Patient and carer participation in old age psychiatry in England. Part I: a systemic perspective of the historical and policy context

A qualitative exploration of family carer's understandings of people with dementia's expectations for the future

BACKGROUND

There is little evidence that outlines how family carers understand the person with dementia's perspective, values and anticipated future needs. Whilst people with dementia should be consulted about their own quality of life and care values, carers - otherwise known as care partners - require such understandings to ensure that the support the person receives into the future upholds their quality of life and is consistent with what they desire.

AIM

This research aimed to explore and describe family carers' experience of supporting the person with dementia to maintain their quality of life by understanding how carers developed an awareness and understanding of the person with dementia's expectations for the future and what they believed was important for the person to whom they provided care.

METHOD

Using an application of the grounded theory method, data were collected from 21 carers during semi structured interviews and analysed using constant comparative analysis.

FINDINGS

Four categories emerged from the data: Knowing the person, Process of decision making, Maintaining normalcy and quality of life and Out of their control.

DISCUSSION

This study provides insights into how carers developed awareness of the expectations of people with dementia. Findings also illuminate carers' perspectives of the changing nature of decision making during the dementia trajectory.

CONCLUSION

Understanding the perspective of the person living with dementia is essential to facilitate advocacy and support that is 'person centred' now and into the future. Assisting carers to incorporate this perspective into caring has the potential to be better facilitated by health professionals and merits further investigation.

Shared decision making with frail older patients: Proposed teaching framework and practice recommendations

This study has two aims: The first aim is to identify core competencies for shared decision making (SDM) with frail older persons, and the second is to determine key elements of a teaching framework, based on the authors' recently developed model for SDM with older patients who are frail. To this end the authors conducted a qualitative inquiry among health professionals (n = 53) and older patients who are frail (n = 16). Participants formulated core competencies and educational needs for SDM with older patients who are frail, which were further explored in the literature. This resulted in practice recommendations and a teaching framework with the following key elements: create a knowledge base for all health professionals, offer practical training, facilitate communication, identify discussion partners, engage patients, and collaborate. The authors' teaching framework for SDM with older patients who are frail may be useful for clinicians, educators, and researchers who aim to promote SDM with older patients who are frail.

The Development and Validation of the Patient Participation Culture Tool for Inpatient Psychiatric Wards (PaCT-PSY)

Patient participation is an important topic in mental health and receives increased attention along with deinstitutionalization. No tool exists to measure healthcare worker-related factors that influence patient participation. A three-staged study was conducted to develop and validate the 'Patient Participation Culture Tool for inpatient PSYchiatric wards' (PaCT-PSY), and to analyse its psychometric properties (n=603). The 60-items tool, comprising thirteen components, showed content validity, strong psychometric properties, and a high internal consistency. The PaCT-PSY measures the patient participation culture on psychiatric wards by exploring healthcare worker's factors influencing patient participation. It enables researchers, practitioners and administrators to develop tailored actions.

Working alliances not loggerheads: understanding and addressing dissonance between families and treating teams in older people's mental health

OBJECTIVES

To identify and describe common sources of dissonance which arise for treating teams in older person's mental health and the strategies for addressing them.

METHODS

A literature review was conducted with the terms: 'family conflict and treatment team', 'family therapy and old age' and 'family caregiver'.

RESULTS

We discuss the importance of an alliance with families regarding older people's mental health, and the contribution of engagement, attachment and family dynamics to dissonance. We offer strategies to prevent and address dissonance.

CONCLUSIONS

To prevent and manage dissonance, its causes need to be identified and understood. Routinely 'thinking family' first, then 'knowing' and 'hearing' the family are crucial steps to enhancing communication with families.

Review of family therapy and dementia: twenty-five years on

BACKGROUND

We reviewed the literature on family therapy and dementia to investigate the following: what is known about the use of family therapy in the context of living with dementia; what are the challenges of working in this context; and what guidelines/models are available to guide family therapists working with families living with dementia.

METHODS

We searched English language literature from 1992 onwards, classified the resulting papers into broad categories of theoretical, expository, or research (descriptive, quantitative, or qualitative), and conducted a narrative review to draw learning points from the identified papers.

RESULTS

In total 31 papers were identified: five theoretical, 11 expository; and 15 research papers. Several papers described methodologies; psychotherapeutic interventions applied to family members; or complex intervention packages in which the role of family therapy could not be separately identified, rather than family therapy. A range of outcomes were investigated, often involving the caregiver. Several authors suggest areas in dementia care where family therapy is likely to be beneficial.

CONCLUSIONS

Although the literature on family therapy and dementia has grown over the past 25 years and suggests potentially useful roles for therapy, a number of challenges exist in terms of context, family, and therapy itself. There is a need for further research, particularly into the following fields: How to evaluate the success of therapy; how to ensure treatment integrity; how to make techniques from family therapy available more widely; and how to train the health and social care workforce in working with families.