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Wand AP, Browne R, Jessop T, Peisah C. A systematic review of evidence-based aftercare for older adults following self-harm. Aust N Z J Psychiatry 2022; 56:1398-1420. [PMID: 35021912 DOI: 10.1177/00048674211067165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Self-harm is closely associated with suicide in older adults and may provide opportunity to intervene to prevent suicide. This study aimed to systematically review recent evidence for three components of aftercare for older adults: (1) referral pathways, (2) assessment tools and safety planning approaches and (3) engagement and intervention strategies. METHODS Databases PubMed, Medline, PsychINFO, Embase and CINAHL were searched from January 2010 to 10 July 2021 by two reviewers. Empirical studies reporting aftercare interventions for older adults (aged 60+) following self-harm (including with suicidal intent) were included. Full text of articles with abstracts meeting inclusion criteria were obtained and independently reviewed by three authors to determine final studies for review. Two reviewers extracted data and assessed level of evidence (Oxford) and quality ratings (Alberta Heritage Foundation for Medical Research Standard Quality Assessment Criteria for quantitative and Attree and Milton checklist for qualitative studies), working independently. RESULTS Twenty studies were reviewed (15 quantitative; 5 qualitative). Levels of evidence were low (3, 4), and quality ratings of quantitative studies variable, although qualitative studies rated highly. Most studies of referral pathways were observational and demonstrated marked variation with no clear guidelines or imperatives for community psychiatric follow-up. Of four screening tools evaluated, three were suicide-specific and one screened for depression. An evidence-informed approach to safety planning was described using cases. Strategies for aftercare engagement and intervention included two multifaceted approaches, psychotherapy and qualitative insights from older people who self-harmed, carers and clinicians. The qualitative studies identified targets for improved aftercare engagement, focused on individual context, experiences and needs. CONCLUSION Dedicated older-adult aftercare interventions with a multifaceted, assertive follow-up approach accompanied by systemic change show promise but require further evaluation. Research is needed to explore the utility of needs assessment compared to screening and evaluate efficacy of safety planning and psychotherapeutic approaches.
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Affiliation(s)
- Anne Pf Wand
- Specialty of Psychiatry, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,School of Psychiatry, Faculty of Medicine, University of NSW (UNSW) Sydney, NSW, Australia.,Older Peoples Mental Health Service, Jara Ward, Concord Centre for Mental Health, Sydney Local Health District, Concord, Australia
| | - Roisin Browne
- School of Psychiatry, Faculty of Medicine, University of NSW (UNSW) Sydney, NSW, Australia.,ForeFront Motor Neuron Disease & Frontotemporal Dementia Clinic, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Capacity Australia, Sydney, NSW, Australia
| | - Tiffany Jessop
- School of Psychiatry, Faculty of Medicine, University of NSW (UNSW) Sydney, NSW, Australia.,Capacity Australia, Sydney, NSW, Australia
| | - Carmelle Peisah
- School of Psychiatry, Faculty of Medicine, University of NSW (UNSW) Sydney, NSW, Australia.,Capacity Australia, Sydney, NSW, Australia
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2
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Intergenerational family relationships and the impact of behavioural variant frontotemporal dementia (bvFTD): a qualitative longitudinal study. AGEING & SOCIETY 2022. [DOI: 10.1017/s0144686x22001088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Research concerning the reciprocal influence of relationships and dementia largely focuses on dyadic relationships despite evidence that whole families are affected. Furthermore, such research generally considers more common forms of dementia such as Alzheimer's disease. Behavioural variant fronto-temporal dementia (bvFTD) primarily although not exclusively affects people below the age of 65 and is distinctly different in its impact from more common forms of dementia, affecting social cognition and therefore relational functioning. We aimed to develop a detailed understanding of intergenerational family experiences of bvFTD over time. We adopted a social constructivist and pluralist approach, using Narrative Thematic Analysis and Grounded Theory. We interviewed seven families in their own homes, including the person with bvFTD, at up to three time-points every six to nine months from 2012 to 2014, resulting in 46 interviews with 19 family members. Three super-ordinate themes were identified: Theme 1: We before bvFTD: cohesive and connected – disconnected and distant; Theme 2: Challenges experienced by us; and Theme 3: Relational outcomes: a changing we – an entrenched we. Results emphasise bvFTD brought early and significant disruption to family relationships. The interplay of prior relational functioning, involving the nature of the relationship for family members, the specific impact of bvFTD on these relationships and family member's understanding of bvFTD was critical to how each family fared over the duration of the research, and the relational outcomes they experienced. These findings suggest health-care practice could enhance its support for families living with bvFTD, through the development of tailored, family-oriented approaches to assessment and practice. Such approaches are necessary to understand how families work together and identify interventions that address the family-specific challenges bvFTD brings. The provision of tailored, relational-focused and specialised information concerning the experience of living with bvFTD is needed to flexibly address families' needs and expectations.
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People and their partners living with Parkinson's and other neurodegenerative diseases: systems' diseases that call for systems' approaches. Int Psychogeriatr 2022; 34:601-603. [PMID: 35332860 DOI: 10.1017/s1041610222000291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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4
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Patrini M. Is family therapy effective for people with autism spectrum disorder and their families? A Cochrane Review summary with commentary. Dev Med Child Neurol 2021; 63:133-134. [PMID: 33244771 DOI: 10.1111/dmcn.14757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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5
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Rao GP, Sivakumar PT, Srivastava S, Sidana RC. Cognitive Therapy and Family Intervention for Patients with Dementia and Psychosis. Indian J Psychiatry 2020; 62:S183-S191. [PMID: 32055061 PMCID: PMC7001351 DOI: 10.4103/psychiatry.indianjpsychiatry_769_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 12/16/2019] [Indexed: 11/25/2022] Open
Affiliation(s)
| | | | - Shrikant Srivastava
- Department of Geriatric Mental Health, K. G. Medical University, Lucknow, Uttar Pradesh, India
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6
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Grey T, Fleming R, Goodenough BJ, Xidous D, Möhler R, O'Neill D. Hospital design for older people with cognitive impairment including dementia and delirium: supporting inpatients and accompanying persons. Hippokratia 2019. [DOI: 10.1002/14651858.cd013482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Thomas Grey
- Trinity College Dublin; TrinityHaus, School of Engineering; 16 Westland Row Dublin Leinster Ireland DO2 YY50
| | - Richard Fleming
- University of Wollongong; Dementia Training Australia; Rm. 114, ITAMS Building, Innovation Campus Wollongong NSW Australia 2522
| | - Belinda J Goodenough
- University of Wollongong; Dementia Training Australia; Rm. 114, ITAMS Building, Innovation Campus Wollongong NSW Australia 2522
| | - Dimitra Xidous
- Trinity College Dublin; TrinityHaus, School of Engineering; 16 Westland Row Dublin Leinster Ireland DO2 YY50
| | - Ralph Möhler
- School of Public Health, Bielefeld University; Department of Health Services Research and Nursing Science; Universitätsstrasse 25 Bielefeld Germany 33615
| | - Desmond O'Neill
- Trinity College; Centre for Ageing, Neuroscience and the Humanities; Trinity Centre for Health Sciences, Tallaght Hospital Dublin Ireland 24
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Baruch N, Burgess J, Pillai M, Allan CL. Treatment for depression comorbid with dementia. EVIDENCE-BASED MENTAL HEALTH 2019; 22:167-171. [PMID: 31558560 PMCID: PMC10231626 DOI: 10.1136/ebmental-2019-300113] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 09/10/2019] [Accepted: 09/11/2019] [Indexed: 01/29/2023]
Abstract
Depression is a common comorbidity in dementia. Randomised controlled studies of antidepressants do not show a significant improvement in depressive symptoms in patients with comorbid dementia and are known to lead to an increase in side effects. However, there are relatively few studies of depression in dementia, and drawing firm conclusions about the use of antidepressants is limited by the amount of data available. Furthermore, it is unclear whether data can be extrapolated from similar populations (eg, those with late-life depression) to inform pharmacotherapy in this patient group. Given the lack of effectiveness and risk of side effects associated with pharmacological treatments, psychological interventions may offer important therapeutic benefits. There is evidence for the effectiveness of individual psychological therapy, and further research will establish which psychological approach is the most effective. Some studies have shown an improvement in depressive symptoms using structured sleep hygiene programmes, exercise, arts interventions and music therapy. These studies are hampered by small data sets, and the benefits to individuals may not be well captured by standard outcome measures. At present, the best evidence for arts-based approaches is in music therapy. Depression with comorbid dementia responds well to electroconvulsive therapy and this is a useful treatment modality for those with severe or life-threatening depressive symptoms. Alternative neurostimulation techniques such as transcranial magnetic stimulation are not widely used at present and further research is needed before they can be a more widely used treatment modality.
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Affiliation(s)
- Nina Baruch
- Oxford Health NHS Foundation Trust, Oxford, Oxfordshire, UK
| | - Jennifer Burgess
- Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
- University of Newcastle, Newcastle upon Tyne, UK
| | - Manjunadh Pillai
- Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Charlotte Louise Allan
- Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
- University of Newcastle, Newcastle upon Tyne, UK
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8
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Wand APF, Peisah C, Draper B, Brodaty H. Carer insights into self-harm in the very old: A qualitative study. Int J Geriatr Psychiatry 2019; 34:594-600. [PMID: 30592092 DOI: 10.1002/gps.5057] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 12/20/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine the insights of carers to better understand self-harm in their older relatives. METHODS An in-depth interview was conducted with the nominated relative/friend (carer) of a person over 80 who had self-harmed within the last month. Carer interpretation and experience of the self-harm and clinical care were explored qualitatively. Audio recordings were transcribed and the content thematically analyzed using N-VIVO. RESULTS Thirty-two carers of 30 older people who self-harmed were interviewed. Physical, social, and psychological issues were identified as contributory to self-harm. Themes relating to the perceived barriers to seeking help included "they can't communicate," "suicide and secrets," and "invalidation." Themes for the intent of self-harm were "attention seeking" and "wanting to die." Themes which emerged for consequences of self-harm for carers were "anger," "guilt and self-blame," and "it made us ill." Themes for solutions to address the underlying factors leading to self-harm were "more practical support and structure," "improving communication," "removing means of self-harm," "advance care directives as a solution for suffering," and "ignoring self-harm." Clinical care themes were "shared shame and stigma," "safety and supervision vs being locked up," "clinicians dismissing the carer," and "relief and support." CONCLUSIONS Validation of carer perspectives and understanding family dynamics may improve communication at various system levels and inform interventions for older persons, concurrently support families, and potentially reduce risk of repeat self-harm. Good care must be holistic, be person-centred, and relieve carer burden. A shared understanding and psychotherapeutic approaches to management of self-harm in late life should be considered.
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Affiliation(s)
- Anne Pamela Frances Wand
- Academic Department of Aged Care Psychiatry, Prince of Wales Hospital, Sydney, New South Wales, Australia.,Discipline of Psychiatry, School of Medicine, University of New South Wales, Sydney, Australia
| | - Carmelle Peisah
- Discipline of Psychiatry, School of Medicine, University of New South Wales, Sydney, Australia.,Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Brian Draper
- Academic Department of Aged Care Psychiatry, Prince of Wales Hospital, Sydney, New South Wales, Australia.,Discipline of Psychiatry, School of Medicine, University of New South Wales, Sydney, Australia
| | - Henry Brodaty
- Academic Department of Aged Care Psychiatry, Prince of Wales Hospital, Sydney, New South Wales, Australia.,Dementia Centre for Research Collaboration and Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
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Edwards HB, Ijaz S, Whiting PF, Leach V, Richards A, Cullum SJ, Cheston RIL, Savović J. Quality of family relationships and outcomes of dementia: a systematic review. BMJ Open 2018; 8:e015538. [PMID: 29358414 PMCID: PMC5780722 DOI: 10.1136/bmjopen-2016-015538] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To evaluate the association between the quality of relationship between a person with dementia and their family carer and outcomes for the person with dementia. DESIGN Systematic review. ELIGIBILITY CRITERIA Cohort studies of people with clinically diagnosed dementia and their main carers. Exposures of interest were any elements of relationship quality, for example, attachment style, expressed emotion and coping style. Our primary outcome was institutionalisation, and secondary outcomes were hospitalisation, death, quality of life and behavioural and psychiatric symptoms of dementia ('challenging behaviour'). DATA SOURCES MEDLINE, Embase, Web of Science, PsycInfo, the Cochrane Library and Opengrey were searched from inception to May 2017. STUDY APPRAISAL AND SYNTHESIS METHODS The Newcastle-Ottawa Scale was used to assess risk of bias. A narrative synthesis of results was performed due to differences between studies. RESULTS Twenty studies were included. None of the studies controlled for all prespecified confounding factors (age, gender, socioeconomic status and severity of dementia). Reporting of results was inadequate with many studies simply reporting whether associations were 'statistically significant' without providing effect size estimates or CIs. There was a suggestion of an association between relationship factors and global challenging behaviour. All studies evaluating global challenging behaviour provided statistical evidence of an association (most P values below 0.02). There was no consistent evidence for an association for any other outcome assessed. CONCLUSIONS There is currently no strong or consistent evidence on the effects of relationship factors on institutionalisation, hospitalisation, death or quality of life for people with dementia. There was a suggestion of an association between relationship factors and challenging behaviour, although the evidence for this was weak. To improve our ability to support those with dementia and their families, further robust studies are needed. PROSPERO REGISTRATION NUMBER CRD42015020518.
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Affiliation(s)
- Hannah B Edwards
- Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Sharea Ijaz
- Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Penny F Whiting
- Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Verity Leach
- Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Alison Richards
- Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Sarah J Cullum
- Psychological Medicine, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Richard IL Cheston
- Department of Health and Social Sciences, University of the West of England, Bristol, UK
| | - Jelena Savović
- Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
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10
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Rolland JS. Neurocognitive Impairment: Addressing Couple and Family Challenges. FAMILY PROCESS 2017; 56:799-818. [PMID: 28887888 DOI: 10.1111/famp.12316] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Conditions involving neurocognitive impairment pose enormous challenges to couples and families. However, research and practice tend to focus narrowly on immediate issues for individual caregivers and their dyadic relationship with the affected member. A broad family systems approach with attention to family processes over time is needed in training, practice, and research. In this paper, Rolland's Family Systems Illness model provides a guiding framework to consider the interaction of different psychosocial types of neurocognitive conditions and their evolution over time with individual, couple, and family life-course development. Discussion addresses key family and couple issues with mild-to-severe cognitive impairment and progressive dementias, including: communication, multigenerational legacies, threatened future neurocognitive disability, ambiguous loss, decisional capacity, reaching limits, placement decisions, issues for adult children and spousal caregivers, and the transformation of intimate bonds. Principles and guidelines are offered to help couples and families master complex challenges, deepen bonds, and forge positive pathways ahead.
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Affiliation(s)
- John S Rolland
- Department of Psychiatry and Behavioral Science, Northwestern University Feinberg School of Medicine, and Chicago Center for Family Health, Chicago, IL
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11
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Pin S, Spini D. Meeting the Needs of the Growing Very Old Population: Policy Implications for a Global Challenge. J Aging Soc Policy 2017; 28:218-31. [PMID: 27110727 DOI: 10.1080/08959420.2016.1181972] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Very old adults are one of the fastest-growing age groups worldwide. Yet they rarely constitute a targeted group for public policies. Drawing on the results of the centenarian studies presented in this special issue, we highlight major challenges that arise from the increase of this population. We outline several promising approaches for policy makers and professionals to develop evidence-based policies and programs that are tailored to the needs of very old adults and their families. We focus our discussion on three key topics essential to life care: the importance of integrated care to meet the complex care needs of the very old; the balance between formal and informal care; and the development of suitable places for living. Besides more specific measures, we propose that policies promoting the social integration of very old adults in their communities would be particularly helpful, as these may benefit not only the very old and their families but also individuals of all ages. We conclude that the development of suitable policies addressing the needs of the very old will benefit from future investigation of cross-cultural similarities and differences in centenarians' characteristics, available services, as well as life conditions they encounter in communities and institutional contexts.
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Affiliation(s)
- Stephanie Pin
- a Institute of Social Sciences, University of Lausanne , Lausanne , Switzerland
| | - Dario Spini
- a Institute of Social Sciences, University of Lausanne , Lausanne , Switzerland
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Cheston R, Ivanecka A. Individual and group psychotherapy with people diagnosed with dementia: a systematic review of the literature. Int J Geriatr Psychiatry 2017; 32:3-31. [PMID: 27388259 DOI: 10.1002/gps.4529] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 05/16/2016] [Accepted: 05/27/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Psychotherapy provides a means of helping participants to resolve emotional threats and play an active role in their lives. Consequently, psychotherapy is increasingly used within dementia care. This paper reviews the existing evidence base for individual and group psychotherapy with people affected by dementia. DESIGN The protocol was registered. We searched electronic databases, relevant websites and reference lists for records of psychotherapy with people affected by Alzheimer's Disease, Vascular dementia, Lewy-body dementia or a mixed condition between 1997 and 2015. We included studies of therapies which met British Association of Counselling and Psychotherapy definitions (e.g. occurs regularly, focuses on talking about life events and facilitates understand of the illness). Art therapy, Cognitive Stimulation and Rehabilitation, Life Review, Reminiscence Therapy and family therapy were excluded. Studies which included people with frontal-temporal dementia and mild cognitive impairment were excluded. Data was extracted using a bespoke form, and risk of bias assessments were carried out independently by both authors. Meta-analysis was not possible because of the heterogeneity of data. RESULTS A total of 1397 papers were screened with 26 papers using randomised, non-randomised controlled trials or repeated measured designs being included. A broad mix of therapeutic modalities, types, lengths and settings were described, focussing largely on people with mild levels of cognitive impairment living in the community. CONCLUSIONS This study was limited to only those studies published in English. The strongest evidence supported the use of short-term group therapy after diagnosis and an intensive, multi-faceted intervention for Nursing Home residents. Many areas of psychotherapy need further research. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Richard Cheston
- University of the West of England, Faculty of Health and Applied Sciences, Bristol, UK
| | - Ada Ivanecka
- University of the West of England, Faculty of Health and Applied Sciences, Bristol, UK
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Jones C, Peisah C. Working alliances not loggerheads: understanding and addressing dissonance between families and treating teams in older people's mental health. Australas Psychiatry 2015; 23:488-92. [PMID: 25788570 DOI: 10.1177/1039856215576421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
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.
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Affiliation(s)
- Carolyn Jones
- Staff Specialist, Sydney Local Health District, Marrickville, NSW, and; Visiting Medical Officer, Aged Care Psychiatry, Coffs Harbour Health Campus, Mid North Coast Local Health District, NSW, Australia
| | - Carmelle Peisah
- Conjoint Associate Professor of Psychiatry, University of New South Wales, Sydney, NSW, and; Clinical Associate Professor of Psychiatry, University of Sydney, Sydney, NSW, and; Clinical Director, Specialist Mental Health Services for Older People, Northern Sydney Local Health District, NSW, Australia
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