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Nijsten JMH, Plouvier AOA, Smalbrugge M, Koopmans RTCM, Leontjevas R, Gerritsen DL. The development and feasibility evaluation of a program to identify and manage apathy in people with dementia: the SABA program. Aging Ment Health 2024; 28:227-237. [PMID: 37382202 DOI: 10.1080/13607863.2023.2228252] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 06/08/2023] [Indexed: 06/30/2023]
Abstract
OBJECTIVES To develop and evaluate feasibility of a program for family and professional caregivers to identify and manage apathy in people with dementia: the Shared Action for Breaking through Apathy program (SABA). METHODS A theory- and practice-based intervention was developed and tested among ten persons with apathy and dementia in two Dutch nursing homes from 2019 to 2021. Feasibility was evaluated with interviews with family caregivers (n = 7) and professional caregivers (n = 4) and two multidisciplinary focus groups with professional caregivers (n = 5 and n = 6). RESULTS SABA was found feasible for identifying and managing apathy. Caregivers mentioned increased knowledge and awareness regarding recognizing apathy and its impact on their relationship with the person with apathy. They experienced increased skills to manage apathy, a greater focus on small-scale activities and increased appreciation of small moments of success. The content, form and accessibility of the program's materials were considered facilitating by all stakeholders, as was the compatibility of the procedures with the usual way of working. The expertise and involvement of stakeholders, staff stability and the support of an ambassador and/or manager were facilitating, while insufficient collaboration was a barrier. Organizational and external aspects like not prioritizing apathy, staff discontinuity, and the Covid-19 pandemic were perceived as barriers. A stimulating physical environment with small-scale living rooms, and access to supplies for activities were considered facilitating. CONCLUSIONS SABA empowers family and professional caregivers to successfully identify and manage apathy. For implementation, it is important to take into account the facilitators and barriers resulting from our study.
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Affiliation(s)
- Johanna M H Nijsten
- Research Institute for Medical Innovation, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboudumc Alzheimer Center, Nijmegen, The Netherlands
- Archipel Landrijt, Expertise Center for Specialized Care, Eindhoven, The Netherlands
| | - Annette O A Plouvier
- Research Institute for Medical Innovation, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboudumc Alzheimer Center, Nijmegen, The Netherlands
| | - Martin Smalbrugge
- Department of Medicine for Older People, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Aging & Later Life, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Raymond T C M Koopmans
- Research Institute for Medical Innovation, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboudumc Alzheimer Center, Nijmegen, The Netherlands
- Waalboog, location Joachim and Anna, Center for Specialised Geriatric Care, Nijmegen, The Netherlands
| | - Ruslan Leontjevas
- Research Institute for Medical Innovation, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboudumc Alzheimer Center, Nijmegen, The Netherlands
- Faculty of Psychology, Open University of the Netherlands, Heerlen, The Netherlands
| | - Debby L Gerritsen
- Research Institute for Medical Innovation, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboudumc Alzheimer Center, Nijmegen, The Netherlands
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Cesana BM, Bergh S, Ciccone A, Cognat E, Fabbo A, Fascendini S, Frisoni GB, Froelich L, Handels R, Jori MC, Mecocci P, Merlo P, Peters O, Tsolaki M, Defanti CA. Predictors of Nursing Home Placement in a Cohort of European People with Alzheimer's Disease and Other Dementia Cases Enrolled in SCU-B or Non SCU-B Centers: The RECage Study. J Alzheimers Dis 2024; 98:1043-1052. [PMID: 38489173 DOI: 10.3233/jad-230878] [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: 03/17/2024]
Abstract
Background Nursing home placement (NHP) can be the final step of patients with Alzheimer's disease. Objective We aimed to identify NHP predictors among 508 people with dementia with a 3-year follow-up. Methods We analyzed data from the international observational RECage study, involving 508 people with especially Alzheimer's disease and comparing a cohort enrolled by five centers with a Special Care Unit for BPSD (behavioral and psychological symptoms of dementia) and another one enrolled by six centers lacking this facility. The tertiary objective of the study was to assess the possible role of the SCU-B in delaying NHP. We assessed the relationship of the baseline characteristics with NHP by means of univariate analysis followed by Cox's multivariate model. Results Patients' mean age was 78.1 years, 54.9% were women. Diagnosis mean age was 75.4 (±8.32) years; the main diagnosis was Alzheimer's disease (296; 58.4%). During follow-up, 96 (18.9%) patients died and 153 (30.1%) were institutionalized without a statistically significant difference between the two cohorts (p = 0.9626). The mean NHP time was 902 (95% CI: 870-934). The multivariable analysis without death as a competing risk retained four independent predictors of NHP: age increase (hazard ratio (HR) = 1.023, 95% CI: 1.000-1.046), patient education level increase (HR = 1.062, 95% CI: 1.024-1.101), Neuropsychiatric Inventory total increase (HR = 1.018; 95% CI: 1.011-1.026), and total Mini-Mental State Examination as a favorable factor (HR = 0.948, 95% CI: 0.925-0.971). Gender (females versus males: HR = 1.265, 95% CI: 0.899-1.781) was included in the final Cox's model for adjusting the estimates for. Conclusions Our data partially agree with the predictors of NHP in literature including the effect of high education level. No caregivers' factors were statistically significant. Clinical trial registration NCT03507504.
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Affiliation(s)
- Bruno Mario Cesana
- Department of Clinical Sciences and Community Health, Unit of Medical Statistics, Biometry and Bioinformatics "Giulio A. Maccacaro" Faculty of Medicine and Surgery, University of Milan, Milan, Italy
| | - Sverre Bergh
- Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway (SCU-B)
| | - Alfonso Ciccone
- Department of Neurology with Neurosurgical Activity "Carlo Poma" Hospital, ASST di Mantova, Mantua, Italy (non-SCU-B)
| | - Emmanuel Cognat
- Cognitive Neurology Centre, Lariboisière-Fernand Widal Hospital GHU AP-HP Nord, Université Paris-Diderot, Paris, France (non-SCU-B)
| | - Andrea Fabbo
- Department of Primary Care, Geriatric Service-Cognitive Disorders and Dementia, Local Health Authority of Modena (AUSL), Modena, Italy (SCU-B)
| | | | - Giovanni B Frisoni
- Division of Geriatrics and Rehabilitation, University Hospitals of Geneva, University of Geneva, Geneva, Switzerland (SCU-B)
| | - Lutz Froelich
- Department of Geriatric Psychiatry, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Mannheim, Germany (SCU-B)
| | - Ron Handels
- Department of Psychiatry and Neuropsychology, Faculty of Health Medicine and Life Sciences, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University Medical Center, Maastricht, the Netherlands
| | | | - Patrizia Mecocci
- Department of Medicine and Surgery, Institute of Gerontology and Geriatrics, University of Perugia, Perugia, Italy
- NVS Department, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden (non-SCU-B)
| | - Paola Merlo
- Neurological Unit (PM), U.V.A. Centre, Humanitas Gavazzeni, Bergamo, Italy (non-SCUB)
| | - Oliver Peters
- Department of Psychiatry, Charité-Universitätsmedizin Berlin, Berlin, Germany (non SCU-B)
| | - Magda Tsolaki
- Greek Association of Alzheimer's Disease and Related Disorders (GAADRD), Thessaloniki, Greece
- First Department of Neurology, School of Medicine, Aristotle University of Thessaloniki (AUTh), Thessaloniki, Greece
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Thunell JA, Joyce GF, Ferido PM, Chen Y, Guadamuz JS, Qato DM, Zissimopoulos JM. Diagnoses and Treatment of Behavioral and Psychological Symptoms of Dementia Among Racially and Ethnically Diverse Persons Living with Dementia. J Alzheimers Dis 2024; 99:513-523. [PMID: 38669535 DOI: 10.3233/jad-231266] [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: 04/28/2024]
Abstract
Background Behavioral and psychological symptoms of dementia (BPSD) and prescribed central nervous system (CNS) active drugs to treat them are prevalent among persons living with Alzheimer's disease and related dementias (PLWD) and lead to negative outcomes for PLWD and their caregivers. Yet, little is known about racial/ethnic disparities in diagnosis and use of drugs to treat BPSD. Objective Quantify racial/ethnic disparities in BPSD diagnoses and CNS-active drug use among community-dwelling PLWD. Methods We used a retrospective cohort of community-dwelling Medicare Fee-for-Service beneficiaries with dementia, continuously enrolled in Parts A, B and D, 2017-2019. Multivariate logistic models estimated rates of BPSD diagnosis and, conditional on diagnosis, CNS-active drug use. Results Among PLWD, 67.1% had diagnoses of an affective, psychosis or hyperactivity symptom. White (68.3%) and Hispanic (63.9%) PLWD were most likely, Blacks (56.6%) and Asians (52.7%) least likely, to have diagnoses. Among PLWD with BPSD diagnoses, 78.6% took a CNS-active drug. Use was highest among whites (79.3%) and Hispanics (76.2%) and lowest among Blacks (70.8%) and Asians (69.3%). Racial/ethnic differences in affective disorders were pronounced, 56.8% of white PLWD diagnosed; Asians had the lowest rates (37.8%). Similar differences were found in use of antidepressants. Conclusions BPSD diagnoses and CNS-active drug use were common in our study. Lower rates of BPSD diagnoses in non-white compared to white populations may indicate underdiagnosis in clinical settings of treatable conditions. Clinicians' review of prescriptions in this population to reduce poor outcomes is important as is informing care partners on the risks/benefits of using CNS-active drugs.
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Affiliation(s)
- Johanna A Thunell
- USC Schaeffer Center for Health Policy and Economics, Los Angeles, CA, USA
- USC Sol Price School of Public Policy, Los Angeles, CA, USA
| | - Geoffrey F Joyce
- USC Schaeffer Center for Health Policy and Economics, Los Angeles, CA, USA
- USC School of Pharmacy, Los Angeles, CA, USA
| | - Patricia M Ferido
- USC Schaeffer Center for Health Policy and Economics, Los Angeles, CA, USA
| | - Yi Chen
- Rush Alzheimer's Disease Center, Chicago, IL, USA
| | - Jenny S Guadamuz
- USC Schaeffer Center for Health Policy and Economics, Los Angeles, CA, USA
- USC School of Pharmacy, Los Angeles, CA, USA
| | - Dima M Qato
- USC Schaeffer Center for Health Policy and Economics, Los Angeles, CA, USA
- USC School of Pharmacy, Los Angeles, CA, USA
| | - Julie M Zissimopoulos
- USC Schaeffer Center for Health Policy and Economics, Los Angeles, CA, USA
- USC Sol Price School of Public Policy, Los Angeles, CA, USA
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Nijsten JMH, Smalbrugge M, Plouvier AOA, Koopmans RTCM, Leontjevas R, Gerritsen DL. Identifying and managing apathy in people with dementia living in nursing homes: a qualitative study. BMC Geriatr 2023; 23:727. [PMID: 37946109 PMCID: PMC10636808 DOI: 10.1186/s12877-023-04422-y] [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: 02/22/2023] [Accepted: 10/20/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Although apathy is common in people with dementia and has profound negative effects, it is rarely diagnosed nor specifically treated in nursing homes. The aim of this study is to explore experiences in identifying and managing apathy from the perspectives of people with dementia and apathy (PwA), family caregivers (FCs) and professional caregivers (PCs). METHODS Descriptive qualitative study with purposive sampling, comprising eleven semi-structured in-depth interviews with PwA, FCs or PCs and focus groups with twelve PCs in Dutch nursing homes. Seventeen additional in-depth interviews with caregivers were held, after signals of increasing apathy during the first Covid-19 lockdown. Using an inductive approach, data was analysed thematically to explore the experiences in identifying and managing apathy from the perspective of different stakeholders. RESULTS Three themes were identified: 1) the challenge to appraise signals, 2) the perceived impact on well-being, 3) applied strategies to manage apathy. Although participants described apathy in line with diagnostic criteria, they were unfamiliar with the term apathy and had difficulties in appraising signals of apathy. Also, the perceived impact of apathy varied per stakeholder. PwA had difficulties reflecting on their internal state. FCs and PCs experienced apathy as challenging when it reduced the well-being of PwA or when they themselves experienced ambiguity, frustration, insecurity, disappointment or turning away. Dealing with apathy required applying specific strategies that included stimulating meaningful contact, adjusting one's expectations, and appreciating little successes. CONCLUSIONS When addressing apathy in nursing homes, it is important to consider that a) all stakeholders experience that appraising signals of apathy is challenging; b) apathy negatively influences the well-being of people with dementia and especially their FCs and PCs; and c) FCs and PCs can successfully, albeit temporarily, manage apathy by using specific strategies.
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Affiliation(s)
- Johanna M H Nijsten
- Radboud University, Nijmegen, The Netherlands.
- Department of Primary and Community Care, Research Institute for Medical Innovation, Radboud University Medical Centre, Nijmegen, The Netherlands.
- Radboud Alzheimer Centre, Nijmegen, The Netherlands.
- Archipel, Landrijt Expertise Centre for Specialized Care, Eindhoven, The Netherlands.
| | - Martin Smalbrugge
- Department of Medicine for Older People, UMC, Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Aging & Later Life, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Annette O A Plouvier
- Department of Primary and Community Care, Research Institute for Medical Innovation, Radboud University Medical Centre, Nijmegen, The Netherlands
- Radboud Alzheimer Centre, Nijmegen, The Netherlands
| | - Raymond T C M Koopmans
- Department of Primary and Community Care, Research Institute for Medical Innovation, Radboud University Medical Centre, Nijmegen, The Netherlands
- Radboud Alzheimer Centre, Nijmegen, The Netherlands
- Waalboog, Joachim and Anna, Centre for Specialized Geriatric Care, Nijmegen, The Netherlands
| | - Ruslan Leontjevas
- Department of Primary and Community Care, Research Institute for Medical Innovation, Radboud University Medical Centre, Nijmegen, The Netherlands
- Radboud Alzheimer Centre, Nijmegen, The Netherlands
- Faculty of Psychology, Open University of the Netherlands, Heerlen, The Netherlands
| | - Debby L Gerritsen
- Department of Primary and Community Care, Research Institute for Medical Innovation, Radboud University Medical Centre, Nijmegen, The Netherlands
- Radboud Alzheimer Centre, Nijmegen, The Netherlands
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De Vincenzo C, Marian I, Piol S, Keisari S, Testoni I. Self-Help Groups within Nursing Homes: The Experiences of Family Caregivers in Northeastern Italy. Behav Sci (Basel) 2023; 13:485. [PMID: 37366737 DOI: 10.3390/bs13060485] [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: 04/18/2023] [Revised: 05/29/2023] [Accepted: 06/06/2023] [Indexed: 06/28/2023] Open
Abstract
Older adults and their family caregivers experience nursing home placement as a particularly critical time of life. The present study explored the experiences of family caregivers of nursing home residents taking part in a self-help group for caregivers. The sample was composed of six caregivers of older adults residing in a nursing home in the northeast of Italy. The respondents, aged 57 to 71, were part of a self-help group set up by the facility between 2017 and 2019. In this qualitative methodological design, we applied the principles of interpretative phenomenological analysis. Two main themes emerged from the interviews: (a) challenges in constructing experience as caregivers; and (b) shared experiences as stabilizing tools. The findings highlight the importance of self-help groups in fostering the well-being of caregivers of older adults living in nursing homes. The self-help group enabled caregivers to deal with nursing home placement and the sense of guilt deriving from it; understand and accept the disabilities affecting their loved one; comprehend the experience of ambiguous loss; and learn to listen to their own needs, thus avoiding physical and emotional exhaustion.
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Affiliation(s)
- Ciro De Vincenzo
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology (FISPPA), University of Padova, 35131 Padova, Italy
| | - Ilenia Marian
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology (FISPPA), University of Padova, 35131 Padova, Italy
| | - Silvia Piol
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology (FISPPA), University of Padova, 35131 Padova, Italy
- School of Creative Arts Therapies, University of Haifa, Haifa 3498838, Israel
| | - Shoshi Keisari
- School of Creative Arts Therapies, University of Haifa, Haifa 3498838, Israel
- Emil Sagol Creative Arts Therapies Research Center, University of Haifa, Haifa 3498838, Israel
| | - Ines Testoni
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology (FISPPA), University of Padova, 35131 Padova, Italy
- Emil Sagol Creative Arts Therapies Research Center, University of Haifa, Haifa 3498838, Israel
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Meziane-Damnée S, Bayle C, Pino M, Lenoir H, Cantegreil I, Rigaud AS. [A psycho-educational program for family caregivers of people with Alzheimer's disease entering an institution]. SOINS. GERONTOLOGIE 2023; 28:20-23. [PMID: 37328202 DOI: 10.1016/j.sger.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
The caregiver of a loved one suffering from a chronic pathology (Alzheimer's disease, Parkinson's disease, stroke, etc.) can be in psychological distress at all stages of the disease, including when the loved one enters an institution. We have designed and implemented a psycho-educational program for family caregivers of institutionalized patients. A preliminary study showed that this program was feasible, gave satisfaction to the caregivers and improved their understanding of the functioning of the institution, their communication with the professionals of the institution and their relationship with their relative in the institution. The program allowed caregivers to find their place within the institution by redefining their role.
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Affiliation(s)
- Souad Meziane-Damnée
- Université Paris Cité, Maladie d'Alzheimer, F-75013 Paris, France; Service gériatrie 1 et 2, AP-HP, Hôpital Broca, F-75013 Paris, France.
| | - Catherine Bayle
- Service gériatrie 1 et 2, AP-HP, Hôpital Broca, F-75013 Paris, France
| | - Maribel Pino
- Université Paris Cité, Maladie d'Alzheimer, F-75013 Paris, France; Service gériatrie 1 et 2, AP-HP, Hôpital Broca, F-75013 Paris, France
| | - Hermine Lenoir
- Université Paris Cité, Maladie d'Alzheimer, F-75013 Paris, France; Service gériatrie 1 et 2, AP-HP, Hôpital Broca, F-75013 Paris, France
| | - Inge Cantegreil
- Université Paris Cité, Maladie d'Alzheimer, F-75013 Paris, France; Service gériatrie 1 et 2, AP-HP, Hôpital Broca, F-75013 Paris, France
| | - Anne-Sophie Rigaud
- Université Paris Cité, Maladie d'Alzheimer, F-75013 Paris, France; Service gériatrie 1 et 2, AP-HP, Hôpital Broca, F-75013 Paris, France
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7
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Du J, Janus SIM, de Boer M, Zuidema SU. The longitudinal patterns of psychotropic drug prescriptions for subpopulations of community-dwelling older people with dementia: electronic health records based retrospective study. BMC PRIMARY CARE 2023; 24:69. [PMID: 36907845 PMCID: PMC10009999 DOI: 10.1186/s12875-023-02021-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 02/27/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND Studies focusing on patterns of psychotropic drug prescriptions (PDPs) for subpopulations of community-dwelling older people with dementia are lacking. OBJECTIVE The aim of this study was to identify the longitudinal patterns of PDPs in subpopulations. METHODS This retrospective study used electronic health records from general practitioners (GPs) in the Netherlands. People (N = 1278) firstly diagnosed with dementia between 2013 and 2015, aged 65 years or older, were selected and categorized into four subpopulations: community-dwelling (CD) group throughout follow-up, ultimately admitted to nursing homes (NH) group, ultimately died (DIE) group, and ultimately deregistered for unclear reasons (DeR) group. Generalised estimating equations were used to estimate the patterns of psychotropic drug prescriptions, after the diagnosis of dementia for a five-year follow-up, and 0-3 months before institutionalisation or death. RESULTS Over the five-year follow-up, antipsychotic prescriptions increased steadily in CD (OR = 1.07 [1.04-1.10]), NH (OR = 1.10 [1.04-1.15]), and DIE (OR = 1.05 [1.02-1.08]) groups. Similarly, prescriptions of antidepressants also showed upward trends in CD (OR = 1.04 [1.02-1.06]), NH (OR = 1.10 [1.02-1.18]), and DIE (OR = 1.04 [1.00-1.08]) groups. The other psychotropic drugs did not show clear changes over time in most of the subpopulations. In the three months before institutionalisation, antipsychotic prescriptions increased (OR = 2.12 [1.26-3.57]) in the NH group compared to prior periods. Likewise, before death, prescriptions of antipsychotics (OR = 1.74 [1.28-2.38]) and hypnotics and sedatives (OR = 2.11 [1.54-2.90]) increased in the DIE group, while anti-dementia drug prescriptions decreased (OR = 0.42 [0.26-0.69]). CONCLUSIONS After community-dwelling older people are diagnosed with dementia, all subpopulations' prescriptions of antipsychotics and antidepressants increase continuously during the follow-up. While we cannot judge whether these prescriptions are appropriate, GPs might consider a more reluctant use of psychotropic drugs and use alternative psychosocial interventions. Additionally, antipsychotic prescriptions rise considerably shortly before institutionalisation or death, which might reflect that older people experience more neuropsychiatric symptoms during this period.
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Affiliation(s)
- Jiamin Du
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Sarah I M Janus
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands.
- Alzheimer Centre Groningen, Groningen, the Netherlands.
| | - Michiel de Boer
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Sytse U Zuidema
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
- Alzheimer Centre Groningen, Groningen, the Netherlands
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Perepezko KM, Gallo JJ, Pontone GM, Hinkle JT, Mills KA. Association of caregiver strain with the trajectory of quality of life in Parkinson's disease. Parkinsonism Relat Disord 2023; 108:105292. [PMID: 36702071 PMCID: PMC9992162 DOI: 10.1016/j.parkreldis.2023.105292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/08/2023] [Accepted: 01/16/2023] [Indexed: 01/24/2023]
Abstract
We aimed to identify caregiver characteristics associated with the trajectory of quality of life (QoL) in Parkinson's disease (PD). We fit a growth mixture model to longitudinal data from the Parkinson Foundation Parkinson's Outcomes Project (POP) to identify the heterogeneity of QOL trajectories in PD. We then used multinomial logistic regression to model baseline factors that predicted class membership. Baseline growth models were fit to QOL scores measured over 4 disease duration time points. A random intercept and slope model was determined to best fit the data. Next, growth mixture models (1, 2, 3, 4, and 5-class) were fit with covariates (Hoehn & Yahr, sex, and depression) and a three-class model was found to provide the best fit. Class 1 (problematic class (10.0%)) represented individuals with poor QOL at baseline and minor improvement over time. Class 2 (moderate class (32.6%)) represented individuals with moderate QOL at baseline with slight worsening over time. Class 3 (favorable class (56.9%)) represented individuals with good QOL at baseline and slight worsening over time. Multinomial regression revealed that lower caregiver strain, better mobility, and better verbal fluency at baseline predicted membership in the favorable compared to the moderate class. Worse mobility and younger age predicted membership in the problematic compared to the moderate class. While previous studies have reported on the association between mobility and cognition, the novel finding of an association between caregiver strain and PD QOL trajectory suggests caregiver strain is important to measure and address in future research and practice.
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Affiliation(s)
- Kate M Perepezko
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
| | - Joseph J Gallo
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Gregory M Pontone
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Jared T Hinkle
- Medical Scientist Training Program, Johns Hopkins School of Medicine, Baltimore, MD, United States; Solomon H. Snyder Department of Neuroscience, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Kelly A Mills
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, United States; Parkinson's and Movement Disorder Center of Maryland, Baltimore, MD, United States
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9
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Gallop K, Pham N, Maclaine G, Saunders E, Black B, Hubig L, Acaster S. Health-related quality-of-life and burden for caregivers of individuals with neurogenic orthostatic hypotension. Neurodegener Dis Manag 2023; 13:35-45. [PMID: 36382590 DOI: 10.2217/nmt-2022-0015] [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: 11/18/2022] Open
Abstract
Aim: This study explores the burden of caring for an individual with neurogenic orthostatic hypotension (nOH) and an underlying neurodegenerative disease (Parkinson's disease, multiple system atrophy, pure autonomic failure or dementia with Lewy bodies). Materials & methods: A survey including several validated instruments was conducted with informal caregivers of individuals with Parkinson's disease, multiple system atrophy, pure autonomic failure or dementia with Lewy bodies. Results: Caregivers of patients with nOH (n = 60) reported greater burden across all outcomes compared with those without nOH (n = 60). Receiving pharmacological treatment for nOH was the variable most consistently associated with significantly better caregiver health-related quality-of-life (p < 0.05). Conclusion: This study demonstrates the burden of nOH on informal caregivers and highlights the potential benefit of pharmacological treatment not only for patients but also indirectly, their caregivers.
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Affiliation(s)
- Katy Gallop
- Acaster Lloyd Consulting Ltd, London, WC1X 8NL, UK
| | - Ngan Pham
- HEOR and Value Strategy, Theravance Biopharma US, Inc. San Francisco, CA 94080, USA
| | - Grant Maclaine
- HEOR and Value Strategy, Theravance Biopharma Ireland, Dublin, D04 N9W8, Ireland
| | | | - Bonnie Black
- Autonomic Dysfunction Center, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Lena Hubig
- Acaster Lloyd Consulting Ltd, London, WC1X 8NL, UK
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Connors MH, Teixeira-Pinto A, Ames D, Woodward M, Brodaty H. Distinguishing apathy and depression in dementia: A longitudinal study. Aust N Z J Psychiatry 2022; 57:884-894. [PMID: 35968798 DOI: 10.1177/00048674221114597] [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: 11/15/2022]
Abstract
OBJECTIVES Apathy is a common symptom in dementia, though can be difficult to distinguish from depression due to shared features and frequent co-occurrence. As such, a significant limitation of much previous research on apathy is the failure to control for depression. The current study sought to address this by examining the trajectory and clinical correlates of apathy after controlling for depression. METHODS Seven hundred and seventy-nine patients with dementia were recruited from nine memory clinics around Australia. Measures of dementia severity, cognition, functional ability, neuropsychiatric symptoms, caregiver burden and medication use were completed at baseline and at regular intervals over a 3-year period. Driving and institutionalisation data were obtained throughout the study. Mortality data were obtained from state registries 8 years after baseline. RESULTS Of the 662 patients with completed measures of neuropsychiatric symptoms, 342 (51.7%) had apathy and 332 (50.2%) had depression at baseline, while 212 (32.0%) had both. Whereas apathy increased over time, depression remained relatively stable. Apathy, but not depression, was associated with greater dementia severity, poorer cognition and function, driving cessation and mortality. Both apathy and depression were associated with greater neuropsychiatric symptoms, psychosis, caregiver burden and institutionalisation. CONCLUSIONS Apathy increases over the course of dementia and is associated with worse clinical outcomes independent of depression. Distinguishing apathy and depression appears important given their different implications for prognosis and management.
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Affiliation(s)
- Michael H Connors
- Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry and Mental Health, UNSW Sydney, Sydney, NSW, Australia
| | | | - David Ames
- National Ageing Research Institute, Melbourne, VIC, Australia.,Academic Unit for Psychiatry of Old Age, The University of Melbourne, Melbourne, VIC, Australia
| | | | - Henry Brodaty
- Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry and Mental Health, UNSW Sydney, Sydney, NSW, Australia
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Villars H, Gardette V, Frayssignes P, Deperetti E, Perrin A, Cantet C, Soto‐Martin M. Predictors of nursing home placement at 2 years in Alzheimer's disease: A follow-up survey from the THERAD study. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5724. [PMID: 35574920 PMCID: PMC9323428 DOI: 10.1002/gps.5724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 04/20/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Nursing Home Placement (NHP) can prove to be the only solution to some dead-end situations in Alzheimer's disease (AD). The predictors of NHP are known and can be related to either the person with dementia or his/her caregiver. We aimed to identify predictors of NHP among people with AD over a 2-year follow-up period, with a particular interest in the modifiable predictors, notably those involving caregivers. METHODS We studied data from the THERAD study, a French monocentric randomized controlled trial, involving 196 community-dwelling dyads, primarily assessing an educational intervention in AD. We performed a bivariate analysis followed by a multivariate Cox model, with a backward stepwise procedure. RESULTS The mean age of the patients was 82 years old, 67.7% were women and 56.9% were living with a partner. The mean age of the caregivers was 65.8 years old, 64.6% were women and half were spouses of the patients with a moderate burden. During the follow-up, 23 patients died and 49 were institutionalized. The majority of NHPs occurred during the first year (35 NHP). The mean time to NHP was 27.77 months after the diagnosis. Five independent predictors of NHP were found: a higher patient education level (aHR 6.31; CI95% = 1.88-21.22), a high caregiver Burden (aHR 3.97; CI95% = 1.33-11.85), the caregiver being the offspring of the patient (aHR 2.92; CI95% = 1.43-5.95), loss of autonomy (aHR 2.75; CI95% = 1.13-6.65) and disinhibition as a behavioural and psychological symptoms of dementia (BPSD) (aHR 2.38; CI95% = 1.26-4.47). CONCLUSIONS Our data are in accordance with the literature in identifying loss of autonomy, burden and BPSD (disinhibition) as risk factors of NHP. We also found high patient education level and status of offspring caregiver as additional factors. It is essential to take into account the caregiver status when designing psychoeducational trials aiming to delay NHP. Further studies need to take into account both the modifiable risk factors related to the patient (productive BPSD) and the needs of offspring caregivers (work-life balance, mental load).
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Affiliation(s)
- Hélène Villars
- Geriatric DepartmentToulouse University HospitalToulouseFrance
- Department of Epidemiology and Public HealthInserm UMR 1295Centre for Research in Population Health (CERPOP)ToulouseFrance
| | - Virginie Gardette
- Geriatric DepartmentToulouse University HospitalToulouseFrance
- Department of Epidemiology and Public HealthInserm UMR 1295Centre for Research in Population Health (CERPOP)ToulouseFrance
| | | | - Eva Deperetti
- Geriatric DepartmentToulouse University HospitalToulouseFrance
| | - Amélie Perrin
- Geriatric DepartmentToulouse University HospitalToulouseFrance
| | - Christelle Cantet
- Department of Epidemiology and Public HealthInserm UMR 1295Centre for Research in Population Health (CERPOP)ToulouseFrance
| | - Maria Soto‐Martin
- Geriatric DepartmentToulouse University HospitalToulouseFrance
- Department of Epidemiology and Public HealthInserm UMR 1295Centre for Research in Population Health (CERPOP)ToulouseFrance
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12
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Villani ER, Fusco D, Franza L, Onder G, Bernabei R, Colloca GF. Characteristics of patients with cancer in European long-term care facilities. Aging Clin Exp Res 2022; 34:671-678. [PMID: 34590240 PMCID: PMC8894167 DOI: 10.1007/s40520-021-01972-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 08/20/2021] [Indexed: 11/30/2022]
Abstract
Purpose Up to 26% of residents in nursing homes (NHs) are affected by cancer. Their care represents a challenge, because NHs are not usually considered a setting focused on oncologic management and care. The aim of this paper is to describe socio-demographic and clinical features of patients with cancer residing in European NHs. Methods Cross-sectional study based on data from the Services and Health for Elderly in Long TERm care (SHELTER) study. Participants were assessed through the interRAI-LTCF, which includes cancer assessment. Results Among 4140 participants (mean age 83.4 years; female 73%), 442 (10.7%) had cancer. Patients with cancer had a higher prevalence of do-not-resuscitate directives compared to those without cancer (21.1% vs 16.5%, p = 0.019). Variables directly associated with cancer were male sex (adj OR 1.67, 95% CI 1.36–2.05), pain (adj OR 1.43, 95% CI 1.16–1.77), fatigue (adj OR 1.25, 95% CI 1.01–1.55), polypharmacy (adj OR 1.59, 95% CI 1.21–2.08) and falls (adj OR. 1.30, 95% CI 1.01–1.67). Dementia was inversely associated with cancer (adj OR 0.74, 95% CI 0.58–0.94). Symptomatic drugs such as opioids (23.5% vs 12.2, p < .001), NSAIDS (7.2% vs 3.9%, p = 0.001), antidepressants (39.1% vs 33.8%, p = 0.026) and benzodiazepines (40.3% vs 34.3, p = 0.012) were all prescribed more in participants with cancer compared to those without cancer. Conclusions Cancer patients are prevalent in European NHs and they show peculiar characteristics. Studies are needed to evaluate the impact of a supportive care approach on the management of NHs residents with cancer throughout all its phases, until the end-of-life care
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Affiliation(s)
- Emanuele Rocco Villani
- Department of Geriatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Largo Francesco Vito n°8, 00168, Rome, Italy.
| | - Domenico Fusco
- Department of Geriatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Largo Francesco Vito n°8, 00168, Rome, Italy
| | - Laura Franza
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Graziano Onder
- Department of Geriatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Largo Francesco Vito n°8, 00168, Rome, Italy
| | - Roberto Bernabei
- Department of Geriatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Largo Francesco Vito n°8, 00168, Rome, Italy
| | - Giuseppe Ferdinando Colloca
- Department of Geriatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Largo Francesco Vito n°8, 00168, Rome, Italy
- Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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13
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Chen YJ, Wang WF, Jhang KM, Chang MC, Chang CC, Liao YC. Prediction of Institutionalization for Patients With Dementia in Taiwan According to Condition at Entry to Dementia Collaborative Care. J Appl Gerontol 2022; 41:1357-1364. [PMID: 35220779 DOI: 10.1177/07334648211073129] [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: 11/15/2022] Open
Abstract
This study aimed to examine the institutionalization rate in patients with dementia in Taiwan, identify the predictors of institutionalization, and conduct a mediation analysis of caregiver burden between neuropsychiatric symptoms and institutionalization. We analyzed data from a retrospective cohort registered in dementia collaborative care (N = 518). The analyses applied univariate and multivariate Cox proportional hazard regression with Firth's penalized likelihood to assess the relationship between each predictor at entry and institutionalization for survival analysis. Thirty (5.8%) patients were censored due to institutionalization after a median follow-up of one-and-a-half years. Neuropsychiatric symptoms, loss of walking ability, and living alone predicted institutionalization. Caregiver burden may partially mediate the effects of neuropsychiatric symptoms and institutionalization. High caregiver burden due to presence of neuropsychiatric symptoms may partially contribute to institutionalization among people living with dementia in Taiwan. However, proper management of neuropsychiatric symptoms and caregiver empowerment may ameliorate institutionalization risk.
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Affiliation(s)
- Yen-Jen Chen
- Department of Psychiatry, 36596Changhua Christian Hospital, Changhua, Taiwan.,Department of Psychiatry, Yuanlin Christian Hospital, Changhua, Taiwan
| | - Wen-Fu Wang
- Department of Neurology, 36596Changhua Christian Hospital, Changhua, Taiwan.,Department of Holistic Wellness, Ming Dao University, Changhua, Taiwan
| | - Kai-Ming Jhang
- Department of Neurology, 36596Changhua Christian Hospital, Changhua, Taiwan
| | - Ming-Che Chang
- Department of Nuclear Medicine, 36596Changhua Christian Hospital, Changhua, Taiwan
| | - Cheng-Chen Chang
- Department of Psychiatry, 36596Changhua Christian Hospital, Changhua, Taiwan.,School of Medicine, 34899Chung Shan Medical University, Taichung, Taiwan
| | - Yi-Cheng Liao
- Department of Psychiatry, 36596Changhua Christian Hospital, Changhua, Taiwan
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14
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Doncel-García B, Mosquera-Lajas Á, Fernández-Gutiérrez N, Fernández-Atutxa A, Lizaso I, Irazusta J. Relationship between negative stereotypes toward aging and multidimensional variables in older people living in two different social environments. Arch Gerontol Geriatr 2021; 98:104567. [PMID: 34781189 DOI: 10.1016/j.archger.2021.104567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/27/2021] [Accepted: 10/31/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND Ageism is studied extensively in community-dwelling older adults, but remains poorly understood in institutionalized older adults. Here, we compared the physical, psychological, and social variables associated with self-reported age-based biases in community-dwelling older adults and in those living in nursing homes (NHs). MATERIAL AND METHODS Participants (n = 272) in this descriptive cross-sectional study lived in NHs (n = 126) or in their homes (n = 146), were 60 years or older, and had no cognitive or serious functional impairments. Those in NHs had been institutionalized for at least six months. The dependent variable was negative stereotypes toward aging (CENVE). We developed generalized linear models (GLMs) by place of residence and sex following the Comprehensive Geriatric Assessment´s (CGA) methodology. RESULTS There is a statistically significant relationship between negative stereotypes of aging and different multidimensional variables. These variables differ between institutionalized and non-institutionalized adults and between men and women. While some variables are non-modifiable (age and sex) others are potentially modifiable (educational level, participation in activities, length of NH stay, hand strength, autonomy, and depression). CONCLUSIONS This study compared, for the first time, levels of ageism in older people living in two different social environments. Because most of the significant variables are modifiable in both environments, our results provide a framework to combat this type of discrimination. Promising strategies include anti-ageism policies and laws, educational interventions, and increased intergenerational contact.
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Affiliation(s)
- Borja Doncel-García
- OSI Bilbao-Basurto, Osakidetza Basque Health Service, Montevideo Etorb. 18, Bilbao E-48013, Spain.
| | - Álvaro Mosquera-Lajas
- Aspaldiko´s Psychosocial Service and Municipal Community Centers, Barrio Kanpanzar auzoa 7, Portugalete E-48920, Spain
| | - Naiara Fernández-Gutiérrez
- Geriatric Department, Igurco Servicios Socio-Sanitarios, Grupo IMQ, Máximo Aguirre 18 Bis, Floor 6, Bilbao E-48011, Spain.
| | - Ainhoa Fernández-Atutxa
- Department of Nursing I, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Barrio Sarriena, Leioa E-48940, Spain.
| | - Izarne Lizaso
- Department of Basic Psychological Processes and their Development, Faculty of Psychology, University of the Basque Country (UPV/EHU), Tolosa Hiribidea 70, San Sebastián E-20018, Spain.
| | - Jon Irazusta
- Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Barrio Sarriena, Leioa E-48940, Spain.
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15
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Kristensen MS, Thygesen LC, Tay DL, Kumar R, Grønvold M, Aldridge M, Ornstein KA. Size and composition of family networks of decedents: A nationwide register-based study. Palliat Med 2021; 35:1652-1662. [PMID: 33823696 DOI: 10.1177/0269216321998602] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Seriously ill individuals rely heavily on family caregivers at the end of life. Yet many do not have family support. AIM To characterize the size and composition of decedents' family networks by cause of death, demographic, clinical, socioeconomic, and geographic characteristics. DESIGN A cross-sectional population-level study with data collected from nation-wide registers. SETTING/PARTICIPANTS All adults in Denmark born between 1935 and 1998 who died of natural causes between 2009 and 2016 were linked at the time of death to living adult spouses/partners, children, siblings, parents, and grandchildren. RESULTS Among 175,755 decedents (median age: 68 years, range: 18-81 years), 61% had a partner at the time of death and 78% had at least one adult child. Ten percent of decedents had no identified living adult family members. Decedents with family had a median of five relatives. Males were more likely to have a spouse/partner (65%) than females (56%). While 93% of decedents dying of cancer had adult family, only 70% of individuals dying of dementia had adult family at the time of death. The majority of cancer decedents co-resided or lived within 30 km of family (88%), compared to only 65% of those dying from psychiatric illness. CONCLUSIONS While the majority of adults had an extensive family network at the time of death, a substantial proportion of decedents had no family, suggesting the need for non-family based long-term service and support systems. Assessment of family networks can expand our understanding of the end-of-life caregiving process and inform palliative care delivery.
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Affiliation(s)
- Marie S Kristensen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Djin L Tay
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | - Raj Kumar
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mogens Grønvold
- Department of Public Health, University of Copenhagen, Denmark
| | - Melissa Aldridge
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Katherine A Ornstein
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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The association between aspects of carer distress and time until nursing home admission in persons with Alzheimer's disease and dementia with Lewy bodies. Int Psychogeriatr 2021; 33:337-345. [PMID: 32524943 DOI: 10.1017/s1041610220000472] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The aim of this study was to explore the association between specific aspects of carer distress and time until nursing home admission (NHA) in people with mild dementia. DESIGN Prospective cohort study. SETTING Participants were recruited from the Dementia Study of Western Norway (DemVest). PARTICIPANTS This study included 107 participants admitted to a nursing home who were diagnosed with Alzheimer's disease (AD, n = 64) and dementia with Lewy bodies (DLB, n = 43) and their primary carers. MEASUREMENTS The Relative Stress Scale (RSS) was used to assess the level of reported distress in carers. Adjusted partial least square (PLS) prediction analysis of baseline items of the RSS was used to study the associations between individual items of the RSS and time until NHA. RESULTS Carer distress is an important contributor to early NHA, explaining 19.3% of the total variance of time until NHA in the model without covariates. In the adjusted PLS model, the most important RSS predictors of time until NHA were feeling frustrated (estimate = -137; CI, -209, -64.5), having limitations on social life (estimate = -118; CI, -172, -64), not being able to get away on vacation (estimate -116; CI, -158.3, -73.7), and feeling unable to cope with the situation (estimate = -63; CI, -122.6, -3.4). CONCLUSIONS Preservation of the informal care capacity represents important steps for improving the management of resources in dementia care. This study identifies aspects of carer distress associated with a shorter time until NHA. Looking beyond the sum score of the RSS helps promote the development of flexible and tailored interventions and perhaps delay NHA.
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17
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Gottesman RT, Blinderman CD. Updated Review of Palliative Care in Dementia. CURRENT GERIATRICS REPORTS 2021. [DOI: 10.1007/s13670-020-00351-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Dufournet M, Moutet C, Achi S, Delphin-Combe F, Krolak-Salmon P, Dauphinot V. Proposition of a corrected measure of the Lawton instrumental activities of daily living score. BMC Geriatr 2021; 21:39. [PMID: 33430781 PMCID: PMC7802257 DOI: 10.1186/s12877-020-01995-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 12/29/2020] [Indexed: 11/18/2022] Open
Abstract
Background We aimed to propose a correction of the Lawton instrumental activity of daily living (IADL) score to take into account the possibility to have never done some activities, and measured its agreement and reliability with the usual IADL score. Methods A cross-sectional study was conducted in outpatients attending French memory clinics between 2014 and 2017. Lawton IADL, cognitive performance, diagnosis, neuropsychiatric symptoms, and sociodemographics characteristics were collected. A corrected IADL was calculated and its agreement with the usual IADL was assessed. Results The study included of 2391 patients (79.9 years old, 61.7% female). Based on the usual IADL, 36.9% of patients had never carried out at least one of the activities. This proportion reached 68.8% for men and 17.7% for women. Women had a mean IADL higher than men: 4.72 vs 3.49, this difference decreased when considering the corrected IADL: 4.82 vs 4.26 respectively. Based on Bland-Altman method, 93.5% of observations lied within the limits agreement. The ICC between the 2 scores was 0.98. The relationships between patients’ characteristics and the IADL scores were similar, regardless the usual or corrected version. Conclusions This corrected IADL score had an excellent degree of agreement with the usual version based the ICC. This simple correction could benefit both for the clinical practice by providing a more accurate description of the real clinical state of the patients allowing to manage them more precisely, and for research involving the evaluation of the functional abilities of patients.
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Affiliation(s)
- Marine Dufournet
- Clinical and Research Memory Centre of Lyon of Lyon (CMRR Lyon), Lyon Institute For Elderly (Institut du vieillissement I-Vie), Hospices civils de Lyon, Lyon, France
| | - Claire Moutet
- Clinical and Research Memory Centre of Lyon of Lyon (CMRR Lyon), Lyon Institute For Elderly (Institut du vieillissement I-Vie), Hospices civils de Lyon, Lyon, France
| | - Sarah Achi
- Clinical and Research Memory Centre of Lyon of Lyon (CMRR Lyon), Lyon Institute For Elderly (Institut du vieillissement I-Vie), Hospices civils de Lyon, Lyon, France
| | - Floriane Delphin-Combe
- Clinical and Research Memory Centre of Lyon of Lyon (CMRR Lyon), Lyon Institute For Elderly (Institut du vieillissement I-Vie), Hospices civils de Lyon, Lyon, France
| | - Pierre Krolak-Salmon
- Clinical and Research Memory Centre of Lyon of Lyon (CMRR Lyon), Lyon Institute For Elderly (Institut du vieillissement I-Vie), Hospices civils de Lyon, Lyon, France.,Research Clinic Centre Aging Brain Frailty (CRC - VCF), Lyon Institute For Elderly (Institut du vieillissement I-Vie), Hospices civils de Lyon, Lyon, France.,University Lyon 1, INSERM, U1028, UMR CNRS 5292, Research Centre of Neurosciences of Lyon, Lyon, France
| | - Virginie Dauphinot
- Clinical and Research Memory Centre of Lyon of Lyon (CMRR Lyon), Lyon Institute For Elderly (Institut du vieillissement I-Vie), Hospices civils de Lyon, Lyon, France. .,Hôpital des Charpennes, 27 avenue Gabriel Péri, 69 100, Villeurbanne, France.
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Vu LH, Markides KS, Downer B. Neuropsychiatric Symptoms by Cognitive Status for Mexican-Americans Aged 85 and Older. Gerontol Geriatr Med 2021; 7:23337214211002724. [PMID: 33796630 PMCID: PMC7983470 DOI: 10.1177/23337214211002724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 02/19/2021] [Accepted: 02/23/2021] [Indexed: 12/28/2022] Open
Abstract
Few studies have investigated the relationship between neuropsychiatric symptoms (NPS) and cognitive status among older Mexican-American adults. Our objective was to describe the NPS of Mexican-Americans 85 years and older according to cognitive status. Data came from Wave 9 (conducted in 2016) of the Hispanic Established Populations for the Epidemiological Study of the Elderly. The final sample consisted of 381 care recipients ≥85 years. The 12-item Neuropsychiatric Inventory was administered to measure NPS among care recipients. Cognitive impairment was defined as a score of ≤18 on the Mini Mental State Exam or by clinical diagnosis of dementia as reported by the caregiver. Logistic regression models were used to estimate the average marginal effect (range = -1 to 1) of cognitive impairment on NPS, controlling for care-recipient characteristics. Overall, 259 (68.0%) participants had one or more NPS. Approximately 87% of care recipients with cognitive impairment had at least one NPS compared to 55.8% of those without cognitive impairment (p < .01). The predicted probability of having one or more NPS was 0.25% points (95% CI = 0.14-0.35) higher for participants with cognitive impairment than those without. NPS are present in the majority of very old Mexican American adults, particularly in those with cognitive impairment.
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Affiliation(s)
- Lan H. Vu
- University of Texas Medical Branch, Galveston, USA
| | | | - Brian Downer
- University of Texas Medical Branch, Galveston, USA
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20
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Lan X, Xiao H, Chen Y. Psychosocial reactions to relocation to a nursing home among Chinese older adults. Arch Gerontol Geriatr 2020; 91:104230. [PMID: 32829084 DOI: 10.1016/j.archger.2020.104230] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/10/2020] [Accepted: 08/10/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study aimed to describe the psychosocial reactions to relocation to a nursing home from the perspective of older adults. METHOD This study applied a qualitative interview design. Narratives from 23 Chinese nursing home residents in a life review program in Fuzhou, China were recorded, transcribed into sentences, and analyzed using qualitative content analysis. RESULTS The following psychosocial reactions to relocation to a nursing home emerged: fear, struggle, compromise, acceptance, and contribution. The fear resulted from negative labels attached to nursing homes, fear of disconnection to society, fear of difficulties in establishing new relationships, and fear of being abandoned by their families. The behaviors of 'struggle' were complaining about family members, thinking of returning home, praying for change, and taking action to leave. The keys to compromise were a choice between maintaining harmony in family relations and the companionship of relatives, a choice between professional care and family care, and a choice between the cost and effectiveness of family care and nursing home care. The process of acceptance included accepting life yet with worries, affirming the benefits of living in a nursing home, and embracing nursing home life. Contribution was mainly reflected in two aspects, a sense of ownership and bring into full play their self-worth. DISCUSSIONS This study generates new insights into knowledge on the psychosocial reactions to relocation to a nursing home. It provides both family members and nursing home staff with direction on how to ensure a smoother relocation process.
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Affiliation(s)
- Xiuyan Lan
- Fujian Provincial Hospital, Fuzhou, China; Fujian Medical University Affiliated Clinical Medical Institute, Fuzhou, China
| | - Huimin Xiao
- School of Nursing, Fujian Medical University, No. 1 Xuefu North Road, University Town, Fuzhou, Fujian, China.
| | - Ying Chen
- School of Nursing, Fujian Medical University, No. 1 Xuefu North Road, University Town, Fuzhou, Fujian, China.
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Terracciano A, Artese A, Yeh J, Edgerton L, Granville L, Aschwanden D, Luchetti M, Glueckauf RL, Stephan Y, Sutin AR, Katz P. Effectiveness of Powerful Tools for Caregivers on Caregiver Burden and on Care Recipient Behavioral and Psychological Symptoms of Dementia: A Randomized Controlled Trial. J Am Med Dir Assoc 2020; 21:1121-1127.e1. [PMID: 31866419 PMCID: PMC7302999 DOI: 10.1016/j.jamda.2019.11.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 08/14/2019] [Accepted: 11/15/2019] [Indexed: 01/26/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the effectiveness of a psychoeducational intervention, Powerful Tools for Caregivers (PTC), for family caregivers of individuals with dementia. DESIGN A pragmatic, 2-arm randomized controlled trial compared the PTC intervention, as delivered in practice, to usual care. Participants randomized to usual care functioned as a control group and then received the PTC intervention. INTERVENTION PTC is a 6-week manualized program that includes weekly 2-hour classes in a group setting facilitated by 2 trained and certified leaders. The educational program helps caregivers to enhance self-care practices and manage emotional distress. SETTING AND PARTICIPANTS Two stakeholder organizations delivered the intervention in community settings. Participants were family caregivers of individuals with dementia recruited from the community in Florida. METHODS Primary outcomes were caregiver burden and behavioral and psychological symptoms of dementia of the care recipient. Secondary outcomes included caregiver depressive symptoms, self-efficacy, self-rated health, and life satisfaction. Measures were collected at baseline (n = 60 participants), postintervention (n = 55), and at 6-week follow-up (n = 44). RESULTS Intent-to-treat analyses found PTC reduced caregiver burden (d = -0.48) and depressive symptoms (d = -0.53), and increased self-confidence (d = 0.68), but found no significant benefit for behavioral and psychological symptoms of dementia in care recipients. PTC was rated highly by participants and program attrition was low, with 94% of caregivers completing at least 4 of the 6 classes. CONCLUSIONS AND IMPLICATIONS Although no significant effects were found for behavioral and psychological symptoms of dementia, this trial supports the effectiveness of PTC to improve caregiver outcomes as delivered in the community.
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Affiliation(s)
| | - Ashley Artese
- Health and Human Performance, Roanoke College, Salem, VA
| | - Jenie Yeh
- College of Medicine, Florida State University, Tallahassee, FL
| | - LaVon Edgerton
- College of Medicine, Florida State University, Tallahassee, FL
| | - Lisa Granville
- College of Medicine, Florida State University, Tallahassee, FL
| | | | | | | | | | | | - Paul Katz
- College of Medicine, Florida State University, Tallahassee, FL
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Iraqi A, Hughes TL. Impact of Behavioral Disturbance on Caregiver Burden and Nursing Home Placement. J Am Med Dir Assoc 2020; 21:1175. [DOI: 10.1016/j.jamda.2020.01.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 01/07/2020] [Accepted: 01/10/2020] [Indexed: 10/24/2022]
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