[Factors associated with dementia caregivers' preference for institutional care]

Occupational Therapy Interventions for Dementia Caregivers: Scoping Review

BACKGROUND AND PURPOSE

caregivers of people with dementia (PwD) often experience a significant caregiver burden. Occupational Therapy (OT) is a helpful discipline for improving quality of life and other health factors for these caregivers. We conducted a Scoping Review to describe OT interventions for caregivers of PwD.

METHODS

two authors searched PubMed, Scopus, EMBASE and Web of Science databases and OT journals indexed in the Journal Citation Reports. Terms included in the search strategy were: dementia, Alzheimer, Parkinson, caregivers and OT. We included articles with experimental design in which an OT intervention in caregivers of PwD was carried out, written in Spanish or English and with the full text available.

RESULTS

a total of 2121 articles were obtained, 31 of which were included; 22 of them described home-based OT interventions: Tailored Activity Program (TAP) (n = 5), Environmental Skill-Building Program (ESP) (n = 4) and Advancing Caregiver Training (ACT) (n = 3) and other household interventions (n = 10); the remaining studies described OT interventions in other settings (n = 9).

CONCLUSIONS

OT interventions for caregivers of PwD were mainly carried out at home. The most commonly used interventions were TAP focused on caregivers of people with Alzheimer's disease, aimed at lessening the burden, depression and stress experienced by caregivers.

Burnout and Quality of Life in Professionals Working in Nursing Homes: The Moderating Effect of Stereotypes

Objective

This study aimed to analyse how stereotypes towards older people moderate the relationship between burnout and quality of life (QoL) of professionals working in nursing homes.

Method

A total of 312 professionals were asked to complete questionnaires of burnout Maslach Burnout Inventory quality of Life (QPL-35) and aging stereotypes (CENVE). The moderation effects were tested using linear regression models.

Results

A negative association was observed between burnout and QoL. It was also found a statistically significant moderator effect of the total score of stereotypes and the health stereotypes, besides a marginally statistically significant moderator effect for motivational stereotypes. The moderator effects were different for people with low and high negative stereotypes. QoL was more affected under conditions of high burnout, in which people with more negative stereotypes tended to present higher QoL than people with lower negative stereotypes.

Conclusion

Highly burned-out professionals in nursing homes may avoid their negative feelings projecting them to residents through stereotypes, as a way of coping with burnout and increasing their QoL. However, this mechanism is an “aggressive reaction” and may have negative effects for both the older adult and the professional. The comprehension of these variables is essential for developing adequate intervention programs.

Forgiveness Interventions for Older Adults: A Review

A meta-analysis of the efficacy of forgiveness interventions in older adults was conducted. International databases (Medline, PsycINFO, Scopus, Web of Science) were searched for studies published from 1990 to 2020 that attempted to promote forgiveness in older adults. Most intervention studies are group treatments targeted towards community-dwelling older adults. Participants in these studies are mainly women. The intervention objectives and contents vary widely and often criteria are not well-defined. Participants that received forgiveness interventions reported significantly higher levels of forgiveness than participants that did not receive treatment. Additionally, forgiveness interventions resulted in more changes in depression, stress and anger than no intervention conditions. Forgiveness treatment also enhances positive states (satisfaction with life, subjective happiness, and psychological wellbeing). The reported effects are moderate. The specific treatment model (e.g., Enright’s, Worthington’s) and format (e.g., group-based interventions and individually delivered programs) do not differentially predict better outcomes. In conclusion, future intervention studies should include more male participants and utilize a broader range of follow-up periods. Caution must be exercised because of the limited number of studies developed to date; researchers must be cautious when generalizing the results.

Validation of the professional good care scale in nursing homes (GCS-NH)

BACKGROUND

There is extensive concern about older people's care in institutions, especially recently in the past years. One of the reasons is linked to the cases of elder abuse, not only shown by academic and scientific sources, but also by social and mass media and their impact on public perception of the institutional setting. What is more, current COVID-19 pandemic consequences on older people have provoked alarm and worry especially about what is happening in institutions.

METHODS

The sample for this study consists of 286 staff working in nursing homes in Spain. This study aimed to assess the psychometric properties of the Professional Good Care Scale in Nursing Homes (GCS-NH).

RESULTS

Results of parallel analyses and exploratory factor analyses (EFAs) showed a four-factor model for the 32-item scale: humanization (9 items), non-infantilization (10 items), respect (7 items) and empowerment (6 items). Then, psychometric properties were tested analysing internal consistency (reliability) and convergent, divergent and criterion validity. High internal consistency (reliability) and different validity evidence were obtained for the total scores of the GCS-NH and its subscales. GCS-NH scores were also capable of detecting risk of probable institutional elder abuse.

CONCLUSIONS

Results show that this scale is an appropriate, valid, and reliable multidimensional instrument to evaluate good care in older institutionalized people by staff. Good care is an outcome of a complex construct in which a wide range of factors converge (staff, older people, and environmental characteristics). The GCS-NH has potential to be used as a multidimensional tool to assess good care.

Personal and Work-Related Factors Associated with Good Care for Institutionalized Older Adults

Despite efforts to promote good care, many institutionalized older adults (IOA) experience elevated neglectful conditions and reduced person-centered care approaches. Based on the job demand–control model, this study aimed to analyze the relationship between nursing home professionals’ personal and organizational factors and good care provided to institutionalized older people. Data was collected through a self-administered survey completed by 208 nursing home staff members. Three dimensions of personal factors (i.e., personal accomplishment, depersonalization, and negative old age stereotypes) were significant predictors of good care. Depersonalization and negative old age stereotypes were negatively associated with IOA, and both good care and personal accomplishment were positively associated with good care in nursing homes. Only one work-related factor (i.e., management support) was positively associated with good care. Personal factors may play a significant role in good care. Management support offers a promising mechanism to promote good care among nursing home professionals. The findings support the need to change the focus on entirely completing care tasks to providing good care of residents in nursing homes that promotes management support, personal accomplishment, personalization and positive old age consideration, attitudes, and behaviors. Policies and interventions should be developed to address in a more humanized way.

Availability and utilization of support services for South African male caregivers of people with Alzheimer’s disease in low-income communities

The purpose of this study was to explore the needs of male caregivers of people with Alzheimer’s disease, by ascertaining the availability and utilization of Alzheimer’s disease-related resources in low-income communities in the Western Cape. Semi-structured interviews were conducted with 11 adult males who were familial caregivers of persons with Alzheimer’s disease. They were recruited via purposeful sampling methods. Thematic analysis of the data generated four major themes, namely Awareness, Knowledge and Education; Caregivers who do not use services; Caregivers who use services and Service needs identified by male caregivers. Predominant findings were that male caregivers in lower income communities do not make use of formal Alzheimer’s disease-related services – albeit being aware of them – because they do not perceive a need for its utilization. Instead, male caregivers prefer assistance in the form of respite care in the home environment to relieve and assist them with household needs. The role of culture may have a substantial influence on these patterns of help-seeking behavior due to the emphasis on a collective approach to caregiving using wider, informal social networks. Needs that were identified by the male caregivers in this study included the general awareness of Alzheimer’s disease, access to information regarding service provision, psychoeducation and affordable services within improved care facilities for low-income communities. The findings of this study suggest a starting point for the needs that should be prioritized to facilitate culturally appropriate service use amongst male caregivers in similar settings.

Factors associated with costs of care in community-dwelling persons with dementia from a third party payer and societal perspective: a cross-sectional study

Background

Besides the importance of estimating the global economic impact of care for persons with dementia, there is an emerging need to identify the key factors associated with this cost. The aim of this study was to analyze associations between the cost of care in community-dwelling persons with dementia and caregiver characteristics from both the healthcare third party payer perspective and the societal perspective.

Methods

Several characteristics based on the cross-sectional data of 355 dyads of informal caregivers and persons with dementia living in Belgium were identified to include in a log-gamma generalized linear model and were used in a multiple linear regression model with bootstrapping to test robustness.

Results

The mean monthly cost of care for a community-dwelling person with dementia was estimated at € 2339 (95% CI € 2133 – € 2545) per person from a societal perspective and at € 968 (95% CI € 825 – € 1111) per person from a third party payer viewpoint. Informal care accounted for the majority of the monthly costs from the societal perspective. Community based healthcare resource use represented the largest cost from the third party perspective. According to the regression analyses, a higher level of functional dependency of the person with dementia and a higher educational level of the caregiver were associated with a higher monthly cost from both a third party payer perspective and a societal perspective. In addition, being retired and a higher quality of life in the caregivers were associated with a lower monthly cost of care from the societal perspective.

Conclusions

Several characteristics of the caregiver and the person with dementia were associated with the monthly costs of care from a third party payer and a societal perspective. Despite the lack of clear causal relationships, the results of this study can assist policy makers in planning and financing future dementia care.

Trial registration

Clinicaltrials.gov NCT02630446, December 15, 2015.

From home care to care home: a phenomenological case study approach to examining the transition of older people to long-term care in Spain

Background and Aims

It has been the tradition in Spain until recently for families to take care of their own older relatives, but this is now changing, especially in urban areas where caring roles are also shifting. This study aims to examine the Spanish care transitions of older people moving from being traditionally a family-centred and gender-based cultural phenomenon to one that is moving gradually into professional care settings.

Method

A phenomenological case study approach was adopted, involving 15 cases exemplifying the care experience in typical primary care settings in one region of Spain, and examined how the transition from home care is happening. In-depth interviews with older people and carers with lived experience regarding the phenomenon took place.

Results

Seven themes were identified portraying the current picture of the phenomenon, evidencing that care of older people is still culturally assumed as family-centred care and a gender-based responsibility, care homes have a negative social image, there are differences between rural and urban areas, there is a lack of training for professional and family carers, and family income and dependency level accelerate the transition.

Conclusions

This study revealed a lack of care services for older people in Spain, inconsistencies in service provision, as well as a lack of professional and non-professional training.

The mediating role of depression in the association between disability and quality of life in Alzheimer's disease

BACKGROUND

An understanding of the determinants of quality of life in Alzheimer's disease (AD) is required in order to develop effective interventions to promote patients' well-being. Most studies have pointed out depression, functional ability and environmental factors. However, unmeasured confounders can jeopardize the interpretation of the results.

OBJECTIVES

To explore the mediating role of depression in the association between functional status and QoL, and establish a procedure to detect confounding variables.

METHODS

A sample of 192 AD patients and their respective caregivers were recruited from day centers and health care centers in the region of Murcia (Spain). The mediating effect was evaluated using causal mediation analysis. Covariates were introduced into the model in a stepwise fashion and sensitivity analyses were performed to assess the influence of potential confounders.

RESULTS

Self-rated depression acted as a partial mediator between functional status and quality of life. The mediating effect was positive and significant even after including both patient- and caregiver-related covariates. Only if confounders explained more than 80% of the residual variance in the mediator or in the outcome, the mediating effects would not be positive.

CONCLUSIONS

The effect of lack of autonomy on the QoL is mostly explained by the negative consequences on mood status. The sensitivity analysis confirms the robustness of this finding.

Roles and Coping Strategies of Sons Caring for a Parent With Dementia

OBJECTIVE. Little is known about sons’ roles in caring for a parent with dementia. To ensure that interventions and practices appropriately match sons’ needs, we investigated their experiences.

METHOD. A qualitative descriptive approach was used; 20 sons of a parent with dementia participated in semistructured interviews.

RESULTS. Participants reported varied paths to becoming a caregiver, primarily undertaking a care management role and managing by using their own occupational experiences and receiving support from other family members, peers, and private and public community services. They experienced negative consequences such as participation restriction and stress and positive consequences such as feelings of satisfaction. Strategies used to cope included boundary setting and practicing self-care.

CONCLUSION. This study highlights the need to consider sons’ role as care managers for their parent with dementia in community-based settings, as well as their need for education and intervention. Occupational therapy practitioners can use this information to inform their practices and support clients and their families.

Predictors of institutionalization of dementia patients in mild and moderate stages: a 4-year prospective analysis

Background

Institutionalization is the most important milestone in the care of dementia patients. This study was aimed at identifying relevant predictors of institutionalization in a broad empirical context and interpreting them on the basis of the predictor model proposed by Luppa et al. [Dement Geriatr Cogn Disord 2008;26:65-78].

Methods

At the start of this study, 357 patients with mild to moderate dementia were examined by their general practitioners, and a telephone interview was conducted with their caregivers. Four years later, the outcomes ‘institutionalization’ and ‘death’ were determined from health insurance data. Forty-one variables were examined for their predictive influence by univariate and multivariate Cox regression.

Results

The risk of institutionalization increased significantly (p ≤ 0.05) with older ages of patients [hazard ratio (HR) = 1.05] and caregivers (HR = 1.03), a higher educational level of the caregiver (HR = 1.83), greater use of community health services (HR = 1.59), greater caregiver burden (HR = 1.02), and when the caregiver and patient lived apart (HR = 1.97).

Conclusion

The results show that there is a multifactorial influence on institutionalization of dementia patients by sociodemographic, health-related, and psychological aspects as well as the care situation, thus validating the predictor model by Luppa et al. [Dement Geriatr Cogn Disord 2008;26:65-78]. Caregiver burden was found to be the strongest predictor accessible to interventions.