1
|
López C, Altuna M. New Community and Sociohealth Challenges Arising from the Early Diagnosis of Mild Cognitive Impairment (MCI). J Pers Med 2023; 13:1410. [PMID: 37763177 PMCID: PMC10532951 DOI: 10.3390/jpm13091410] [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: 08/25/2023] [Revised: 09/14/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023] Open
Abstract
Population aging increases the risk of developing neurodegenerative diseases that cause cognitive impairment. Advances in clinical practice and greater social awareness of the importance of cognitive impairment have led to an increase in the number of people with early diagnosis, predementia. Increasing access to biomarkers to assess whether Alzheimer's disease (AD) is the underlying cause of mild cognitive impairment (MCI) has undoubted clinical benefits (access to potentially disease-modifying treatments, among others) but is also responsible for new social-health care challenges. Understanding the psychosocial impact of a diagnosis of MCI due to AD or another neurodegenerative disease is essential to create future strategies to reduce the emotional overload of patients, their risk of discrimination and stigmatization, and to favor their social inclusion. We present a narrative review of the diagnostic process of mild cognitive impairment in clinical practice, with a holistic person-centered approach, and discuss the implications of such diagnosis (benefits and risks) and strategies on how to address them.
Collapse
Affiliation(s)
- Carolina López
- Fundación CITA-Alzheimer Fundazioa, 20009 Gipuzkoa, Spain
| | - Miren Altuna
- Fundación CITA-Alzheimer Fundazioa, 20009 Gipuzkoa, Spain
- Osakidetza, Organización Sanitaria Integrada (OSI), 20690 Gipuzkoa, Spain
| |
Collapse
|
2
|
Gaubert F, Chainay H. Decision-Making Competence in Patients with Alzheimer's Disease: A Review of the Literature. Neuropsychol Rev 2021; 31:267-287. [PMID: 33576942 DOI: 10.1007/s11065-020-09472-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 12/15/2020] [Indexed: 10/22/2022]
Abstract
Decision-making competence (DMC) appears to be influenced by the congruency between the characteristics of the individual, the task and the context. Indeed, the ability to make decisions seems to be highly sensitive to cognitive changes as observed, in particular, in the healthy elderly. Few studies have investigated these relations in pathological ageing. In this review, we focus on DMC in patients with Alzheimer's disease (AD) and the links its impairment could have with deficits in episodic memory, working memory, and executive functions. Decision-making under risk and under ambiguity appears to be impaired early in the progress of AD, with the deficit being greater during the later stages of the disease. In addition, some studies suggest that the impairment of DMC is exacerbated by deficits in other cognitive functions, in particular working memory and executive functions. This degradation in the ability to make decisions seriously affects the quality of life of patients and their relatives, since they frequently face important decisions, especially concerning healthcare, finance or accommodation. Thus, the growing incapacity to decide for themselves increases patients' and caregivers' stress and burden. The challenge for future studies is to determine how best to help patients and their families in the decisional process.
Collapse
Affiliation(s)
- Fanny Gaubert
- Laboratoire d'Etude des Mécanismes Cognitifs, Université Lyon 2, 5 avenue Pierre Mendès France, 69676, Bron, France.
| | - Hanna Chainay
- Laboratoire d'Etude des Mécanismes Cognitifs, Université Lyon 2, 5 avenue Pierre Mendès France, 69676, Bron, France
| |
Collapse
|
3
|
Bhatt J, Walton H, Stoner CR, Scior K, Charlesworth G. The nature of decision-making in people living with dementia: a systematic review. Aging Ment Health 2020; 24:363-373. [PMID: 30521371 DOI: 10.1080/13607863.2018.1544212] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: The objectives of this systematic review were to: 1) understand how people living with dementia are involved in making decisions; 2) explore the different decisional styles and domains of decision-making that people living with dementia experience and 3) identify what influences the level of decisional involvement of people living with dementia.Methods: A systematic review of literature identified studies from Medline, PsycINFO, HAPI and CINAHL databases. Search terms related to decision-making and dementia. Qualitative and quantitative research designs were included. Appraisal of included studies was done using quality ratings. All studies focused on how decision-making took place. Extracted findings were synthesised narratively with concept mapping, conceptualisation and an exploration of connections between studies to develop an overall model of decision-making involvementResults: Fifteen studies fully met the eligibility criteria (thirteen qualitative and two quantitative). All studies had moderate (n = 10) to high (n = 5) quality ratings. Participants were predominantly people living with dementia (n = 13), Parkinson's disease and stroke. The model of decision-making encompasses four decisional styles (managed autonomy, mutual, reductive and delegated) determined by different degrees of involvement from the person living with dementia and their supporter. The decisional style implemented was influenced by the presence or absence of background (the Freedom of Choice framework) and contextual factors (risk, relationships and resources).Conclusion: Decision-making in dementia is complex and influenced by many factors beyond cognitive impairment alone. This review indicates that decision-making in dementia takes place through decisional styles, determined by unique levels of involvement from people living with dementia and their carers.
Collapse
Affiliation(s)
- Jem Bhatt
- Research Department of Clinical, Educational and Health Psychology, Faculty of Brain Sciences, University College London, London, UK
| | - Holly Walton
- Research Department of Clinical, Educational and Health Psychology, Faculty of Brain Sciences, University College London, London, UK
| | - Charlotte R Stoner
- Research Department of Clinical, Educational and Health Psychology, Faculty of Brain Sciences, University College London, London, UK
| | - Katrina Scior
- Research Department of Clinical, Educational and Health Psychology, Faculty of Brain Sciences, University College London, London, UK
| | - Georgina Charlesworth
- Research Department of Clinical, Educational and Health Psychology, Faculty of Brain Sciences, University College London, London, UK
| |
Collapse
|
4
|
Henriksen N, Moholt JM, Blix BH. Perceptions of Family Caregivers of Home-Dwelling Persons with Dementia regarding Access to Information and Involvement in Decisions. J Aging Soc Policy 2020; 32:260-275. [DOI: 10.1080/08959420.2019.1707058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Nils Henriksen
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Jill-Marit Moholt
- Centre for Care Research North, Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Bodil H. Blix
- Centre for Care Research North, Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| |
Collapse
|
5
|
Caregiver decisions along the Alzheimer's disease trajectory. Geriatr Nurs 2018; 40:257-263. [PMID: 30503603 DOI: 10.1016/j.gerinurse.2018.10.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 10/22/2018] [Accepted: 10/29/2018] [Indexed: 11/23/2022]
Abstract
Despite the rising prevalence of Alzheimer's disease (AD), there is limited systematic evidence about disease specific decisions. The aim of this qualitative descriptive study was to identify decisions across the AD trajectory using focus groups of past and present caregivers. Qualitative content analysis revealed three main categories with corresponding categories and sub-categories. Main Category One-Decisions pertaining to self-yielded two categories: decision pertaining to the offering of self and care for the caregiver. Main Category Two-Decisions pertaining to the patient-yielded three categories: decisions about care and treatment, living arrangements, and protecting the patient from harm. Main Category Three-Communication and relationships in decisions-yielded two categories: navigation and negotiations. The results of this study will inform healthcare providers and caregivers as they work together to anticipate, prepare, and plan for care management decisions over the AD trajectory.
Collapse
|
6
|
Cresp SJ, Lee SF, Moss C. Substitute decision makers' experiences of making decisions at end of life for older persons with dementia: A systematic review and qualitative meta-synthesis. DEMENTIA 2018; 19:1532-1559. [PMID: 30253658 DOI: 10.1177/1471301218802127] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Substitute decision makers are important for people with advanced dementia, particularly at the end of life. Substitute decision makers report issues in providing support, and physical and psychological consequences from the role. However, there is no synthesised evidence about how substitute decision makers are affected by and experience making decisions for older persons diagnosed with dementia at end of life. Methodology: A protocol for a qualitative systematic review was developed. Seven articles met both inclusion and research quality criteria following a comprehensive search for published and unpublished studies (January 2007-2017, English language). Meta-synthesis was achieved through meta-aggregation of the results from included studies. RESULTS Meta-aggregation of 20 themes into eight categories resulted in five synthesised findings. The findings were: 'trust'; 'guilt, mistrust and confusion'; 'translating quality of life'; 'negotiating families'; and 'uncertainty and reactivity'. Trust in healthcare personnel positively affected substitute decision makers and supported their adaptability. Substitute decision makers experienced guilt, mistrust, and confusion as they encountered increased complexity in care and health interventions as social needs changed. Substitute decision makers experienced complexities and struggles as they interpreted quality of life and negotiated end of life treatment decisions. Substitute decision makers experienced practical needs to negotiate family as they fulfilled their support roles. Ambiguity in advance care plans, limited knowledge of dementia, end of life uncertainties, and communication issues reduced substitute decision makers' proactivity. Implications: Being a substitute decision maker for people with advanced dementia at end of life is stressful. Health professionals need to be cognizant of substitute decision makers experiences and needs, and identify mechanisms to achieve support and education. The findings generate need for further investigation of interventions to meet the needs of substitute decision makers.
Collapse
Affiliation(s)
- Sarah Jane Cresp
- Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
| | - Susan Fiona Lee
- Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
| | - Cheryle Moss
- Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
| |
Collapse
|
7
|
Slyer JT, Archibald E, Moyo F, Truglio-Londrigan M. Advance care planning and anticipatory decision making in patients with Alzheimer disease. Nurse Pract 2018; 43:23-31. [PMID: 29757832 DOI: 10.1097/01.npr.0000532763.68509.e4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Early advance care planning and anticipatory decision making in the Alzheimer disease (AD) trajectory is a strategy NPs can incorporate to improve managing uncertainty around common decisions. This article explores decisions patients and caregivers face along the AD trajectory and provides resources for patients, caregivers, and NPs.
Collapse
Affiliation(s)
- Jason T Slyer
- Jason T. Slyer is a clinical assistant professor at Pace University, College of Health Professions, New York, N.Y., and an NP at Matrix Medical Network, New York, N.Y. Ella Archibald is a family NP at Hospital for Special Surgery, New York, N.Y. Fernea Moyo is an NP at New York Presbyterian Hospital, New York, N.Y. Marie Truglio-Londrigan is a professor at Pace University College of Health Professions, Lienhard School of Nursing, New York, N.Y
| | | | | | | |
Collapse
|
8
|
Vanderschaeghe G, Dierickx K, Vandenberghe R. Review of the Ethical Issues of a Biomarker-Based Diagnoses in the Early Stage of Alzheimer's Disease. JOURNAL OF BIOETHICAL INQUIRY 2018; 15:219-230. [PMID: 29532386 DOI: 10.1007/s11673-018-9844-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 10/02/2017] [Indexed: 05/24/2023]
Abstract
BACKGROUND Today, many healthcare or dementia organizations, clinicians, and companies emphasize the importance of detection of Alzheimer's disease in an early phase. This idea has gained considerable momentum due to the development of biomarkers, the recent FDA and EMA approval of three amyloid tracers, and the failure of a number of recent therapeutic trials conducted in the early dementia phase. On the one hand, an early etiological diagnosis can lead to early and more efficacious intervention. On the other hand, it is questioned how early an etiological diagnosis is beneficial to the patient. Here we consider ethical issues related to the process of biomarker testing and the impact on the diagnostic disclosure to patients with mild cognitive impairment due to prodromal Alzheimer's disease. METHODS A systematic review of the theoretical bioethics literature was performed by using electronic databases. The review was limited to articles published in English between 2003 and 2016. RESULTS A total of twenty articles were included in our effort to make an analysis of the ethical challenges. One of the biggest challenges was the uncertainty and the predictive value of the biomarker-based diagnosis where patients can be amyloid positive without full certainty whether or when they will develop symptomatic decline due to Alzheimer's disease. Another challenge was the tension between the right to know versus the wish not to know, the limited efficacy of currently available treatment options, and the opportunities and consequences after receiving such an early diagnosis. CONCLUSION Based on the results and the additional comments in the discussion, several unanswered questions emerged. Therefore, careful consideration of all these ethical issues is required before the disclosure of a biomarker-based diagnosis to the patient with mild cognitive impairment due to Alzheimer's disease.
Collapse
Affiliation(s)
- Gwendolien Vanderschaeghe
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
| | - Kris Dierickx
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Rik Vandenberghe
- Laboratory for Cognitive Neurology, Department of Neurology, KU Leuven BELGIUM; Alzheimer Research Centre KU Leuven, Leuven Research Institute for Neurodegenerative Disorders KU Leuven and Neurology Department of UZ Leuven Hospitals (Campus Gasthuisberg), UZ Leuven / KU Leuven, Leuven, Belgium
| |
Collapse
|
9
|
Vanderschaeghe G, Schaeverbeke J, Bruffaerts R, Vandenberghe R, Dierickx K. Amnestic MCI patients' experiences after disclosure of their amyloid PET result in a research context. ALZHEIMERS RESEARCH & THERAPY 2017; 9:92. [PMID: 29197423 PMCID: PMC5712105 DOI: 10.1186/s13195-017-0321-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 11/13/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Biomarkers such as amyloid imaging are increasingly used for diagnosis in the early stages of Alzheimer's disease. Very few studies have examined this from the perspective of the patient. To date, there is only limited evidence about how patients experience and value disclosure in an early disease stage. METHODS Semistructured interviews were carried out with 38 patients with amnestic mild cognitive impairment as part of an investigator-driven diagnostic trial (EudraCT, 2013-004671-12; registered on 20 June 2014) in which participants could opt to know the binary outcome (positive/negative) result of their amyloid positron emission tomography (PET) scan. Verbatim transcripts of the interviews were evaluated using qualitative content analysis and NVivo 11 software. RESULTS Eight of 38 patients received a positive amyloid PET scan result, and the remaining 30 patients received a negative amyloid PET scan result. After disclosure of the result to the patients, we interviewed each patient twice: 2 weeks after disclosure and 6 months after disclosure. Patients had difficulties in repeating the exact words used during disclosure of their amyloid PET scan result by the neurologist; yet, they could recall the core message of the result in their own words. Some patients were confused by the terminology of an amyloid-positive/negative test result. At 6 months, two of eight patients with a positive amyloid PET scan result experienced emotional difficulties (sadness, feeling worried). Three of 30 patients with a negative amyloid PET scan result started to doubt whether they had received the correct result. Patients reported that they experienced advantages after the disclosure, such as information about their health status, the possibility of making practical arrangements, medication, enjoying life more, and a positive impact on relationships. They also reported disadvantages following disclosure, such as having emotional difficulties, feeling worried about when their symptoms might worsen, the risk of a more patronizing attitude by relatives, and the possibility of a wrong diagnosis. CONCLUSIONS This exploratory study shows that the majority of patients can accurately recall the information received during disclosure. The experienced advantages and disadvantages reported by our patients depended on the outcome of the result (positive or negative) and the interval of the conducted interview (2 weeks or 6 months after amyloid PET disclosure). Discrepancies were found between patients' expectations according to the interview prior to amyloid PET disclosure (Vanderschaeghe et al. [Neuroethics. 2017;10:281-97]) and their actual experiences after their amyloid PET disclosure.
Collapse
Affiliation(s)
- Gwendolien Vanderschaeghe
- Department of Public Health and Primary Care, Centre for Biomedical Ethics and Law, KU Leuven, Kapucijnenvoer 35 Blok D, Box 7001, 3000, Leuven, Belgium.
| | - Jolien Schaeverbeke
- Department of Neurosciences, Laboratory for Cognitive Neurology, KU Leuven, O&N II, Herestraat 49, Box 1021, 3000, Leuven, Belgium.,Alzheimer Research Centre KU Leuven, Leuven research Institute for Neuroscience and Disease, KU Leuven, Leuven, Belgium
| | - Rose Bruffaerts
- Department of Neurosciences, Laboratory for Cognitive Neurology, KU Leuven, O&N II, Herestraat 49, Box 1021, 3000, Leuven, Belgium.,Neurology Department, University Hospitals Leuven (UZ Leuven, Campus Gasthuisberg), Leuven, Belgium
| | - Rik Vandenberghe
- Department of Neurosciences, Laboratory for Cognitive Neurology, KU Leuven, O&N II, Herestraat 49, Box 1021, 3000, Leuven, Belgium. .,Alzheimer Research Centre KU Leuven, Leuven research Institute for Neuroscience and Disease, KU Leuven, Leuven, Belgium. .,Neurology Department, University Hospitals Leuven (UZ Leuven, Campus Gasthuisberg), Leuven, Belgium.
| | - Kris Dierickx
- Department of Public Health and Primary Care, Centre for Biomedical Ethics and Law, KU Leuven, Kapucijnenvoer 35 Blok D, Box 7001, 3000, Leuven, Belgium
| |
Collapse
|
10
|
Olabarrieta-Landa L, Romero AC, Panyavin I, Arango-Lasprilla JC. Perception of ethical misconduct by neuropsychology professionals in Spain. NeuroRehabilitation 2017; 41:527-538. [PMID: 28946581 DOI: 10.3233/nre-162144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To examine the prevalence of perceived ethical misconduct in clinical practice, teaching, and research in the field of neuropsychology in Spain. METHOD Two hundred and fifteen self-identified mental health professionals who engage in neuropsychology practice in Spain completed an online survey from July to December of 2013. In the ethics section of the survey, participants were asked to identify if neuropsychologists they know who work in their country engaged in specific kinds of ethical misconduct. RESULTS 41% reported receiving formal training in professional ethics. The clinical findings are as follows. The highest rate of perceived misconduct was found in the area of professional training and expertise, with an average of 40.7%, followed by research/publications (25.6%), clinical care (23.9%), and professional relationships (8.8%). Specifically, regarding training, over half of respondents (56.7%) know professionals who claim themselves to be neuropsychologists, even though they lack proper training or expertise and 46.0% know professionals in the field who do not have adequate training for experience to be working in the field. Regarding research/publications, 41.9% of respondents know professionals who appear as authors on publications where they have not made a significant contribution. Regarding clinical care, over one third of respondents endorse knowing professionals who (1) provide results of neuropsychological evaluations in such a way that patients or other professionals are not likely to understand (37.2%) and (2) do not have the skills or training to work with patients who are culturally different from them (34.9%). CONCLUSIONS Less than half of survey respondents reported receiving ethics training. It is possible that introducing more or improved ethics courses into pre-graduate and/or graduate school curriculums, and/or requiring continuing ethics education certification may reduce perceived ethical misconduct among neuropsychological professionals in Spain.
Collapse
Affiliation(s)
| | - Alfonso Caracuel Romero
- Departamento de Psicología Evolutiva y de la Educación, Facultad de Educación, Universidad de Granada, Granada, Spain
| | - Ivan Panyavin
- Department of Psychology and Education, University of Deusto, Bilbao, Spain
| | - Juan Carlos Arango-Lasprilla
- BioCruces Health Research Institute, Cruces University Hospital, Barakaldo, Spain.,IKERBASQUE, Basque Foundation for Science, Bilbao, Spain
| |
Collapse
|
11
|
Vanderschaeghe G, Schaeverbeke J, Vandenberghe R, Dierickx K. Amnestic MCI Patients' Perspectives toward Disclosure of Amyloid PET Results in a Research Context. NEUROETHICS-NETH 2017; 10:281-297. [PMID: 28725289 PMCID: PMC5486502 DOI: 10.1007/s12152-017-9313-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 03/03/2017] [Indexed: 12/19/2022]
Abstract
Background Researchers currently are not obligated to share individual research results (IRR) with participants. This non-disclosure policy has been challenged on the basis of participants’ rights to be aware and in control of their personal medical information. Here, we determined how patients view disclosure of research PET results of brain amyloid and why they believe it is advantageous or disadvantageous to disclose. Method As a part of a larger diagnostic trial, we conducted semi-structured interviews with patients with amnestic Mild Cognitive Impairment (aMCI). Participants had the option to receive their brain amyloid PET scan result (i.e., their IRR). Interviews were conducted before they received their IRR. Results A total of 38 aMCI patients (100% of study participants) wanted to know their IRR. The two most frequently mentioned reasons for choosing IRR disclosure were to better understand their brain health status and to be better able to make informed decisions about future personal arrangements (e.g., inheritance tax, moving into a smaller house, end-of-life decisions, etc.). Emotional risk was mentioned as the primary disadvantage of knowing one’s IRR. On the other hand, non-disclosure was considered to be emotionally difficult also, as patients would be uncertain about their future health condition. Conclusions Many patients diagnosed clinically with aMCI want to know their brain amyloid test results, even though this knowledge may be disadvantageous to them. Knowing what is going on with their health and the ability to make informed decisions about their future were the two principal advantages mentioned for obtaining their amyloid PET results. Because of the overwhelming consensus of aMCI patients was to disclose their brain amyloid PET scan results, researchers should strongly consider releasing this information to research subjects.
Collapse
Affiliation(s)
- Gwendolien Vanderschaeghe
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35 Blok D Box 7001, 3000 Leuven, Belgium
| | - Jolien Schaeverbeke
- Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven, 0&N II, Herestraat 49 box 1027, 3000 Leuven, Belgium.,Alzheimer Research Centre KU Leuven, Leuven research Institute for Neurodegenerative Disorders, Leuven, Belgium
| | - Rik Vandenberghe
- Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven, 0&N II, Herestraat 49 box 1027, 3000 Leuven, Belgium.,Alzheimer Research Centre KU Leuven, Leuven research Institute for Neurodegenerative Disorders, Leuven, Belgium.,Memory Clinic / Neurology, University Hospitals Leuven (UZ Leuven, Campus Gasthuisberg), Leuven, Belgium
| | - Kris Dierickx
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35 Blok D Box 7001, 3000 Leuven, Belgium
| |
Collapse
|
12
|
Moyle W, Fetherstonhaugh D, Greben M, Beattie E. Influencers on quality of life as reported by people living with dementia in long-term care: a descriptive exploratory approach. BMC Geriatr 2015; 15:50. [PMID: 25903463 PMCID: PMC4409997 DOI: 10.1186/s12877-015-0050-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Accepted: 04/15/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Over half of the residents in long-term care have a diagnosis of dementia. Maintaining quality of life is important, as there is no cure for dementia. Quality of life may be used as a benchmark for caregiving, and can help to enhance respect for the person with dementia and to improve care provision. The purpose of this study was to describe quality of life as reported by people living with dementia in long-term care in terms of the influencers of, as well as the strategies needed, to improve quality of life. METHODS A descriptive exploratory approach. A subsample of twelve residents across two Australian states from a national quantitative study on quality of life was interviewed. Data were analysed thematically from a realist perspective. The approach to the thematic analysis was inductive and data-driven. RESULTS Three themes emerged in relation to influencers and strategies related to quality of life: (a) maintaining independence, (b) having something to do, and (c) the importance of social interaction. CONCLUSIONS The findings highlight the importance of understanding individual resident needs and consideration of the complexity of living in large group living situations, in particular in regard to resident decision-making.
Collapse
Affiliation(s)
- Wendy Moyle
- Director Centre for Health Practice Innovation, Menzies Health Institute Queensland, Griffith University, Nathan Campus, Brisbane, Australia.
- Dementia Collaborative Research Centre-Consumers and Carers (DCRC-CC), Queensland University of Technology, Brisbane, Australia.
| | - Deirdre Fetherstonhaugh
- Dementia Collaborative Research Centre-Consumers and Carers (DCRC-CC), Queensland University of Technology, Brisbane, Australia.
- Australian Centre for Evidence Based Aged Care (ACEBAC), La Trobe University, Melbourne, Australia.
| | - Melissa Greben
- Research Assistant, Centre for Health Practice Innovation, Griffith University, Brisbane, Queensland, Australia.
| | - Elizabeth Beattie
- Director DCRC-CC, Queensland University of Technology, Brisbane, Australia.
| |
Collapse
|