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Zhou Y, Thakkar N, Phelan EA, Ishado E, Li CY, Borson S, Sadak T. How do care partners overcome the challenges associated with falls of community-dwelling older people with dementia? A qualitative study. DEMENTIA 2024:14713012241267137. [PMID: 39033360 DOI: 10.1177/14713012241267137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024]
Abstract
BACKGROUND AND OBJECTIVES Previous studies have found that falls among community-dwelling older people with dementia negatively impact the health and well-being of their relative/friend care partners. Limited studies have explored the challenges care partners experience because of older people's falls (including fall incidents and fall risks). We sought to investigate care partners' experiences of these challenges and how care partners responded. METHODS We conducted an inductive thematic analysis of 48 dementia care partner interviews (age range: 33-86, mean: 61, 70.8% women; 58.3% adult children; 29.2% spouse; 62.5% completed college; 25% people of color), conducted after a health crisis of older people with dementia from three local university-affiliated hospitals in the United States. FINDINGS Care partners reported that falls in older people with dementia can intensify overall care demands and lead to self-sacrificing behaviors, dissatisfaction with healthcare providers, conflicts with care recipients, and intense emotions. Care partners described several adaptations to mitigate these impacts, including practicing acceptance, approaching falls as an opportunity for learning, facilitating collaborations within formal/informal care networks, collaborating with older people with dementia to balance autonomy and safety, and modifying the physical environment. DISCUSSIONS AND IMPLICATIONS Falls among older people with dementia are a significant stressor and an important activation stimulus for their care partners. Our findings suggest that care partners are "second clients" and "competent collaborators." As they provide important insights about fall prevention, care partners should be engaged to co-design new multi-level interventions to facilitate collaborations among care networks, older people with dementia, and service providers.
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Affiliation(s)
- Yuanjin Zhou
- Steve Hicks School of Social Work, University of Texas at Austin, USA
| | - Nirali Thakkar
- Steve Hicks School of Social Work, University of Texas at Austin, USA
| | - Elizabeth A Phelan
- Department of Health Systems and Population Health, University of Washington, USA
| | - Emily Ishado
- School of Nursing, University of Washington, USA
| | - Chih-Ying Li
- Department of Occupational Therapy, and School of Public and Population Health, University of Texas Medical Branch, USA
- Department of Population Health and Health Disparities, University of Texas Medical Branch, USA
| | - Soo Borson
- Department of Family Medicine, University of Southern California Keck School of Medicine, USA
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2
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Pepper A. Risk and dementia. Br J Community Nurs 2024; 29:271-274. [PMID: 38814836 DOI: 10.12968/bjcn.2024.29.6.271] [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: 06/01/2024]
Abstract
People with dementia and their family carers may be subject to a number of different risks; these risks may overlap with, and impact on one another. Due to changes in capacity that come with dementia, people with the diagnosis may be overly cautious about decisions made relating to risk made on their behalf, and this may have a negative impact on their wellbeing and quality of life. This article aims to educate community nurses on the risks they need to be aware of when working with families affected by dementia, and presents a risk enablement framework as a way of assessing and managing risk in a person-centred way.
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Affiliation(s)
- Amy Pepper
- Admiral Nurse Research Assistant, Dementia UK
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3
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Hoe J, Profyri E, Kemp C, Manela M, Webster L, Anthony J, Costafreda S, Arrojo F, Souris H, Livingston G. Risk assessment for people living with dementia: a systematic review. Int Psychogeriatr 2024; 36:263-288. [PMID: 38053362 DOI: 10.1017/s1041610223004398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
OBJECTIVE This systematic review identified key components of risk assessment for people with dementia, examined attitudes toward risk identification and risk assessment, and appraised existing risk assessment tools. METHODS Systematic searches of five databases on two platforms (EBSCO, OVID) and gray literature databases (Open Grey, Base) were conducted. Studies were screened for inclusion based on predetermined eligibility criteria and quality assessed using the Mixed Methods Appraisal Tool. Findings were tabulated and synthesized using thematic synthesis. RESULTS Our review found people with dementia, their family carers, and healthcare professionals differed in how risk is conceptualized, with views being shaped by media perceptions, personal experiences, socio-cultural influences, dementia knowledge, and dementia severity. We found that mobilization (causing falls inside and getting lost outside) is the most frequently identified risk factor. Our findings show people with dementia are generally risk-tolerant, while healthcare professionals may adopt risk-averse approaches because of organizational requirements. We found factors that disrupt daily routines, living and caring arrangements, medication management, and unclear care pathways contribute toward adverse risk events. We discovered that most studies about risk and risk assessment scales did not consider insight of the person with dementia into risks although this is important for the impact of a risk. No risk instrument identified had sufficient evidence that it was useful. CONCLUSION Accurate risk assessment and effective communication strategies that include the perspectives of people with dementia are needed to enable risk-tolerant practice. No risk instrument to date was shown to be widely acceptable and useful in practice.
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Affiliation(s)
- Juanita Hoe
- Geller Institute of Ageing and Memory, University of West London, London, UK
- School of Health Sciences, University of London, London, UK
| | - Elena Profyri
- School of Health Sciences, University of London, London, UK
| | - Charlotte Kemp
- School of Health Sciences, University of London, London, UK
| | - Monica Manela
- UCL Division of Psychiatry, University College London, Maple House, London, UK
| | - Lucy Webster
- UCL Division of Psychiatry, University College London, Maple House, London, UK
- Centre for Health Services Studies, University of Kent, Canterbury, Kent, UK
| | - Justine Anthony
- School of Health Sciences, University of London, London, UK
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, UK
| | - Sergi Costafreda
- UCL Division of Psychiatry, University College London, Maple House, London, UK
- Camden, and Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | - Frank Arrojo
- Alzheimer's Society Research Network, Alzheimer's Society, London, UK
| | - Helen Souris
- Camden, and Islington NHS Foundation Trust, St Pancras Hospital, London, UK
- Dementia Clinical Network, NHS England and NHS Improvement (London Region, London, UK
| | - Gill Livingston
- UCL Division of Psychiatry, University College London, Maple House, London, UK
- Camden, and Islington NHS Foundation Trust, St Pancras Hospital, London, UK
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Meyer C, Dickins M, O’Keefe F, Hall K, Lowthian J. Risk Negotiation With People With Dementia: From Co-designed Paper Version to Implementation Preparation of an Electronic Conversation Tool. Gerontol Geriatr Med 2023; 9:23337214221149772. [PMID: 36726412 PMCID: PMC9885029 DOI: 10.1177/23337214221149772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/11/2022] [Accepted: 12/14/2022] [Indexed: 01/28/2023] Open
Abstract
The home care workforce provides essential support for older people with dementia to live a life of fulfillment. "Enabling Choices," an evidence-informed conversation tool, aims to negotiate risk around everyday activities between home care workers, people with dementia and their informal carers. This paper describes tool conversion into electronic format and preparation for implementation throughout a large Australian health and aged care service provider, utilizing the Implementation Framework for Aged Care (IFAC). Using codesign principles, the tool was converted from paper-based to electronic format involving frontline, operational and Information Management Services staff, and people with dementia/carers. Focus groups and interviews identified tool acceptability, feasibility, and appropriateness. For implementation preparation, the wider socio-cultural-political context was mapped, and key questions of the IFAC addressed. Environment, workflow, and training requirements were determined, and strategies for behavior change ascertained. Numerous opportunities and challenges exist for the widespread upscale of an evidence-informed tool into practice.
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Affiliation(s)
- Claudia Meyer
- Bolton Clarke Research Institute,
Forest Hill, VIC, Australia,La Trobe University, Bundoora, VIC,
Australia,Monash University, Frankston, VIC,
Australia,Flinders University, Adelaide, SA,
Australia,Claudia Meyer, Bolton Clarke Research
Institute, Level 1, 347 Burwood Highway, Forest Hill, VIC 3131, Australia.
| | - Marissa Dickins
- Bolton Clarke Research Institute,
Forest Hill, VIC, Australia,Monash University, Clayton, VIC,
Australia
| | - Fleur O’Keefe
- Bolton Clarke Research Institute,
Forest Hill, VIC, Australia
| | - Kylie Hall
- Bolton Clarke Research Institute,
Forest Hill, VIC, Australia
| | - Judy Lowthian
- Bolton Clarke Research Institute,
Forest Hill, VIC, Australia,Monash University, Clayton, VIC,
Australia,University of Queensland, St Lucia,
Australia
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5
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Backhouse T, Ruston A, Killett A, Ward R, Rose-Hunt J, Mioshi E. Risks and risk mitigation in homecare for people with dementia-A two-sided matter: A systematic review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:2037-2056. [PMID: 35703588 DOI: 10.1111/hsc.13865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 03/18/2022] [Accepted: 05/27/2022] [Indexed: 06/15/2023]
Abstract
Policy guidance promotes supporting people to live in their own homes for as long as possible with support from homecare services. People living with dementia who need such support can experience a range of physical and cognitive difficulties, which can increase the risks associated with homecare for this group. We aimed to examine risk and safety issues for people with dementia and their homecare workers and risk mitigation practices adopted by homecare workers to address identified risks. We searched MEDLINE, EMBASE, AMED, CINAHL, PsycINFO, ASSIA and Cochrane Central Register of Controlled Trials databases 5 March 2021. Included studies focussed on homecare for people with dementia and had a risk or safety feature reported. Risk of bias was assessed with the Joanna Briggs Institute Critical Appraisal tools. Two authors assessed articles for potential eligibility and quality. A narrative synthesis combines the findings. The search identified 2259 records; 27 articles, relating to 21 studies, met the eligibility criteria. The review identified first-order risks that homecare workers in the studies sought to address. Two types of risk mitigation actions were reported: harmful interventions and beneficial interventions. Actions adopted to reduce risks produced intended benefits but also unintended consequences, creating second-order risks to both clients with dementia and homecare workers, placing them at greater risk. Risk mitigation interventions should be person-centred, the responsibility of all relevant professions, and planned to minimise the creation of unintended risks.
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Affiliation(s)
- Tamara Backhouse
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Annmarie Ruston
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Anne Killett
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Renée Ward
- Older Persons' Services, East Suffolk and North Essex NHS Foundation Trust, Colchester, UK
| | - Julia Rose-Hunt
- Dementia Intensive Support Team East, Norfolk and Suffolk Foundation Trust, Norwich, UK
| | - Eneida Mioshi
- School of Health Sciences, University of East Anglia, Norwich, UK
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6
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Prendergast L, Toms G, Seddon D, Tudor Edwards R, Anthony B, Jones C. 'It was just - everything was normal': outcomes for people living with dementia, their unpaid carers, and paid carers in a Shared Lives day support service. Aging Ment Health 2022:1-9. [PMID: 35848206 DOI: 10.1080/13607863.2022.2098921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Short breaks support the wellbeing of people living with dementia (PLWD) and their unpaid carers. However, little is known about the benefits of community-based short breaks. The objective of this study was to conduct interviews with stakeholders of a Shared Lives (SL) day support service to explore mechanisms and outcomes for the service. The aim of the study was to refine a logic model for a SL day support service for PLWD, their unpaid carers, and paid carers. This logic model shall form the basis for a Social Return on Investment evaluation to identify the social value contributed by the service. METHODS Thirteen interviews were conducted with service stakeholders including PLWD, unpaid carers and paid carers. Framework analysis assisted in the synthesis of the findings into a logic model. RESULTS The logic model refined through the interviews, detailed service mechanisms (inputs, activities, outputs) and outcomes. An overarching theme from the interviews concerned the importance of triadic caring relationships, which conferred benefits for those involved in the service. CONCLUSION SL day support fosters triadic caring relationships, and interview data suggests that these relationships are associated with meaningful outcomes for PLWD, their unpaid carers, and paid carers. We highlight the implications for policy, practice, and future research.
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Affiliation(s)
- Louise Prendergast
- School of Medical and Health Sciences, Bangor University, Bangor, Wales, UK
| | - Gill Toms
- School of Medical and Health Sciences, Bangor University, Bangor, Wales, UK
| | - Diane Seddon
- Centre for Ageing and Dementia Research (CADR), Dementia Services Development Centre (DSDC) Wales Research Centre, School of Medical and Health Sciences, Bangor University, Bangor, Wales, UK
| | - Rhiannon Tudor Edwards
- Centre for Health Economics and Medicines Evaluation (CHEME), Bangor University, Bangor, Wales, UK
| | - Bethany Anthony
- Centre for Health Economics and Medicines Evaluation (CHEME), Bangor University, Bangor, Wales, UK
| | - Carys Jones
- School of Medical and Health Sciences, Bangor University, Bangor, Wales, UK
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Goodwin I, Lea E, Bindoff A, Doherty K. Exploring perceptions of eating with dementia: Findings from a massive open online course. Appetite 2022; 177:106126. [PMID: 35697154 DOI: 10.1016/j.appet.2022.106126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 06/05/2022] [Accepted: 06/06/2022] [Indexed: 11/30/2022]
Abstract
People with dementia are at high risk of malnutrition as a result of progressive symptoms that affect eating. Maximising opportunities to enhance nutrition and strategies to encourage eating are a crucial part of providing care. Caregiver knowledge and a person-centred approach to eating is essential to reduce symptom burden and maintain quality of life. There is currently limited research investigating first person perceptions of eating with dementia, particularly beyond small sample sizes. Therefore, this paper aims to explore community perceptions of how best to encourage eating for people with dementia using findings from an online course. Within the Understanding Dementia Massive Open Online Course, responses to the following statement were collected: 'If I had dementia, the things that might help me to eat include…'. A total of 3,651 participant responses were collected from the 2018 and 2019 course enrolments and analysed using structural topic modelling and secondary thematic analysis. The majority of participants were female, tertiary educated Australians over 50 years old. A third were paid caregivers. Thirteen topics were isolated from topic modelling that can be reduced into six broad categories: food type personalisation, meal choice, meal presentation, eating environment, eating assistance and end of life nutrition. Participant responses demonstrated diverse awareness of important aspects to encourage eating in dementia. Findings support the need for improved uptake of nutritional strategies in practice and education on eating with dementia to support caregivers.
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Affiliation(s)
- Isabelle Goodwin
- School of Health Sciences, University of Tasmania, Tasmania, Australia; Wicking Dementia Research and Education Centre, Tasmania, Australia.
| | - Emma Lea
- Wicking Dementia Research and Education Centre, Tasmania, Australia
| | - Aidan Bindoff
- Wicking Dementia Research and Education Centre, Tasmania, Australia
| | - Kathleen Doherty
- Wicking Dementia Research and Education Centre, Tasmania, Australia
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8
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Caring for people with dementia in their own homes: homecare workers' experiences of tolerating and mitigating risk. AGEING & SOCIETY 2022. [DOI: 10.1017/s0144686x22000575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Little is known about risk management in homecare for people with dementia. We aimed to gain an understanding of the ways in which homecare workers assess and manage risk whilst caring for people with dementia in their own homes. We conducted a qualitative interview study with 17 homecare workers assisting people with dementia with their personal care. Interviews were face-to-face, semi-structured, recorded and transcribed verbatim. Analysis was inductive and thematic. A key theme of risk was identified, with three main sources: the client as a source of risk to the homecare worker, the clients' home and behaviours as a risk to the client, and the wider health and social care system as a risk to both clients and homecare workers. Three interrelated aspects of risk were found to influence homecare workers' decision making and actions: homecare workers' perception of the level of risk, their perceived ability to control the risk and their tolerability of risk. The higher the perceived risk, the stronger the action taken by the worker or agency to mitigate it and the greater the impact on the client. To support effective development of this workforce there is a need to devise training that incorporates the use of tacit knowledge and experiential learning. Risk management policies for homecare should acknowledge and utilise the expertise, experiences and values of homecare workers.
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Territorial and Gender Differences in the Home Care of Family Members with Dementia. LAND 2022. [DOI: 10.3390/land11010113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The increasing prevalence of dementia is threatening the capacity of health and social service systems to provide long-term care support at the territorial level. In both rural and urban areas, specific family members (gendered care) are responsible for the daily care of their relatives. The aim of this work is to explore gender and territorial implications in the provision of in-home care by family members. To this end, family caregivers in Navarre, Spain, were administered the Psychosocial Adjustment to Illness Scale (PAIS-SR) and a semi-structured interview. The results show the good psychosocial adjustment of caregivers of relatives with dementia but the negative impacts of caregiving in the domestic, relational, and psychological domains. Moreover, the feminization of psychological distress was found to predominate in rural areas since mainly women are responsible for instrumental and care tasks, while men seek other complementary forms of support. Place of residence (rural vs. urban) was found to exert a strong effect on the respondents’ conception, life experience, and provision of care. Consequently, territorial and gender differences in coping with and adjusting to care require the design of contextualized actions adapted to caregivers’ needs.
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Curnow E, Rush R, Gorska S, Forsyth K. Differences in assistive technology installed for people with dementia living at home who have wandering and safety risks. BMC Geriatr 2021; 21:613. [PMID: 34717561 PMCID: PMC8556981 DOI: 10.1186/s12877-021-02546-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 10/12/2021] [Indexed: 02/04/2023] Open
Abstract
Background Assistive Technology for people with dementia living at home is not meeting their care needs. Reasons for this may be due to limited understanding of variation in multiple characteristics of people with dementia including their safety and wandering risks, and how these affect their assistive technology requirements. This study therefore aimed to explore the possibility of grouping people with dementia according to data describing multiple person characteristics. Then to investigate the relationships between these groupings and installed Assistive Technology interventions. Methods Partitioning Around Medoids cluster analysis was used to determine participant groupings based upon secondary data which described the person characteristics of 451 people with dementia with Assistive Technology needs. Relationships between installed Assistive Technology and participant groupings were then examined. Results Two robust clustering solutions were identified within the person characteristics data. Relationships between the clustering solutions and installed Assistive Technology data indicate the utility of this method for exploring the impact of multiple characteristics on Assistive technology installations. Living situation and caregiver support influence installation of assistive technology more strongly than level of risk or cognitive impairment. People with dementia living alone received different AT from those living with others. Conclusions Results suggest that caregiver support and the living situation of the person with dementia influence the type and frequency of installed Assistive Technology. Reasons for this include the needs of the caregiver themselves, the caregiver view of the participants’ needs, caregiver response to alerts, and the caregiver contribution to the assistive technology assessment and selection process. Selection processes should be refined to account for the needs and views of both caregivers and people with dementia. This will require additional assessor training, and the development of validated assessments for people with dementia who have additional impairments. Policies should support the development of services which provide a wider range of AT to facilitate interventions which are focused on the needs of the person with dementia.
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Affiliation(s)
- Eleanor Curnow
- School of Health Sciences, Queen Margaret University, Edinburgh, EH21 6UU, UK.
| | - Robert Rush
- School of Health Sciences, Queen Margaret University, Edinburgh, EH21 6UU, UK
| | - Sylwia Gorska
- School of Health Sciences, Queen Margaret University, Edinburgh, EH21 6UU, UK
| | - Kirsty Forsyth
- School of Health Sciences, Queen Margaret University, Edinburgh, EH21 6UU, UK
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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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Wehrmann H, Michalowsky B, Lepper S, Mohr W, Raedke A, Hoffmann W. Priorities and Preferences of People Living with Dementia or Cognitive Impairment - A Systematic Review. Patient Prefer Adherence 2021; 15:2793-2807. [PMID: 34934309 PMCID: PMC8684431 DOI: 10.2147/ppa.s333923] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/01/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Knowledge about the priorities and preferences of people living with dementia (PwD) might help to individualize treatment, care, and support, which could improve patient-related outcomes. This study aimed to summarize preferences of PwD or people with mild cognitive impairment (MCI), considering all relevant aspects of health care and everyday life. METHODS We conducted a systematic literature review and included studies about patient preferences published in English between January 1, 1990 and October 28, 2019. The inclusion criteria were that preferences were elicited directly by PwD or patients with MCI. We used the International Consortium for Health Outcomes Management value set for dementia to categorize the preferences into the following topics: a) clinical status, b) symptoms, functioning, and quality of life, and c) sustainability of care. RESULTS Of 578 initially identified studies, 45 met the inclusion criteria. Patients preferred to be informed about the diagnosis as early as possible, especially for anticipatory care planning. They ranked caregiver quality of life as their highest priority. They preferred not to be a burden to others more than their caregivers' mood, their own functional status, or their own distressing behaviors. Furthermore, PwD are eager to participate in medical decisions, especially in those about creating an everyday life routine. PwD preferred their own quality of life, self-efficacy, and emotional well-being. Institutionalized PwD preferred individualized and person-centered care. According to the sustainability of care, PwD preferred to maintain close bonds with their family at the end of their life and wanted to be treated with empathy. CONCLUSION This systematic review provides essential insights into cognitively impaired patients' preferences, which are rarely considered in treatment, care, and support services. Further studies should evaluate whether considering preferences in treatment and care or daily living can improve patient-reported outcomes.
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Affiliation(s)
- Hannah Wehrmann
- Translational Health Care Research, German Center for Neurodegenerative Diseases (DZNE) Site Rostock/Greifswald, Greifswald, Germany
| | - Bernhard Michalowsky
- Translational Health Care Research, German Center for Neurodegenerative Diseases (DZNE) Site Rostock/Greifswald, Greifswald, Germany
- Correspondence: Bernhard Michalowsky Tel +49 3834 86 75 07 Email
| | - Simon Lepper
- Translational Health Care Research, German Center for Neurodegenerative Diseases (DZNE) Site Rostock/Greifswald, Greifswald, Germany
| | - Wiebke Mohr
- Translational Health Care Research, German Center for Neurodegenerative Diseases (DZNE) Site Rostock/Greifswald, Greifswald, Germany
| | - Anika Raedke
- Translational Health Care Research, German Center for Neurodegenerative Diseases (DZNE) Site Rostock/Greifswald, Greifswald, Germany
| | - Wolfgang Hoffmann
- Translational Health Care Research, German Center for Neurodegenerative Diseases (DZNE) Site Rostock/Greifswald, Greifswald, Germany
- Epidemiology of Health Care and Community Health, Institute for Community Medicine & University Medicine Greifswald (UMG), Greifswald, Germany
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Saunders PA, McMullen T, Barsness S, Carle A, Hanna GP. The COVID-19 Pandemic Reignites the Need for Person-Centered Gerontological Approach. Gerontol Geriatr Med 2021; 7:23337214211041800. [PMID: 34541258 PMCID: PMC8442476 DOI: 10.1177/23337214211041800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 08/02/2021] [Indexed: 12/22/2022] Open
Abstract
The national response to the COVID-19 pandemic pressed gerontologists to reflect, redesign, and reform services supporting older adults. Efforts to isolate a peer cohort to stabilize and maintain a standard of health had adverse outcomes and added pressure conflicting with autonomy and individual desires. In this, person-centered care emerges as a meaningful archetype to address dignity and independence. This article presents views from academics and practitioners across an interdisciplinary spectrum, arising from a webinar hosted by Georgetown University Program in Aging & Health. A description of personhood as an extension of the humanities is followed by a robust discussion of safety and autonomy for older adults during the COVID-19 pandemic. We examine the necessary commute between critical gerontological theory and the practice of humanistic gerontology. Further, this article disentangles humanism and person-centered care to balance autonomy and safety for older adults in congregate living situations and focuses on specific populations: people with dementia and their care partners. Discussion on the importance of person-centered policy development in a public health pandemic is also explored. The article concludes with a call to action for the adoption of a comprehensive person-centered care model across the fields of gerontology and geriatric medicine.
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Affiliation(s)
| | - Tara McMullen
- Aging and Health Program, Georgetown University, Washington, DC, USA
| | - Sonya Barsness
- Aging and Health Program, Georgetown University, Washington, DC, USA
| | - Andrew Carle
- Aging and Health Program, Georgetown University, Washington, DC, USA
| | - Gay Powell Hanna
- Aging and Health Program, Georgetown University, Washington, DC, USA
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Lopes Dos Santos MC, Navarta-Sánchez MV, Moler JA, García-Lautre I, Anaut-Bravo S, Portillo MC. Psychosocial Adjustment of In-Home Caregivers of Family Members with Dementia and Parkinson's Disease: A Comparative Study. PARKINSON'S DISEASE 2020; 2020:2086834. [PMID: 32399168 PMCID: PMC7204185 DOI: 10.1155/2020/2086834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 01/31/2020] [Accepted: 04/03/2020] [Indexed: 01/16/2023]
Abstract
Neurodegenerative diseases such as Parkinson's and dementia are highly prevalent worldwide. People who suffer from these disorders often receive in-home care and assistance from family members, who must dedicate a considerable amount of time to the care recipient. The study of family caregivers' psychosocial adjustment to the degenerative processes of both conditions is of interest due to the implications for the quality of life of both the care receiver and the caregiver, as well as other family members. This study compares the psychosocial adjustment of family members who care for people with dementia and Parkinson's disease and identifies the main sociodemographic variables that affect the processes of adjustment to both conditions. To this end, the Psychosocial Adjustment to Illness Scale (PAIS-SR) and a sociodemographic form were administered to 157 family caregivers in Navarre, Spain. The results show that adjustment to the disease in family caregivers of people with Parkinson's disease and dementia is, in general, satisfactory and related to variables such as place of residence, income, and employment status. The illness itself (Parkinson's or dementia), however, is found to be the most influential variable in the level of psychosocial adjustment.
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Affiliation(s)
| | | | - José Antonio Moler
- Department of Statistics, Information Technology and Mathematics, Public University of Navarra, Pamplona, Spain
| | - Ignacio García-Lautre
- Department of Statistics, Information Technology and Mathematics, Public University of Navarra, Pamplona, Spain
| | - Sagrario Anaut-Bravo
- Department of Sociology and Social Work, Public University of Navarra, Pamplona, Spain
| | - Mari Carmen Portillo
- ARC Wessex, NIHR, School of Health Sciences, University of Southampton, Southampton, UK
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