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Potter CM, Peters M, Cundell M, McShane R, Fitzpatrick R. Living well while providing support: validation of LTCQ-Carer for assessing informal carers' quality of life. Qual Life Res 2023; 32:3507-3520. [PMID: 37530960 PMCID: PMC10624753 DOI: 10.1007/s11136-023-03485-z] [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] [Accepted: 07/08/2023] [Indexed: 08/03/2023]
Abstract
PURPOSE Despite international policies to support the health and wellbeing of informal (family) caregivers, there is no consensus on how to evaluate the effectiveness of carer support. We aimed to develop and validate a new quality-of-life measure for carers (LTCQ-Carer) and to assess its potential for use within a clinical pathway. METHODS Psychometric properties of LTCQ-Carer were tested through cognitive interviews (qualitative phase) and a pilot survey (quantitative phase). Participants were family caregivers of people recently diagnosed with mild cognitive impairment (MCI) or dementia, recruited through one of 14 memory clinics in south-east England. They self-completed the new measure and comparative existing measures (EQ-5D, ASCOT-Carer). Ongoing feedback from memory clinic staff on potential use of LTCQ-Carer was collected. RESULTS Interview participants (n = 10) found all draft items of LTCQ-Carer relevant and prompted inclusion of a new item on 'time to yourself'. Responses from survey participants (n = 107) indicated acceptability (low missing data), high internal reliability (Cronbach's α = 0.95), and a general construct (single factor loadings 0.43-0.86 for all items). Observation of predicted associations with EQ-5D and ASCOT-Carer supported construct validity. Responsiveness requires further testing as evidence was inconclusive. Clinical staff feedback on potential use was positive. CONCLUSION LTCQ-Carer is a valid new measure for assessing family caregivers' quality of life across broad health and social care domains, expanding the range of high-quality tools for evaluating carer support. When used concurrently with patient assessment, it could highlight carer needs and prompt appropriate family support at the earliest point in the clinical pathway.
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Affiliation(s)
- Caroline M Potter
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
- Applied Research Collaboration Oxford and Thames Valley (NIHR ARC OxTV), National Institute for Health and Care Research, Oxford Health NHS Foundation Trust, Oxford, UK.
- Oxford Institute of Population Ageing, University of Oxford, Oxford, UK.
| | - Michele Peters
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Applied Research Collaboration Oxford and Thames Valley (NIHR ARC OxTV), National Institute for Health and Care Research, Oxford Health NHS Foundation Trust, Oxford, UK
| | | | | | - Ray Fitzpatrick
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Applied Research Collaboration Oxford and Thames Valley (NIHR ARC OxTV), National Institute for Health and Care Research, Oxford Health NHS Foundation Trust, Oxford, UK
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2
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Guzzon A, Rebba V, Paccagnella O, Rigon M, Boniolo G. The value of supportive care: A systematic review of cost-effectiveness of non-pharmacological interventions for dementia. PLoS One 2023; 18:e0285305. [PMID: 37172047 PMCID: PMC10180718 DOI: 10.1371/journal.pone.0285305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 04/20/2023] [Indexed: 05/14/2023] Open
Abstract
BACKGROUND Almost 44 million people are currently living with dementia worldwide. This number is set to increase threefold by 2050, posing a serious threat to the sustainability of healthcare systems. Overuse of antipsychotic drugs for the management of the symptoms of dementia carries negative consequences for patients while also increasing the health expenditures for society. Supportive care (SC) interventions could be considered a safer and potentially cost-saving option. In this paper we provide a systematic review of the existing evidence regarding the cost-effectiveness and cost-utility of SC interventions targeted towards persons living with dementia and their caregivers. METHODS A systematic literature review was performed between February 2019 and December 2021 through searches of the databases PubMed (MEDLINE), Cochrane Library, CENTRAL, Embase and PsycINFO. The search strategy was based on PRISMA 2020 recommendations. We considered studies published through December 2021 with no lower date limit. We distinguished between five categories of SC strategies: cognitive therapies, physical activity, indirect strategies (organisational and environmental changes), interventions primarily targeted towards family caregivers, and multicomponent interventions. RESULTS Of the 5,479 articles retrieved, 39 met the inclusion criteria. These studies analysed 35 SC programmes located at different stages of the dementia care pathway. Eleven studies provided evidence of high cost-effectiveness for seven interventions: two multicomponent interventions; two indirect interventions; two interventions aimed at caregivers of community-dwelling persons with dementia; one community-based cognitive stimulation and occupational programme. CONCLUSION We find that the most promising SC strategies in terms of cost-effectiveness are multicomponent interventions (targeted towards both nursing home residents and day-care service users), indirect strategies (group living and dementia care management at home), some forms of tailored occupational therapy, together with some psychosocial interventions for caregivers of community-dwelling persons with dementia. Our results suggest that the adoption of effective SC interventions may increase the economic sustainability of dementia care.
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Affiliation(s)
- Angelica Guzzon
- CRIEP (Interuniversity Research Centre on Public Economics), Veneto, Italy
- Department of Economics, Ca' Foscari University of Venice, Venice, Italy
| | - Vincenzo Rebba
- CRIEP (Interuniversity Research Centre on Public Economics), Veneto, Italy
- Department of Economics and Management "Marco Fanno", University of Padova, Padova, Italy
| | - Omar Paccagnella
- Department of Statistical Sciences, University of Padova, Padova, Italy
| | | | - Giovanni Boniolo
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
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Health economic evaluations of interventions for supporting adult carers in the UK: a systematic review from the NICE Guideline. Int Psychogeriatr 2022; 34:839-852. [PMID: 33583436 DOI: 10.1017/s1041610220004111] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Policy making increasingly needs cost-effectiveness evidence to inform resource allocation. The objective of this review is to identify and to investigate evidence evaluating the cost-effectiveness of interventions aimed to support adult carers, drawing on the National Institute for Health and Care guideline on Supporting Adult Carers. METHODS The protocol of the review was aimed to identify the economic studies published from 2003 onwards on all types of interventions for supporting adult carers. The applicability to the review and methodological quality of included economic evaluations were assessed using pre-established checklists specified in the National Institute for Health and Care (NICE) manual for developing guidelines. RESULTS Our search yielded 10 economic evaluations. The main types of strategies evaluated were psychological and emotional support, training, and education support interventions. We found that the interventions more likely to be cost-effective were usually tailored to the specific carers' circumstances and delivered face-to-face and were multi-component in nature, including elements of psycho-education, training, psychological and practical support. The narrative synthesis of results indicated a wide variation in cost-effectiveness findings and methodological quality. CONCLUSIONS This article indicates that systematic reviews of economic evaluations can be considered as an appropriate means to support decision makers in allocating health and social care resources. Given the high economic and social impact of unpaid caring, and based on the research gaps identified, we recommend that future economics research should be targeted on interventions for identifying carers; and programs for providing carers with support and advice to help them to enter, remain in or return to paid work.
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Birkenhäger‐Gillesse EG, Achterberg WP, Janus SI, Zuidema SU, van den Hout WB. Cost-effectiveness of dementia training for caregivers in caregiver-patient dyads: A randomized controlled study. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2022; 8:e12281. [PMID: 35774593 PMCID: PMC9216199 DOI: 10.1002/trc2.12281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 02/11/2022] [Accepted: 02/11/2022] [Indexed: 11/23/2022]
Abstract
Introduction We evaluated the cost-effectiveness of the "More at Home with Dementia" intervention, a multicomponent training program for co-residing caregivers of people with dementia (PwDs). Methods We performed a two-armed randomized controlled trial with an intervention and a control group. Participants were community-dwelling caregivers living with a person with dementia (59 randomized to intervention and 50 to control arm). The training program lasted 5 days and took place in a holiday accommodation. Quality-adjusted life-years (QALYs) were calculated using the EuroQol-5 Dimensions 3 Levels (EQ-5D-3L) for caregivers and PwDs. Costs for informal and formal social care, as well as health care, were collected at four times over a 6-month period from baseline. Information on nursing home admission or death was collected for 2 years after baseline. Results QALYs for caregivers and PwDs added together were 0.12 higher in the intervention group compared with the control group (P = .11). After 1 year, there tended to be fewer nursing home admissions in the intervention group, but this difference was lost by 2 years (P = .19). The cost of the intervention was estimated at €1000 (USD 1090) per dyad. Compared with the control group, the intervention group used other health care and formal social care significantly less for a year after baseline (P = .02 and .001, respectively). The estimated decrease in total costs was €10,437 (P = .07), with an estimated 96% probability that the intervention was cost-effective vs usual care. Discussion The multicomponent "More at Home with Dementia" training program is effective and appears to save costs compared with usual care. Savings appear to be achieved by delaying nursing home admissions and by reducing the use of other care resources. Further research is also needed to clarify if this intervention is effective for caregivers who do not live with a PwD, such as adult children, and for the caregivers of patients with other debilitating chronic diseases. At the same time, effort is advised to implement caregiver training in standard care programs.
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Affiliation(s)
- Elizabeth G. Birkenhäger‐Gillesse
- Department of General Practice and Elderly Care MedicineUniversity of GroningenUniversity Medical Center GroningenGroningenthe Netherlands
- Laurens Care CentersRotterdamthe Netherlands
| | - Wilco P. Achterberg
- Department of Public Health and Primary CareLeiden University Medical CenterLeidenthe Netherlands
| | - Sarah I.M. Janus
- Department of General Practice and Elderly Care MedicineUniversity of GroningenUniversity Medical Center GroningenGroningenthe Netherlands
| | - Sytse U. Zuidema
- Department of General Practice and Elderly Care MedicineUniversity of GroningenUniversity Medical Center GroningenGroningenthe Netherlands
| | - Wilbert B. van den Hout
- Department of Medical Decision Making & Quality of CareLeiden University Medical CenterLeidenthe Netherlands
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Huo Z, Chan JYC, Lin J, Bat BKK, Chan TK, Tsoi KKF, Yip BHK. Supporting Informal Caregivers of People With Dementia in Cost-Effective Ways: A Systematic Review and Meta-Analysis. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:1853-1862. [PMID: 34838284 DOI: 10.1016/j.jval.2021.05.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 04/07/2021] [Accepted: 05/30/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Caring for persons with dementia is a heavy burden for informal caregivers. This study aimed to appraise the economic evidence of interventions supporting informal caregivers of people with dementia. METHODS Literature was searched, and trial-based studies evaluating the costs and effects of interventions supporting informal caregivers of people with dementia were included. Cost data were analyzed from both healthcare and societal perspectives. Random-effects models were used to synthesize cost and effect data, based on mean differences (MDs) or standardized MDs. RESULTS Of 33 eligible studies identified from 48 588 records, 14 (42.4%) showed net savings in total cost regardless of analytical perspectives. Among 22 studies included in meta-analyses, caregiver-focused psychosocial interventions showed improvements in caregivers' psychological health (n = 4; standardized MD 0.240; 95% confidence interval 0.094-0.387); nevertheless, the increases in societal cost were significant (n = 5; MD 3144; 95% confidence interval 922-5366). Psychological intervention and behavioral management engaging patient-caregiver dyads showed positive effects on caregivers' subjective burden, also with increases in total cost. Subgroup analyses indicated that the inclusion of different intervention components, the caregiver characteristics, and the follow-up periods could affect the costs and effects of interventions supporting informal caregivers. CONCLUSIONS Psychosocial interventions directed at informal caregivers and dyad-based psychological and behavioral interventions are effective but also expensive. The use of these interventions depends on the society's willingness to pay. More comprehensive economic evidence of interventions supporting informal caregivers is required, and the design of intervention should focus more on different intervention components, characteristics of patients and caregivers, and healthcare systems.
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Affiliation(s)
- Zhaohua Huo
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Joyce Y C Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Jiaer Lin
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Baker K K Bat
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Tak Kit Chan
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Kelvin K F Tsoi
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong; Stanley Ho Big Data Decision Analytics Research Centre, The Chinese University of Hong Kong, Shatin, Hong Kong.
| | - Benjamin H K Yip
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong.
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Determinants of the need for respite according to the characteristics of informal carers of elderly people at home: results from the 2015 French national survey. BMC Health Serv Res 2021; 21:995. [PMID: 34548072 PMCID: PMC8456521 DOI: 10.1186/s12913-021-06935-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 08/19/2021] [Indexed: 11/21/2022] Open
Abstract
Background The demographic and social changes associated with population aging and the increasing incidence of chronic diseases underscore the importance of the role of informal carers. The number of informal carers is increasing and negative consequences associated with providing care, such as burnout, are known. However the influence of socioeconomic and psychological factors on the need for respite have not been well characterized to date. Informal care represents an essential component of health care systems and long-term care. The purpose of this study was to shed light on how the characteristics of informal carers affect the need for respite. Methods We used data from a nationally representative survey, Capacités Aides et Resources des Seniors (CARE - ménage), collected in 2015 by the National Institute for Statistics and Economic Studies (INSEE) and the Directorate for Research, Studies, Assessment and Statistics (DREES). The determinants of the need for respite among the characteristics of informal caregivers were explored using a probit model. To handle missing data, sensitivity analyses were performed using multiple imputations. Results Our study included N = 4033 dyads of informal carers and care recipients. The mean age was 61 for carers. The majority of carers were female, married, the child of the care recipient. Almost 27% reported a need for respite. A worse health status, feeling of loneliness, having a lack of time for oneself and needing to provide more than 30 h of care per month very significantly increased the need for respite irrespective of whether or not the carer lived with the care recipient (p < 0.01). Providing care to other persons was likely to induce a greater need for respite (p < 0.01). Cohabitation of the informal carer and the care recipient was likely to increase the need for respite (p < 0.05). Conversely, however, being closely acquainted with the care recipient showed a reduced need for respite in comparison with that of carers who are married to their care recipient (p < 0.05). Conclusions These findings provide useful information for policymakers, physicians and other health professionals for reducing carers’ risk of exhaustion and burnout and for referring carers to the relevant service, e.g. psychological intervention, respite care support, training support and education support. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06935-x.
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Contreras ML, Mioshi E, Kishita N. Factors Related to the Quality of Life in Family Carers of People With Dementia: A Meta-Analysis. J Geriatr Psychiatry Neurol 2021; 34:482-500. [PMID: 32394770 PMCID: PMC8326913 DOI: 10.1177/0891988720924713] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES This meta-analysis aimed to (1) quantitatively synthesize evidence of factors related to the quality of life (QoL) of family carers of people with dementia and (2) explore moderating factors that may influence the strength of the relationship between such potential predictive factors and carer QoL. METHODS Studies that investigated correlations between patient/carer factors and QoL in unpaid family carers of people with dementia and were published in English, Spanish, Portuguese, or Japanese were included. RESULTS Thirty-three studies were identified. The pooled correlations with carer QoL (effect size) were significantly large for depression (-0.58), significantly moderate for subjective burden (-0.47), and significantly small for people with dementia's neuropsychiatric symptoms (-0.24). These results indicated to be robust in the context of publication bias. The results of subgroup analyses demonstrated the social and economic development status of the country where study participants resided did not moderate these effects. CONCLUSION Carer depression, subjective burden, and people with dementia's neuropsychiatric symptoms may play a critical role in maintaining QoL of family carers regardless of the social and economic circumstances.
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Affiliation(s)
- Milena L. Contreras
- School of Health Sciences, University of East Anglia, Norwich, United Kingdom,Naoko Kishita, School of Health Sciences, University of East Anglia, Norwich NR4 7TJ, United Kingdom.
| | - Eneida Mioshi
- School of Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Naoko Kishita
- School of Health Sciences, University of East Anglia, Norwich, United Kingdom
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8
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Shaw CA, Williams KN, Lee RH, Coleman CK. Cost-effectiveness of a telehealth intervention for in-home dementia care support: Findings from the FamTechCare clinical trial. Res Nurs Health 2021; 44:60-70. [PMID: 33075157 PMCID: PMC8459671 DOI: 10.1002/nur.22076] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/03/2020] [Accepted: 10/05/2020] [Indexed: 01/28/2023]
Abstract
Determining the cost-effectiveness of technological interventions is a crucial aspect in assuring these interventions can be adopted. The FamTechCare intervention is an innovative telehealth support that links family caregivers of persons living with dementia to tailored feedback from dementia care experts based on caregiver-initiated video recordings of challenging care situations. The FamTechCare intervention has demonstrated significant reductions in caregiver depression and increases in caregiver competence when compared to standard telephone support. The purpose of this article is to report on the cost-effectiveness of the FamTechCare telehealth intervention. Process-based costing and a cost-effectiveness analysis using the incremental cost-effectiveness ratio (ICER) was completed with 68 caregiver and person living dementia with dyads. The cost of the 12-week FamTechCare telehealth intervention was found to be greater ($48.43 per dyad per week) due to the telehealth equipment, recording application, and expert panel time compared with the telephone support intervention ($6.96 per dyad per week). The ICER was $18.51 for caregiver depression and $36.31 for caregiver competence indicating that it cost no more than $36.38 per dyad per week over 12 weeks to achieve significant improvement in depression and competence in the FamTechCare caregivers compared to the telephone support caregivers. The FamTechCare intervention appears to be cost-effective when compared to the telephone support intervention and remains near the willingness-to-pay threshold for caregivers providing in-home dementia care support.
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Affiliation(s)
- Clarissa A Shaw
- College of Nursing, University of Iowa, Iowa City, Iowa, USA
| | | | - Robert H Lee
- Kansas Medical Center, University of Kansas, Kansas City, Kansas, USA
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9
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Guets W, Al-Janabi H, Perrier L. Cost-Utility Analyses of Interventions for Informal Carers: A Systematic and Critical Review. PHARMACOECONOMICS 2020; 38:341-356. [PMID: 31853801 DOI: 10.1007/s40273-019-00874-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Demographic and epidemiological changes place an increasing reliance on informal carers. Some support programmes exist, but funding is often limited. There is a need for economic evaluation of interventions for carers to assist policymakers in prioritizing carer support. OBJECTIVE Our aim was to systematically review and critically appraise cost-utility analyses of interventions for informal carers, in order to assess the methods employed and the quality of the reporting. METHODS A systematic review of databases was conducted using MEDLINE, Embase, PsycINFO, and EconLit of items published between 1950 and February 2019. Published studies were selected if they involved a cost-utility analysis of an intervention mainly or jointly targeting informal carers. The reporting quality of economic analyses was evaluated using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. RESULTS An initial set of 1364 potentially relevant studies was identified. The titles and the abstracts were then screened, resulting in the identification of 62 full-text articles that warranted further assessment of their eligibility. Of these, 20 economic evaluations of informal carer interventions met the inclusion criteria. The main geographical area was the UK (n = 11). These studies were conducted in mental and/or behavioural (n = 15), cardiovascular (n = 3) or cancer (n = 2) clinical fields. These cost-utility analyses were based on randomized clinical trials (n = 16) and on observational studies (n = 4), of which only one presented a Markov model-based economic evaluation. Four of the six psychological interventions were deemed to be cost effective versus two of the four education/support interventions, and four of the nine training/support interventions. Two articles achieved a CHEERS score of 100% and nine of the economic evaluations achieved a score of 85% in terms of the CHEERS criteria for high-quality economic studies. CONCLUSIONS Our critical review highlights the lack of cost-utility analyses of interventions to support informal carers. However, it also shows the relative prominence of good reporting practices in these analyses that other studies might be able to build on.
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Affiliation(s)
- Wilfried Guets
- University of Lyon, Centre Léon Bérard, GATE L-SE UMR 5824, Lyon, France.
| | | | - Lionel Perrier
- University of Lyon, Centre Léon Bérard, GATE L-SE UMR 5824, Lyon, France
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10
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Wang XR, Liu SX, Robinson KM, Shawler C, Zhou L. The impact of dementia caregiving on self-care management of caregivers and facilitators: a qualitative study. Psychogeriatrics 2019; 19:23-31. [PMID: 30088311 DOI: 10.1111/psyg.12354] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 06/29/2018] [Indexed: 01/26/2023]
Abstract
BACKGROUND Caregivers of patients with dementia or Alzheimer's disease (AD) face special health challenges due to the progressive nature of the disease. Self-care has crucial importance on individuals' management of life, health, and well-being. However, limited evidence is available on self-care management of dementia and AD caregivers. This study aimed to investigate the influence of caregiving on the self-care management of dementia and AD caregivers based on the caregivers' experience. In addition, the facilitators of caregivers' self-care management were assessed. METHODS A sample of 45 caregivers of patients with dementia or AD was recruited from a local community in the south-eastern USA. Semi-structured interviews were conducted. Data were transcribed verbatim and analyzed by the method of cross-case thematic analysis of qualitative data. RESULTS As reported by the caregivers, caregiving negatively influenced their self-care management, including physical self-care and mental and social self-care. Both internal and external facilitators were found that can assist caregivers' self-care. Caregivers differ considerably in their demographic characteristics, caregiving tasks, and self needs. CONCLUSION Self-care management of dementia and AD caregivers can be largely affected by caregiving. Awareness, motivation, and knowledge of self-care, as well as knowledge of health-care resources, are important prerequisites for caregivers to achieve self-care management. Given the massive differences in caregiving situations, future intervention studies based on the specific needs of individual caregivers are warranted.
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Affiliation(s)
- Xiao-Rong Wang
- Department of Gerontology, Jinan Central Hospital Affiliated to Shandong University, Jinan, China
| | - Sheng-Xin Liu
- Division of Human Nutrition, Wageningen University & Research, Wageningen, The Netherlands
| | - Karen M Robinson
- School of Nursing University of Louisville, Louisville, Kentucky, USA
| | - Celeste Shawler
- School of Nursing University of Louisville, Louisville, Kentucky, USA
| | - Lei Zhou
- Department of Urology, Jinan Central Hospital Affiliated to Shandong University, Jinan, China
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11
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The opportunity costs of caring for people with dementia in Southern Spain. GACETA SANITARIA 2019; 33:17-23. [DOI: 10.1016/j.gaceta.2017.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 06/12/2017] [Accepted: 06/19/2017] [Indexed: 11/24/2022]
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12
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Koumakis L, Chatzaki C, Kazantzaki E, Maniadi E, Tsiknakis M. Dementia Care Frameworks and Assistive Technologies for Their Implementation: A Review. IEEE Rev Biomed Eng 2019; 12:4-18. [DOI: 10.1109/rbme.2019.2892614] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Rahja M, Laver K, Comans T, Crotty M. What Does the Australian General Public Know About Treatments for Dementia? A Population Survey. Gerontol Geriatr Med 2018; 4:2333721418793442. [PMID: 30128330 PMCID: PMC6090500 DOI: 10.1177/2333721418793442] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 06/24/2018] [Accepted: 07/17/2018] [Indexed: 01/09/2023] Open
Abstract
Objective: To identify the Australian general population’s awareness
regarding the presence and effectiveness of treatments for dementia.
Method: An online survey administered through a consumer panel
provider (PureProfile). Included were people aged 18 years or above living in
Australia. The survey asked participants about their knowledge of treatments for
dementia and attitudes toward the effectiveness of evidence-based treatments.
Results: Of the 1,001 participants, more than half (63.5%)
could not spontaneously name any treatments that improved outcomes for people
with dementia. When asked about the efficacy of specific treatments, “brain
training” was considered to be “very likely” to be effective by approximately
half (49.4%) of the participants followed by “education for caregivers” (46.2%)
and “healthy diet” (43.4%). Discussion: Knowledge of treatments for
dementia among the Australian public is poor. There is a need to better educate
the public about treatments that have demonstrated effectiveness to improve
their uptake and use.
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Affiliation(s)
- Miia Rahja
- Flinders University, Bedford Park, South Australia, Australia.,The University of Sydney, Sydney, New South Wales, Australia
| | - Kate Laver
- Flinders University, Bedford Park, South Australia, Australia.,The University of Sydney, Sydney, New South Wales, Australia
| | - Tracy Comans
- The University of Sydney, Sydney, New South Wales, Australia.,The University of Queensland, Brisbane, Queensland, Australia
| | - Maria Crotty
- Flinders University, Bedford Park, South Australia, Australia.,The University of Sydney, Sydney, New South Wales, Australia
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Rahja M, Comans T, Clemson L, Crotty M, Laver K. Economic evaluations of occupational therapy approaches for people with cognitive and/or functional decline: A systematic review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2018; 26:635-653. [PMID: 29532555 DOI: 10.1111/hsc.12553] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/22/2018] [Indexed: 02/28/2024]
Abstract
With the ageing of the world's population comes significant implications for nearly all sectors of society, including health and aged care spending. Health and aged care systems need to respond to the increasing need for services for older people. Occupational therapy is concerned with maintaining a person's functional independence and well-being from preventative and treatment perspectives. The aim of this systematic review was to identify the costs and outcomes of occupational therapy for people with cognitive and/or functional decline. The searches for this review were conducted on 23 September 2016 and updated on 20 April 2017. Full economic evaluation studies, partial economic evaluations, randomised trials reporting estimates of resource use or costs associated with intervention(s) and comparator(s) and studies with pre- and post-intervention cost comparators were included. Thirteen studies met the inclusion criteria. The type and duration of occupational therapy intervention in the included studies varied, ranging from one-off assessments through to systematic multicomponent programmes. Results suggested that structured occupational therapy interventions which comprised of multiple consultations and engaged caregivers delivered better functional and economic outcomes.
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Affiliation(s)
- Miia Rahja
- Department of Rehabilitation, Aged and Extended Care, Flinders Medical Centre, Flinders University, Bedford Park, SA, Australia
- Cognitive Decline Partnership Centre, The University of Sydney, Hornsby Ku-Ring-Gai Hospital, Hornsby, NSW, Australia
| | - Tracy Comans
- Cognitive Decline Partnership Centre, The University of Sydney, Hornsby Ku-Ring-Gai Hospital, Hornsby, NSW, Australia
- Centre for Health Services Research, The University of Queensland, Woolloongabba, QLD, Australia
| | - Lindy Clemson
- Cognitive Decline Partnership Centre, The University of Sydney, Hornsby Ku-Ring-Gai Hospital, Hornsby, NSW, Australia
- Ageing Work and Health Research Unit, Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW, Australia
| | - Maria Crotty
- Department of Rehabilitation, Aged and Extended Care, Flinders Medical Centre, Flinders University, Bedford Park, SA, Australia
- Cognitive Decline Partnership Centre, The University of Sydney, Hornsby Ku-Ring-Gai Hospital, Hornsby, NSW, Australia
| | - Kate Laver
- Department of Rehabilitation, Aged and Extended Care, Flinders Medical Centre, Flinders University, Bedford Park, SA, Australia
- Cognitive Decline Partnership Centre, The University of Sydney, Hornsby Ku-Ring-Gai Hospital, Hornsby, NSW, Australia
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15
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Nickel F, Barth J, Kolominsky-Rabas PL. Health economic evaluations of non-pharmacological interventions for persons with dementia and their informal caregivers: a systematic review. BMC Geriatr 2018. [PMID: 29523090 PMCID: PMC5845149 DOI: 10.1186/s12877-018-0751-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background This systematic review aims to review the literature on trial-based economic evaluations of non-pharmacological interventions directly targeted at persons with dementia as well as persons with mild cognitive impairment and their respective caregivers. Methods A systematic literature research was conducted for the timeframe from 2010 to 2016 in the following databases: Centre for Reviews and Dissemination, EconLit, Embase, Cochrane Library, PsycINFO and PubMed. Study quality was assessed according to the Drummond criteria. Results In total sixteen publications were identified. Health economic evaluations indicated the cost-effectiveness of physical exercise interventions and occupational therapy. There was also evidence to suggest that psychological and behavioral therapies are cost-effective. Health economic studies investigating psychosocial interventions mainly targeted towards informal caregivers showed inconsistent results. Conclusions Due to the increasing prevalence of dementia non-pharmacological interventions and their health economic impact are of increasing importance for health care decision-makers and HTA agencies. Electronic supplementary material The online version of this article (10.1186/s12877-018-0751-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Franziska Nickel
- Interdisciplinary Centre for Health Technology Assessment (HTA) and Public Health (IZPH), Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany. .,National Graduate College 'Optimisation strategies in Dementia - OptiDem', Karl and Veronica Carstens-Foundation, Essen, Germany.
| | - Janina Barth
- Interdisciplinary Centre for Health Technology Assessment (HTA) and Public Health (IZPH), Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany.,National Graduate College 'Optimisation strategies in Dementia - OptiDem', Karl and Veronica Carstens-Foundation, Essen, Germany
| | - Peter L Kolominsky-Rabas
- Interdisciplinary Centre for Health Technology Assessment (HTA) and Public Health (IZPH), Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany.,National Graduate College 'Optimisation strategies in Dementia - OptiDem', Karl and Veronica Carstens-Foundation, Essen, Germany
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16
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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: 3.0] [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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17
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Farina N, Page TE, Daley S, Brown A, Bowling A, Basset T, Livingston G, Knapp M, Murray J, Banerjee S. Factors associated with the quality of life of family carers of people with dementia: A systematic review. Alzheimers Dement 2017; 13:572-581. [DOI: 10.1016/j.jalz.2016.12.010] [Citation(s) in RCA: 143] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 12/03/2016] [Accepted: 12/21/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Nicolas Farina
- Centre for Dementia Studies Brighton and Sussex Medical School Brighton UK
| | | | - Stephanie Daley
- Centre for Dementia Studies Brighton and Sussex Medical School Brighton UK
| | - Anna Brown
- School of Psychology University of Kent Canterbury UK
| | - Ann Bowling
- Health Sciences University of Southampton Southampton UK
| | - Thurstine Basset
- Lived Experience Advisory Panel Sussex Partnership NHS Foundation Trust Hove UK
| | | | - Martin Knapp
- Department of Social Policy London School of Economics London UK
| | - Joanna Murray
- Institute of Psychiatry, Psychology & Neuroscience King's College London London UK
| | - Sube Banerjee
- Centre for Dementia Studies Brighton and Sussex Medical School Brighton UK
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18
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Current issues and future research priorities for health economic modelling across the full continuum of Alzheimer's disease. Alzheimers Dement 2017; 13:312-321. [PMID: 28063281 DOI: 10.1016/j.jalz.2016.12.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 12/01/2016] [Accepted: 12/09/2016] [Indexed: 11/20/2022]
Abstract
Available data and models for the health-economic evaluation of treatment in Alzheimer's disease (AD) have limitations causing uncertainty to decision makers. Forthcoming treatment strategies in preclinical or early AD warrant an update on the challenges associated with their economic evaluation. The perspectives of the co-authors were complemented with a targeted review of literature discussing methodological issues and data gaps in AD health-economic modelling. The methods and data available to translate treatment efficacy in early disease into long-term outcomes of relevance to policy makers and payers are limited. Current long-term large-scale data accurately representing the continuous, multifaceted, and heterogeneous disease process are missing. The potential effect of disease-modifying treatment on key long-term outcomes such as institutionalization and death is uncertain but may have great effect on cost-effectiveness. Future research should give priority to collaborative efforts to access better data on the natural progression of AD and its association with key long-term outcomes.
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19
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Laver K, Milte R, Dyer S, Crotty M. A Systematic Review and Meta-Analysis Comparing Carer Focused and Dyadic Multicomponent Interventions for Carers of People With Dementia. J Aging Health 2016; 29:1308-1349. [PMID: 27458254 PMCID: PMC5680909 DOI: 10.1177/0898264316660414] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Objective: The aim of this study was to compare the efficacy of two approaches: multicomponent interventions that focus on working with the carer and dyadic interventions that work with both the carer and the person with dementia. Method: A systematic review involving a search of Medline, EMBASE, and PsycINFO in October 2015 was performed. Randomized controlled trials involving carers of people with dementia and comparing multicomponent interventions with usual care were included. Results: Pooling of all studies demonstrated that multicomponent interventions can reduce depressive symptoms, improve quality of life, reduce carer impact, and reduce behavioral and psychological symptoms of dementia as well as caregiver upset with these symptoms. We were unable to find a significant difference in the effects of dyadic interventions in comparison with carer focused interventions for these outcomes. Discussion: Although effect sizes associated with intervention are small, multicomponent interventions are relatively inexpensive to deliver, acceptable, and widely applicable.
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Affiliation(s)
- Kate Laver
- 1 Flinders University, Adelaide, South Australia, Australia.,2 NHMRC Cognitive Decline Partnership Centre, Australia
| | - Rachel Milte
- 1 Flinders University, Adelaide, South Australia, Australia.,2 NHMRC Cognitive Decline Partnership Centre, Australia
| | - Suzanne Dyer
- 1 Flinders University, Adelaide, South Australia, Australia.,2 NHMRC Cognitive Decline Partnership Centre, Australia
| | - Maria Crotty
- 1 Flinders University, Adelaide, South Australia, Australia.,2 NHMRC Cognitive Decline Partnership Centre, Australia
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20
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Fortinsky RH, Gitlin LN, Pizzi LT, Piersol CV, Grady J, Robison JT, Molony S. Translation of the Care of Persons with Dementia in their Environments (COPE) intervention in a publicly-funded home care context: Rationale and research design. Contemp Clin Trials 2016; 49:155-65. [PMID: 27394383 PMCID: PMC4979745 DOI: 10.1016/j.cct.2016.07.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 07/03/2016] [Accepted: 07/05/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Dementia is the leading cause of loss of independence in older adults worldwide. In the U.S., approximately 15 million family members provide care to relatives with dementia. This paper presents the rationale and design for a translational study in which an evidence-based, non-pharmacologic intervention for older adults with dementia and family caregivers (CGs) is incorporated into a publicly-funded home care program for older adults at risk for nursing home admission. METHODS The 4-month Care of Persons with Dementia in their Environments (COPE) intervention is designed to optimize older adults' functional independence, and to improve CG dementia management skills and health-related outcomes. COPE features 10 in-home occupational therapy visits, and 1 in-home visit and 1 telephone contact by an advanced practice nurse. COPE was deemed efficacious in a published randomized clinical trial. In the present study, older adults with dementia enrolled in the Connecticut Home Care Program for Elders (CHCPE) and their CGs are randomly assigned to receive COPE plus their ongoing CHCPE services, or to continue receiving CHCPE services only. OUTCOMES The primary outcome for older adults with dementia is functional independence; secondary outcomes are activity engagement, quality of life, and prevention or alleviation of neuropsychiatric symptoms. CG outcomes include perceived well-being and confidence in using activities to manage dementia symptoms. Translational outcomes include net financial benefit of COPE, and feasibility and acceptability of COPE implementation into the CHCPE. COPE has the potential to improve health-related outcomes while saving Medicaid waiver and state revenue-funded home care program costs nationwide.
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Affiliation(s)
- Richard H Fortinsky
- Center on Aging, School of Medicine, University of Connecticut, United States.
| | - Laura N Gitlin
- School of Nursing, Johns Hopkins University, United States
| | - Laura T Pizzi
- College of Pharmacy, Thomas Jefferson University, United States
| | | | - James Grady
- Department of Community Medicine and Health Care, School of Medicine, University of Connecticut, United States
| | - Julie T Robison
- Center on Aging, School of Medicine, University of Connecticut, United States
| | - Sheila Molony
- School of Nursing, Quinnipiac University, United States
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21
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Abstract
BACKGROUND Family caregivers of persons with dementia often require support services to help ease the challenges of providing care. Although the efficacy of some dementia caregiver interventions seems apparent, evidence indicating which types of protocols can best meet the diverse needs of individual families is not yet available. Because of this gap, families must often turn to professionals for such guidance, but it remains unknown whether professionals from different disciplines are more inclined to recommend particular types of services than others. This study assessed whether recommendations of supportive interventions to hypothetical dementia family caregivers differed by professional discipline. METHODS In a cross-sectional survey design, a convenience sample of 422 dementia care professionals across the USA viewed up to 24 randomly selected, hypothetical scenarios that systematically varied characteristics of persons with dementia and their caregivers. For each scenario, 7 possible intervention recommendations were rated. A total of 6,890 scenarios were rated and served as the unit of analysis. RESULTS General linear models revealed that discipline was often a stronger predictor of how likely professionals were to recommend dementia caregiver interventions than caregiver, care recipient, or other professional characteristics. Psychotherapists tended to recommend psychoeducation more than other professionals, while those in medicine were more likely to recommend training of the person with dementia and psychotherapy. CONCLUSIONS The heterogeneity in recommendations suggests that the professional source of information influences the types of support families are directed toward. Empirical evidence should inform these professional judgments to better achieve person-centered care for families.
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22
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Papastavrou E, Andreou P, Middleton N, Tsangari H, Papacostas S. Dementia caregiver burden association with community participation aspect of social capital. J Adv Nurs 2015; 71:2898-910. [DOI: 10.1111/jan.12762] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2015] [Indexed: 01/08/2023]
Affiliation(s)
- Evridiki Papastavrou
- School of Health Sciences; Department of Nursing; Cyprus University of Technology; Limassol Cyprus
| | - Panayiota Andreou
- School of Health Sciences; Department of Nursing; Cyprus University of Technology; Limassol Cyprus
| | - Nicos Middleton
- School of Health Sciences; Department of Nursing; Cyprus University of Technology; Limassol Cyprus
| | - Haritini Tsangari
- Department of Economics and Finance; School of Business; University of Nicosia; Cyprus
| | - Savvas Papacostas
- Cyprus School of Molecular Medicine/The Cyprus Institute of Neurology & Genetics; Nicosia Cyprus
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23
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Dixon J, Ferdinand M, D'Amico F, Knapp M. Exploring the cost-effectiveness of a one-off screen for dementia (for people aged 75 years in England and Wales). Int J Geriatr Psychiatry 2015; 30:446-52. [PMID: 25043227 DOI: 10.1002/gps.4158] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 05/07/2014] [Accepted: 05/23/2014] [Indexed: 11/10/2022]
Abstract
OBJECTIVE This paper examines the numbers of people with dementia who could be diagnosed and the likely cost-effectiveness of a one-off screen for dementia for people aged 75 years in England and Wales. METHODS The study uses static decision modelling to compare a one-off screen for dementia with a no-screen scenario. Estimates for the model were drawn from systematic reviews, high-quality studies and government and administrative sources. A panel of experts also advised the study. RESULTS An estimated 3514 people could be diagnosed as a result of screening, 2152 of whom would otherwise never receive a diagnosis. The study identified societal economic impact of between £3,649,794 (net costs) and £4,685,768 (net savings), depending on assumptions. CONCLUSIONS Our analysis suggests that screening could be cost-effective, especially as treatments and social care interventions become more effective and if diagnosis by current routes remains low or occurs later than is optimal. This study was, however, limited by available evidence and a range of quality of life benefits, cost savings and potential harms could not be quantified. It was also beyond the scope of this study to consider dynamic factors such as repeat screening, mortality, disease trajectories or trends in the numbers of people with dementia. A larger study would be needed for this, involving more complex and innovative approaches to generating estimates for modelling. We did not compare population screening for people aged 75 years to other methods for increasing diagnosis rates.
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Affiliation(s)
- Josie Dixon
- Personal Social Services Research Unit, London School of Economics, London, UK
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24
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Zendjidjian XY, Boyer L. Challenges in measuring outcomes for caregivers of people with mental health problems. DIALOGUES IN CLINICAL NEUROSCIENCE 2015. [PMID: 25152655 PMCID: PMC4140510 DOI: 10.31887/dcns.2014.16.2/xzendjidjian] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patient-reported outcomes (PROs) are increasingly important in health care and mental health research. Furthermore, caregivers become partners in care for patients with mental disorders, and health workers are more attentive to the expectations and needs of caregivers. A number of outcomes for caregivers are measured and used in daily practice in order to promote actions to improve health care systems and progress in research on the impact of mental disorders on their caregivers. This paper proposes an inventory of the different outcomes and different measurement tools used to assess the impact of disorders, raising a number of methodological and conceptual issues that limit the relevance of measurement tools and complicate their use. Finally, we propose some recommendations promoting the development of relevant outcome measures for caregivers and their integration into current systems of care.
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Affiliation(s)
- Xavier Y Zendjidjian
- Aix-Marseille University, EA 3279-Public Health, Chronic Diseases and Quality of Life-Research Unit, Marseille, France; Department of Psychiatry, La Conception University Hospital, Marseille, France
| | - Laurent Boyer
- Aix-Marseille University, EA 3279-Public Health, Chronic Diseases and Quality of Life -Research Unit, Marseille, France
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25
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Dahlrup B, Nordell E, Steen Carlsson K, Elmståhl S. Health economic analysis on a psychosocial intervention for family caregivers of persons with dementia. Dement Geriatr Cogn Disord 2014; 37:181-95. [PMID: 24157891 DOI: 10.1159/000355365] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/22/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Psychosocial intervention has shown positive effects on the caregivers' burden and satisfaction. The aims of this study were to describe the cost and cost-effectiveness of such an intervention. METHODS We analyzed resource use and costs of formal care for 308 persons with dementia and their caregivers' health-related quality of life (HRQoL). RESULTS The costs of home help services were lower in the subgroup of spouse caregivers in the intervention group and the cost of nursing home placement was lower in the intervention group. While the person with dementia lived at home, caregivers in the intervention group reported a higher HRQoL (p < 0.01). After the person with dementia had moved to a nursing home, spouses in the control group had a lower HRQoL (p < 0.001). CONCLUSION The result can be interpreted as a positive effect of the intervention focusing on the identified specific needs of the family caregivers.
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Affiliation(s)
- Beth Dahlrup
- Division of Geriatric Medicine, Department of Health Sciences, Lund University, Malmö, Sweden
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26
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Macdonald M, Lang A. Applying Risk Society Theory to findings of a scoping review on caregiver safety. HEALTH & SOCIAL CARE IN THE COMMUNITY 2014; 22:124-133. [PMID: 23905543 DOI: 10.1111/hsc.12056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/12/2013] [Indexed: 06/02/2023]
Abstract
Chronic Illness represents a growing concern in the western world and individuals living with chronic illness are primarily managed at home by family caregivers. A scoping review of the home-care literature (2004-2009; updated with review articles from 2010 to January 2013) on the topic of the caregiver revealed that this group experiences the following safety-related concerns: caregivers are conscripted to the role, experience economic hardship, risk being abused as well as abusing, and may well become patients themselves. Methodology and methods used in the scoping review are presented as well as a brief overview of the findings. The concepts of risk and safety are defined. Risk Society Theory is introduced and used as a lens to view the findings, and to contribute to an understanding of the construction of risk in contemporary health-care.
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Affiliation(s)
- Marilyn Macdonald
- Faculty of Health Professions, School of Nursing, Dalhousie University, Halifax, NS, Canada
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27
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Joling KJ, Bosmans JE, van Marwijk HWJ, van der Horst HE, Scheltens P, Vroomen JLM, van Hout HPJ. The cost-effectiveness of a family meetings intervention to prevent depression and anxiety in family caregivers of patients with dementia: a randomized trial. Trials 2013; 14:305. [PMID: 24053631 PMCID: PMC3849827 DOI: 10.1186/1745-6215-14-305] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 09/11/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dementia imposes a heavy burden on health and social care systems as well as on family caregivers who provide a substantial portion of the care. Interventions that effectively support caregivers may prevent or delay patient institutionalization and hence be cost-effective. However, evidence about the cost-effectiveness of such interventions is scarce. The aim of this study was to evaluate the cost-effectiveness of a family meetings intervention for family caregivers of dementia patients in comparison with usual care over a period of 12 months. METHODS The economic evaluation was conducted from a societal perspective alongside a randomized trial of 192 primary caregivers with community-dwelling dementia patients. Outcome measures included the Quality Adjusted Life-Years (QALY) of caregivers and patients and the incidence of depression and anxiety disorders in caregivers. Missing cost and effect data were imputed using multiple imputations. Bootstrapping was used to estimate uncertainty around the cost-differences and the incremental cost-effectiveness ratio (ICER). The bootstrapped cost-effect pairs were plotted on a cost-effectiveness plane and used to estimate cost-effectiveness curves. RESULTS No significant differences in costs and effects between the groups were found. At 12 months, total costs per patient and primary caregiver dyad were substantial: €77,832 for the intervention group and €75,201 for the usual care group (adjusted mean difference per dyad €4,149, 95% CI -13,371 to 21,956, ICER 157,534). The main cost driver was informal care (66% of total costs), followed by patients' day treatment and costs of hospital and long-term care facility admissions (23%). Based on the cost-effectiveness acceptability curves, the maximum probability that the intervention was considered cost-effective in comparison with usual care reached 0.4 for the outcome QALY per patient-caregiver dyad and 0.6 for the caregivers' incidence of depression and/or anxiety disorders regardless of the willingness to pay. CONCLUSIONS The annual costs of caring for a person with dementia were substantial with informal care being by far the largest contributor to the total societal costs. Based on this study, family meetings cannot be considered a cost-effective intervention strategy in comparison with usual care. TRIAL REGISTRATION ISRCTN register, ISRCTN90163486.
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Affiliation(s)
- Karlijn J Joling
- Department of General Practice and Elderly Care Medicine, VU University Medical Centre, EMGO + Institute for Health and Health Care Research, Van der Boechorststraat 7, 1081, BT Amsterdam, The Netherlands
| | - Judith E Bosmans
- Faculty of Earth and Life Sciences, VU University Amsterdam, De Boelelaan 1085, 1081, HV Amsterdam, The Netherlands
| | - Harm WJ van Marwijk
- Department of General Practice and Elderly Care Medicine, VU University Medical Centre, EMGO + Institute for Health and Health Care Research, Van der Boechorststraat 7, 1081, BT Amsterdam, The Netherlands
| | - Henriëtte E van der Horst
- Department of General Practice and Elderly Care Medicine, VU University Medical Centre, EMGO + Institute for Health and Health Care Research, Van der Boechorststraat 7, 1081, BT Amsterdam, The Netherlands
| | - Philip Scheltens
- Department of Neurology, VUmc Alzheimer Center, De Boelelaan 1118, 1081, HZ Amsterdam, The Netherlands
| | - Janet L MacNeil Vroomen
- Department of General Practice and Elderly Care Medicine, VU University Medical Centre, EMGO + Institute for Health and Health Care Research, Van der Boechorststraat 7, 1081, BT Amsterdam, The Netherlands
- Department of Internal Medicine, Section Geriatrics, Amsterdam Medical Center, Meibergdreef 9, 1105, AZ Amsterdam, The Netherlands
| | - Hein PJ van Hout
- Department of General Practice and Elderly Care Medicine, VU University Medical Centre, EMGO + Institute for Health and Health Care Research, Van der Boechorststraat 7, 1081, BT Amsterdam, The Netherlands
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