spillovers as all impacts from an intervention on all parties or entities other than the users of the intervention under evaluation. This definition encompasses a broader range of potential costs and effects, beyond informal caregivers and family members. The expanded impact inventory enables a systematic approach to identifying broader impacts of health interventions. The mapping review shows that the relevance of different types of spillovers is context-specific. Some spillovers are regularly included in economic evaluations, although not always recognised as such, while others are not. A consistent use of the term "spillovers", improved measurement of these costs and effects, and increased transparency in reporting them are still necessary. To that end, we propose a research agenda.
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Affiliation(s)
- María J Mendoza-Jiménez
- Erasmus School of Health Policy & Management (ESHPM), Erasmus University Rotterdam, Rotterdam, The Netherlands.
- Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, Rotterdam, The Netherlands.
- Facultad de Ciencias Sociales y Humanísticas, Escuela Superior Politécnica del Litoral (ESPOL), Guayaquil, Ecuador.
| | - Job van Exel
- Erasmus School of Health Policy & Management (ESHPM), Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Werner Brouwer
- Erasmus School of Health Policy & Management (ESHPM), Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, Rotterdam, The Netherlands
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Mage S, Benton D, Gonzalez A, Zaragoza G, Wilber K, Tucker-Seeley R, Meyer K. "I Lay Awake at Night": Latino Family Caregivers' Experiences Covering Out-of-Pocket Costs When Caring for Someone Living With Dementia. THE GERONTOLOGIST 2024; 64:gnad011. [PMID: 36786288 PMCID: PMC10733120 DOI: 10.1093/geront/gnad011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The financial burden of caregiving has received less research attention than physical and emotional costs. This is especially true for underserved ethnic minorities. Financial strain affects mental and physical health and is unequally distributed across caregivers of different races and ethnicities. Although caregivers overall spend, on average, one quarter of their income on caregiving, Latino caregivers, the focus of this study, spend nearly half. RESEARCH DESIGN AND METHODS To better understand this disparity, we conducted 11 qualitative interviews with 14 Latino caregivers of persons living with dementia located in either California or Texas. Interview transcripts were thematically coded, guided by a material-psychosocial-behavioral conceptual model of financial strain. RESULTS We identified 3 themes: daily needs and costs, psychological distress caused by financial issues, and stressful barriers to accessing family and societal support. Furthermore, interviews revealed how Latino culture may influence spending patterns and management of costs. Findings suggest that preference by Latino families to care for a family member in the home may be met with a financial disadvantage due to the high out-of-pocket costs of care. DISCUSSION AND IMPLICATIONS A better understanding of the factors contributing to high costs for Latino caregivers and how these costs affect caregivers will inform approaches at both the individual and policy levels and develop culturally relevant interventions to help Latino families to lower caregiving costs. This is especially important as the number of Latinos living with dementia is expected to increase over the next 4 decades and effective interventions are lacking.
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Affiliation(s)
- Susanna Mage
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
| | - Donna Benton
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
| | - Alexander Gonzalez
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
| | | | - Kate Wilber
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
| | - Reginald Tucker-Seeley
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
- ZERO—The End of Prostate Cancer, Alexandria, Virginia, USA
| | - Kylie Meyer
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
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Gaugler JE, Borson S, Epps F, Shih RA, Parker LJ, McGuire LC. The intersection of social determinants of health and family care of people living with Alzheimer's disease and related dementias: A public health opportunity. Alzheimers Dement 2023; 19:5837-5846. [PMID: 37698187 PMCID: PMC10840787 DOI: 10.1002/alz.13437] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 07/28/2023] [Accepted: 08/01/2023] [Indexed: 09/13/2023]
Abstract
In this Perspective article, we highlight current research to illustrate the intersection of social determinants of health (SDOHs) and Alzheimer's disease and related dementia (ADRD) caregiving. We then outline how public health can support ADRD family caregivers in the United States. Emerging research suggests that family care for persons with ADRD is influenced by SDOHs. Public health actions that address these intersections such as improved surveillance and identification of ADRD caregivers; building and enhancing community partnerships; advancing dementia-capable health care and related payment incentives; and reducing the stigma of dementia and ADRD caregiving can potentially enhance the health and well-being of dementia caregivers. By engaging in one or all of these actions, public health practitioners could more effectively address the myriad of challenges facing ADRD caregivers most at risk for emotional, social, financial, psychological, and health disruption.
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Affiliation(s)
- Joseph E. Gaugler
- Building Our Largest Dementia Infrastructure (BOLD) Public Health Center of Excellence on Dementia Caregiving, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Soo Borson
- BOLD Public Health Center of Excellence on Early Detection, NYU Grossman School of Medicine, New York, New York, USA
| | - Fayron Epps
- BOLD Public Health Center of Excellence on Dementia Caregiving, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Regina A. Shih
- BOLD Public Health Center of Excellence on Dementia Caregiving, RAND Social and Behavioral Policy Program, RAND Corporation, Santa Monica, California, USA
| | - Lauren J. Parker
- BOLD Public Health Center of Excellence on Dementia Caregiving, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Lisa C. McGuire
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Rossetto F, Isernia S, Realdon O, Borgnis F, Blasi V, Pagliari C, Cabinio M, Alberoni M, Mantovani F, Clerici M, Baglio F. A digital health home intervention for people within the Alzheimer's disease continuum: results from the Ability-TelerehABILITation pilot randomized controlled trial. Ann Med 2023; 55:1080-1091. [PMID: 36929703 PMCID: PMC10030155 DOI: 10.1080/07853890.2023.2185672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
PURPOSE This study tested the efficacy of digital-health home intervention for people within the Alzheimer's disease (AD)-continuum. METHODS Thirty people within the AD continuum were randomly assigned to a telerehabilitation (ABILITY; 6 males, Mage=78.2 ± 3.95) or treatment as usual (TAU; 8 males, Mage=77.13 ± 6.38), performing cognitive and physical activities at home for six weeks. The ABILITY intervention additionally included a digital platform enabling communication between the hospital and the patient's home. Efficiency, such as adherence, perceived fit of demands and skills, usability, and effectiveness measures, including neuropsychological level, neuropsychiatric symptoms, and autonomy in daily living, were collected before (T0), after the treatment (T1), and at the 1-year-follow-up (T2). RESULTS The ABILITY program was efficient, with a higher adherence (81% vs. 62%), a higher perceived fit of demands and skills than TAU (p<.05), and a good level of technology usability. In terms of effectiveness, a treatment effect (ABILITY > TAU) emerged on the global cognitive level, especially in language, executive functions, and memory domains. Moreover, a treatment carry-over effect (1-year follow-up) was observed in global cognitive functions (especially language) (ABILITY > TAU), behavioral symptoms, and caregiver distress (TAU > ABILITY). CONCLUSIONS Our preliminary findings suggest that ABILITY is a promising eHealth intervention to improve at-home treatment adherence and to preserve cognitive and behavioral abilities.
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Affiliation(s)
| | - Sara Isernia
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Olivia Realdon
- Department of Human Sciences for Education, Università degli Studi di Milano-Bicocca, Milan, Italy
| | | | - Valeria Blasi
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | | | - Monia Cabinio
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | | | - Fabrizia Mantovani
- Department of Human Sciences for Education, Università degli Studi di Milano-Bicocca, Milan, Italy
| | - Mario Clerici
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
- Department of Physiopathology and Transplants, Università degli Studi di Milano, Milan, Italy
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Goto Y, Morita K, Suematsu M, Imaizumi T, Suzuki Y. Caregiver Burdens, Health Risks, Coping and Interventions among Caregivers of Dementia Patients: A Review of the Literature. Intern Med 2023; 62:3277-3282. [PMID: 36858522 PMCID: PMC10713358 DOI: 10.2169/internalmedicine.0911-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 01/23/2023] [Indexed: 03/03/2023] Open
Abstract
Over 55 million people reportedly suffer from dementia worldwide. In Japan, it is estimated that 1 in 5 people over 65 years old will have dementia by 2025, of which more than 20% will live with symptoms that require home/nursing care. Given the lack of effective medical treatments for dementia, informal caregivers play essential roles in allowing dementia patients to live with dignity. Our review focusing on caregiver burden showed that this burden has not been sufficiently addressed, despite having negative effects on caregivers' health, employment, and finances. It is important to consider non-pharmacological interventions that contribute to effective coping strategies for mitigating the caregiver burden. Online communication tools may be a viable intervention measure to educate caregivers on the importance of sharing resilient coping strategies to reduce their stress so that they can continue to provide care for their loved ones.
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Affiliation(s)
- Yasuyuki Goto
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Japan
| | | | - Mina Suematsu
- Education for Community-Oriented Medicine, Nagoya University Graduate School of Medicine, Japan
| | | | - Yusuke Suzuki
- Centre for Community Liason & Patient Consultations, Nagoya University Hospital, Japan
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Agyemang-Duah W, Rosenberg MW. Healthcare utilization among informal caregivers of older adults in the Ashanti region of Ghana: a study based on the health belief model. Arch Public Health 2023; 81:187. [PMID: 37872631 PMCID: PMC10591341 DOI: 10.1186/s13690-023-01200-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 10/09/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Existing global evidence suggests that informal caregivers prioritize the health (care) of their care recipients (older adults) over their own health (care) resulting in sub-optimal health outcomes among this population group. However, data on what factors are associated with healthcare utilization among informal caregivers of older adults are not known in a sub-Saharan African context. Guided by the Health Belief Model (HBM), the principal objective of this study was to examine the association between the dimensions of the HBM and healthcare utilization among informal caregivers of older adults in the Ashanti Region of Ghana. METHODS Data were extracted from a large cross-sectional study of informal caregiving, health, and healthcare survey among caregivers of older adults aged 50 years or above (N = 1,853; mean age of caregivers = 39.15 years; and mean age of care recipients = 75.08 years) in the Ashanti Region of Ghana. Poisson regression models were used to estimate the association between the dimensions of the HBM and healthcare utilization among informal caregivers of older adults. Statistical significance of the test was set at a probability level of 0.05 or less. RESULTS The results showed that 72.9% (n = 1351) of the participants were females, 56.7% (n = 1051) were urban informal caregivers and 28.6% (n = 530) had no formal education. The results further showed that 49.4% (n = 916) of the participants utilized healthcare for their health problems at least once in the past year before the survey. The final analysis showed a positive and statistically significant association between perceived susceptibility to a health problem (β = 0.054, IRR = 1.056, 95% CI = [1.041-1.071]), cues to action (β = 0.076, IRR = 1.079, 95% CI = [1.044-1.114]), self-efficacy (β = 0.042, IRR = 1.043, 95% CI = [1.013-1.074]) and healthcare utilization among informal caregivers of older adults. The study further revealed a negative and statistically significant association between perceived severity of a health problem and healthcare utilization (β= - 0.040, IRR = 0.961, 95% CI= [0.947-0.975]) among informal caregivers of older adults. The results again showed that non-enrollment in a health insurance scheme (β= - 0.174, IRR = 0.841, 95% CI= [0.774-0.913]) and being unemployed (β= - 0.088, IRR = 0.916, 95% CI= [0.850-0.986]) were statistically significantly associated with a lower log count of healthcare utilization among informal caregivers of older adults. CONCLUSION The findings of this study to a large extent support the dimensions of the HBM in explaining healthcare utilization among informal caregivers of older adults in the Ashanti Region of Ghana. Although all the dimensions of the HBM were significantly associated with healthcare utilization in Model 1, perceived barriers to care-seeking and perceived benefits of care-seeking were no longer statistically significant after controlling for demographic, socio-economic and health-related variables in the final model. The findings further suggest that the dimensions of the HBM as well as demographic, socio-economic and health-related factors contribute to unequal healthcare utilization among informal caregivers of older adults in the Ashanti Region of Ghana.
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Affiliation(s)
- Williams Agyemang-Duah
- Department of Geography and Planning, Queen's University, Kingston, ON, K7L 3N6, Canada.
| | - Mark W Rosenberg
- Department of Geography and Planning, Queen's University, Kingston, ON, K7L 3N6, Canada
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Osstyn SL, Handels R, Boots LMM, Balvert SCE, Evers SMAA, de Vugt ME. The effectiveness and health-economic evaluation of "Partner in Balance," a blended self-management program for early-stage dementia caregivers: study protocol for a cluster-randomized controlled trial. Trials 2023; 24:427. [PMID: 37349828 DOI: 10.1186/s13063-023-07423-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 05/29/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Informal caregivers of people with dementia are crucial in dementia care. However, they are insufficiently supported and report caregiver burdens, which urges the need for cost-effective interventions aimed at supporting caregivers. This paper presents the design of a study evaluating the effectiveness, cost-effectiveness, and cost-utility of a blended self-management program for early-stage dementia caregivers. METHODS/DESIGN A pragmatic, cluster randomized controlled trial with a shared control group will be conducted. Participants will be informal caregivers of people with early-stage dementia and will be recruited by local care professionals. Randomization will be carried out at the level of the care professional level in a ratio of 35% to 65% (control arm vs. intervention arm). Participants in the control arm will receive care as usual and the intervention arm will receive the blended care self-management program "Partner in Balance" within a usual care setting in the Netherlands. Data will be collected at baseline and at 3-, 6-, 12-, and 24-month follow-ups. The primary outcome for effectiveness (part 1) is care management self-efficacy. For the health-economic evaluation (part 2) total care costs and the quality of life for individuals with dementia (cost-effectiveness) and quality-adjusted life years (cost-utility) will be the base case analysis. Secondary outcomes (parts 1 and 2) will include depression, anxiety, perceived informal caregiving stress, service-use self-efficacy, quality of life, caregivers' gain, and perseverance time. A process evaluation (part 3) will investigate the internal and external validity of the intervention. DISCUSSION In this trial, we plan to evaluate the effectiveness, cost-effectiveness, and cost-utility of "Partner in Balance" among informal caregivers of people with dementia. We expect to find a significant increase in care management self-efficacy, and the program to be cost-effective, and provide valuable insights to stakeholders of "Partner in Balance." TRIAL REGISTRATION ClinicalTrials.gov, NCT05450146. Registered on 4 November 2022.
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Affiliation(s)
- Sander L Osstyn
- Department of Psychiatry and Neuropsychology and Alzheimer Center Limburg, School for Mental Health and Neuroscience (MHeNS), Maastricht University, PO Box 6166200 MD, Maastricht, The Netherlands
| | - Ron Handels
- Department of Psychiatry and Neuropsychology and Alzheimer Center Limburg, School for Mental Health and Neuroscience (MHeNS), Maastricht University, PO Box 6166200 MD, Maastricht, The Netherlands
| | - Lizzy M M Boots
- Department of Psychiatry and Neuropsychology and Alzheimer Center Limburg, School for Mental Health and Neuroscience (MHeNS), Maastricht University, PO Box 6166200 MD, Maastricht, The Netherlands
| | - Sanne C E Balvert
- Department of Clinical Neuropsychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Silvia M A A Evers
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, PO Box 6166200 MD, Maastricht, The Netherlands
- Centre of Economic Evaluations & Machine Learning, Trimbos Institute, Utrecht, The Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Marjolein E de Vugt
- Department of Psychiatry and Neuropsychology and Alzheimer Center Limburg, School for Mental Health and Neuroscience (MHeNS), Maastricht University, PO Box 6166200 MD, Maastricht, The Netherlands.
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Choi E, Seo HJ, Choo IH, Kim SM, Park JM, Choi YM, Yang EY. Caregiving burden and healthcare utilization in family caregivers of people with dementia: Long term impact of the public family caregiver intervention. Geriatr Nurs 2023; 51:408-414. [PMID: 37146557 DOI: 10.1016/j.gerinurse.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/07/2023] [Accepted: 04/11/2023] [Indexed: 05/07/2023]
Abstract
Despite community-based interventions to decrease the caregiving burden on family caregivers of people with dementia (PwD), long-term assessment of community-based public programs is lacking. Therefore, the study aims to identify the long-term effects of community-based dementia caregiver intervention on the caregiving burden and healthcare utilization among family caregivers for PwD. Additionally, we investigated the predictors of caregiving burden and healthcare utilization. Of the participants, 32 (76%) intervention and 15 (38%) control groups responded to the one-year follow-up. We assessed caregiver burden using the short-form Zarit Burden Interview (sZBI) and collected healthcare utilization data using questionnaire at baseline and 12 months. Compared with the control group, the intervention group did not experience a reduction in caregiving burden and healthcare utilization. Predictors of caregivers' perceived burden were spouses as the primary caregiver and having multiple comorbidities. The predictors identified in this study should be considered when implementing public family support programs.
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Affiliation(s)
- Eunjeong Choi
- College of Nursing, Chungnam National University, Daejeon, South Korea
| | - Hyun-Ju Seo
- College of Nursing, Chungnam National University, Daejeon, South Korea.
| | - Il Han Choo
- Department of Neuropsychiatry, College of Medicine, Chosun University and Chosun University Hospital, Gwangju, South Korea
| | - Seong Min Kim
- Dowool Health Welfare Center, Junggalchi-gil 73, Namwon-si, Jeollabuk-do, 55725, South Korea
| | - Jeong Min Park
- Department of Nursing, Nambu University, Gwangju, South Korea
| | - Yu Mi Choi
- College of Nursing, Graduate School of Chungnam National University, Daejeon, South Korea
| | - Eun-Young Yang
- Department of Nursing, Songwon University, Gwangju, South Korea
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Hugenschmidt CE, Ip EH, Laurita-Spanglet J, Babcock P, Morgan AR, Fanning JT, King K, Thomas JT, Soriano CT. IMOVE: Protocol for a randomized, controlled 2x2 factorial trial of improvisational movement and social engagement interventions in older adults with early Alzheimer's disease. Contemp Clin Trials Commun 2023; 32:101073. [PMID: 36949846 PMCID: PMC10025420 DOI: 10.1016/j.conctc.2023.101073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 01/02/2023] [Accepted: 01/14/2023] [Indexed: 01/25/2023] Open
Abstract
Background In addition to cognitive impairment, people with Alzheimer's disease (PWAD) experience neuropsychiatric symptoms (e.g., apathy, depression), altered gait, and poor balance that further diminish their quality of life (QoL). Here, we describe a unique, randomized, controlled trial to test the hypothesis that both movement and social engagement aspects of a group dance intervention alter the connectivity of key brain networks involved in motor and social-emotional functioning and lead to improved QoL in PWAD. Methods IMOVE (NCT03333837) was a single-center, randomized, controlled 2x2 factorial trial that assigned PWAD/caregiver dyads to one of 4 study conditions (Movement Group, Movement Alone, Social Group, or Usual Care control). The Movement Group participated in twice-weekly group improvisational dance (IMPROVment® Method) classes for 12 weeks. The Movement Alone intervention captured the same dance movement and auditory stimuli as the group class without social interaction, and the Social Group used improvisational party games to recapitulate the fun and playfulness of the Movement Group without the movement. The primary outcome was change in QoL among PWAD. Key secondary outcomes were functional brain network measures assessed using graph-theory analysis of resting-state functional magnetic resonance imaging scans, as well as neuropsychiatric symptoms, gait, and balance. Results A total of 111 dyads were randomized; 89 completed the study, despite interruption and modification of the protocol due to COVID-19 restrictions (see companion paper by Fanning et al.). The data are being analyzed and will be submitted for publication in 2023.
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Affiliation(s)
- Christina E. Hugenschmidt
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Corresponding author. Medical Center Boulevard, Winston-Salem, NC, 27157, USA.
| | - Edward H. Ip
- Department of Biostatistics and Data Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | | | - Phyllis Babcock
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Ashley R. Morgan
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Jason T. Fanning
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - Kamryn King
- Department of Theatre and Dance, Wake Forest University, Winston-Salem, NC, USA
| | - Jantira T. Thomas
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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Abstract
This article describes the public health impact of Alzheimer's disease, including prevalence and incidence, mortality and morbidity, use and costs of care, and the overall impact on family caregivers, the dementia workforce and society. The Special Report examines the patient journey from awareness of cognitive changes to potential treatment with drugs that change the underlying biology of Alzheimer's. An estimated 6.7 million Americans age 65 and older are living with Alzheimer's dementia today. This number could grow to 13.8 million by 2060 barring the development of medical breakthroughs to prevent, slow or cure AD. Official death certificates recorded 121,499 deaths from AD in 2019, and Alzheimer's disease was officially listed as the sixth-leading cause of death in the United States. In 2020 and 2021, when COVID-19 entered the ranks of the top ten causes of death, Alzheimer's was the seventh-leading cause of death. Alzheimer's remains the fifth-leading cause of death among Americans age 65 and older. Between 2000 and 2019, deaths from stroke, heart disease and HIV decreased, whereas reported deaths from AD increased more than 145%. This trajectory of deaths from AD was likely exacerbated by the COVID-19 pandemic in 2020 and 2021. More than 11 million family members and other unpaid caregivers provided an estimated 18 billion hours of care to people with Alzheimer's or other dementias in 2022. These figures reflect a decline in the number of caregivers compared with a decade earlier, as well as an increase in the amount of care provided by each remaining caregiver. Unpaid dementia caregiving was valued at $339.5 billion in 2022. Its costs, however, extend to family caregivers' increased risk for emotional distress and negative mental and physical health outcomes - costs that have been aggravated by COVID-19. Members of the paid health care workforce are involved in diagnosing, treating and caring for people with dementia. In recent years, however, a shortage of such workers has developed in the United States. This shortage - brought about, in part, by COVID-19 - has occurred at a time when more members of the dementia care workforce are needed. Therefore, programs will be needed to attract workers and better train health care teams. Average per-person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are almost three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 22 times as great. Total payments in 2023 for health care, long-term care and hospice services for people age 65 and older with dementia are estimated to be $345 billion. The Special Report examines whether there will be sufficient numbers of physician specialists to provide Alzheimer's care and treatment now that two drugs are available that change the underlying biology of Alzheimer's disease.
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Applebaum JW, Shieu MM, McDonald SE, Dunietz GL, Braley TJ. The Impact of Sustained Ownership of a Pet on Cognitive Health: A Population-Based Study. J Aging Health 2023; 35:230-241. [PMID: 36006805 DOI: 10.1177/08982643221122641] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Objectives: To examine associations between sustained ownership of a pet and cognitive outcomes among a national sample of U.S. adults. Methods: Weighted linear mixed models were estimated using the Health and Retirement Study (2010-2016, n = 1369) to compare repeated measures of cognitive function between respondents who endorsed owning a pet in a sustained manner (>5 years), versus those who owned a pet ≤5 years, and non-pet owners. Results: Respondents aged 65+ who owned a pet >5 years demonstrated higher composite cognitive scores, compared to non-pet owners (β = .76, p = .03). Sustained pet ownership was associated with higher immediate (β = .3, p = .02) and delayed (β = .4, p = .007) word recall scores. There were no significant differences in cognitive scores between pet owners and non-owners aged < 65. Discussion: Sustained ownership of a pet could mitigate cognitive disparities in older adults. Further studies are needed to examine potential causal pathways, including physical activity and stress buffering, versus selection effects.
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Affiliation(s)
- Jennifer W Applebaum
- Department of Sociology and Criminology & Law, 3463University of Florida, Gainesville, FL, USA
| | - Monica M Shieu
- Department of Neurology, 1259University of Michigan, Ann Arbor, MI, USA
| | - Shelby E McDonald
- Clark-Hill Institute for Positive Youth Development, Department of Psychology, 6889Virginia Commonwealth University, Richmond, VA, USA
| | | | - Tiffany J Braley
- Department of Neurology, 1259University of Michigan, Ann Arbor, MI, USA
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Bertrand E, Marinho V, Naylor R, Bomilcar I, Laks J, Spector A, Mograbi DC. Metacognitive Improvements Following Cognitive Stimulation Therapy for People with Dementia: Evidence from a Pilot Randomized Controlled Trial. Clin Gerontol 2023; 46:267-276. [PMID: 36482733 DOI: 10.1080/07317115.2022.2155283] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Impaired self-awareness is a common feature of dementia, with considerable clinical impact. Some therapeutic strategies such as cognitive stimulation and psychotherapy have been suggested to mitigate loss of awareness. Nevertheless, evidence of intervention improving awareness of deficits is scarce. The present study aims to explore the impact of a Brazilian adapted version of Cognitive Stimulation Therapy (CST-Brasil), an evidence-based psychosocial intervention for people with dementia (PwD), on the level of awareness, reporting here a secondary outcome of a pilot randomized controlled trial. METHODS 47 people with mild to moderate dementia attending an out-patient unit were randomly allocated to CST (n = 23) or treatment as usual (TAU) (n = 24) across 7 weeks, in a pilot randomized controlled trial. Awareness was measured before and after the intervention. RESULTS Results indicated that people in both groups increased in overall awareness of the disease, but only those receiving CST exhibited improvements of awareness of cognitive ability. CONCLUSIONS These findings suggest that CST may also improve metacognitive abilities in PwD, which could potentially be applied to other settings with beneficial effects. CLINICAL IMPLICATIONS Considering the negative impacts of anosognosia, CST-led improvements in awareness have the potential to benefit PwD and their caregivers.
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Affiliation(s)
- Elodie Bertrand
- Laboratoire Mémoire, Cerveau et Cognition (LMC2 UR7536), Institut de Psychologie, Université Paris Cité, Paris, France
| | - Valeska Marinho
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Renata Naylor
- Department of Psychology, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Iris Bomilcar
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Jerson Laks
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Translational Biomedicine Postgraduate Programme, Universidade do Grande Rio (Unigranrio), Duque de Caxias, Brazil
| | - Aimee Spector
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Daniel C Mograbi
- Department of Psychology, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil
- Psychology & Neuroscience, Institute of Psychiatry, King's College London, London, UK
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Boxer RS, Daddato AE, Jessen A, Portz JD, Shetterly S. Hospitalizations of Caregivers Increases Risk of Hospitalization for Patients Living with Dementia. J Gen Intern Med 2023; 38:502-507. [PMID: 36376629 PMCID: PMC9905325 DOI: 10.1007/s11606-022-07902-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 10/26/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Rebecca S Boxer
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA.
| | - Andrea E Daddato
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Andrew Jessen
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Jennifer D Portz
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine Anschutz Medical Campus, Aurora, CO, USA
| | - Susan Shetterly
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
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Nemcikova M, Katreniakova Z, Nagyova I. Social support, positive caregiving experience, and caregiver burden in informal caregivers of older adults with dementia. Front Public Health 2023; 11:1104250. [PMID: 36761127 PMCID: PMC9905841 DOI: 10.3389/fpubh.2023.1104250] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 01/05/2023] [Indexed: 01/26/2023] Open
Abstract
Introduction Dementia is currently one of the major causes of disability and dependency among older adults worldwide. Cognitive dysfunction, neuropsychiatric symptoms, somatic complaints, and functional impairment fundamentally affect not only a person living with dementia (PLwD), but also his/her informal caregiver(s), often resulting in a high caregiver burden. A number of variables, including the caregiver's sociodemographic characteristics, the clinical characteristics of PLwD, social support, and the caregiver's personal resources determine the caregiver's burden. Objectives The aim of this study was to investigate the associations of caregiver burden in informal caregivers of PLwD with perceived social support, positive caregiving experience, and applying therapeutic communication methods. Methods The data were collected from September 2021 to February 2022 among 115 "PLwD-informal caregiver" dyads in the community settings in Slovakia. Measures included the Zarit Burden Interview (ZBI-12), the Oslo Social Support Scale (OSSS-3), the Positive Aspects of Caregiving Scale (PACS), and two questions on applying therapeutic communication methods-reminiscence and validation according to Naomi Feil. The Short IQCODE was used for assessing cognitive decline in PLwD. Pearson's and Spearman's correlations, t-tests, Chi-square, ANOVA, and linear multiple regression analyses were used to analyze the data (IBM SPSS 27). Results The mean age of informal caregivers was 54 ± 12.4 years (81.7% of women) and the mean caregiving duration was 4.8 ± 4.8 years. The mean age of PLwD was 80.5 ± 8.3 years (73.0% of women) and their Short IQCODE mean score was 4.1 ± 1.0. Lower caregiving burden was significantly associated with higher perceived social support (β = 0.33, p < 0.01), with higher positive caregiving experience (β = 0.33, p < 0.01), and higher caregiving intensity (β = 0.24, p < 0.05) among informal caregivers of PLwD. The associations between caregiver burden and applying two therapeutic communication methods were not significant. Conclusions Implementing psycho-social and educational public health interventions focused on strengthening social support and maintaining positive perceptions of caregiving can help reduce the increased risk of caregiver burden in informal caregivers of older adults with dementia.
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Affiliation(s)
- Marta Nemcikova
- Department of Social and Behavioural Medicine, Faculty of Medicine, PJ Safarik University in Kosice, Kosice, Slovakia
| | - Zuzana Katreniakova
- Department of Social and Behavioural Medicine, Faculty of Medicine, PJ Safarik University in Kosice, Kosice, Slovakia,Slovak Public Health Association - SAVEZ, Kosice, Slovakia,*Correspondence: Zuzana Katreniakova ✉
| | - Iveta Nagyova
- Department of Social and Behavioural Medicine, Faculty of Medicine, PJ Safarik University in Kosice, Kosice, Slovakia,Slovak Public Health Association - SAVEZ, Kosice, Slovakia
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Lin RS, Yu DS, Chau PH, Li PW, Ismail Z. Reliability and Validity of the Traditional Chinese Version of the Mild Behavioral Impairment - Checklist Among Persons With Mild Cognitive Impairment - A Validation Study. J Geriatr Psychiatry Neurol 2023; 36:26-38. [PMID: 35430911 DOI: 10.1177/08919887221093363] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To evaluate the reliability and validity of the traditional Chinese version of the Mild Behavioral Impairment Checklist (MBI-C) among Hong Kong Chinese with mild cognitive impairment (MCI). METHODS A total of 172 participants were recruited from 2 community facilities. Cronbach's alpha (α) was calculated to evaluate internal consistency. Intra-class correlation coefficient (ICC) was used to measure 2-week test-retest reliability. Construct validity was evaluated by conducting exploratory factor analysis to identify the internal structure of MBI-C, and assessing the correlation between theoretically related constructs, including objective and subjective cognitive impairment, neurotic personality, social supports, and maladaptive coping. Concurrent validity was assessed by its correlation with Neuropsychiatric Inventory Questionnaire (NPI-Q). RESULTS The results revealed good internal consistency and test-retest reliability of the MBI-C. Item analysis identified 4 items with low item-to-total correlations. The EFA identified a seven-factor structure. Hypothesis testing identified its significant correlations with subjective cognitive impairment, neurotic personality, social supports, and maladaptive coping. Concurrent validity was supported by its significant correlation with the NPI-Q. CONCLUSIONS The traditional Chinese version of MBI-C is a valid and reliable outcome measure to assess the severity of neuropsychiatric symptoms of the MCI population.
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Affiliation(s)
- Rose Sy Lin
- School of Nursing, Li Ka Shing Faculty of Medicine, 71020University of Hong Kong, Hong Kong
| | - Doris Sf Yu
- School of Nursing, Li Ka Shing Faculty of Medicine, 71020University of Hong Kong, Hong Kong
| | - Pui H Chau
- School of Nursing, Li Ka Shing Faculty of Medicine, 71020University of Hong Kong, Hong Kong
| | - Polly Wc Li
- School of Nursing, Li Ka Shing Faculty of Medicine, 71020University of Hong Kong, Hong Kong
| | - Zahinoor Ismail
- Hotchkiss Brain Institute and O'Brien Institute for Public Health, 2129University of Calgary, Calgary, AB, Canada
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Coe NB, White L, Oney M, Basu A, Larson EB. Public spending on acute and long-term care for Alzheimer's disease and related dementias. Alzheimers Dement 2023; 19:150-157. [PMID: 35293675 PMCID: PMC9477973 DOI: 10.1002/alz.12657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 01/20/2022] [Accepted: 02/17/2022] [Indexed: 01/18/2023]
Abstract
INTRODUCTION We estimate the spending attributable to Alzheimer's disease and related dementias (ADRD) to the United States government for the first 5 years post-diagnosis. METHODS Using data from the Health and Retirement Study matched to Medicare and Medicaid claims, we identify a retrospective cohort of adults with a claims-based ADRD diagnosis along with matched controls. RESULTS The costs attributable to ADRD are $15,632 for traditional Medicare and $8833 for Medicaid per dementia case over the first 5 years after diagnosis. Seventy percent of Medicare costs occur in the first 2 years; Medicaid costs are concentrated among the longer-lived beneficiaries who are more likely to need long-term care and become Medicaid eligible. DISCUSSION Because the distribution of the incremental costs varies over time and between insurance programs, when interventions occur and the effect on the disease course will have implications for how much and which program reaps the benefits.
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Affiliation(s)
- Norma B Coe
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lindsay White
- Center for Health Care Quality and Outcomes, RTI International, Seattle, Washington, USA
| | - Melissa Oney
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Anirban Basu
- Department of Pharmacy, University of Washington, Seattle, Washington, USA
| | - Eric B Larson
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
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Guzzon A, Rebba V, Paccagnella O, Rigon M, Boniolo G. The value of supportive care: A systematic review of cost-effectiveness of non-pharmacological interventions for dementia. PLoS One 2023; 18:e0285305. [PMID: 37172047 PMCID: PMC10180718 DOI: 10.1371/journal.pone.0285305] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 04/20/2023] [Indexed: 05/14/2023] Open
Abstract
BACKGROUND Almost 44 million people are currently living with dementia worldwide. This number is set to increase threefold by 2050, posing a serious threat to the sustainability of healthcare systems. Overuse of antipsychotic drugs for the management of the symptoms of dementia carries negative consequences for patients while also increasing the health expenditures for society. Supportive care (SC) interventions could be considered a safer and potentially cost-saving option. In this paper we provide a systematic review of the existing evidence regarding the cost-effectiveness and cost-utility of SC interventions targeted towards persons living with dementia and their caregivers. METHODS A systematic literature review was performed between February 2019 and December 2021 through searches of the databases PubMed (MEDLINE), Cochrane Library, CENTRAL, Embase and PsycINFO. The search strategy was based on PRISMA 2020 recommendations. We considered studies published through December 2021 with no lower date limit. We distinguished between five categories of SC strategies: cognitive therapies, physical activity, indirect strategies (organisational and environmental changes), interventions primarily targeted towards family caregivers, and multicomponent interventions. RESULTS Of the 5,479 articles retrieved, 39 met the inclusion criteria. These studies analysed 35 SC programmes located at different stages of the dementia care pathway. Eleven studies provided evidence of high cost-effectiveness for seven interventions: two multicomponent interventions; two indirect interventions; two interventions aimed at caregivers of community-dwelling persons with dementia; one community-based cognitive stimulation and occupational programme. CONCLUSION We find that the most promising SC strategies in terms of cost-effectiveness are multicomponent interventions (targeted towards both nursing home residents and day-care service users), indirect strategies (group living and dementia care management at home), some forms of tailored occupational therapy, together with some psychosocial interventions for caregivers of community-dwelling persons with dementia. Our results suggest that the adoption of effective SC interventions may increase the economic sustainability of dementia care.
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Affiliation(s)
- Angelica Guzzon
- CRIEP (Interuniversity Research Centre on Public Economics), Veneto, Italy
- Department of Economics, Ca' Foscari University of Venice, Venice, Italy
| | - Vincenzo Rebba
- CRIEP (Interuniversity Research Centre on Public Economics), Veneto, Italy
- Department of Economics and Management "Marco Fanno", University of Padova, Padova, Italy
| | - Omar Paccagnella
- Department of Statistical Sciences, University of Padova, Padova, Italy
| | | | - Giovanni Boniolo
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
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23
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Mehdipanah R, Briceño EM, Heeringa SG, Gonzales XF, Levine DA, Langa KM, Garcia N, Longoria R, Chang W, Morgenstern LB. Neighborhood SES and Cognitive Function Among Hispanic/Latinx Residents: Why Where You Live Matters. Am J Prev Med 2022; 63:574-581. [PMID: 35691843 PMCID: PMC10662479 DOI: 10.1016/j.amepre.2022.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 03/03/2022] [Accepted: 04/11/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Few studies have examined the impacts of neighborhood SES and individual ethnicity and SES characteristics on cognitive function in aging populations. Hispanics/Latinx are more likely to have cognitive impairment and be community dwellers than non-Hispanic Whites. Neighborhood factors can have greater impacts on the relationship between Hispanics/Latinx and cognitive function. This study examines these relationships in Nueces County, Texas. METHODS A mixed-effects regression analysis of data from 1,140 older adults participating in the Brain Attack Surveillance in Corpus Christi - Cognitive project from 2018 to 2020 was completed. Cognitive function was measured with the Montreal Cognitive Assessment, a cognitive screening measure. Participant addresses were geocoded to obtain census tracts, which were proxies for neighborhoods. Neighborhood SES was measured by household median income, percentage of Hispanic/Latinx residents, and percentage of residents aged ≥65 years with Medicaid, all from the American Community Survey. Interactions were used to examine the impact of neighborhood SES on ethnicity and cognitive function. RESULTS The sample consisted of 62.5% Hispanic/Latinx and 37.5% non-Hispanic White participants. Results from the F-statistics, test of effects, indicate that being older (F4,1138=45.04; p<0.001), being a man (F1,1130=4.35; p<0.050), having low education (F3,1121=40.83; p<0.001), completing the Montreal Cognitive Assessment test in Spanish (F1,1140=15.35; p<0.001), and being Hispanic/Latinx (F1,962=20.84; p<0.001) were all associated with lower Montreal Cognitive Assessment scores. Neighborhood income was positively associated (F1,69.6=6.95; p<0.050) with Montreal Cognitive Assessment scores. Neighborhood income (β=0.32; p<0.050) and percentage with Medicaid (β=0.06; p<0.050) independently moderated the associations between ethnicity and Montreal Cognitive Assessment scores. CONCLUSIONS Findings suggest that neighborhood SES could further impact cognitive function independent of individual characteristics. This could be attributed to minimal resources in communities with lower SES, impacting policies and programs for older individuals, particularly those with worse cognitive function.
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Affiliation(s)
- Roshanak Mehdipanah
- Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan.
| | - Emily M Briceño
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, Michigan
| | - Steven G Heeringa
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan
| | - Xavier F Gonzales
- Department of Life Sciences, Texas A&M University-Corpus Christi, Corpus Christi, Texas
| | - Deborah A Levine
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Kenneth M Langa
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan; Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan; Ann Arbor VA Center for Clinical Management Research, Ann Arbor, Michigan
| | - Nelda Garcia
- Department of Neurology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Ruth Longoria
- Department of Neurology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Wen Chang
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan
| | - Lewis B Morgenstern
- Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan; Department of Neurology, University of Michigan Medical School, Ann Arbor, Michigan
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24
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Fuju T, Yamagami T, Yamaguchi H, Yamazaki T. A randomized controlled trial of the "positive diary" intervention for family caregivers of people with dementia. Perspect Psychiatr Care 2022; 58:1949-1958. [PMID: 34951029 PMCID: PMC9786811 DOI: 10.1111/ppc.13013] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 09/22/2021] [Accepted: 12/10/2021] [Indexed: 12/30/2022] Open
Abstract
PURPOSE We examined the effectiveness of the "positive diary," in which family caregivers of people with dementia write down three good things that happened with reasons at the end of each day. DESIGN AND METHODS In this randomized controlled trial, the intervention group used the "positive diary," while the control group kept a record of each meal for 4 weeks. FINDINGS The intervention group showed improvement on several measures of wellbeing including Neuropsychiatric Inventory Questionnaire and Center for Epidemiologic Studies Depression Scale. PRACTICE IMPLICATIONS The "positive diary" is a useful self-care tool for caregivers of people with dementia.
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Affiliation(s)
- Taiga Fuju
- Tokyo Center for Dementia Care Research and Practices, Tokyo, Japan.,Gunma University Graduate School of Health Sciences, Gunma, Japan
| | - Tetsuya Yamagami
- Gunma University Graduate School of Health Sciences, Gunma, Japan
| | | | - Tsuneo Yamazaki
- Gunma University Graduate School of Health Sciences, Gunma, Japan
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25
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Mehdipanah R, Briceño EM, Gonzales X, Heeringa SG, Levine DA, Langa KM, Garcia N, Longoria R, Morgenstern LB. Dementia care needs for individuals and caregivers among Mexican Americans and non-Hispanic Whites. Aging Ment Health 2022; 26:1630-1641. [PMID: 34096422 PMCID: PMC8864934 DOI: 10.1080/13607863.2021.1925222] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Mexican Americans (MA) are more likely to have cognitive impairment and dementia (CID), be diagnosed at an earlier age and live with CID longer, compared to non-Hispanic Whites (NHW). While studies have examined unmet needs of individuals with CID and their caregivers, few have focused on MA populations in the U.S. This paper examines the needs of community-residing individuals with CID and their caregivers in Nueces County, Texas, a county with one of the largest MA populations in the U.S., while exploring ethnic differences in needs identified. Using concept mapping, a mixed-method approach, qualitative input on perceived needs by informal caregivers and health professionals was collected. Participants then sorted and rated perceived needs. Using this information, multidimensional scaling and cluster analyses were conducted to map the relationship between perceived needs and determine their importance and priority. Five clusters were derived for caregivers and four for the health professionals. Themes across both caregivers and health professionals highlighted the need for specialized and team-based medical care, caregiver support and training, along with socio-economic and physical needs that help with day-to-day care of individuals with CID. Among caregivers, MA rated financial resources as more important and of higher priority compared to NHW. The health professionals' perspectives were aligned with those of all caregivers. By understanding the needs of caregivers and individuals with CID, we can help families deal with this disease and let caregivers thrive. This is especially important for minority populations like MAs.
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Affiliation(s)
| | - Emily M. Briceño
- University of Michigan Medical School, Department of Physical Medicine & Rehabilitation
| | - Xavier Gonzales
- Texas A&M University-Corpus Christi, Department of Life Sciences
| | | | - Deborah A. Levine
- University of Michigan Medical School, Department of Internal Medicine
| | - Kenneth M. Langa
- University of Michigan Institute for Social Research,University of Michigan Medical School, Department of Internal Medicine,Veterans Affairs Ann Arbor Center for Clinical Management Research
| | - Nelda Garcia
- University of Michigan Medical School, Department of Neurology
| | - Ruth Longoria
- University of Michigan Medical School, Department of Neurology
| | - Lewis B. Morgenstern
- University of Michigan, School of Public Health,University of Michigan Medical School, Department of Neurology
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26
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Chan SY, Yu HW, Yang MC, Lee YC, Chen YM. The Impact of Multiple Long-Term Care Services Use on Dementia and Nondementia Caregivers’ Health Care Utilization and Costs. J Appl Gerontol 2022; 41:2341-2352. [DOI: 10.1177/07334648221114110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background The study examined the effects of multiple long-term care (LTC) services (i.e., using both social and professional care services) on caregivers of service recipients with and without dementia. Methods We retrieved data for 10,771 caregivers of older adults in the Ten-Year Long-Term Care Project (TLTCP) in Taiwan. We examined the effects of care recipients’ initial prescription of single or multiple LTC services on their caregivers’ healthcare services use, including outpatient, emergency department (ED), and inpatient services. Results For care recipients prescribed a single LTC service, dementia caregivers had 0.82 more ED visits and 10.4% higher total fees than nondementia caregivers ( p < .05). However, for care recipients prescribed multiple LTC services, dementia caregivers and nondementia caregivers used healthcare services at similar levels, and dementia caregivers had 3.5% lower per-visit outpatient fees ( p < .05). Discussion Providing multiple LTC services for people with dementia results in great benefit to their caregivers.
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Affiliation(s)
- Su-Yuan Chan
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Hsiao-Wei Yu
- Department of Gerontology and Health Care Management, College of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Ming-Ching Yang
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Yue-Chune Lee
- Institute of Health and Welfare Policy, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ya-Mei Chen
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
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27
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Meyer K, Gassoumis Z, Wilber K. The Differential Effects of Caregiving Intensity on Overnight Hospitalization. West J Nurs Res 2022; 44:528-539. [PMID: 33764207 PMCID: PMC8463626 DOI: 10.1177/01939459211002907] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aims to examine how caregiving for a spouse affects caregivers' likelihood of overnight hospitalization. Using data from the Health and Retirement Study, we examine the odds of spousal caregivers experiencing an overnight hospitalization in the previous two years according to caregiving status, intensity, and change in caregiving intensity. Caregivers were no more likely to experience an overnight hospitalization than noncaregivers (OR = .92; CI [.84, 1.00]). Effects varied by intensity of care. Compared to noncaregivers, caregivers who reported providing no assistance with activities of daily living were less likely to experience overnight hospitalization (OR = .77; CI [.66, .89]); however, caregivers who provided care to someone living with dementia for 4 to <6 years had 2.11 times the odds of experiencing an overnight hospitalization (CI [1.16, 3.85]). Although caregivers overall experience overnight hospitalization at a similar rate as noncaregivers, there are differences between caregivers by the intensity of care.
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Affiliation(s)
- Kylie Meyer
- Caring for the Caregiver, University of Texas Health Science Center at San Antonio
- Glenn Biggs Institute on Alzheimer’s and Neurodegenerative Diseases, University of Texas Health Science Center at San Antonio
| | | | - Kathleen Wilber
- Leonard Davis School of Gerontology, University of Southern California
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28
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Beaton D, McLaughlin PM, Orange JB, Munoz DP, Mandzia J, Abrahao A, Binns MA, Black SE, Borrie M, Dowlatshahi D, Freedman M, Fischer CE, Finger EC, Frank A, Grimes D, Hassan A, Kumar S, Lang AE, Levine B, Marras C, Masellis M, Pollock BG, Rajji TK, Ramirez J, Sahlas DJ, Saposnik G, Scott CJM, Seitz DP, Strother SC, Sunderland KM, Tan B, Tang-Wai DF, Troyer AK, Turnbull J, Zinman L, Swartz RH, Tartaglia MC, Breen DP, Kwan D, Roberts AC, The Ondri Investigators. Caregiving concerns and clinical characteristics across neurodegenerative and cerebrovascular disorders in the Ontario neurodegenerative disease research initiative. Int J Geriatr Psychiatry 2022; 37. [PMID: 35633037 DOI: 10.1002/gps.5727] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 04/20/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Caregiving burdens are a substantial concern in the clinical care of persons with neurodegenerative disorders. In the Ontario Neurodegenerative Disease Research Initiative, we used the Zarit's Burden Interview (ZBI) to examine: (1) the types of burdens captured by the ZBI in a cross-disorder sample of neurodegenerative conditions (2) whether there are categorical or disorder-specific effects on caregiving burdens, and (3) which demographic, clinical, and cognitive measures are related to burden(s) in neurodegenerative disorders? METHODS/DESIGN N = 504 participants and their study partners (e.g., family, friends) across: Alzheimer's disease/mild cognitive impairment (AD/MCI; n = 120), Parkinson's disease (PD; n = 136), amyotrophic lateral sclerosis (ALS; n = 38), frontotemporal dementia (FTD; n = 53), and cerebrovascular disease (CVD; n = 157). Study partners provided information about themselves, and information about the clinical participants (e.g., activities of daily living (ADL)). We used Correspondence Analysis to identify types of caregiving concerns in the ZBI. We then identified relationships between those concerns and demographic and clinical measures, and a cognitive battery. RESULTS We found three components in the ZBI. The first was "overall burden" and was (1) strongly related to increased neuropsychiatric symptoms (NPI severity r = 0.586, NPI distress r = 0.587) and decreased independence in ADL (instrumental ADLs r = -0.566, basic ADLs r = -0.43), (2) moderately related to cognition (MoCA r = -0.268), and (3) showed little-to-no differences between disorders. The second and third components together showed four types of caregiving concerns: current care of the person with the neurodegenerative disease, future care of the person with the neurodegenerative disease, personal concerns of study partners, and social concerns of study partners. CONCLUSIONS Our results suggest that the experience of caregiving in neurodegenerative and cerebrovascular diseases is individualized and is not defined by diagnostic categories. Our findings highlight the importance of targeting ADL and neuropsychiatric symptoms with caregiver-personalized solutions.
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Affiliation(s)
- Derek Beaton
- Rotman Research Institute, Baycrest Health Sciences, Toronto, ON, Canada
| | - Paula M McLaughlin
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada.,Nova Scotia Health Authority, Halifax, NS, Canada.,Department of Medicine - Geriatrics, Dalhousie University, Halifax, NS, Canada
| | - Joseph B Orange
- School of Communication Sciences and Disorders, Western University, London, ON, Canada.,Canadian Centre for Activity and Aging, Western University, London, ON, Canada.,Faculty of Health Sciences, Western University, London, ON, Canada
| | - Douglas P Munoz
- Department of Biomedical and Molecular Sciences, Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
| | - Jennifer Mandzia
- Department of Clinical Neurological Sciences, London Health Sciences Center, Western University, London, ON, Canada
| | - Agessandro Abrahao
- Department of Medicine (Division of Neurology), University of Toronto, Toronto, ON, Canada.,Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Malcolm A Binns
- Rotman Research Institute, Baycrest Health Sciences, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Sandra E Black
- Department of Medicine (Division of Neurology), University of Toronto, Toronto, ON, Canada.,Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Michael Borrie
- Department of Medicine, Division of Geriatric Medicine, Western University, Toronto, ON, Canada
| | - Dar Dowlatshahi
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Morris Freedman
- Rotman Research Institute, Baycrest Health Sciences, Toronto, ON, Canada.,Department of Medicine (Division of Neurology), University of Toronto, Toronto, ON, Canada
| | - Corinne E Fischer
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Elizabeth C Finger
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Andrew Frank
- Bruyere Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - David Grimes
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Ayman Hassan
- Northern Ontario School of Medicine, Clinical Science Division, Depart of Internal Medicine, Thunder Bay, ON, Canada
| | - Sanjeev Kumar
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Anthony Edward Lang
- Department of Medicine (Division of Neurology), University of Toronto, Toronto, ON, Canada.,Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, ON, Canada
| | - Brian Levine
- Rotman Research Institute, Baycrest Health Sciences, Toronto, ON, Canada.,Department of Medicine (Division of Neurology), University of Toronto, Toronto, ON, Canada.,Department of Psychology, University of Toronto, Toronto, ON, Canada
| | - Connie Marras
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, ON, Canada
| | - Mario Masellis
- Department of Medicine (Division of Neurology), University of Toronto, Toronto, ON, Canada.,Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Bruce G Pollock
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Tarek K Rajji
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Adult Neurodevelopment and Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Joel Ramirez
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada.,LC Campbell Cognitive Neurology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Demetrios J Sahlas
- Department of Medicine (Division of Neurology), McMaster University, Hamilton, ON, Canada
| | - Gustavo Saposnik
- Outcomes and Decision Neuroscience Research Unit, Toronto, ON, Canada
| | - Christopher J M Scott
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada.,LC Campbell Cognitive Neurology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Dallas P Seitz
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Stephen C Strother
- Rotman Research Institute, Baycrest Health Sciences, Toronto, ON, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Kelly M Sunderland
- Rotman Research Institute, Baycrest Health Sciences, Toronto, ON, Canada
| | - Brian Tan
- Rotman Research Institute, Baycrest Health Sciences, Toronto, ON, Canada
| | - David F Tang-Wai
- Department of Medicine (Division of Neurology), University of Toronto, Toronto, ON, Canada.,Department of Medicine (Geriatric Medicine), University of Toronto, Toronto, ON, Canada.,University Hospital Network Memory Clinic, Toronto, ON, Canada
| | - Angela K Troyer
- Department of Psychology, University of Toronto, Toronto, ON, Canada.,Neuropsychology & Cognitive Health Program, Baycrest Health Sciences, Toronto, ON, Canada
| | - John Turnbull
- Department of Medicine (Division of Neurology), McMaster University, Hamilton, ON, Canada
| | - Lorne Zinman
- Department of Medicine (Division of Neurology), University of Toronto, Toronto, ON, Canada.,Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Richard H Swartz
- Department of Medicine (Division of Neurology), University of Toronto, Toronto, ON, Canada.,Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Maria Carmela Tartaglia
- Department of Medicine (Division of Neurology), University of Toronto, Toronto, ON, Canada.,Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada.,Division of Neurology, Krembil Neuroscience Centre Memory Clinic, Toronto, ON, Canada
| | - David P Breen
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, UK.,Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Donna Kwan
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
| | - Angela C Roberts
- School of Communication Sciences and Disorders, Western University, London, ON, Canada.,Roxelyn and Richard Pepper Department of Communication Sciences and Disorders and Department of Computer Science, Northwestern University, Evanston, Illinois, USA
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29
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Klein AZ, Magge A, O'Connor K, Gonzalez-Hernandez G. Automatically Identifying Twitter Users for Interventions to Support Dementia Family Caregivers: Annotated Data Set and Benchmark Classification Models (Preprint). JMIR Aging 2022; 5:e39547. [PMID: 36112408 PMCID: PMC9526111 DOI: 10.2196/39547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/08/2022] [Accepted: 07/08/2022] [Indexed: 12/21/2022] Open
Abstract
Background More than 6 million people in the United States have Alzheimer disease and related dementias, receiving help from more than 11 million family or other informal caregivers. A range of traditional interventions has been developed to support family caregivers; however, most of them have not been implemented in practice and remain largely inaccessible. While recent studies have shown that family caregivers of people with dementia use Twitter to discuss their experiences, methods have not been developed to enable the use of Twitter for interventions. Objective The objective of this study is to develop an annotated data set and benchmark classification models for automatically identifying a cohort of Twitter users who have a family member with dementia. Methods Between May 4 and May 20, 2021, we collected 10,733 tweets, posted by 8846 users, that mention a dementia-related keyword, a linguistic marker that potentially indicates a diagnosis, and a select familial relationship. Three annotators annotated 1 random tweet per user to distinguish those that indicate having a family member with dementia from those that do not. Interannotator agreement was 0.82 (Fleiss kappa). We used the annotated tweets to train and evaluate support vector machine and deep neural network classifiers. To assess the scalability of our approach, we then deployed automatic classification on unlabeled tweets that were continuously collected between May 4, 2021, and March 9, 2022. Results A deep neural network classifier based on a BERT (bidirectional encoder representations from transformers) model pretrained on tweets achieved the highest F1-score of 0.962 (precision=0.946 and recall=0.979) for the class of tweets indicating that the user has a family member with dementia. The classifier detected 128,838 tweets that indicate having a family member with dementia, posted by 74,290 users between May 4, 2021, and March 9, 2022—that is, approximately 7500 users per month. Conclusions Our annotated data set can be used to automatically identify Twitter users who have a family member with dementia, enabling the use of Twitter on a large scale to not only explore family caregivers’ experiences but also directly target interventions at these users.
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Affiliation(s)
- Ari Z Klein
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Arjun Magge
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Karen O'Connor
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
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30
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Liu J, Lou Y, Cheung ESL, Wu B. Use of tangible, educational and psychological support services among Chinese American dementia caregivers. DEMENTIA 2022; 21:1914-1932. [PMID: 35511805 PMCID: PMC10123869 DOI: 10.1177/14713012221099781] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVES Though many studies have examined the service utilization of dementia caregivers, there is limited empirical evidence from Asian Americans in this field. Guided by Andersen's behavioral model of health services use, we aimed to understand what factors were associated with utilizing multiple types of services among Chinese American dementia caregivers. RESEARCH DESIGN AND METHODS We collected survey data from 134 Chinese dementia caregivers in New York City. Logistic regression models were conducted to test the associations between predisposing, enabling, and need factors and the likelihood of using tangible (home health aide, adult daycare, respite care), educational (lectures and workshops), and psychological (peer support groups and psychological counseling) support services. RESULTS Several variables conceptualized by Andersen's model, including caregiver's knowledge about services, caring tasks, length of care and burden, and care recipient's physical and cognitive deteriorations, were significantly associated with higher possibilities of using multiple types of services. Three sociocultural factors-residing in Chinatown, availability of alternative family caregivers, and diagnosis of cognitive deterioration-were also associated with higher likelihood of using educational or psychological services. DISCUSSION AND IMPLICATIONS The findings extend the existing literature on service utilization of caregivers by highlighting the importance of distinguishing types of services and considering sociocultural factors in future research and practice.
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Affiliation(s)
- Jinyu Liu
- School of Social Work, 5798Columbia University, New York, NY, USA
| | - Yifan Lou
- School of Social Work, 5798Columbia University, New York, NY, USA
| | | | - Bei Wu
- Rory Meyers College of Nursing, 5894New York University, New York, NY, USA
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31
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Okamura T, Ura C, Shimmei M, Takase A, Shoji R, Ogawa Y. Reflections of Buddhist priests who started a dementia carers' café in Japan. DEMENTIA 2022; 21:1856-1868. [PMID: 35452323 DOI: 10.1177/14713012221092212] [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: 11/17/2022]
Abstract
AIM Faith-based organizations are a potential global resource; however, details of their activities have not been fully explored in the academic literature. In Japan, little is known about delivering support for dementia caregivers in a faith-based setting. In this study, we spoke with priests who started carers' cafés to support people who have dementia and people who care for them. These "carers' cafés" are set up in temples and this movement is slowly expanding. The aim of this study was to (1) provide a detailed description of a carers' café and (2) report the reflections of the Buddhist priests who have been involved in the project from the beginning. METHODS We conducted in-depth interviews with five Buddhist priests who pioneered the carers' café movement, and conducted a thematic analysis of the transcripts using a qualitative descriptive approach. RESULTS Six prominent themes were identified: "A carers' café aligns with Buddhist doctrine," "...reveals the strengths of Buddhism and its temples," "...facilitates priests' personal growth," and "...introduces viewpoints from outside of Buddhism." CONCLUSIONS Carers' cafés set up in temples have a positive impact on the Buddhist priests who are involved and on the visitors. One possible reason for this is that the relationship between the temple and the local residents has a long history and thus provides a sense of security for those who are suffering from the realities related to dementia. To create a more inclusive society, it is necessary for secular entities to support this new movement.
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Affiliation(s)
| | - Chiaki Ura
- 13971Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Masaya Shimmei
- Department of Psychology and Welfare, 13171Den-en Chofu University, Tokyo, Japan
| | - Akinori Takase
- Institute of Regional Development, 13083Taisho University, Tokyo, Japan
| | | | - Yukan Ogawa
- Institute of Regional Development, 13083Taisho University, Tokyo, Japan
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Cost-Effectiveness of an Online Intervention for Caregivers of People Living With Dementia. J Am Med Dir Assoc 2022; 23:1468-1473. [PMID: 35395216 DOI: 10.1016/j.jamda.2022.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 02/15/2022] [Accepted: 03/05/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Little evidence exists on costs or cost-effectiveness of online interventions for caregivers of people living with dementia. We aimed to assess cost-effectiveness of online cognitive behavioral therapy (CBT) for dementia caregivers with mild-to-moderate depression/anxiety, with or without telephone support, relative to a psychoeducational control treatment. DESIGN Cost-effectiveness study of data from 3-armed randomized controlled trial comparing computerized CBT (cCBT) or telephone-supported cCBT (cCBT+Telephone) to modular online educational program on dementia (Psychoeducation). SETTING AND PARTICIPANTS UK-resident adult dementia caregivers with mild-to-moderate anxiety/depression. COST-EFFECTIVENESS ANALYSIS We calculated health and social care costs, from participant-reported data collected at baseline, 12, 26 weeks, costs of intervention delivery. We examined 3 outcomes: cost of one-point reduction in General Health Questionnaire-12 (GHQ-12) rating at 26-weeks, cost of prevented "caseness" on GHQ-12 at 26 weeks, and cost per quality-adjusted life year (QALY) based on Short Form-6 Dimensions (SF-6D) over 26 weeks. RESULTS Data from 176 participants (44 cCBT, 91 cCBT+Telephone, 41 Psychoeducation) were analyzed. Costs did not differ between cCBT and Psychoeducation; costs were £125 higher in cCBT+Telephone. Control and intervention groups did not differ on GHQ-12. Caseness was lower in cCBT+Telephone than Psychoeducation; cost of preventing a case was £610, and probability of cost-effectiveness on this outcome reached 98.5% at willingness to pay (WTP) of £12,900. Mean QALY did not differ between cCBT+Telephone and Psychoeducation. QALY gain in cCBT was 0.01 (95% CI 0.001, 0.021). Cost per QALY was £8130. Although base case probability of cost-effectiveness of cCBT was 93% at WTP-per-QALY of £27,600, sensitivity analyses suggested cCBT+Telephone was the more cost-effective. CONCLUSIONS AND IMPLICATIONS We report preliminary evidence for adopting telephone-supported online CBT. This may be cost-effective in preventing a case of mental health disorder if, absent a societally accepted WTP threshold for this outcome, payers are willing to pay £12,900. Future research should investigate whether supported/unsupported online CBT improves health-related quality of life.
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Abstract
This article describes the public health impact of Alzheimer's disease (AD), including incidence and prevalence, mortality and morbidity, use and costs of care, and the overall impact on family caregivers, the dementia workforce and society. The Special Report discusses consumers' and primary care physicians' perspectives on awareness, diagnosis and treatment of mild cognitive impairment (MCI), including MCI due to Alzheimer's disease. An estimated 6.5 million Americans age 65 and older are living with Alzheimer's dementia today. This number could grow to 13.8 million by 2060 barring the development of medical breakthroughs to prevent, slow or cure AD. Official death certificates recorded 121,499 deaths from AD in 2019, the latest year for which data are available. Alzheimer's disease was officially listed as the sixth-leading cause of death in the United States in 2019 and the seventh-leading cause of death in 2020 and 2021, when COVID-19 entered the ranks of the top ten causes of death. Alzheimer's remains the fifth-leading cause of death among Americans age 65 and older. Between 2000 and 2019, deaths from stroke, heart disease and HIV decreased, whereas reported deaths from AD increased more than 145%. More than 11 million family members and other unpaid caregivers provided an estimated 16 billion hours of care to people with Alzheimer's or other dementias in 2021. These figures reflect a decline in the number of caregivers compared with a decade earlier, as well as an increase in the amount of care provided by each remaining caregiver. Unpaid dementia caregiving was valued at $271.6 billion in 2021. Its costs, however, extend to family caregivers' increased risk for emotional distress and negative mental and physical health outcomes - costs that have been aggravated by COVID-19. Members of the dementia care workforce have also been affected by COVID-19. As essential care workers, some have opted to change jobs to protect their own health and the health of their families. However, this occurs at a time when more members of the dementia care workforce are needed. Average per-person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are almost three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 22 times as great. Total payments in 2022 for health care, long-term care and hospice services for people age 65 and older with dementia are estimated to be $321 billion. A recent survey commissioned by the Alzheimer's Association revealed several barriers to consumers' understanding of MCI. The survey showed low awareness of MCI among Americans, a reluctance among Americans to see their doctor after noticing MCI symptoms, and persistent challenges for primary care physicians in diagnosing MCI. Survey results indicate the need to improve MCI awareness and diagnosis, especially in underserved communities, and to encourage greater participation in MCI-related clinical trials.
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Noel MA, Lackey E, Labi V, Bouldin ED. Efficacy of a Virtual Education Program for Family Caregivers of Persons Living with Dementia. J Alzheimers Dis 2022; 86:1667-1678. [PMID: 35213371 PMCID: PMC9108574 DOI: 10.3233/jad-215359] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background: Family caregivers of people with dementia often experience negative impacts including stress and burden. Psychoeducational programs can reduce these negative outcomes. Objective: To evaluate whether this virtual caregiver education program changes caregiver confidence, self-efficacy, and burden relative to controls. Methods: This was a pre-post comparison of a five-week, synchronous, virtual caregiver education program delivered by a clinician and caregiver support specialist covering aspects of dementia, including changes in cognition, behavior, functional abilities, caregiver-care recipient roles, communication, and caregiver self-care. Caregivers (n = 90) were surveyed at baseline, at completion of intervention, and three months thereafter; controls (n = 44) were surveyed at two points six weeks apart. We compared validated measures of caregiver confidence, self-efficacy, and burden using generalized estimating equations. Results: Participants’ confidence and self-efficacy increased over follow-up compared with controls (p < 0.01 for intervention*time in regression models). There was no difference in burden. All participants (100%) reported perceived increased knowledge, 97% perceived increased confidence, and 95% perceived increased ability to manage dementia-related behaviors after the course. Conclusion: This virtual caregiver education program was effective in improving caregiver confidence and self-efficacy and participants’ self-reported impact was equivalent to those who had taken previous courses in person. Caregivers with greater confidence and self-efficacy have been shown to have better health outcomes and decreased stress and depressive symptoms. Health professionals, health care organizations, and public health agencies should consider using efficacious virtual caregiver education programs in rural and other community settings, during public health crises, or in standard practice as an alternative to in-person programs.
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Affiliation(s)
| | | | - Vanna Labi
- Gillings School of Global Public Health, University of North Carolina -Chapel Hill, Asheville, NC, USA
| | - Erin D Bouldin
- Department of Health and Exercise Science, Appalachian State University, Boone, NC, USA
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Aldridge MD, Moreno J, McKendrick K, Li L, Brody A, May P. Association Between Hospice Enrollment and Total Health Care Costs for Insurers and Families, 2002-2018. JAMA HEALTH FORUM 2022; 3:e215104. [PMID: 35977281 PMCID: PMC8903119 DOI: 10.1001/jamahealthforum.2021.5104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 12/07/2021] [Indexed: 12/19/2022] Open
Abstract
Importance Use of hospice has been demonstrated to be cost saving to the Medicare program and yet the extent to which hospice saves money across all payers, including whether it shifts costs to families, is unknown. Objective To estimate the association between hospice use and total health care costs including family out-of-pocket health care spending. Design Setting and Participants This retrospective cohort study of health care spending in the last 6 months of life used data from the nationally representative Medicare Current Beneficiary Survey (MCBS) between the years 2002 and 2018. Participants were MCBS participants who resided in the community and died between 2002 and 2018. Exposures Covariate balancing propensity scores were used to compare participants who used hospice (n = 2113) and those who did not (n = 3351), stratified by duration of hospice use. Main Outcomes and Measures Total health care expenditures were measured across payers (family out-of-pocket, Medicare, Medicare Advantage, Medicaid, private insurance, private health maintenance organizations, Veteran's Administration, and other) and by expenditure type (inpatient care, outpatient care, medical visits, skilled nursing, home health, hospice, durable medical equipment, and prescription drugs). Results The study population included 5464 decedents (mean age 78.7 years; 48% female) and 38% enrolled with hospice. Total health care expenditures were lower for those who used hospice compared with propensity score weighted non-hospice control participants for the last 3 days of life ($2813 lower; 95% CI, $2396-$3230); last week of life ($6806 lower; 95% CI, $6261-$7350); last 2 weeks of life ($8785 lower; 95% CI, $7971-$9600); last month of life ($11 747 lower; 95% CI, $10 072-$13 422); and last 3 months of life ($10 908 lower; 95% CI, $7283-$14 533). Family out-of-pocket expenditures were lower for hospice enrollees in the last 3 days of life ($71; 95% CI, $43-$100); last week of life ($216; 95% CI, $175-$256); last 2 weeks of life ($265; 95% CI, $149-$382); and last month of life ($670; 95% CI, $530-$811) compared with those who did not use hospice. Health care savings were associated with reductions in inpatient care. Conclusions and Relevance In this population-based cohort study of community-dwelling Medicare beneficiaries, hospice enrollment was associated with lower total health care costs for the last 3 days to 3 months of life. Importantly, we found no evidence of cost shifting from Medicare to families related to hospice enrollment. The magnitude of lower out-of-pocket spending to families who enrolled with hospice is meaningful to many Americans, particularly those with lower socioeconomic status.
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Affiliation(s)
- Melissa D. Aldridge
- Icahn School of Medicine at Mount Sinai, New York, New York
- James J. Peters Bronx VA Medical Center, Bronx, New York
| | - Jaison Moreno
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Lihua Li
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ab Brody
- NYU Rory Meyers College of Nursing, New York, New York
- NYU Grossman School of Medicine, New York, New York
| | - Peter May
- Trinity College Dublin, Dublin, Ireland
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Clair L, Anderson H, Anderson C, Ekuma O, Prior HJ. Cardiovascular disease and the risk of dementia: a survival analysis using administrative data from Manitoba. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2022; 113:455-464. [PMID: 35025100 PMCID: PMC9043061 DOI: 10.17269/s41997-021-00589-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 10/15/2021] [Indexed: 01/16/2023]
Abstract
OBJECTIVES Recent research has shown that cardiovascular disease (CVD) raises the risk of dementia and other forms of cognitive decline. Generally, these studies are unable to model the time of diagnosis of CVD in their analyses and treat CVD as a time-fixed variable. Our objective was to assess the risk of being diagnosed with dementia for individuals diagnosed with CVD when CVD is time-dependent. METHODS We performed a retrospective cohort study using administrative health datasets from the Manitoba Population Research Data Repository in Canada. We constructed a longitudinal dataset to track individuals enrolled in the Manitoba Health Insurance Registry between April 1, 1997 and March 31, 2015. The study population consisted of 496,192 individuals 30 years of age or older who were not diagnosed with CVD or dementia prior to April 1, 1997. Diagnoses of CVD and dementia were based on diagnosis codes from medical claims and hospitalizations and the use of prescription medications. Hazard ratios were then computed using adjusted Cox-proportional hazards analyses. RESULTS Among the CVD subgroups considered, atrial fibrillation, ischemic heart disease, and stroke increased the risk of developing dementia, with stroke doubling one's risk of being diagnosed with the disease (hazard ratio: 1.95; 95% confidence interval: 1.9, 2.01). Age, lower socioeconomic status, and worsening comorbidities also increased the risk of being diagnosed with dementia. CONCLUSION A diagnosis of CVD is associated with an increased risk of a future diagnosis of dementia. Promoting good cardiovascular health may serve as an effective measure for preventing dementia.
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Affiliation(s)
- Luc Clair
- Department of Economics, University of Winnipeg, 515 Portage, Avenue, Winnipeg, MB R3B 2E9 Canada ,Canadian Centre for Agri-Food Research in Health and Medicine, Winnipeg, MB Canada
| | - Hope Anderson
- Canadian Centre for Agri-Food Research in Health and Medicine, Winnipeg, MB Canada ,College of Pharmacy, University of Manitoba, Winnipeg, MB Canada
| | - Christopher Anderson
- Department of Pharmacology and Therapeutics, University of Manitoba, Winnipeg, MB Canada ,Neuroscience Research Program, Kleysen Institute for Advanced Medicine, Health Sciences Centre, Winnipeg, MB Canada
| | - Okechukwu Ekuma
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB Canada
| | - Heather J. Prior
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB Canada
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Shah NR, Kim KM, Wong V, Cohen E, Rosenbaum S, Cahan EM, Milstein A, Sørensen HT, Horváth-Puhó E. Mothers of children with major congenital anomalies have increased health care utilization over a 20-year post-birth time horizon. PLoS One 2021; 16:e0260962. [PMID: 34879106 PMCID: PMC8654179 DOI: 10.1371/journal.pone.0260962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 11/19/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE This population-based, matched cohort study aimed to evaluate utilization of health care services by mothers of children with major congenital anomalies (MCAs), compared to mothers of children without MCAs over a 20-year post-birth time horizon in Denmark. METHODS Our analytic sample included mothers who gave birth to an infant with a MCA (n = 23,927) and a cohort of mothers matched to them by maternal age, parity and infant's year of birth (n = 239,076). Primary outcomes were period prevalence and mothers' quantity of health care utilization (primary, inpatient, outpatient, surgical, and psychiatric services) stratified by their child's age (i.e., ages 0-6 = before school, ages 7-13 = pre-school + primary education, and ages 14-18 = secondary education or higher). The secondary outcome measure was length of hospital stays. Outcome measures were adjusted for maternal age at delivery, parity, marital status, income quartile, level of education in the year prior to the index birth, previous spontaneous abortions, maternal pregnancy complications, maternal diabetes, hypertension, alcohol-related diseases, and maternal smoking. RESULTS In both cohorts the majority of mothers were between 26 and 35 years of age, married, and employed, and 47% were primiparous. Mothers of infants with anomalies had greater utilization of outpatient, inpatient, surgical, and psychiatric services, compared with mothers in the matched cohort. Inpatient service utilization was greater in the exposed cohort up to 13 years after a child's birth, with the highest risk in the first six years after birth [adjusted risk ratio, 1.13; 95% confidence interval (CI), 1.12-1.14], with a decrease over time. Regarding the quantity of health care utilization, the greatest difference between the two groups was in inpatient service utilization, with a 39% increased rate in the exposed cohort during the first six years after birth (adjusted rate ratio, 1.39; 95% CI, 1.37-1.42). During the first 6 years after birth, mothers of children with anomalies stayed a median of 6 days (interquartile range [IQR], 3-13) in hospital overall, while the comparison cohort stayed a median of 4 days (IQR, 2-7) in hospital overall. Rates of utilization of outpatient clinics (adjusted rate ratio, 1.36; 95% CI, 1.29-1.42), as well as inpatient (adjusted rate ratio, 1.77; 95% CI, 1.68-1.87), and surgical services (adjusted rate ratio, 1.33; 95% CI, 1.26-1.41) was higher in mothers of children with multiple-organ MCAs during 0 to 6 years after birth. Among mothers at the lowest income levels, utilization of psychiatric clinic services increased to 59% and when their child was 7 to 13 years of age (adjusted rate ratio, 1.59; 95% CI, 1.24-2.03). CONCLUSION Mothers of infants with a major congenital anomaly had greater health care utilization across services. Health care utilization decreased over time or remained stable for outpatient, inpatient, and surgical care services, whereas psychiatric utilization increased for up to 13 years after an affected child's birth. Healthcare utilization was significantly elevated among mothers of children with multiple MCAs and among those at the lowest income levels.
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Affiliation(s)
- Nirav R. Shah
- Clinical Excellence Research Center, School of Medicine, Stanford University, Stanford, California, United States of America
| | - Kyung Mi Kim
- Clinical Excellence Research Center, School of Medicine, Stanford University, Stanford, California, United States of America
| | - Venus Wong
- Clinical Excellence Research Center, School of Medicine, Stanford University, Stanford, California, United States of America
| | - Eyal Cohen
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Sarah Rosenbaum
- Clinical Excellence Research Center, School of Medicine, Stanford University, Stanford, California, United States of America
| | - Eli M. Cahan
- Clinical Excellence Research Center, School of Medicine, Stanford University, Stanford, California, United States of America
- School of Medicine, New York University, New York, New York, United States of America
| | - Arnold Milstein
- Clinical Excellence Research Center, School of Medicine, Stanford University, Stanford, California, United States of America
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Division of Epidemiology, Department of Health Research and Policy, Stanford University, Stanford, California, United States of America
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Ryan L. Accessing community dementia care services in Ireland: Emotional barriers for caregivers. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:1980-1989. [PMID: 33682982 DOI: 10.1111/hsc.13342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 01/06/2021] [Accepted: 02/15/2021] [Indexed: 06/12/2023]
Abstract
Despite the benefits of utilising community-based care services (CBS) for people with dementia and their caregiver being well established, people with dementia and caregivers use fewer services in comparison to other people in need of care. While societal, cultural and logistical factors effecting caregiver use of CBS are frequently studied, research of internal emotional barriers, mental limitations created by one's own self that prevents open communication of thoughts and feelings, and their effect on CBS use is limited. This paper explores internal emotional barriers on caregivers' use of CBS within the Irish Healthcare System. Professional Healthcare Providers were also interviewed as a preliminary indicator of their awareness of these internal emotional barriers and their impact on caregivers' use of CBS. Using interpretive description methodology, interviews with 20 caregivers and fourteen dementia professional healthcare providers were transcribed and a thematic analysis methodology applied to illuminate themes/patterns within participants' subjective perceptions of caregivers emotional barriers to using CBS. Four themes emerge: reluctance to question general practitioner (GP) authority; embarrassment during level of care requirement reviews; sense of obligation to provide all care; and fear of stigma. Caregivers interviewed were reluctant to communicate concerns with professional healthcare providers (PHPs), thereby reducing the PHP's awareness of these barriers and delaying/preventing use of CBS. As key gatekeepers within the care pathway, GPs should address the uneven power dynamic with the caregiver through user-centred models of care, which actively encourage open dialogue, and receive training to identify the indicative behaviours of internal emotional barriers and empower the caregiver to communicate their feelings/concerns directly.
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Affiliation(s)
- Priyanka Shrestha
- Betty Irene Moore School of Nursing, University of California, Davis, Davis, California
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Hutmacher F, Schouwink K. "It is the beautiful things that let us live": How engaging in creative activities outside of standardized interventions helps family members of persons with Dementia. DEMENTIA 2021; 21:396-409. [PMID: 34632825 PMCID: PMC8811328 DOI: 10.1177/14713012211041804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Creative activities can have profound positive effects on family members of persons with dementia. Typically, these effects have been studied in the context of standardized arts-based interventions. However, family members of persons with dementia may also engage in creative activities outside of standardized interventions. As these kinds of creative activities have not been investigated so far, the present study tried to fill this gap based on seven semi-structured interviews. The interviews were analysed using qualitative content analysis. The participants reported a wide range of activities that included, but were not limited to, prototypical creative activities such as making music and writing. Crucially, the positive effects extended beyond the experience of engaging in the activities themselves and also included significant changes in cognitions, emotions and behaviour that helped the participants to make meaning of the challenges and difficulties that are associated with the dementia diagnosis of a loved one.
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Affiliation(s)
- Fabian Hutmacher
- Human-Computer-Media Institute, 9190University of Würzburg, Würzburg, Germany
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Hebdon M, Badger TA, Segrin C, Pasvogel A. Social support and healthcare utilization of caregivers of Latinas with breast cancer. Support Care Cancer 2021; 29:4395-4404. [PMID: 33740132 PMCID: PMC8475626 DOI: 10.1007/s00520-020-05983-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 12/29/2020] [Indexed: 10/21/2022]
Abstract
BACKGROUND Family caregivers experience significant health consequences related to caregiving, including higher mortality rates. Latino caregivers may have additional challenges related to social determinants of health. Gender and social support are key factors to consider in the context of chronic illnesses and healthcare use in caregivers of Latinos diagnosed with cancer. PURPOSE The purpose of this study was to examine the moderating effect of gender and social support on the relationship between chronic illnesses and healthcare utilization in caregivers of Latina breast cancer survivors. METHODS This was a secondary analysis of family caregivers from an experimental study with breast cancer survivors and their designated family caregivers. Participants completed telephone surveys about demographics, presence of chronic illnesses, frequency of emergency department, urgent care, and hospital visits, social support, and acculturation. Data were analyzed for direct and moderated relationships. RESULTS There was a significant relationship between number of chronic illnesses and healthcare utilization, informational support, and social isolation. Income and acculturation were not related to chronic illnesses or healthcare utilization. Gender did not moderate the relationship between chronic illnesses and healthcare utilization. Informational support was a marginal moderator of the relationship between chronic illnesses and healthcare utilization alone and with acculturation and income included as covariates. CONCLUSIONS Clinicians should consider the influence of informational support and social isolation on chronic illnesses and healthcare use in caregivers of Latina breast cancer survivors, specifically, how these factors may influence navigation of the healthcare system.
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Affiliation(s)
- Megan Hebdon
- College of Nursing, University of Utah, Salt Lake City, UT, USA.
| | - Terry A Badger
- College of Nursing, University of Arizona, Tucson, AZ, USA
| | - Chris Segrin
- Department of Communication, University of Arizona, Tucson, AZ, USA
| | - Alice Pasvogel
- College of Nursing, University of Arizona, Tucson, AZ, USA
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Sheehan OC, Haley WE, Howard VJ, Huang J, Rhodes JD, Roth DL. Stress, Burden, and Well-Being in Dementia and Nondementia Caregivers: Insights From the Caregiving Transitions Study. THE GERONTOLOGIST 2021; 61:670-679. [PMID: 32816014 DOI: 10.1093/geront/gnaa108] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Few population-based studies have directly compared caregivers of persons with dementia to caregivers of persons with other disabilities (nondementia caregivers). We enrolled dementia and nondementia caregivers who were providing substantial and sustained care and compared these groups on measures of caregiver stressors, appraisals of burden, and well-being. RESEARCH DESIGN AND METHODS Caregivers (N = 251) who provided continuous care for at least 1 year and at least 5 h per week were recruited from the population-based REasons for Geographic And Racial Differences in Stroke (REGARDS) study. Caregivers reported on dementia caregiving status, stressors, burden, and well-being. RESULTS Forty-seven percent (n = 117) reported caring for a person with dementia. Dementia caregivers reported more stressors, providing more care for self-care and behavioral problems than nondementia caregivers. Dementia caregivers also reported higher appraisals of stress and burden, and more depressive symptoms, but did not differ from nondementia caregivers on mental and physical health quality of life. In multivariable-adjusted models, adjustment for the total number of care recipient problems attenuated differences between dementia and nondementia caregivers on burden and depression measures. DISCUSSION AND IMPLICATIONS Dementia and nondementia caregivers showed relatively few differences in indicators of overall well-being in this population-based sample, perhaps because both groups of caregivers in this study were providing substantial care. Dementia caregivers may require special assistance with dementia-specific problems such as behavioral problems. Clinical interventions and policy changes targeting highly burdened caregivers are needed to support them in allowing their care recipients to age in place at home.
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Affiliation(s)
- Orla C Sheehan
- Center on Aging and Health, Division of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, Maryland
| | | | - Virginia J Howard
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham
| | - Jin Huang
- Center on Aging and Health, Division of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, Maryland
| | - J David Rhodes
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham
| | - David L Roth
- Center on Aging and Health, Division of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, Maryland
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Grande G, Vetrano DL, Mazzoleni F, Lovato V, Pata M, Cricelli C, Lapi F. Detection and Prediction of Incident Alzheimer Dementia over a 10-Year or Longer Medical History: A Population-Based Study in Primary Care. Dement Geriatr Cogn Disord 2021; 49:384-389. [PMID: 33242874 DOI: 10.1159/000509379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 06/11/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Despite the crucial role played by general practitioners in the identification and care of people with cognitive impairment, few data are available on how they may improve the early recognition of patients with Alzheimer dementia (AD), especially those with long (i.e., 10 years and longer) medical history. AIMS To investigate the occurrence and the predictors of AD during a 10-year or longer period prior AD diagnosis in primary care patients aged 60 years or older. MATERIALS AND METHODS A cohort study with a nested case-control analysis has been conducted. Data were extracted from the Italian Health Search Database (HSD), an Italian database with primary care data. AD cases have been defined in accordance with the International Classification of Diseases, ninth edition (ICD-9-CM) codes and coupled with the use of anti-dementia drugs. Prevalence and incidence rates of AD have been calculated. To test the association between candidate predictors, being identified in a minimum period of 10 years, and incident cases of AD, we used a multivariate conditional logistic regression model. RESULTS As recorded in the primary care database, AD prevalence among patients aged 60 years or older was 0.8% during 2016, reaching 2.4% among nonagenarians. Overall, 1,889 incident cases of AD have been identified, with an incidence rate as high as 0.09% person-year. Compared with 18,890 matched controls, history of hallucinations, agitation, anxiety, aberrant motor behavior, and memory deficits were positively associated with higher odds of AD (p < 0.001 for all) diagnosis. A previous diagnosis of depression and diabetes and the use of low-dose aspirin and non-steroidal anti-inflammatory drugs were associated with higher odds of AD (p < 0.05 for all). CONCLUSION Our findings show that, in accordance with primary care records, 1% of patients aged 60 years and older have a diagnosis of AD, with an incident AD diagnosis of 0.1% per year. AD is often under-reported in primary care settings; yet, several predictors identified in this study may support general practitioners to early identify patients at risk of AD.
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Affiliation(s)
- Giulia Grande
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Davide L Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.,Department of Geriatrics, Catholic University of Rome, Rome, Italy.,Centro di Medicina dell'Invecchiamento, Fondazione Policlinico "A. Gemelli" IRCCS, Rome, Italy
| | | | | | | | - Claudio Cricelli
- Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Francesco Lapi
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy,
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Lin RSY, Yu DSF, Pui Hing Chau P, Li PWC. An empowerment-psycho-behavioral program on neuropsychiatric symptoms in persons with mild cognitive impairment: Study protocol of a randomized controlled trial. J Adv Nurs 2021; 77:3507-3517. [PMID: 33909293 DOI: 10.1111/jan.14871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 04/07/2021] [Indexed: 11/29/2022]
Abstract
AIMS Neuropsychiatric symptoms (NPS) are highly prevalent among persons with mild cognitive impairment (PwMCI). However, the mainstay of treatments only focuses on cognitive training. This study develops an empowerment-psycho-behavioural programme to improve the NPS and other health outcomes of this preclinical cohort. The empirical effects and the participants' perception and experience of the programme will be explored. DESIGN This sequential mixed-method study comprises a single-blind randomized controlled trial and a qualitative study. METHODS This study will recruit 250 PwMCI from the community and randomize them to either the intervention group to receive a 13-week empowerment-psycho-behavioural programme which focuses on promoting cognitive coping and stress adaptation, or the control group to receive a health education programme which serves as an attention placebo with content unrelated to dementia. The primary outcome is NPS, and the secondary outcomes include cognitive function, subjective memory complaints and health-related quality of life. These outcomes will be measured at baseline, upon completing the programme and 4 weeks thereafter. A purposive sample of 30 participants from the intervention group will be interviewed for their engagement experience in the programme. This study received funding support in July 2020. DISCUSSION Given the high prevalence and detrimental effects of NPS on disease progression, effective management is yet to be determined. Underpinned by the Progressively Lowered Stress Threshold (PLST) Model, the empowerment-psycho-behavioural programme is designed. Results on the outcome-based evaluation and the patients' experience can advance the science in this under-addressed area. IMPACT This study enhances our understanding of the PLST Model in explaining the manifestations of NPS by the stress-coping disequilibrium at the early disease stage. It will shed important insight into the care management of MCI to attend both cognition function and psychological well-being in research and clinical context. TRIAL REGISTRATION This study is registered in the ClinicalTrials.gov (NCT04723667) and the HKU Clinical Trials Registry (HKUCTR-2915).
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Affiliation(s)
- Rose S Y Lin
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong
| | - Doris S F Yu
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong
| | - Patsy Pui Hing Chau
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong
| | - Polly W C Li
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong
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45
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Cheng Y, Wang Z, Yang T, Lv W, Huang H, Zhang Y. Factors influencing depression in primary caregivers of patients with dementia in China: A cross-sectional study. Geriatr Nurs 2021; 42:734-739. [PMID: 33857837 DOI: 10.1016/j.gerinurse.2021.03.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/22/2021] [Accepted: 03/24/2021] [Indexed: 10/21/2022]
Abstract
This study aims to estimate the prevalence and factors of depression in primary caregivers of people with dementia in China, based on a biopsychosocial medical model. A sample of 285 caregiver-patient dyads was recruited from a tertiary psychiatric hospital in Nanjing, between December 2018 and November 2019. The prevalence of depression among primary caregivers of people with dementia was 42.8%. Binary logistic regression analyses revealed that caregivers' gender (OR=4.692), social support (OR=0.131), health condition (OR=12.994), extraversion (OR=0.102) and neuroticism (OR=2.978) were predictive of depression in those caregivers. Of the above, health condition was the major factor associated with caregiver's depression. The Box-Tidwell method was used to show a linear relationship between continuous independent variables and dependent variable logit conversion values (p = 0.0045). Suggestions are provided to develop support service programs and interventions tailored to caregivers, to help meet their basic substance and mental health needs. (147 words).
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Affiliation(s)
- Yin Cheng
- School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, 211166, Nanjing, China
| | - Zhaoqin Wang
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, 264 Guangzhou Road, Gulou District, 210029, Nanjing, China
| | - Tianting Yang
- Nursing Department, The Affiliated Brain Hospital of Nanjing Medical University, 264 Guangzhou Road, Gulou District, 210029, Nanjing, China
| | - Wenjun Lv
- Nursing Department, The Affiliated Brain Hospital of Nanjing Medical University, 264 Guangzhou Road, Gulou District, 210029, Nanjing, China
| | - Haolian Huang
- Nursing Department, The Affiliated Brain Hospital of Nanjing Medical University, 264 Guangzhou Road, Gulou District, 210029, Nanjing, China
| | - Yanhong Zhang
- Nursing Department, The Affiliated Brain Hospital of Nanjing Medical University, 264 Guangzhou Road, Gulou District, 210029, Nanjing, China; School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, 211166, Nanjing, China.
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46
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Kürten L, Dietzel N, Kolominsky-Rabas PL, Graessel E. Predictors of the one-year-change in depressiveness in informal caregivers of community-dwelling people with dementia. BMC Psychiatry 2021; 21:177. [PMID: 33812389 PMCID: PMC8019174 DOI: 10.1186/s12888-021-03164-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/12/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The care of people with dementia is usually carried out by their family members, which can cause objective und subjective burden and raise their risk of depressiveness. Thus, the aim of this study is to identify predictors of the change in depressiveness of informal caregivers over 1 year in order to be able to derive hypotheses for interventions that promise success. METHODS The Bavarian Dementia Survey (BayDem) is a multi-center, longitudinal study conducted at three different sites in Bavaria, Germany. Participants were people with dementia and their informal caregivers. Data was collected at baseline and after 12 months by standardized face-to-face interviews in cooperation with local players. The informal caregivers' depressiveness was assessed with the WHO-5. Data was also collected on the people with dementia's cognition (MMSE), behavioral symptoms (NPI) and comorbidities (Charlson Comorbidity Index) as well as caregivers' social inclusion (LSNS), time spent on care and care contribution (RUD). For statistical analysis, a multiple regression model was used. RESULTS The data of 166 people with dementia and their informal caregivers was analyzed. Of the latter, 46% were categorized as "likely depressed". The change in depressiveness over a year was significantly predicted by baseline depressiveness as well as an increase in the time informal caregivers spent supervising the person with dementia. CONCLUSIONS Informal caregivers of people with dementia are at high risk of depression. The time spent supervising the person with dementia has a significant impact on increasing depressiveness. This highlights the importance of support services to provide the informal caregiver with relief and possibly reduce depressiveness.
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Affiliation(s)
- Lara Kürten
- Interdisciplinary Center for Health Technology Assessment (HTA) and Public Health (IZPH), Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.
| | - Nikolas Dietzel
- Interdisciplinary Center for Health Technology Assessment (HTA) and Public Health (IZPH), Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Peter L Kolominsky-Rabas
- Interdisciplinary Center for Health Technology Assessment (HTA) and Public Health (IZPH), Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Elmar Graessel
- Center for Health Services Research in Medicine, Department of Psychiatry and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
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47
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Lewis JP, Manson SM, Jernigan VB, Noonan C. "Making Sense of a Disease That Makes No Sense": Understanding Alzheimer's Disease and Related Disorders Among Caregivers and Providers Within Alaska Native Communities. THE GERONTOLOGIST 2021; 61:363-373. [PMID: 32789474 PMCID: PMC8023374 DOI: 10.1093/geront/gnaa102] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND AND OBJECTIVES With the rate of Alzheimer's disease and related dementias (ADRD) increasing among Alaska Indian/Alaska Native (AI/AN) people, the Alaska Native Health system is ill-prepared to meet the challenges associated with the growing population at risk of ADRD. The high cost of care, inadequate training of health care providers, and lack of supportive services for caregivers are especially concerning. RESEARCH DESIGN AND METHODS Interviews were conducted with 22 AN caregivers for ANs with ADRD and 12 ANs and non-Native health care providers in communities across Alaska. Interviews lasted approximately 60 min and were transcribed verbatim. We employed directed content analysis to examine the major agreements and disagreements between the participants' understandings of ADRD in each of the domains of Kleinman's Explanatory Model of Illness. RESULTS Caregivers and health care providers expressed concerns about the lack of understanding, resources, and awareness of ADRD among ANs in rural and urban communities. Both caregivers and providers recognized the need to obtain an early diagnosis, blend Western and traditional medicines, promote lifestyle and dietary changes, and foster training for caregivers. Health care providers acknowledged their limited exposure to AN understanding of ADRD and wish to receive culturally relevant training to better serve AN. DISCUSSION AND IMPLICATIONS As the older AN adult population grows, the need for culturally responsive training and support services will continue to increase. We recommend establishing rural outreach and support groups for caregivers, developing an understanding of how ANs view ADRD to train and educate health care providers, and implement screening early for memory loss during routine medical examinations.
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Affiliation(s)
- Jordan P Lewis
- Memory Keepers Medical Discovery Team, University of Minnesota Medical School, Duluth Campus, Aurora
| | - Spero M Manson
- Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, Aurora
| | - Valarie B Jernigan
- Center for Indigenous Health Research and Policy, Oklahoma State University, Tulsa
| | - Carolyn Noonan
- Institute for Research and Education to Advance Community Health, Washington State University, Pullman
- Elson S. Floyd College of Medicine, Washington State University, Pullman
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Abstract
This article describes the public health impact of Alzheimer's disease (AD), including incidence and prevalence, mortality and morbidity, use and costs of care, and the overall impact on caregivers and society. The Special Report discusses the challenges of providing equitable health care for people with dementia in the United States. An estimated 6.2 million Americans age 65 and older are living with Alzheimer's dementia today. This number could grow to 13.8 million by 2060 barring the development of medical breakthroughs to prevent, slow or cure AD. Official death certificates recorded 121,499 deaths from AD in 2019, the latest year for which data are available, making Alzheimer's the sixth-leading cause of death in the United States and the fifth-leading cause of death among Americans age 65 and older. Between 2000 and 2019, deaths from stroke, heart disease and HIV decreased, whereas reported deaths from AD increased more than 145%. This trajectory of deaths from AD was likely exacerbated in 2020 by the COVID-19 pandemic. More than 11 million family members and other unpaid caregivers provided an estimated 15.3 billion hours of care to people with Alzheimer's or other dementias in 2020. These figures reflect a decline in the number of caregivers compared with a decade earlier, as well as an increase in the amount of care provided by each remaining caregiver. Unpaid dementia caregiving was valued at $256.7 billion in 2020. Its costs, however, extend to family caregivers' increased risk for emotional distress and negative mental and physical health outcomes - costs that have been aggravated by COVID-19. Average per-person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are more than three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 23 times as great. Total payments in 2021 for health care, long-term care and hospice services for people age 65 and older with dementia are estimated to be $355 billion. Despite years of efforts to make health care more equitable in the United States, racial and ethnic disparities remain - both in terms of health disparities, which involve differences in the burden of illness, and health care disparities, which involve differences in the ability to use health care services. Blacks, Hispanics, Asian Americans and Native Americans continue to have a higher burden of illness and lower access to health care compared with Whites. Such disparities, which have become more apparent during COVID-19, extend to dementia care. Surveys commissioned by the Alzheimer's Association recently shed new light on the role of discrimination in dementia care, the varying levels of trust between racial and ethnic groups in medical research, and the differences between groups in their levels of concern about and awareness of Alzheimer's disease. These findings emphasize the need to increase racial and ethnic diversity in both the dementia care workforce and in Alzheimer's clinical trials.
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49
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Rashedi V, Foroughan M, Chehrehnegar N. Psychometric Properties of the Persian Montreal Cognitive Assessment in Mild Cognitive Impairment and Alzheimer Disease. Dement Geriatr Cogn Dis Extra 2021; 11:51-57. [PMID: 33976692 PMCID: PMC8077519 DOI: 10.1159/000514673] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 12/27/2022] Open
Abstract
Introduction The Montreal Cognitive Assessment (MoCA) is a cognitive screening test widely used in clinical practice and suited for the detection of Mild Cognitive Impairment (MCI). The aims were to evaluate the psychometric properties of the Persian MoCA as a screening test for mild cognitive dysfunction in Iranian older adults and to assess its accuracy as a screening test for MCI and mild Alzheimer disease (AD). Method One hundred twenty elderly with a mean age of 73.52 ± 7.46 years participated in this study. Twenty-one subjects had mild AD (MMSE score ≤21), 40 had MCI, and 59 were cognitively healthy controls. All the participants were administered the Mini-Mental State Examination (MMSE) to evaluate their general cognitive status. Also, a battery of comprehensive neuropsychological assessments was administered. Results The mean score on the Persian version of the MoCA and the MMSE were 19.32 and 25.62 for MCI and 13.71 and 22.14 for AD patients, respectively. Using an optimal cutoff score of 22 the MoCA test detected 86% of MCI subjects, whereas the MMSE with a cutoff score of 26 detected 72% of MCI subjects. In AD patients with a cutoff score of 20, the MoCA had a sensitivity of 94% whereas the MMSE detected 61%. The specificity of the MoCA was 70% and 90% for MCI and AD, respectively. Discussion The results of this study show that the Persian version of the MoCA is a reliable screening tool for detection of MCI and early stage AD. The MoCA is more sensitive than the MMSE in screening for cognitive impairment, proving it to be superior to MMSE in detecting MCI and mild AD.
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Affiliation(s)
- Vahid Rashedi
- School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran.,Iranian Research Center on Aging, The University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mahshid Foroughan
- Iranian Research Center on Aging, The University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Negin Chehrehnegar
- Linnaeus Centre HEAD, Swedish Institute for Disability Research, Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
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50
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Walsh S, Pertl M, Gillespie P, Lawlor B, Brennan S, O'Shea E. Factors influencing the cost of care and admission to long-term care for people with dementia in Ireland. Aging Ment Health 2021; 25:512-520. [PMID: 31847539 DOI: 10.1080/13607863.2019.1699901] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To explore the factors associated with the cost of care and admission to long-term care (LTC) for people with dementia living at home in Ireland. METHODS Data on formal and informal resource use for people with dementia, and their LTC admission, were obtained from a national study of spousal dementia caregivers. Functional status was measured using the Bristol Activities of Daily Living Scale, while behavioural and psychiatric symptoms were evaluated using the Neuropsychiatric Inventory. Multivariable regression analysis was used to model costs and the predictors of LTC admission. RESULTS Physical and cognitive symptoms were significantly associated with costs. Severely impaired functional ability was associated with a €2,308 increase in mean total 30-day monthly costs. Psychosis was associated with a €335 increase in primary and community 30-day monthly care costs. These factors also make it more likely that a person with dementia is admitted to LTC. Having an older caregiver also increases the risk of admission to LTC, while living in a rural area and having a female caregiver reduce the likelihood of admission. CONCLUSIONS Dependency matters for the cost of care. Physical and cognitive symptoms, caregiver age and gender, and geographic location are significant predictors of admission to LTC.
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Affiliation(s)
- Sharon Walsh
- Centre for Economic and Social Research on Dementia, Discipline of Economics, National University of Ireland Galway, Galway, Ireland
| | - Maria Pertl
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Paddy Gillespie
- Health Economic and Policy Analysis Centre, Discipline of Economics, National University of Ireland Galway, Galway, Ireland
| | - Brian Lawlor
- Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin 2, Ireland
| | - Sabina Brennan
- Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin 2, Ireland
| | - Eamon O'Shea
- Centre for Economic and Social Research on Dementia, Discipline of Economics, National University of Ireland Galway, Galway, Ireland
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