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Wang W, Roumell E, Xu C, Lu Z. Home Through Their Eyes: A Qualitative Exploration of the Meaning of Home for Persons With Dementia and Impact of Physical Environment During Meaning-Making. J Gerontol B Psychol Sci Soc Sci 2024; 79:gbae107. [PMID: 38863436 DOI: 10.1093/geronb/gbae107] [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: 01/03/2024] [Indexed: 06/13/2024] Open
Abstract
OBJECTIVES This study aimed to examine the meaning of home for persons with dementia and the role of the physical environment during their meaning-making process. In response to a growing number of persons with dementia, there has been a strong advocacy for prioritizing the development of dementia-friendly environments within design practice and research agendas, for which "home" has become one of the important loci. However, of the limited studies on the meaning of home from the perspective of those individuals who continue to live in their own homes after developing dementia, even fewer addressed this issue within the Chinese context. METHODS Five dyads, persons with dementia and their family caregivers, participated in the qualitative phenomenology study. Ten home visits-2 visits per dyad-were conducted, during which interview data, photographs, and field notes were collected. Phenomenological analysis was applied within and across the data sets. RESULTS Three key themes emerged-"Three Dimensions of Home" revealed that "home" goes beyond physical residence and immediate family connections, including meaningful objects and places, enduring relationships, self-identity, and lived experiences.; "The Impact of Physical Environment" and "The Impact of Cognitive Impairment" showed the complex interactions between the environment, cognitive impairment, and meaning-making. DISCUSSION An exploration of the essence of meaning of home within the Chinese context, in person-environment relationships with dementia progression, and implications for future research and practice on dementia-related environments and care were further discussed. This study contributes insights into enhancing the well-being of persons with dementia and benefiting their caregivers.
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Affiliation(s)
- Wenjin Wang
- Department of Landscape Architecture & Urban Planning, Texas A&M University, College Station, Texas, USA
| | - Elizabeth Roumell
- Department of Educational Administration & Human Resource Development, Texas A&M University, College Station, Texas, USA
| | - Chuanyue Xu
- Department of Architecture, Texas A&M University, College Station, Texas, USA
| | - Zhipeng Lu
- Department of Architecture, Texas A&M University, College Station, Texas, USA
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Ortiz-Mallasén V, Claramonte-Gual E, Cervera-Gasch Á, Mena-Tudela D, Valero-Chillerón MJ, Andreu-Pejó L, Llagostera-Reverter I, González-Chordá VM. Educational Intervention for the Management of Nonspecific Lower Back Pain in Nonprofessional Caregivers (TRANSFE Program): A Quasi-Experimental Study. NURSING REPORTS 2024; 14:1570-1586. [PMID: 39051354 PMCID: PMC11270366 DOI: 10.3390/nursrep14030118] [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: 04/23/2024] [Revised: 06/21/2024] [Accepted: 06/25/2024] [Indexed: 07/27/2024] Open
Abstract
Nonspecific lower back pain is one of the main health issues experienced by nonprofessional caregivers of dependent individuals. The repetitive movements and efforts made by caregivers to assist dependent individuals are associated with the onset of this lower back pain. The main objective of this study was to assess the effectiveness of an educational intervention for the management of nonspecific lower back pain in nonprofessional caregivers of dependent individuals (TRANSFE program). The secondary objectives were to (i) evaluate the effectiveness of the TRANSFE program on other variables (caregiver burden, perceived social support, and health-related quality of life), (ii) obtain the sociodemographic profile of the sample, and (iii) determine the baseline of the study variables. A quasi-experimental study with post-intervention measurements at 3 months was conducted. Thirty-six nonprofessional caregivers of dependent individuals participated in this study. The presence of lower back pain (back pain index), low back pain (visual analogue scale), disability due to low back pain (Oswestry disability index), perceived social support (Duke-UNK scale), caregiver burden (Zarit burden scale), and health-related quality of life (EuroQol-5D) were assessed. The intervention significantly improved all the studied variables related to lower back pain (p < 0.001). The intervention was effective on other variables related to nonprofessional caregiving such as caregiver burden, perceived social support, and health-related quality of life, albeit with moderate results. An educational intervention for lower back pain experienced by caregivers of dependent individuals was effective in reducing lower back pain and addressing caregiver burden, perceived social support, and health-related quality of life. This study was registered retrospectively on the Open Science Framework platform on 20 June 2024, with the registration number 10.17605/OSF.IO/K7WTE.
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Affiliation(s)
- Víctor Ortiz-Mallasén
- Nursing Department, Jaume I University, Avda Sos Baynat s/n, 12071 Castellón de la Plana, Spain; (Á.C.-G.); (D.M.-T.); (M.J.V.-C.); (L.A.-P.); (I.L.-R.); (V.M.G.-C.)
| | - Eloy Claramonte-Gual
- Department of Health in Castellón, Valencian Health System, Avda Benicassim, 128, 12004 Castellón de la Plana, Spain;
| | - Águeda Cervera-Gasch
- Nursing Department, Jaume I University, Avda Sos Baynat s/n, 12071 Castellón de la Plana, Spain; (Á.C.-G.); (D.M.-T.); (M.J.V.-C.); (L.A.-P.); (I.L.-R.); (V.M.G.-C.)
| | - Desirée Mena-Tudela
- Nursing Department, Jaume I University, Avda Sos Baynat s/n, 12071 Castellón de la Plana, Spain; (Á.C.-G.); (D.M.-T.); (M.J.V.-C.); (L.A.-P.); (I.L.-R.); (V.M.G.-C.)
| | - María Jesús Valero-Chillerón
- Nursing Department, Jaume I University, Avda Sos Baynat s/n, 12071 Castellón de la Plana, Spain; (Á.C.-G.); (D.M.-T.); (M.J.V.-C.); (L.A.-P.); (I.L.-R.); (V.M.G.-C.)
| | - Laura Andreu-Pejó
- Nursing Department, Jaume I University, Avda Sos Baynat s/n, 12071 Castellón de la Plana, Spain; (Á.C.-G.); (D.M.-T.); (M.J.V.-C.); (L.A.-P.); (I.L.-R.); (V.M.G.-C.)
| | - Irene Llagostera-Reverter
- Nursing Department, Jaume I University, Avda Sos Baynat s/n, 12071 Castellón de la Plana, Spain; (Á.C.-G.); (D.M.-T.); (M.J.V.-C.); (L.A.-P.); (I.L.-R.); (V.M.G.-C.)
| | - Víctor Manuel González-Chordá
- Nursing Department, Jaume I University, Avda Sos Baynat s/n, 12071 Castellón de la Plana, Spain; (Á.C.-G.); (D.M.-T.); (M.J.V.-C.); (L.A.-P.); (I.L.-R.); (V.M.G.-C.)
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Harriman NW, Bassil DT, Farrell MT, Du Toit J, Gómez-Olivé Casas FX, Tollman SM, Berkman LF. Associations between cohort derived dementia and COVID-19 serological diagnosis among older Black adults in rural South Africa. Front Public Health 2024; 11:1304572. [PMID: 38249406 PMCID: PMC10796535 DOI: 10.3389/fpubh.2023.1304572] [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: 09/29/2023] [Accepted: 12/01/2023] [Indexed: 01/23/2024] Open
Abstract
Objectives This study investigates the association between cohort derived dementia and serologically confirmed SARS-CoV-2 infection, an underexplored phenomena in low-and middle-income countries. Examining this relationship in a rural South African community setting offers insights applicable to broader healthcare contexts. Methods Data were collected from Black South Africans in the Mpumalanga province who participated in the Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa. Cohort derived dementia was developed using a predictive model for consensus-based dementia diagnosis. Multinomial logistic regression models estimated the association between predicted dementia probability in 2018 and SARS-CoV-2 infection risk in 2021, controlling for demographics, socioeconomic status, and comorbidities. Results Fifty-two percent of the tested participants had serologically confirmed SARS-CoV-2 infections. In the fully adjusted model, cohort derived dementia was significantly associated with over twice the risk of serological diagnosis of COVID-19 (RRR = 2.12, p = 0.045). Conclusion Complying with COVID-19 prevention recommendations may be difficult for individuals with impaired cognitive functioning due to their symptoms. Results can inform community-based public health initiatives to reduce COVID-19 transmission among South Africa's rapidly aging population.
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Affiliation(s)
- Nigel Walsh Harriman
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Cambridge, Massachusetts, MA, United States
| | - Darina T. Bassil
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Cambridge, Massachusetts, MA, United States
| | - Meagan T. Farrell
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Cambridge, Massachusetts, MA, United States
| | - Jacques Du Toit
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - F. Xavier Gómez-Olivé Casas
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Stephen M. Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Lisa F. Berkman
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Cambridge, Massachusetts, MA, United States
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Wang W, Dubois B, Lu Z. Home Triad: A New Exploration of Home for People Living With Dementia Based on Lefebvre's Spatial Triad. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2024; 17:253-269. [PMID: 37667575 DOI: 10.1177/19375867231195283] [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: 09/06/2023]
Abstract
OBJECTIVES This article examines a novel theoretical framework, which we term Home Triad, for research and practice involving people living with dementia (PLWD). BACKGROUND Most of the existing home-related research on PLWD focuses on interior modifications, home care interventions and models, place attachment, and/or institutional homelike environments. However, limited studies have examined the meaning of home from PLWD's perspective, and even fewer have simultaneously considered the individual experience of PLWD, the external power (e.g., the role of design), and their interaction dynamics in the meaning-making process. METHODS We developed home triad based on Lefebvre's spatial triad. Inspired by Chaudhury's home story structure, we conducted a life story analysis of a person living with dementia, "Kai," under four contexts-childhood home, neighborhood and city, daily routine, and attachment-within home triad. RESULTS Home triad abstracts "home" with a dialectically interconnected relationship of the conceived, perceived, and lived home. Through PLWD's everyday life, the essence of home is primarily shaped by the interaction between their lived and perceived homes. However, a person's experiences of and participation in home living activities are also planned and/or regulated by different groups of people (caregivers, designers, and policymakers), who play important roles in the conceived home. Critically examining how PLWD's lived and perceived home is constrained or enabled through the conceived home deserves greater future research efforts. CONCLUSION A systematic examination of the essence of home for PLWD using home triad can facilitate subsequent research and practice that promote PLWD's health, well-being, and quality of life.
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Affiliation(s)
- Wenjin Wang
- School of Architecture, Texas A&M University, College Station, TX, USA
| | | | - Zhipeng Lu
- School of Architecture, Texas A&M University, College Station, TX, USA
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Gambella E, Valenza S, Giulietti MV, Gagliardi C, Civerchia P, Fabbietti P, Lattanzio F, Pelliccioni G. "The Community That Takes Care of Itself": A Feasibility Study to Support Families Caring for a Loved One With Alzheimer Disease. FAMILY & COMMUNITY HEALTH 2022; 45:238-246. [PMID: 35985024 DOI: 10.1097/fch.0000000000000333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This pilot project was aimed at supporting those families caring at home for loved ones suffering from Alzheimer dementia. Fourteen dyads of "caregivers-loved ones with dementia" were recruited and assigned either to the experimental group (n = 7) or to the control group (n = 7). The experimental group attended a training course, an Alzheimer Café, a self-help group for caregivers, and the support from a volunteer and professional nurse in-home visits, while the control group's dyads attended a standard intervention. To investigate the effects of this integrated and interprofessional model of care, caregivers completed the Caregiver Burden Inventory and 2 ad hoc structured questions to evaluate whether quality of life of the dyads was changed. Moreover, the caregivers of the experimental group completed the Self-Assessment Single Questionnaire, version 6 (Q-UAV6). Only caregivers of the experimental group reported a significant reduction in burden and an improved quality of life of the dyad. They also showed a greater acceptance of the disease, became experts in the care of their loved ones, and improved their relationship. The creation of a service integration network of professionals, volunteers, and families has been shown to be useful in supporting those families caring at home for loved ones suffering from Alzheimer dementia.
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Affiliation(s)
- Elena Gambella
- Department of Neurology (Ms Gambella and Drs Giulietti, Civerchia, and Pelliccioni), Centre for Socio-Economic Research on Ageing (Ms Gagliardi), Laboratory of Geriatric Pharmacoepidemiology (Mr Fabbietti), and Scientific Direction (Dr Lattanzio), IRCCS INRCA-National Institute of Health & Science on Ageing, Ancona, Italy; and Department of Hospital Psychology, Ospedali Riuniti Marche Nord, Pesaro, Italy (Dr Valenza)
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Breen R, Savundranayagam MY, Orange JB, Kothari A. Quality home care for persons living with dementia: Personal support workers' perspectives in Ontario, Canada. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e2497-e2506. [PMID: 34951066 DOI: 10.1111/hsc.13692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 11/29/2021] [Accepted: 12/06/2021] [Indexed: 06/14/2023]
Abstract
There is a global need to understand how the quality of home care for persons living with dementia is perceived by their most frequent formal caregivers, personal support workers (PSW), especially given the expected rise in the prevalence of dementia. The aim of this study was to explore the perceptions of PSW regarding what constitutes quality home care for persons with dementia. Qualitative content analysis was undertaken to interpret semi-structured interviews with PSW (N = 15). Study findings indicate that quality home care is perceived to be (1) person-centered; (2) provided by PSW with dementia-specific education and training; (3) facilitated by specific PSW experiences, abilities and characteristics; (4) enhanced by accessible information, services and education for persons with dementia and their caregivers; (5) provided by an inclusive dementia care team; and (6) facilitated by organisational supports and respect. However, findings also indicated differences in what PSW perceive as quality home care versus what they are experiencing when providing care for persons with dementia. Participants advocated for increased supports to them through ongoing dementia-specific education and training, increased teamwork among care providers, increased wages, sufficient and qualified staffing, and increased exchange of client information. The findings highlight the importance of exploring front-line workers' perspectives and how they can help revise current healthcare policies and inform future policy development.
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Affiliation(s)
- Rachel Breen
- School of Health Studies, University of Western Ontario, London, Ontario, Canada
| | | | - Joseph B Orange
- School of Communications Sciences and Disorders, University of Western Ontario, London, Ontario, Canada
| | - Anita Kothari
- School of Health Studies, University of Western Ontario, London, Ontario, Canada
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Mansfield E, Cameron E, Carey M, Boyes A, Nair B, Hall A, Sanson-Fisher R. Prevalence and Type of Unmet Needs Experienced by People Living with Dementia. J Alzheimers Dis 2022; 87:833-842. [DOI: 10.3233/jad-215183] [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]
Abstract
Background: Accurately identifying the unmet needs of community-dwelling people with dementia allows targeted support to be provided to assist these individuals to stay at home. Objective: We developed a self-report instrument to identify the unmet needs of community-dwelling people with dementia and used this to explore the prevalence and type of unmet needs present in this population. Methods: This was a cross-sectional survey of people with dementia living in the community in Australia. Participants were recruited from geriatric clinics, respite centers, aged care providers, and carers attending support groups. Eligible people with dementia were provided with a study information pack and survey which included the self-report Unmet Needs Instrument for Dementia (UNI-D), sociodemographic characteristics and survey acceptability. Results: The UNI-D contained 26 items across 5 domains and demonstrated acceptable internal consistency, face and construct validity, and acceptability. Ninety-five eligible participants completed the survey (response rate 35%) with 85% identifying at least one unmet need (median = 4; IQR = 1–9). The items most frequently endorsed included needing more help with remembering things (64%), finding possible treatments for dementia (44%), understanding who to contact regarding a problem or concern related to dementia (36%), and to see friends and family more often (33%). Conclusion: The UNI-D is a promising tool to identify the self-reported needs of people with dementia. The development and rigorous testing of interventions targeting unmet needs related to health and wellbeing, dementia support, and meaningful activities appears warranted.
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Affiliation(s)
- Elise Mansfield
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Emilie Cameron
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Mariko Carey
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Allison Boyes
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Balakrishnan Nair
- John Hunter Hospital, Hunter New England Local Health District, New Lambton Heights, New South Wales, Australia
- Medical Education and Professional Development, School of Medicine and Public Health, College of Health and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Alix Hall
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
| | - Rob Sanson-Fisher
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
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Tuijt R, Rees J, Frost R, Wilcock J. Exploring how triads of people living with dementia, carers and health care professionals function in dementia health care: A systematic qualitative review and thematic synthesis. DEMENTIA 2021; 20:1080-1104. [PMID: 32212862 PMCID: PMC8047709 DOI: 10.1177/1471301220915068] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Many qualitative studies report the post-diagnostic care experiences of carers and people living with dementia; however, this is not often accompanied by opportunities to hear the corresponding views of their health care professionals and how this triadic relationship functions. The aim of this review was to identify and thematically synthesize the experiences of health care services reported by people living with dementia, their carers and health care professionals. METHODS Medline, PsycINFO, Embase and CINAHL were searched from inception to 31 July 2019 for qualitative research including people living with dementia, carers and health care professionals. Data were coded and thematically synthesised using NVivo. RESULTS Of 10,045 search results, 29 papers relating to 27 studies were included in the final synthesis, including 261 people living with dementia, 444 carers and 530 health care professionals. Six themes emerged related to the functioning of a dementia care triad: (1) involving the person living with dementia, (2) establishing expectations of care and the roles of the members of the triad, (3) building trust, (4) effective communication, (5) continuity of care and (6) understanding the unique relationship dynamics within each triad. DISCUSSION The interactions and complexity of triadic dementia care relationships further our understanding of how to improve dementia care. Awareness of possible diverging attitudes highlights areas of necessary improvement and further research into facilitating engagement, such as when multiple professionals are involved or where there are mismatched expectations of the roles of triad members. In order to operate efficiently as a triad member, professionals should be aware of how pre-existing relations can influence the composition of a triad, encourage the involvement of the person living with dementia, clarify the expectations of all parties, establish trusting relationships and enable communication within the direct triad and beyond.
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Affiliation(s)
- Remco Tuijt
- Remco Tuijt, Research Department of Primary Care and Population Health, University College London, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK.
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Frias CE, Risco E, Zabalegui A. Psychoeducational intervention on burden and emotional well-being addressed to informal caregivers of people with dementia. Psychogeriatrics 2020; 20:900-909. [PMID: 33015927 DOI: 10.1111/psyg.12616] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/24/2020] [Accepted: 09/02/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND In dementia it is necessary that a family member become an informal caregiver. This labour has social, physical and emotional repercussions on the caregiver's health. The objective was to assesses the impact of the INFOSA-DEM intervention on burden and emotional well-being among caregivers of people with dementia, evaluating the effects at 3 and 6 months. METHOD We adopted an experimental, non-randomised design with an intervention group and a control group. The intervention group received the intervention and the control group received usual care. The study was carried out in the catchment areas of three centres specialising in the care of people with cognitive impairment in the province of Barcelona. RESULTS At 3 months, there was an improvement with respect to burden in the intervention group with a significant worsening (P < 0.012) in the control group. Similarly, a positive effect on emotional well-being was observed in the intervention group compared with a small negative effect among controls. CONCLUSIONS Programs addressed to informal caregivers based on psychoeducational and cognitive-behavioural therapies are effective in improving quality of life and emotional well-being, and in reducing burden, with a positive effect on the quality of care provided at home.
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Affiliation(s)
- Cindy E Frias
- Department of Nursing, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Ester Risco
- Hospital Pere I Virgili of Barcelona, Barcelona, Spain
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Alvira C, Cabrera E, Kostov B, Risco E, Farré M, Miguel S, Zabalegui A. Validity and reliability of the Spanish caregiver reaction assessment scale for caregivers of people with dementia. Int J Nurs Pract 2020; 27:e12848. [PMID: 32476205 DOI: 10.1111/ijn.12848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 07/09/2019] [Accepted: 04/17/2020] [Indexed: 01/21/2023]
Abstract
AIM Of the few instruments available to measure the important, positive aspects of caring, the Caregiver Reaction Assessment is regarded as the most suitable, but there is no validated Spanish version. The aim of this study was to translate the Caregiver Reaction Assessment into Spanish and assess its psychometric properties. METHODS The Caregiver Reaction Assessment was translated into Spanish and then back translated. Validation included construct validity, criterion validity and reliability: 287 interviews were conducted with informal caregivers of patients with dementia between November 2010 and April 2012. RESULTS Principal component analysis confirmed the original instrument's five subscales. Criterion validity showed a moderate negative correlation between the impact on health and the EQ-5D (r = -.43), that is, a greater impact on health correlated with lower health-related quality of life. The Caregiver Reaction Assessment showed good internal consistency, with a Cronbach alpha of .804, and good temporal stability for the distinct subscales, with intraclass correlation coefficients varying from .683 to .729 (p < .001). CONCLUSION The Caregiver Reaction Assessment is a reliable, valid instrument for the measurement of the reactions of informal caregivers of patients with dementia, with good psychometric properties.
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Affiliation(s)
- Carmen Alvira
- Department of Nursing, CAP Comte Borrell, CAPSBE, Barcelona, Spain
| | - Esther Cabrera
- School of Health Sciences TecnoCampus, Pompeu Fabra University, Mataró, Spain
| | - Belchin Kostov
- Group for Research in Primary Care, IDIBAPS, Barcelona, Spain
| | - Ester Risco
- Department of Nursing, Hospital Clínic de Barcelona, Spain
| | - Marta Farré
- Department of Nursing, Hospital Clínic de Barcelona, Universitat de Barcelona (UB), Barcelona, Spain
| | - Susana Miguel
- School of Health Sciences Gimbernat i Tomàs Cerdà, UAB, Barcelona, Spain
| | - Adelaida Zabalegui
- School of Health Sciences Gimbernat i Tomàs Cerdà, UAB, Barcelona, Spain
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Varik M, Medar M, Saks K. Informal caregivers' experiences of caring for persons with dementia in Estonia: A narrative study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:448-455. [PMID: 31637794 DOI: 10.1111/hsc.12877] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 09/10/2019] [Accepted: 09/24/2019] [Indexed: 06/10/2023]
Abstract
This paper presents the results of a qualitative study aimed at exploring the experiences and needs of informal caregivers of persons with dementia and identifying caregiver expectations for support. The research was based on phenomenological and social constructionist approaches; it also took experience-centred and culturally oriented approaches to narratives. It was conducted in Estonia in 2017 by means of unstructured in-depth interviews with 16 informal caregivers who had relatives with dementia. The narrative approach used in this study proved to be an appropriate and valuable method to understand the situations of the caregivers of the people with dementia, in identifying their needs and expectations, and in developing social understanding for caregivers. The results are divided under four thematic headings: awareness of dementia; process of caregiving and different caregiving roles; influence of caregiving on personal life; and expectations of empowerment. We found that it is necessary to raise public awareness of dementia and develop person-centred support services for the people living with dementia.
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Affiliation(s)
- Merle Varik
- School of Governance, Law and Society, Tallinn University, Tallinn, Estonia
- Tartu Health Care College, Tartu, Estonia
| | - Marju Medar
- School of Governance, Law and Society, Tallinn University, Tallinn, Estonia
| | - Kai Saks
- University of Tartu, Tartu, Estonia
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Hameed S, Fuh JL, Senanarong V, Ebenezer EGM, Looi I, Dominguez JC, Park KW, Karanam AK, Simon O. Role of Fluid Biomarkers and PET Imaging in Early Diagnosis and its Clinical Implication in the Management of Alzheimer's Disease. J Alzheimers Dis Rep 2020; 4:21-37. [PMID: 32206755 PMCID: PMC7081089 DOI: 10.3233/adr-190143] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2020] [Indexed: 12/13/2022] Open
Abstract
Clinical diagnosis of Alzheimer's disease (AD) is based on symptoms; however, the challenge is to diagnose AD at the preclinical stage with the application of biomarkers and initiate early treatment (still not widely available). Currently, cerebrospinal fluid (CSF) amyloid-β 42 (Aβ42) and tau are used in the clinical diagnosis of AD; nevertheless, blood biomarkers (Aβ42 and tau) are less predictive. Amyloid-positron emission tomography (PET) imaging is an advancement in technology that uses approved radioactive diagnostic agents (florbetapir, flutemetamol, or florbetaben) to estimate Aβ neuritic plaque density in adults with cognitive impairment evaluated for AD and other causes of cognitive decline. There is no cure for AD to date-the disease progression cannot be stopped or reversed; approved pharmacological agents (donepezil, galantamine, and rivastigmine; memantine) provide symptomatic treatment. However, the disease-modifying therapies are promising; aducanumab and CAD106 are in phase III trials for the early stages of AD. In conclusion, core CSF biomarkers reflect pathophysiology of AD in the early and late stages; the application of approved radiotracers have potential in amyloid-PET brain imaging to detect early AD.
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Affiliation(s)
- Shahul Hameed
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore
- Duke NUS Medical School, Singapore
| | - Jong-Ling Fuh
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Vorapun Senanarong
- Division of Neurology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Irene Looi
- Clinical Research Centre, Hospital Seberang Jaya, Penang, Malaysia
- Department of Medicine, Hospital Seberang Jaya, Penang, Malaysia
| | | | - Kyung Won Park
- Department of Neurology and Cognitive Disorders and Dementia Center, Institute of Convergence Bio-Health, Dong-A University College of Medicine, Busan, Republic of Korea
| | | | - Oliver Simon
- Novartis (Singapore) Pte. Ltd., Singapore, Singapore
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13
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Frias CE, Garcia-Pascual M, Montoro M, Ribas N, Risco E, Zabalegui A. Effectiveness of a psychoeducational intervention for caregivers of People With Dementia with regard to burden, anxiety and depression: A systematic review. J Adv Nurs 2020; 76:787-802. [PMID: 31808211 DOI: 10.1111/jan.14286] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 11/07/2019] [Accepted: 11/27/2019] [Indexed: 11/28/2022]
Abstract
AIM To assess the effectiveness of psychoeducational interventions with respect to burden, anxiety and depression in family caregivers of People With Dementia living at home. BACKGROUND In dementia, the family assumes the role of main caregiver, maintaining the patient in a good state of health. Nevertheless, burden, anxiety and depression may have negative repercussions in caregivers. Therefore, professional supports through psychoeducational programmes are recommended as interventions for improving caregivers' health. DESIGN A quantitative systematic review. DATA SOURCES Electronic searches were performed in CINAHL/AMED/CENTRAL/Web of Science/LILACS/PUBMED from January 2005-August 2018. REVIEW METHODS The review was conducted using the JADAD scale to assess bias risk and the quality of the randomized controlled trials (RCTs) and the CONSORT instrument to assess study quality report. The extracted data were reviewed by independent reviewer pairs. The review was reported using PRISMA. RESULTS A total of 18 RCTs met inclusion criteria. Seven were classified as Technology-based Interventions and 11 as Group-based Interventions. CONCLUSION Psychoeducational interventions for caregivers allow them to increase their knowledge of the illness, develop problem-solving skills and facilitate social support. Technology-based Interventions significantly affect burden while Group-based Interventions affect anxiety, depression, insomnia and burden and quality of life and self-efficacy. IMPACT Research findings can be used to classify caregivers in future interventions according to illness stage to obtain more precise results.
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Affiliation(s)
| | | | | | - Nuria Ribas
- Hospital Clinic of Barcelona, Barcelona, Spain
| | - Ester Risco
- Hospital Clinic of Barcelona, Barcelona, Spain
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14
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Warrick N, Prorok JC, Seitz D. Care of community-dwelling older adults with dementia and their caregivers. CMAJ 2019; 190:E794-E799. [PMID: 29970368 DOI: 10.1503/cmaj.170920] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Natalie Warrick
- Cancer Care Ontario (Warrick, Prorok, Seitz); Institute of Health Policy, Management and Evaluation (Warrick), University of Toronto, Toronto, Ont.; School of Public Health and Health Systems (Prorok), University of Waterloo, Waterloo, Ont.; Department of Psychiatry (Seitz), Queen's University, Kingston, Ont
| | - Jeanette C Prorok
- Cancer Care Ontario (Warrick, Prorok, Seitz); Institute of Health Policy, Management and Evaluation (Warrick), University of Toronto, Toronto, Ont.; School of Public Health and Health Systems (Prorok), University of Waterloo, Waterloo, Ont.; Department of Psychiatry (Seitz), Queen's University, Kingston, Ont
| | - Dallas Seitz
- Cancer Care Ontario (Warrick, Prorok, Seitz); Institute of Health Policy, Management and Evaluation (Warrick), University of Toronto, Toronto, Ont.; School of Public Health and Health Systems (Prorok), University of Waterloo, Waterloo, Ont.; Department of Psychiatry (Seitz), Queen's University, Kingston, Ont.
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15
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Smith TO, Pearson M, Pfeiffer K, Crotty M, Lamb SE. Caregiver Interventions for Adults Discharged from the Hospital: Systematic Review and Meta-Analysis. J Am Geriatr Soc 2019; 67:1960-1969. [PMID: 31350918 DOI: 10.1111/jgs.16048] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 04/30/2019] [Accepted: 05/31/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To review the evidence evaluating the effectiveness of informal caregiver interventions to facilitate the recovery of older people discharged from the hospital. DESIGN Systematic review and meta-analysis. SETTING Hospital and community. METHODS Published and unpublished randomized and nonrandomized controlled trials assessing the effectiveness of informal caregiver interventions to support the recovery of older people discharged from the hospital were identified (to March 2019). The primary outcome was patient health-related quality of life (HRQOL). Secondary outcomes included patient function, caregiver burden, caregiver HRQOL, psychological distress, adverse events, and health resource use. Studies were critically appraised and meta-analyzed. PARTICIPANTS Adults who had been admitted to the hospital. RESULTS A total of 23 studies were eligible (4695 participants). The indication for hospital admission was stroke in 21 trials (91%). Interventions consisted of training and/or skills-based programs, with or without home visits/telephone follow-up. Caregiver interventions for patients following stroke may provide no benefit for patient HRQOL at 12 months (standardized mean difference = .29; 95% confidence interval = -.12 to .69; low-quality evidence). Caregiver interventions demonstrated benefit for caregiver burden and both patient and caregiver anxiety at 12 months. No consistent effect was found on functional outcomes, depression, HRQOL, adverse events, or health resource use measures. CONCLUSIONS Informal caregivers who receive training to facilitate the recovery of older people discharged from the hospital following stroke may have a lower burden and reduced anxiety at 12 months compared with those who do not. However, the evidence was moderate to low quality. Further study is warranted to explore whether caregiver interventions can be modified for nonstroke populations such as those with hip fracture. J Am Geriatr Soc 67:1960-1969, 2019.
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Affiliation(s)
- Toby O Smith
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Matthew Pearson
- Physiotherapy Outpatients Department, Dynamic Health, Cambridgeshire Community Services NHS Trust, Huntingdon, United Kingdom
| | - Klaus Pfeiffer
- Department of Clinical Gerontology and Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Maria Crotty
- Flinders Medical Centre, Flinders University, Adelaide, Australia
| | - Sarah E Lamb
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
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16
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Rehabilitation for People Living with Dementia: A Scoping Review of Processes and Outcomes. J Aging Res 2019; 2019:4141050. [PMID: 31275651 PMCID: PMC6589218 DOI: 10.1155/2019/4141050] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 05/03/2019] [Accepted: 05/09/2019] [Indexed: 12/13/2022] Open
Abstract
Objectives The aim of this scoping review was to map intervention studies of rehabilitation for people living with dementia regarding processes and outcomes, with a particular focus on whether the intervention is person-centred, home-based, or organised adopting a multidisciplinary approach and measures outcomes relating to everyday functioning and well-being. Methods A systematic search of electronic databases was conducted in PubMed, CINAHL, PsycINFO, Embase, and Cochrane. Studies from 2005 to November 2018 were collected and screened for relevance and quality. Randomised control trials and prospective cohort trials reporting a statistically significant effect on one or more outcome measures were included. Included studies were mapped according to selected processes and outcome measures. Results Twenty-six intervention studies were included and mapped. Nineteen of the interventions were person-centred, nine were home-based, and 14 reported a multidisciplinary approach. Twelve of the interventions had activities of daily living as an outcome measure, and 14 had quality of life as an outcome measure. Conclusion Person-centredness appears in most rehabilitation interventions for people living with dementia. Other processes and outcomes are heterogeneously described in the research literature. Rehabilitation programmes can be home-based or take place at a centre. Although not exclusive, the organisation of rehabilitation can be multidisciplinary. Fewer than half of the intervention studies measure the impact on activities of daily living and quality of life. Future guidelines must take into account the weak evidence regarding these aspects.
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17
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Chacón Valera C, Bartolomé Regué M, Font Ritort S, Cabrera Torres E. How to Undertake Aging in a Healthy Way: Changes and Opportunities. AQUICHAN 2019. [DOI: 10.5294/aqui.2019.19.1.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective: To know the socio-demographic characteristics of the elderly adults (60-70 years), of the population of Mataró (Barcelona), and their relationship with the knowledge degree and training needs perceived to face a healthy aging. Materials and methods: Descriptive observational cross-sectional study in which a sample of 306 people was analysed. Socio-demographic data and variables related to leisure activities, health status, training, formative needs and predisposition to take a course on aging were evaluated. Results: About a 60 % of the respondents showed interest in receiving training about; healthy habits (59,1 %), proper diet (62,0 %), work out (59,6 %), future limitations (62,6 %), why we grow old (61,0 %), frequent illnesses in the elderly (62,5 %), use of medication (66,1 %), use of the health system (61,9 %), social resources (70,0 %), new technologies (64,0 %), care of sick people (60,5 %), and security aspects (61,6 %). Conclusions: There is a need to receive training among the elderly adult population in order to cope with aging in a healthier way. The main needs perceived by the elderly are: Healthy habits, possible future limitations due to the aging process, use of medication, functioning of the health system and access to social resources, new technologies and, finally, caring for sick relatives.
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18
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Chen HC, Chan SWC, Yeh TP, Huang YH, Chien IC, Ma WF. The Spiritual Needs of Community-Dwelling Older People Living With Early-Stage Dementia-A Qualitative Study. J Nurs Scholarsh 2019; 51:157-167. [PMID: 30604590 DOI: 10.1111/jnu.12454] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE To explore the spiritual needs of community-dwelling older people living with early-stage dementia. DESIGN A descriptive qualitative research design with purposive sampling was used. METHODS Ten older people who were receiving home care services from a mental hospital in central Taiwan were recruited. In-depth semistructured interviews were conducted and content analysis was performed. FINDINGS Four themes emerged that described the spiritual wishes and needs of older people with early-stage dementia: the wish to turn back time, the need to instill meaning into past experiences, the need to rely on faith-based strength, and the wish to have one's remaining life under control. The spiritual needs centered on a strong yearning to engage in a tug-of-war with time to reverse the impaired memory and independence. CONCLUSIONS This study provides insights into the spiritual needs of older people with early-stage dementia. They struggled to maintain a balance between independence and dependence, build a sense of self and value, seek guidance and support from religious faith, and retain control over their lives. CLINICAL RELEVANCE The findings can be expected to help caregivers improve care of older people with dementia by empowering older people to hold onto control in their lives and providing opportunities for them to connect with others for fulfilling their spiritual needs.
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Affiliation(s)
- Hsing-Chia Chen
- Head Nurse, Department of Nursing, Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nantou, Taiwan
| | - Sally Wai-Chi Chan
- Upsilon Eta, Professor and Dean of School, School of Nursing and Midwifery, The University of Newcastle, Newcastle, Australia
| | - Tzu-Pei Yeh
- Assistant Professor, School of Nursing, China Medical University, Taichung, Taiwan and Adjunct Supervisor, Department of Nursing, China Medical University Hospital, Taichung, Taiwan
| | - Yao-Hui Huang
- Supervisor, Department of Nursing, Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nantou, Taiwan
| | - I-Chia Chien
- Superintendent, Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nantou, Taiwan, and Adjunct Professor, Department of Public Health & Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Wei-Fen Ma
- Lambda Beta-at-Large, Professor, School of Nursing, China Medical University , Taichung, Taiwan; Adjunct Supervisor, Department of Nursing, China Medical University Hospital, Taichung, Taiwan; and Professor, Brain Disease Research Center, China Medical University Hospital, Taichung, Taiwan
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19
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Huis In Het Veld JG, Verkaik R, van Meijel B, Francke AL. A systematic meta-review of self-management support for people with dementia. DEMENTIA 2018; 19:253-269. [PMID: 29699409 DOI: 10.1177/1471301218772894] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Self-management support for people with dementia is important to help them and their family caregivers to cope with challenges in daily live. Insight into the effects of self-management support interventions on people with dementia is however lacking, despite existing relevant systematic reviews. We therefore conducted a meta-review of relevant systematic reviews, following the PRISMA statement. Systematic literature searches were conducted in PubMed, CINAHL, the Cochrane Library, Embase and PsycINFO. The searches were done in December 2015, and all relevant references until then were taken into consideration. No conclusions about the effects of self-management support interventions on people with dementia could be drawn. Recommendations for future research and practice include that self-management support interventions and effect measurements should be wider in scope than psychological well-being.
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Affiliation(s)
- Judith G Huis In Het Veld
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU University Medical Center, The Netherlands
| | - Renate Verkaik
- Netherlands Institute for Health Services Research (Nivel), The Netherland
| | - Berno van Meijel
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, The Netherlands.,Inholland University of Applied Sciences, The Netherlands.,Parnassia Psychiatric Institute, The Netherlands.,GGZ-VS, Academy for Masters in Advanced Nursing Science, The Netherlands
| | - Anneke L Francke
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU University Medical Center, The Netherlands.,Netherlands Institute for Health Services Research (Nivel), The Netherland
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20
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Tang SH, Chio OI, Chang LH, Mao HF, Chen LH, Yip PK, Hwang JP. Caregiver active participation in psychoeducational intervention improved caregiving skills and competency. Geriatr Gerontol Int 2018; 18:750-757. [PMID: 29356339 DOI: 10.1111/ggi.13246] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/07/2017] [Accepted: 11/21/2017] [Indexed: 11/30/2022]
Abstract
AIM To determine whether giving dementia caregivers active psychoeducational intervention is more efficacious than passive intervention for improving their caregiving skills and reducing their caregiving burden. METHODS This study was a prospective, single-blinded, controlled trial with 43 caregiver/person-with-dementia dyads. The dyads were randomly assigned to the active psychoeducational intervention (AP) group, which used role-play, discussion, and development of problem-solving capacity to build up their caregiving skills and competence, or the passive psychoeducational intervention (PP) group, which gave caregivers educational materials on common caregiving strategies. Primary outcomes were the levels of caregiver competence (Care Skill Inventory [CSI]), burden (Chinese Zarit Burden Inventory [CZBI]), and distress caused by the behavioral and psychological symptoms of dementia (Neuropsychiatric Inventory-Questionnaire [NPI-Q]). Outcomes were assessed pre-test, post-test and after 3 months. Repeated measures one-way analysis of variance was used to compare mean-change scores between time-points, and generalized estimating equations (GEE) were used to compare groups. RESULTS Post-test or 3-month (or both) Care Skill Inventory, Chinese Zarit Burden Inventory and Neuropsychiatric Inventory-Questionnaire distress levels were significantly (p < 0.05) better in the AP but not in the PP group. The generalized estimating equation intergroup comparison, adjusted for potential confounders, showed that Care Skill Inventory in the AP group was more significantly improved than in the PP group, and that Chinese Zarit Burden Inventory nearly reached significance. CONCLUSIONS Active rather than passive psychoeducation, even in a short (3 months) intervention of six visits, was more efficacious for improving caregiving competence. Future studies will require larger samples. Geriatr Gerontol Int 2018; 18: 750-757.
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Affiliation(s)
- Sai-Hung Tang
- Taiwan Catholic Foundation of Alzheimer's Disease and Related Dementia, Taipei, Taiwan
| | - Oi-I Chio
- Taiwan Catholic Foundation of Alzheimer's Disease and Related Dementia, Taipei, Taiwan
| | - Ling-Hui Chang
- Department of Occupational Therapy, Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hui-Fen Mao
- School of Occupational Therapy, National Taiwan University, Taipei, Taiwan
| | - Li-Hua Chen
- Taiwan Catholic Foundation of Alzheimer's Disease and Related Dementia, Taipei, Taiwan
| | - Ping-Keung Yip
- Department of Neurology, Cardinal Tien Hospital, New Taipei City, Taiwan.,School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Jen-Ping Hwang
- Department of Psychiatry, Veterans General Hospital, Taipei, Taiwan.,Division of Psychiatry, School of Medicine, National Yang-Ming University, Taipei, Taiwan
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21
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Risco E, Zabalegui A, Miguel S, Farré M, Alvira C, Cabrera E. Aplicación del modelo Balance of Care en la toma de decisiones acerca del mejor cuidado para las personas con demencia. GACETA SANITARIA 2017; 31:518-523. [PMID: 27751643 DOI: 10.1016/j.gaceta.2016.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 07/18/2016] [Accepted: 07/26/2016] [Indexed: 01/29/2023]
Affiliation(s)
- Ester Risco
- Departamento de Enfermería, Hospital Clínic de Barcelona, Barcelona, España
| | - Adelaida Zabalegui
- Departamento de Enfermería, Hospital Clínic de Barcelona, Barcelona, España
| | - Susana Miguel
- Escuela de Ciencias de la Salud Gimbernat i Tomàs Cerdà, Universitat Autònoma de Barcelona, Sant Cugat del Vallès (Barcelona), España
| | - Marta Farré
- Departamento de Enfermería, Hospital Clínic de Barcelona, Barcelona, España
| | - Carme Alvira
- Centro de Atención Primària Comte Borrell, Barcelona, España
| | - Esther Cabrera
- Escuela Superior de Ciencias de la Salud TecnoCampus, Universidad Pompeu Fabra, Mataró (Barcelona), España.
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22
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Thomas S, Dalton J, Harden M, Eastwood A, Parker G. Updated meta-review of evidence on support for carers. HEALTH SERVICES AND DELIVERY RESEARCH 2017. [DOI: 10.3310/hsdr05120] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundPolicy and research interest in carers continues to grow. A previous meta-review, published in 2010, by Parkeret al.(Parker G, Arksey H, Harden M.Meta-review of International Evidence on Interventions to Support Carers. York: Social Policy Research Unit, University of York; 2010) found little compelling evidence of effectiveness about specific interventions and costs.ObjectiveTo update what is known about effective interventions to support carers of ill, disabled or older adults.DesignRapid meta-review.SettingAny relevant to the UK health and social care system.ParticipantsCarers (who provide support on an unpaid basis) of adults who are ill, disabled or older.InterventionsAny intervention primarily aimed at carers.Main outcome measuresAny direct outcome for carers.Data sourcesDatabase searches (including Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, MEDLINE, Applied Social Sciences Index and Abstracts and Social Care Online) for systematic reviews published from January 2009 to 2016.Review methodsWe used EndNote X7.4 (Thomson Reuters, CA, USA) to screen titles and abstracts. Final decisions on the inclusion of papers were made by two reviewers independently, using a Microsoft Excel®2013 spreadsheet (Microsoft Corporation, Redmond, WA, USA). We carried out a narrative synthesis structured by patient condition and by seven outcomes of interest. We assessed the quality of the included systematic reviews using established criteria. We invited a user group of carers to give their views on the overall findings of our review.ResultsSixty-one systematic reviews were included (27 of high quality, 25 of medium quality and nine of low quality). Patterns in the literature were similar to those in earlier work. The quality of reviews had improved, but primary studies remained limited in quality and quantity. Of the high-quality reviews, 14 focused on carers of people with dementia, four focused on carers of those with cancer, four focused on carers of people with stroke, three focused on carers of those at the end of life with various conditions and two focused on carers of people with mental health problems. Multicomponent interventions featured prominently, emphasising psychosocial or psychoeducational content, education and training. Multiple outcomes were explored, primarily in mental health, burden and stress, and well-being or quality of life. Negative effects following respite care were unsupported by our user group. As with earlier work, we found little evidence on intervention cost-effectiveness. No differences in review topics were found across high-, medium- and low-quality reviews.LimitationsThe nature of meta-reviews precludes definitive conclusions about intervention effectiveness, for whom and why. Many of the included reviews were small in size and authors generally relied on small numbers of studies to underpin their conclusions. The meta-review was restricted to English-language publications. Short timescales prevented any investigation of the overlap of primary studies, and growth in the evidence base since the original meta-review meant that post-protocol decisions were necessary.ConclusionsThere is no ‘one size fits all’ intervention to support carers. Potential exists for effective support in specific groups of carers. This includes shared learning, cognitive reframing, meditation and computer-delivered psychosocial support for carers of people with dementia, and psychosocial interventions, art therapy and counselling for carers of people with cancer. Counselling may also help carers of people with stroke. The effectiveness of respite care remains a paradox, given the apparent conflict between the empirical evidence and the views of carers.Future workMore good-quality, theory-based, primary research is warranted. Evidence is needed on the differential impact of interventions for various types of carers (including young carers and carers from minority groups), and on the effectiveness of constituent parts in multicomponent programmes. Further research triangulating qualitative and quantitative evidence on respite care is urgently required. The overlap of primary studies was not formally investigated in our review, and this warrants future evaluation.Study registrationThis study is registered as PROSPERO CRD42016033367.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Sian Thomas
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Jane Dalton
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Melissa Harden
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Alison Eastwood
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Gillian Parker
- Social Policy Research Unit, University of York, York, UK
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Tucker S, Sutcliffe C, Bowns I, Challis D, Saks K, Verbeek H, Cabrera E, Karlsson S, Leino-Kilpi H, Meyer G, Soto ME. Improving the mix of institutional and community care for older people with dementia: an application of the balance of care approach in eight European countries. Aging Ment Health 2016; 20:1327-1338. [PMID: 26327584 DOI: 10.1080/13607863.2015.1078285] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To examine whether the mix of community and institutional long-term care (ILTC) for people with dementia (PwD) in Europe could be improved; assess the economic consequences of providing alternative services for particular groups of ILTC entrants and explore the transnational application of the 'Balance of Care' (BoC) approach. METHOD A BoC study was undertaken in Estonia, Finland, France, Germany, the Netherlands, Spain, Sweden, and the UK as part of the RightTimePlaceCare project. Drawing on information about 2014 PwD on the margins of ILTC admission, this strategic planning framework identified people whose needs could be met in more than one setting, and compared the relative costs of the possible alternatives. RESULTS The findings suggest a noteworthy minority of ILTC entrants could be more appropriately supported in the community if enhanced services were available. This would not necessarily require innovative services, but more standard care (including personal and day care), assuming quality was ensured. Potential cost savings were identified in all countries, but community care was not always cheaper than ILTC and the ability to release resources varied between nations. CONCLUSIONS This is believed to be the first transnational application of the BoC approach, and demonstrates its potential to provide a consistent approach to planning across different health and social care systems. Better comparative information is needed on the number of ILTC entrants with dementia, unit costs and outcomes. Nevertheless, the findings offer important evidence on the appropriateness of current provision, and the opportunity to learn from different countries' experience.
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Affiliation(s)
- S Tucker
- a Personal Social Services Research Unit , University of Manchester , Manchester , UK
| | - C Sutcliffe
- a Personal Social Services Research Unit , University of Manchester , Manchester , UK
| | - I Bowns
- a Personal Social Services Research Unit , University of Manchester , Manchester , UK
| | - D Challis
- a Personal Social Services Research Unit , University of Manchester , Manchester , UK
| | - K Saks
- b Department of Internal Medicine , University of Tartu , Tartu , Estonia
| | - H Verbeek
- c Department of Health Services Research, CAPHRI School for Public Health and Primary Care , Maastricht University , Maastricht , The Netherlands
| | - E Cabrera
- d School of Health Sciences, Tecno Campus , University Pompeu Fabra , Barcelona , Spain
| | - S Karlsson
- e Department of Health Sciences , Lund University , Lund , Sweden
| | - H Leino-Kilpi
- f Department of Nursing Science , University of Turku and Turku University Hospital , Turku , Finland
| | - G Meyer
- g Faculty of Health, School of Nursing Science , University of Witten/Herdecke , Witten , Germany.,h Institute for Health and Nursing Science , Martin Luther University Halle-Wittenberg , Halle-Wittenberg , Germany
| | - M E Soto
- i Geriatrics Department, Gerontôpole , Toulouse University Hospital , Toulouse , France
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Chang A, Singh N, Boyd L, Lawson C. Strategies to Improve Radiographic Practices for Patients With Alzheimer's Disease: A Systematic Review. J Med Imaging Radiat Sci 2016; 47:362-366. [PMID: 31047262 DOI: 10.1016/j.jmir.2016.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 08/22/2016] [Accepted: 09/14/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Alzheimer's disease (AD) patients are one of the highest health care service users globally. In the context of radiography, there are many AD patients who undergo imaging procedures for common age-related conditions. However, there is currently no literature on how radiographers can effectively manage such patients in imaging situations. METHODOLOGY This review examined the literature regarding the interaction between Alzheimer's patients and other health care professionals (eg, nurses) and the strategies that have been used to improve patient compliance and accommodate functional decline. FINDINGS Many strategies relating to care of patients with AD are long term, and cannot be applied in a radiographic setting, where patients may only present once. Transferrable strategies for a radiographic setting include the support of carers during the examination process, a reduction in noise and use of calming music, and allowing the patient to personalize the examination room by bringing a photograph or an item of comfort. CONCLUSION These simple strategies can reduce the level of anxiety experienced by AD patients, reduce typical behavioral symptoms of agitation, aggression and discomfort, and increase patient cooperation and responsiveness.
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Affiliation(s)
- Angie Chang
- Warringal Radiology MIA, Heidelberg, Victoria, Australia
| | - Nabita Singh
- Department of Medical Imaging and Radiation Sciences, Monash University, Melbourne, Victoria, Australia
| | - Lori Boyd
- Department of Medical Imaging and Radiation Sciences, Monash University, Melbourne, Victoria, Australia
| | - Celeste Lawson
- Professional Communication Program, School of Education and the Arts, Central Queensland University, Rockhampton, Queensland, Australia.
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Robinson KM, Crawford TN, Buckwalter KC, Casey DA. Outcomes of a Two-Component Intervention on Behavioral Symptoms in Persons With Dementia and Symptom Response in Their Caregivers. J Appl Gerontol 2016; 37:570-594. [DOI: 10.1177/0733464816677549] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose: This study evaluated the longitudinal influence of an individualized evidence-based psychoeducational intervention for caregivers on frequency of behavioral symptoms in persons with dementia (PWD) and caregiver reaction to these symptoms. The intervention included information about the disease process using Progressively Lowered Stress Threshold (PLST) content and a family meeting based on Mittelman’s New York University Intervention. Method: A quasi-experimental study design was implemented. The Revised Memory and Behavior Problems Checklist was administered to N = 127 caregiver/care recipient dyads at baseline, 6, 12, and 18 months follow-up. All caregivers were enrolled in the intervention at baseline and followed over 18 months. Linear mixed models were developed to evaluate effects on frequency of behavioral symptoms in PWD and caregiver response. Results: The most frequently occurring behavior was memory problems, although depressive behaviors produced the most negative caregiver responses. Between baseline and 6-month follow-up, there was a significant decrease in frequency of behavioral symptoms. Overall, there was a significant decrease in caregiver’s reaction to behavioral symptoms from baseline to 18-month follow-up.
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Risk factors related to the admission of people with dementia into a long-term care institution in Spain: an explorative study. AGEING & SOCIETY 2016. [DOI: 10.1017/s0144686x16000970] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
ABSTRACTRisk factors associated with admission of people with dementia to long-term care institutions need to be identified to support health-care professionals in dementia care at home. An explorative study, combining quantitative and qualitative data collection methods, was performed in people with dementia in Spain. The sample, consisting of people with dementia receiving formal care from health-care professionals but at risk of institutionalisation, and their informal care-givers; and people with dementia recently admitted to a long-term care institution, and their informal care-givers, was interviewed between November 2010 and April 2012. Perceived reasons for admission were determined through an open-ended question put to both groups. Presumed risk factors were collected with validated questionnaires and analysed using bivariate analysis. A total of 287 people with dementia and informal care-givers were studied. Reasons given by the institutionalised group were mostly related to the level of dependency of the person with dementia. People recently admitted to a long-term care institution had more cognitive impairment, a greater degree of dependency and poorer quality of life than those still living at home. Home-care services in Spain need to develop or improve interventions based on the risk factors identified in this study: informal care-giver profile, high cognitive impairment, high level of dependency and the poor quality of life of the person with dementia.
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Fowler CN, Kott K, Wicks MN, Rutledge C. An Interprofessional Virtual Healthcare Neighborhood: Effect on Self-Efficacy and Sleep Among Caregivers of Older Adults With Dementia. J Gerontol Nurs 2016; 42:39-47. [PMID: 27598270 DOI: 10.3928/00989134-20160901-02] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 07/06/2016] [Indexed: 11/20/2022]
Abstract
An Interprofessional Virtual Healthcare Neighborhood (VHN) was designed to deliver information, peer support, and professional guidance to caregivers of individuals with dementia. The VHN was also enhanced with an actigraphy band to monitor caregivers' sleep. The study sample comprised two groups (N = 28): caregivers participating in the VHN and those receiving usual care. Measures of sleep quality and quantity, using an actigraphy band; general self-efficacy, using the General Self-Efficacy Scale; and insomnia, using the Insomnia Severity Index, were measured pre- and postintervention for the intervention and comparison groups. Neither group reported significant changes in sleep quality or quantity over time. Insomnia severity decreased for both groups. Self-efficacy became worse for the comparison group, yet remained virtually unchanged for the intervention group. Overall, the current study also showed an effective use of technology to reach homebound caregivers of older adults with dementia. [Journal of Gerontological Nursing, 42(11), 39-47.].
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Gilhooly KJ, Gilhooly MLM, Sullivan MP, McIntyre A, Wilson L, Harding E, Woodbridge R, Crutch S. A meta-review of stress, coping and interventions in dementia and dementia caregiving. BMC Geriatr 2016; 16:106. [PMID: 27193287 PMCID: PMC4872341 DOI: 10.1186/s12877-016-0280-8] [Citation(s) in RCA: 218] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 05/09/2016] [Indexed: 01/08/2023] Open
Abstract
Background There has been a substantial number of systematic reviews of stress, coping and interventions for people with dementia and their caregivers. This paper provides a meta-review of this literature 1988-2014. Method A meta-review was carried out of systematic reviews of stress, coping and interventions for people with dementia and their caregivers, using SCOPUS, Google Scholar and CINAHL Plus databases and manual searches. Results The meta-review identified 45 systematic reviews, of which 15 were meta-analyses. Thirty one reviews addressed the effects of interventions and 14 addressed the results of correlational studies of factors associated with stress and coping. Of the 31 systematic reviews dealing with intervention studies, 22 focused on caregivers, 6 focused on people with dementia and 3 addressed both groups. Overall, benefits in terms of psychological measures of mental health and depression were generally found for the use of problem focused coping strategies and acceptance and social-emotional support coping strategies. Poor outcomes were associated with wishful thinking, denial, and avoidance coping strategies. The interventions addressed in the systematic reviews were extremely varied and encompassed Psychosocial, Psychoeducational, Technical, Therapy, Support Groups and Multicomponent interventions. Specific outcome measures used in the primary sources covered by the systematic reviews were also extremely varied but could be grouped into three dimensions, viz., a broad dimension of “Psychological Well-Being v. Psychological Morbidity” and two narrower dimensions of “Knowledge and Coping” and of “Institutionalisation Delay”. Conclusions This meta-review supports the conclusion that being a caregiver for people with dementia is associated with psychological stress and physical ill-health. Benefits in terms of mental health and depression were generally found for caregiver coping strategies involving problem focus, acceptance and social-emotional support. Negative outcomes for caregivers were associated with wishful thinking, denial and avoidance coping strategies. Psychosocial and Psychoeducational interventions were beneficial for caregivers and for people with dementia. Support groups, Multicomponent interventions and Joint Engagements by both caregivers and people with dementia were generally found to be beneficial. It was notable that virtually all reviews addressed very general coping strategies for stress broadly considered, rather than in terms of specific remedies for specific sources of stress. Investigation of specific stressors and remedies would seem to be a useful area for future research. Electronic supplementary material The online version of this article (doi:10.1186/s12877-016-0280-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- K J Gilhooly
- Department of Clinical Sciences, Brunel University London, Uxbridge, UB8 3PH, UK.
| | - M L M Gilhooly
- Department of Clinical Sciences, Brunel University London, Uxbridge, UB8 3PH, UK
| | - M P Sullivan
- Department of Clinical Sciences, Brunel University London, Uxbridge, UB8 3PH, UK
| | - A McIntyre
- Department of Clinical Sciences, Brunel University London, Uxbridge, UB8 3PH, UK
| | - L Wilson
- Department of Clinical Sciences, Brunel University London, Uxbridge, UB8 3PH, UK
| | - E Harding
- Department of Clinical Sciences, Brunel University London, Uxbridge, UB8 3PH, UK.,Dementia Research Centre, Institute of Neurology, University College London, London, WC1N 3BG, UK
| | - R Woodbridge
- Department of Clinical Sciences, Brunel University London, Uxbridge, UB8 3PH, UK
| | - S Crutch
- Dementia Research Centre, Institute of Neurology, University College London, London, WC1N 3BG, UK
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Risco E, Cabrera E, Farré M, Alvira C, Miguel S, Zabalegui A. Perspectives About Health Care Provision in Dementia Care in Spain: A Qualitative Study Using Focus-Group Methodology. Am J Alzheimers Dis Other Demen 2016; 31:223-30. [PMID: 26340965 PMCID: PMC10852885 DOI: 10.1177/1533317515603818] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
BACKGROUND The aim of this study is to identify the barriers and facilitators in dementia care with respect to information provision, communication, and collaboration from the perspectives of the person with dementia, family caregivers, and health care professionals over the course of the illness. METHODS A qualitative study using Focus-Group methodology was carried out in people with dementia, family caregivers, and health care providers. RESULTS The categories that emerged from the analysis were insufficient information provided, specific dementia care needs, and acceptance of long-term care institutionalization from the people with dementia and caregivers' groups and insufficient communication between health care providers, differential information according to disease stage, and home care coordination from the health care providers' groups. CONCLUSION The family is a key element in successful care coordination during dementia care provision. New effective strategies including self-management and emergent roles, such as case managers, could bring great benefits to people with dementia, caregivers, and health care providers.
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Affiliation(s)
- Ester Risco
- Department of Nursing, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Esther Cabrera
- School of Health Sciences TecnoCampus, Pompeu Fabra University, Mataró, Spain
| | - Marta Farré
- Department of Nursing, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Carme Alvira
- Department of Nursing, Comte Borrell Primary Care, Comte Borrell, Barcelona, Spain
| | - Susana Miguel
- School of Health Sciences Gimbernat i Tomàs Cerdà, UAB. Av. de la Generalitat, Barcelona, Spain
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Lethin C, Leino-Kilpi H, Roe B, Soto MM, Saks K, Stephan A, Zwakhalen S, Zabalegui A, Karlsson S. Formal support for informal caregivers to older persons with dementia through the course of the disease: an exploratory, cross-sectional study. BMC Geriatr 2016; 16:32. [PMID: 26832354 PMCID: PMC4734848 DOI: 10.1186/s12877-016-0210-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 01/26/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In European countries, knowledge about availability and utilization of support for informal caregivers caring for older persons (≥65 years) with dementia (PwD) is lacking. To be able to evaluate and develop the dementia support system for informal caregivers to PwD, a survey of European support systems and professionals involved is needed. The aim of this study was to explore support for informal caregivers to PwD in European countries. We investigated the availability and utilization of support in each of the participating countries, and the professional care providers involved, through the dementia disease. METHODS A mapping system was used in 2010-2011 to gather information about estimations of availability, utilization, and professional providers of support to informal caregivers caring for PwD. Data collected was representing each country as a whole. RESULTS There was high availability of counselling, caregiver support, and education from the diagnosis to the intermediate stage, with a decrease in the late to end of life stage. Utilization was low, although there was a small increase in the intermediate stage. Day care and respite care were highly available in the diagnosis to the intermediate stage, with a decrease in the late to end of life stage, but both types of care were utilized by few or no caregivers through any of the disease stages. Professionals specialized in dementia (Bachelor to Master's degree) provided counselling and education, whereas caregiver support for informal caregivers and day care, respite care, and respite care at home were provided by professionals with education ranging from upper secondary schooling to a Master's degree. CONCLUSIONS Counselling, caregiver support, and education were highly available in European countries from diagnosis to the intermediate stage of the dementia disease, decreasing in the late/end of life stages but were rarely utilized. Countries with care systems based on national guidelines for dementia care seem to be more aware of the importance of professionals specialized in dementia care when providing support to informal caregivers. Mapping the systems of support for informal caregivers of PwD is a valuable tool for evaluating existing systems, internationally, nationally and locally for policy making.
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Affiliation(s)
- Connie Lethin
- />Faculty of medicine, Department of Health Sciences, Lund University, Box 157, SE-221 00 Lund, Sweden
| | - Helena Leino-Kilpi
- />Nursing Science, University of Turku, Turku University Hospital, Turku, Finland
| | - Brenda Roe
- />Evidence Based Practice Research Centre, Faculty of Health and Social Care, Edge Hill University, Ormskirk, Lancashire, UK
| | - Maria Martin Soto
- />Alzheimer’s disease Research and Clinical Centre in Toulouse, University Hospital, Toulouse, France
| | - Kai Saks
- />Department of internal medicine, University of Tartu, Tartu, Estonia
| | - Astrid Stephan
- />Faculty of Health, School of Nursing Science, Witten/Herdecke University, Witten, Germany
| | - Sandra Zwakhalen
- />Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
| | | | - Staffan Karlsson
- />Faculty of medicine, Department of Health Sciences, Lund University, Box 157, SE-221 00 Lund, Sweden
| | - on behalf of the RightTimePlaceCare Consortium
- />Faculty of medicine, Department of Health Sciences, Lund University, Box 157, SE-221 00 Lund, Sweden
- />Nursing Science, University of Turku, Turku University Hospital, Turku, Finland
- />Evidence Based Practice Research Centre, Faculty of Health and Social Care, Edge Hill University, Ormskirk, Lancashire, UK
- />Alzheimer’s disease Research and Clinical Centre in Toulouse, University Hospital, Toulouse, France
- />Department of internal medicine, University of Tartu, Tartu, Estonia
- />Faculty of Health, School of Nursing Science, Witten/Herdecke University, Witten, Germany
- />Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
- />Hospital Clinic of Barcelona, Barcelona, Spain
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Abstract
Research literature in the dementia field lacks examples of ‘best-practices’ demonstrating concretely how it is possible to support the sense of coherence in people with dementia. The purpose of this study was to elucidate the nurses’ views concerning a caring approach that may support the sense of coherence in people with dementia. The data were collected through participant observation and focus group interviews during a four-month period in 2011. Sixteen registered nurses recruited from two Norwegian nursing homes participated in this study. The data were interpreted using a phenomenological-hermeneutical method. Three themes were identified: ‘being in the moment’, ‘doing one thing at a time’, and ‘creating joy and contentment’. An overall interpretation of these themes is described by the metaphor ‘slow nursing’, a caring approach that may lead to supporting the sense of coherence in people with dementia.
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Affiliation(s)
- Daniela Lillekroken
- Faculty of Health Sciences, Oslo and Akershus University College, Norway
- Faculty of Health and Sport Sciences, University of Agder, Norway
| | - Solveig Hauge
- Faculty of Health and Social Studies, Telemark University College, Norway
| | - Åshild Slettebø
- Faculty of Health and Sport Sciences, University of Agder, Norway
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Bökberg C, Ahlström G, Leino-Kilpi H, Soto-Martin ME, Cabrera E, Verbeek H, Saks K, Stephan A, Sutcliffe C, Karlsson S. Care and Service at Home for Persons With Dementia in Europe. J Nurs Scholarsh 2015; 47:407-16. [DOI: 10.1111/jnu.12158] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Christina Bökberg
- Doctoral Student and Lecturer, Department of Health Sciences, Faculty of Medicine; Lund University; Sweden
| | - Gerd Ahlström
- Professor, Director of the research group Older People's Health and Person-centred Care, Co-coordinator for the Swedish National Graduate School for Competitive Science on Ageing and Health (SWEAH), Department of Health Sciences; Faculty of Medicine, Lund University; Sweden
| | - Helena Leino-Kilpi
- Lampda Pi , Professor and Chair in Nursing Science; University of Turku, Finland, and Nurse Manager, Turku University Hospital; Finland
| | - Maria E. Soto-Martin
- Medical Doctor, Gerontopôle Alzheimer´s Disease Research and Clinical Center; Toulouse University Hospital; France
| | - Esther Cabrera
- Associate Professor, School of Health Sciences, TecnoCampus; University Pompeu Fabra, Mataró (Barcelona); Spain
| | - Hilde Verbeek
- Assistant Professor, Department of Health Services Research; Maastricht University; The Netherlands
| | - Kai Saks
- Associate Professor, Department of Internal Medicine; University of Tartu; Estonia
| | - Astrid Stephan
- Doctoral Student and Research Associate, School of Nursing Science; Witten/Herdecke University; Germany
| | - Caroline Sutcliffe
- Research Associate, Personal Social Services Research Unit, School of Nursing, Midwifery, and Social Work; University of Manchester; England
| | - Staffan Karlsson
- Assistant Professor, Department of Health Sciences; Faculty of Medicine, Lund University; Sweden
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The association between physical dependency and the presence of neuropsychiatric symptoms, with the admission of people with dementia to a long-term care institution: A prospective observational cohort study☆☆This paper was submitted as an entry for the European Academy of Nursing Science's Rosemary Crow award, sponsored by the International Journal of Nursing Studies. The award is open to current doctoral students or recent graduates of the academy's programme. Int J Nurs Stud 2015; 52:980-7. [DOI: 10.1016/j.ijnurstu.2015.02.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 01/20/2015] [Accepted: 02/17/2015] [Indexed: 01/06/2023]
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Bökberg C, Ahlström G, Karlsson S, Hallberg IR, Janlöv AC. Best practice and needs for improvement in the chain of care for persons with dementia in Sweden: a qualitative study based on focus group interviews. BMC Health Serv Res 2014; 14:596. [PMID: 25433673 PMCID: PMC4255660 DOI: 10.1186/s12913-014-0596-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 11/10/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Persons with dementia receive health care and social services from a wide range of professional care providers during the disease trajectory, presenting risks of miscommunication, duplication and/or missed nursing interventions. Accordingly, the aim of this study was to investigate professional care providers' views on conditions for best practice in terms of collaboration and improvement needs in the chain of care from early to end-of-life stage for persons with dementia in Sweden. METHODS The study had a qualitative design based on three focus group interviews. A strategic sample of 23 professional care providers was included. Data were subjected to content analysis based on the three stages of dementia (early, moderate, end-of-life). RESULTS The results were divided into five categories: Diagnosis is a prerequisite for specialized dementia care, Creating routines in the chain of care, Competent staff a prerequisite for high-quality care, Day care facilitates transition in the chain of care and Next-of-kin participation is a prerequisite for continuity in the chain of care. It was clear that, according to the participants, best practice in dementia care in Sweden is not achieved in every respect. It appeared that transitions of care between different organizations are critical events which need to be improved. The further the disease progresses, the less collaboration there seems to be among professional care providers, which is when the next of kin are usually called upon to maintain continuity in the chain of care. CONCLUSIONS The results indicate that, according to the care providers, best practice in terms of collaboration is achieved to a higher degree during the early stage of dementia compared with the moderate and end-of-life stages. Lack of best practice strategies during these stages makes it difficult to meet the needs of persons with dementia and reduce the burden for next of kin. These are experiences to be taken into account to improve the quality of dementia care. Implementation research is needed to develop strategies for best practice on the basis of national knowledge-based guidelines and to apply these strategies in the moderate and end-of-life stages.
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Karlsson S, Bleijlevens M, Roe B, Saks K, Martin MS, Stephan A, Suhonen R, Zabalegui A, Hallberg IR. Dementia care in European countries, from the perspective of people with dementia and their caregivers. J Adv Nurs 2014; 71:1405-16. [PMID: 25430690 DOI: 10.1111/jan.12581] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2014] [Indexed: 12/18/2022]
Abstract
AIM To investigate persons with dementia and their informal caregivers' views of inter-sectoral information, communication and collaboration throughout the trajectory of dementia care, in eight European countries. BACKGROUND Living with dementia and being next of kin to a person with dementia means having to live through stages that have different characteristics, needs, challenges and requirements. DESIGN Qualitative research. Focus groups were conducted in England, Estonia, Finland, France, Germany, The Netherlands, Spain and Sweden. METHODS Persons with dementia and their informal caregivers (N = 137) participated in focus group interviews during 2011. Content analysis generated a tentative model of information, communication and collaboration for people with dementia and their caregivers, which was then tested. RESULTS The core finding was that information, communication and collaboration were to be focused on the persons with dementia and the informal caregivers. Entering into the trajectory of the disease and its consequences was addressed as an important point of departure. The relation to professional care required establishing a trusting relationship, tailor-made intervention and a single person or organization to contact. Professional knowledge and commitment, variation in service and care adapted to needs were important. CONCLUSION As focus of care is on the person with dementia and their informal caregivers, a dyadic approach seems most suitable for dementia care. A trusting relationship and a specific person or organization to contact seem to be indicators of best practice, as does adaptation to the needs of the person with dementia and their informal caregiver.
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Affiliation(s)
| | | | - Brenda Roe
- Edge Hill University/University of Manchester, UK
| | | | - Maria Soto Martin
- Alzheimer's Disease Research and Clinical Center in Toulouse University Hospital, France
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Alvira MC, Risco E, Cabrera E, Farré M, Rahm Hallberg I, Bleijlevens MHC, Meyer G, Koskenniemi J, Soto ME, Zabalegui A. The association between positive-negative reactions of informal caregivers of people with dementia and health outcomes in eight European countries: a cross-sectional study. J Adv Nurs 2014; 71:1417-34. [PMID: 25250659 DOI: 10.1111/jan.12528] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2014] [Indexed: 11/29/2022]
Abstract
AIM To describe the associations between positive and negative reactions of informal caregivers of people with dementia and health outcomes across eight European Countries. BACKGROUND Caring for someone with dementia may have implications for the caregiver's own health and for the care recipient. These consequences could be associated with caregivers' reactions to the process of care. DESIGN Association study based on cross-sectional data. METHODS Participants were people with dementia and their informal caregivers living at home or in long-term care institutions. Data were collected between November 2010-April 2012 using the Caregiver Reaction Assessment (with dimensions of self-esteem, lack of family support, financial problems, disrupted schedule and health problems) and associations were sought with informal caregiver burden, quality of life and psychological well-being and with dementia sufferers' neuropsychiatric symptoms, comorbidity and dependency in activities of daily living using correlation coefficients. RESULTS Data from 2014 participants were used. Variability across countries was noted, as well as differences between care at home and in long-term care institutions. In general, self-esteem and lack of family support correlated with caregiver burden and psychological well-being. Associations were also found between disrupted schedule and caregiver burden, psychological well-being and quality of life. Health problems were clearly associated with caregiver burden, psychological well-being and quality of life. CONCLUSION Study results support links between the reactions of informal caregivers of people with dementia and health outcomes. These may have implications in terms of how services are addressed.
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Affiliation(s)
| | | | - Esther Cabrera
- University Pompeu Fabra, School TecnoCampus, Mataró, Spain
| | - Marta Farré
- Department of Internal Medicine, Hospital Clínic de Barcelona, Spain
| | | | | | - Gabriele Meyer
- Martin-Luther-University Halle-Wittenberg, Institute of Health and Nursing Science, Germany
| | | | - Maria E Soto
- Department of Geriatrics, University Hospital of Toulouse, France
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Borisovskaya A, Pascualy M, Borson S. Cognitive and neuropsychiatric impairments in Alzheimer's disease: current treatment strategies. Curr Psychiatry Rep 2014; 16:470. [PMID: 25023513 DOI: 10.1007/s11920-014-0470-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This update on Alzheimer's disease (AD) discusses treatment strategies for cognitive and neuropsychiatric symptoms (such as agitation, psychosis, anxiety, and depression) common in this illness, emphasizing in particular nonpharmacologic strategies such as cognitive interventions, physical exercise, and psychotherapy. We provide an overview of cognitive enhancers and their combination strategies and medications commonly used for treatment of neuropsychiatric symptoms in AD. Finally, we give recommendations for providing support to caregivers and suggest how to identify caregiver/patient pairs most in need of intensive dementia care services.
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Affiliation(s)
- Anna Borisovskaya
- VA Puget Sound Healthcare System, Department of Psychiatry and Behavioral Sciences, University of Washington, 1660 S. Columbian Way, S-116, Seattle, WA, 98108, USA,
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