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Vandersman P, Chakraborty A, Rowley G, Tieman J. The matter of grief, loss and bereavement in families of those living and dying in residential aged care setting: A systematic review. Arch Gerontol Geriatr 2024; 124:105473. [PMID: 38728822 DOI: 10.1016/j.archger.2024.105473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/23/2024] [Accepted: 05/03/2024] [Indexed: 05/12/2024]
Abstract
The grief, loss and bereavement needs of the families of those living and dying in residential aged care setting is not very well understood. This systematic review examines grief, loss, and bereavement experience of, and interventions relating to, family caregivers of those entering, living and dying in residential aged care. Out of 2023 papers that were identified, 35 met the inclusion criteria which included (n=28) qualitative and (n=7) quantitative intervention studies. The qualitative findings indicated quality of care provided to the resident at the end of their life, and after death care influenced family caregivers' grief reactions. The intervention studies revealed that educational interventions have the potential to lead to some benefits in the context of grief loss and bereavement outcomes. Recognizing the emotional experiences and support needs of families and carers may enhance the understanding of the ageing, caring, dying, grieving pathway for older people and their families.
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Affiliation(s)
- Priyanka Vandersman
- Research Centre for Palliative Care, Death, and Dying, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia.
| | - Amal Chakraborty
- Faculty of Medicine and Health, University Centre for Rural Health, The University of Sydney, Sydney, Australia
| | - Georgia Rowley
- School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Jennifer Tieman
- Research Centre for Palliative Care, Death, and Dying, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
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White J, Falcioni D, Barker R, Bajic-Smith J, Krishnan C, Mansfield E, Hullick C. Persisting gaps in dementia carer wellbeing and education: A qualitative exploration of dementia carer experiences. J Clin Nurs 2024. [PMID: 39152552 DOI: 10.1111/jocn.17404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 07/30/2024] [Accepted: 08/02/2024] [Indexed: 08/19/2024]
Abstract
AIMS To explore the emotional wellbeing of dementia carers in the lead up to and during transition of a person living with dementia to a residential aged care facility. DESIGN An interpretative qualitative study. METHODS Semi-structured interviews were conducted with informal carers of person living with dementia between February and June 2023. Data were analysed using an inductive thematic approach and resulted in three themes. RESULTS The majority of carers were adult children (n = 19) and six were wives. Carers lived across metropolitan (n = 20) and regional settings (n = 5) in the most populous state of Australia. Three themes were identified which were attributed to different aspects of the carer role: (1) Carer emotional journey as dementia progresses - impacted by knowledge and lack of support; (2) Questioning decision making-underpinned by knowledge and confidence; and (3) Challenges in re-establishing identity - impacted by ongoing concerns. CONCLUSION As dementia progresses carers of person living with dementia consistently reported gaps in knowledge including how to access support. Specifically, this study identified the need for more to be done to help carers to develop the skills needed for their role, including participation in care planning and identifying care preferences for the future. Nurses can play a key role in promoting referral to services that support carers. Findings offer practical solutions to ameliorate carer stress and promote shared decision making. REPORTING METHOD This research was guided by the Consolidated Criteria for Reporting Qualitative Research.
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Affiliation(s)
- Jennifer White
- College of Health Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, Newcastle NSW, Australia
| | - Dane Falcioni
- College of Health Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, Newcastle NSW, Australia
| | - Roslyn Barker
- Hunter New England Local Health District, New Lambton Heights, New South Wales, Australia
| | | | - Chitra Krishnan
- Hunter New England Local Health District, New Lambton Heights, New South Wales, Australia
| | - Elise Mansfield
- College of Health Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, Newcastle NSW, Australia
| | - Carolyn Hullick
- Hunter Medical Research Institute, New Lambton Heights, Newcastle NSW, Australia
- Hunter New England Local Health District, New Lambton Heights, New South Wales, Australia
- Australian Commission of Safety and Quality in Health Care, Sydney, New South Wales, Australia
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Iwasaki Y, Fukahori H, Okumura-Hiroshige A, Sakai I, Inoue S, Sugiyama T, Nasu K, Ogawara H. Family Caregivers' Needs in Long-Term Care Facilities: A Descriptive Qualitative Study. Res Gerontol Nurs 2024; 17:177-187. [PMID: 38916473 DOI: 10.3928/19404921-20240614-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
PURPOSE To explore the needs of family caregivers (FCs) and how these are addressed in long-term care facilities (LTCFs). METHOD A descriptive qualitative study was performed, using semi-structured interviews with 23 FCs from seven LTCFs in Japan. RESULTS Inductive content analysis revealed three main themes: Coexistent Needs Related to Residents' and FCs' Own Well-Being, Means by Which FCs Promote Residents' and Their Own Well-Being, and Managing Conflicting Needs by Prioritizing and Compromising. FCs recognized that their needs relate to the well-being of residents and themselves, and both needs coexist. To address these multifaceted needs, FCs engaged in various activities while seeking support. However, limited availability of means often made it challenging to meet multiple needs simultaneously, leading FCs to manage these conflicting needs by prioritizing or compromising. CONCLUSION The current study underscores the significance of comprehensive support that simultaneously addresses FCs' conflicting needs, rather than approaching each need separately. [Research in Gerontological Nursing, 17(4), 177-187.].
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Brooks D, Wyles K, Pachana NA, Beattie E, Gaugler JE. Tailored videoconferencing counselling program to support family carers of people living with dementia during the transition to permanent residential care: a pilot and feasibility randomised trial. BMC Geriatr 2024; 24:375. [PMID: 38671367 PMCID: PMC11055339 DOI: 10.1186/s12877-024-04907-4] [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] [Received: 10/10/2023] [Accepted: 03/20/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Decisions surrounding the permanent residential care placement of people living with dementia can be stressful and distressing; however, providing access to targeted information and support prior to placement may help carers better cope. This mixed methods study aimed to test the feasibility, acceptability, and potential benefits of providing a tailored, individual counselling program (the Residential Care Transition Module), delivered via videoconferencing, to Australian family carers of a relative with dementia during the transition to permanent residential care. METHODS A total of 18 family carers were randomly allocated to receive either the counselling intervention (six sessions delivered over 12 weeks) or a check-in call, delivered by a trained Transition Counsellor. Both groups received help-sheets about residential care, coping with placement, and managing feelings. Carers completed online surveys about stress, guilt, anxiety, depression, grief, and support for caring at baseline and four months post-baseline. Carers were also invited to participate in semi-structured exit interviews, conducted after follow-up surveys were completed. Process data relating to recruitment, retention, intervention dose and delivery were collected via logs. Quantitative data were analysed using descriptive statistics and repeated measures ANOVA. Qualitative data, relating to feasibility, acceptability, and perceived benefits of the program, were analysed using the 'framework' approach developed by the Medical Research Council to inform the process evaluation of complex interventions. RESULTS Qualitative findings indicated that delivery of the counselling program during the transition period was deemed by participants to be feasible and acceptable. Delivery via videoconferencing was deemed convenient and acceptable, with few technical issues. The skills and knowledge of the Transition Counsellor were perceived to be important mechanisms of impact. Though not statistically significant, promising quantitative findings were identified in terms of reduced carer stress and guilt and improved support for caring. CONCLUSIONS Delivery of a tailored counselling program via videoconferencing to family carers of people living with dementia during the transition to residential care was feasible and acceptable. The program has the potential to improve transitional support to family carers. TRIAL REGISTRATION This study was registered in the Australian New Zealand Clinical Trials Registry: ACTRN12621001462875.
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Affiliation(s)
- Deborah Brooks
- School of Nursing, Queensland University of Technology, Brisbane, Australia.
- The University of Queensland Centre for Clinical Research, Brisbane, Australia.
| | - Katy Wyles
- School of Nursing, Queensland University of Technology, Brisbane, Australia
| | - Nancy A Pachana
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Elizabeth Beattie
- School of Nursing, Queensland University of Technology, Brisbane, Australia
| | - Joseph E Gaugler
- School of Psychology, The University of Queensland, Brisbane, Australia
- School of Public Health, University of Minnesota, Minneapolis, MN, USA
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Nishimura M, Harrison Dening K, Sampson EL, Vidal EIDO, Nakanishi M, Davies N, Abreu W, Kaasalainen S, Eisenmann Y, Dempsey L, Moore KJ, Bolt SR, Meijers JMM, Dekker NL, Miyashita M, Nakayama T, van der Steen JT. A palliative care goals model for people with dementia and their family: Consensus achieved in an international Delphi study. Palliat Med 2024; 38:457-470. [PMID: 38634232 PMCID: PMC11025301 DOI: 10.1177/02692163241234579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
BACKGROUND Advance care planning in dementia includes supporting the person and their family to consider important goals of care. International research reports the importance of psycho-social-spiritual aspects towards end of life. AIM To develop a multidimensional international palliative care goals model in dementia for use in practice. DESIGN International Delphi study integrating consensus and evidence from a meta-qualitative study. The Delphi panel rated statements about the model on a 5-point agreement scale. The criteria for consensus were pre-specified. SETTING/PARTICIPANTS Seventeen researchers from eight countries developed an initial model, and 169 candidate panellists were invited to the international online Delphi study. RESULTS Panellists (107; response 63.3%) resided in 33 countries. The model comprised four main care goals: (1) Comfort ensured; (2) Control over function maintained; (3) Identity protected and personhood respected and (4) Coping with grief and loss-person and caregiver supported. The model reflects how needs and care goals change over time with the progression of dementia, concluding with bereavement support. The first version of the model achieved a consensus after which it was slightly refined based on feedback. We did not achieve a consensus on adding a goal of life prolongation, and on use of the model by people with dementia and family themselves. CONCLUSION A new palliative care goals model for people with dementia and their families includes relationship aspects for use by professionals and achieved a consensus among a panel with diverse cultural background. The position of life prolongation in relation to palliative care goals needs further research.
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Affiliation(s)
- Mayumi Nishimura
- Department of Health Informatics, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto Prefecture, Japan
| | | | - Elizabeth L Sampson
- Royal London Hospital and Centre for Psychiatry and Mental health, East London NHS Foundation Trust, London, UK
- Wolfson Institute of Population Health, Queen Mary University London, London, UK
| | | | - Miharu Nakanishi
- Department of Psychiatric Nursing, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Nathan Davies
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Wilson Abreu
- Center for Health Technology and Ser- vices Research, University of Porto (ESEP/CINTESIS), Porto, Portugal
| | | | - Yvonne Eisenmann
- Department of Palliative Medicine, University Hospital of Cologne, Cologne, North Rhine-Westphalia, Germany
| | - Laura Dempsey
- Department of Nursing and Healthcare, Technological University of the Shannon: Midlands Midwest, Athlone, Ireland
| | - Kirsten J Moore
- National Ageing Research Institute, Parkville, VIC, Australia
- Medicine-Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia
| | - Sascha R Bolt
- Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, North Brabant, The Netherlands
| | - Judith MM Meijers
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, Limburg, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
- Zuyderland Care, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | - Natashe Lemos Dekker
- Institute of Cultural Anthropology and Development Sociology, Leiden University, Leiden, South Holland, The Netherlands
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Takeo Nakayama
- Department of Health Informatics, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto Prefecture, Japan
| | - Jenny T van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, South Holland, The Netherlands
- Department of Primary and Community Care, Radboud University, Nijmegen, The Netherlands
- Cicely Saunders Institute, King’s College London, UK
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Taranrød LB, Kirkevold Ø, Pedersen I, Eriksen S. The transition of care from farm-based daycare for people with dementia: The perspective of next of kin. Int J Qual Stud Health Well-being 2023; 18:2228047. [PMID: 38016039 PMCID: PMC10291912 DOI: 10.1080/17482631.2023.2228047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 06/18/2023] [Indexed: 11/30/2023] Open
Abstract
PURPOSE The aim of the present study was to explore the next of kin's experiences with the transition for people with dementia from a farm-based daycare (FDC) to another service in the municipality. METHODS The study has a qualitative, descriptive design. Eight semi-structured interviews with next of kin were conducted. The data were analysed in accordance with content analysis. RESULTS Through the analysis three main categories were developed: (1) Bearing the burden, (2) Being in transition, and (3) Feeling supported. The transition period was highly stressful for next of kin due to the exacerbation of their relatives' dementia symptoms. The next of kin focussed on optimizing the everyday lives of their relatives with dementia, even at the expense of their own well-being. Most participants experienced support from FDC, healthcare services and their informal network. CONCLUSIONS The study contributes important insights into the next of kin's experiences. Good quality service, close dialog, information, and support between the different part in the transition process, can be useful for the further development of services with good quality and to reduce the negative effects of care on next of kin.
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Affiliation(s)
- Liv Bjerknes Taranrød
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Øyvind Kirkevold
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Centre for Age Related Functional Decline and Diseases (AFS) at Innlandet Hospital Trust, Hamar, Norway
- Department of Health Sciences in Gjøvik, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway
| | - Ingeborg Pedersen
- Department of Public Health Science, Ås, Norway, Norwegian University of Life Sciences, Ås, Norway
| | - Siren Eriksen
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Bachelor of Nursing, Lovisenberg Diaconal University College, Oslo, Norway
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Radcliffe KG, Halim M, Ritchie CS, Maus M, Harrison KL. Care Setting Transitions for People With Dementia: Qualitative Perspectives of Current and Former Care Partners. Am J Hosp Palliat Care 2023; 40:1310-1316. [PMID: 36730920 PMCID: PMC10394111 DOI: 10.1177/10499091231155601] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Care partners (CP) of people with dementia (PWD) report that decisions about care setting are aided by the support of healthcare providers. However, providers are often underprepared to offer adequate counseling. This qualitative study aimed to identify what support from providers will assist CPs in making decisions related to care setting throughout the dementia journey. We conducted semi-structured interviews with current CPs of PWD and former CPs of decedents. We utilized the constant comparative method to identify themes regarding preferences around care setting as the PWD progressed from diagnosis to end-of-life. Participants were 31 CPs, including 16 current and 15 former CPs. CPs had a mean age of 67 and were primarily white (n = 23/31), female (n = 21/31), and spouses (n = 24/31). Theme 1: Current CPs discussed overwhelming uncertainty pertaining to care setting, expressing "I don't know when I need to plan on more care," and a desire to understand "what stage we are at." Theme 2: Later in the disease, former CPs wanted guidance from healthcare providers on institutional placement ("I sure would've loved some help finding better places") or support to stay in the home ("a doctor had to come to the house"). CPs want early, specific guidance from healthcare providers related to transitions between home and long-term care. Early in the disease course, counseling geared toward prognosis and expected disease course helps CPs make plans. Later, caregivers want help identifying locations or institutionalization or finding home care resources.
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Affiliation(s)
- Kate G Radcliffe
- UC Berkeley-UCSF Joint Medical Program, University of California at Berkeley, Berkeley, CA, USA
- School of Medicine, University of California at San Francisco, San Francisco, CA, USA
| | - Madina Halim
- Division of Geriatrics, Department of Medicine, University of California at San Francisco, San Francisco, CA, USA
| | - Christine S Ritchie
- Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Marlon Maus
- School of Public Health, University of California at Berkeley, Berkeley, CA, USA
| | - Krista L Harrison
- Division of Geriatrics, Department of Medicine, University of California at San Francisco, San Francisco, CA, USA
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
- Global Brain Health Institute, University of California, San Francisco, CA, USA
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Groenvynck L, Khemai C, de Boer B, Beaulen A, Hamers JPH, van Achterberg T, van Rossum E, Meijers JMM, Verbeek H. The perspectives of older people living with dementia regarding a possible move to a nursing home. Aging Ment Health 2023; 27:2377-2385. [PMID: 37099667 DOI: 10.1080/13607863.2023.2203693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 04/04/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND/OBJECTIVES Moving into a nursing home is often an unavoidable life event for older people living with dementia. It is associated with negative emotions and outcomes. Research capturing their perspectives is scarce. This study aims to identify how older people living with dementia perceive a potential life in a nursing home and to understand their (future) care wishes. MATERIALS AND METHODS This study is part of the European TRANS-SENIOR research network. The study followed a qualitative phenomenological methodology. Semi-structured interviews with 18 community-dwelling older people living with dementia were conducted between August 2018 and October 2019 (METCZ20180085). A stepwise interpretive phenomenological analysis was performed. RESULTS The majority of community-dwelling older people feared the idea of potentially moving to a nursing home. The participants associated a possible move with negative perceptions and emotions. Additionally, this study emphasized the importance of knowledge of current and past experiences with care when identifying the participant's wishes. They wanted to remain (a) individuals, who are (b) autonomous and have (c) social contacts if they would move to a nursing home. DISCUSSION/IMPLICATIONS This study showed how past and current care experiences can educate/inform healthcare professionals on the future care wishes of older people living with dementia. The results indicated that listening to the wishes, and life stories of people living with dementia could be a way of identifying 'a suitable time' to suggest a move to a nursing home. This could improve the transitional care process and adjustment to living in a nursing home.
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Affiliation(s)
- Lindsay Groenvynck
- Maastricht University, Care and Public Health Research Institute, Department of Health Services Research, Maastricht, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
- KU Leuven, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Leuven, Belgium
| | - Chandni Khemai
- Maastricht University, Care and Public Health Research Institute, Department of Health Services Research, Maastricht, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Bram de Boer
- Maastricht University, Care and Public Health Research Institute, Department of Health Services Research, Maastricht, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Audrey Beaulen
- Maastricht University, Care and Public Health Research Institute, Department of Health Services Research, Maastricht, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Jan P H Hamers
- Maastricht University, Care and Public Health Research Institute, Department of Health Services Research, Maastricht, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Theo van Achterberg
- KU Leuven, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Leuven, Belgium
| | - Erik van Rossum
- Maastricht University, Care and Public Health Research Institute, Department of Health Services Research, Maastricht, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
- Zuyd University of Applied Sciences, Academy of Nursing, Research centre on Community Care, Heerlen, The Netherlands
| | - Judith M M Meijers
- Maastricht University, Care and Public Health Research Institute, Department of Health Services Research, Maastricht, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
- Zuyderland Care, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | - Hilde Verbeek
- Maastricht University, Care and Public Health Research Institute, Department of Health Services Research, Maastricht, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
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Bjørge H, Halvorsrud L, Goyal AR. Always on alert: How relatives of family members with dementia experience the transition from home to permanent nursing home placement. Nurs Open 2023; 10:6300-6308. [PMID: 37345273 PMCID: PMC10416068 DOI: 10.1002/nop2.1877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 05/05/2023] [Accepted: 05/29/2023] [Indexed: 06/23/2023] Open
Abstract
AIM Our aim was to gain insight into how the relatives of family members with dementia have experienced their family members' transition from home to permanent nursing home placement. DESIGN Our research was a qualitative case study. METHODS Inspired by Kvale and Brinkmann's phenomenological-hermeneutic approach, we performed the thematic analysis of semi-structured interviews describing how the relatives of family members with dementia have experienced the dementia trajectory. RESULTS Twelve relatives of family members with dementia living in nursing homes agreed to participate. The descriptions of relatives' experiences indicated four primary themes: mismatches between healthcare services and the family members' needs, witnessing the family members' cognitive decline, the effects of the experiences on the relatives' health and well-being and what matters to the relatives during their family members' transition to nursing home. Mismatches between available resources in the municipalities and the family members' healthcare needs were the most distressing experiences, along with the family members' gradual cognitive decline. In response, the relatives stressed individualized support, continuity in follow-up care and regular information-sharing between them and staff members caring for their family members. They also highlighted the importance of facilitating seamless transitions from home to nursing homes.
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Affiliation(s)
| | - Liv Halvorsrud
- Oslo Metropolitan UniversityOsloMetNorway
- Østfold University CollegeHaldenNorway
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Bermejo Gómez I, Gallego-Alberto L, Losada Baltar A, Mérida Herrera L, García Batalloso I, Márquez-González M. [Anticipatory grief in family caregivers of persons with dementia. Psychosocial correlates and impact on caregiver's health: A literature review]. Rev Esp Geriatr Gerontol 2023; 58:101374. [PMID: 37246011 DOI: 10.1016/j.regg.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 04/08/2023] [Accepted: 05/02/2023] [Indexed: 05/30/2023]
Abstract
INTRODUCTION Taking care of a relative with dementia may be linked to negative consequences for the caregiver. One of the processes that can be experienced is anticipatory grief, that is defined as the feelings of pain and loss that appear in the caregiver before the death of the person cared for. OBJECTIVES The review aimed to conceptualize anticipatory grief in this population, to study the related psychosocial variables, and to know the repercussions for the health of the caregiver. METHOD A systematic search was made under the directives of PRISMA statement in the ProQuest, PubMed, Web of Science (WOS), and Scopus databases, including studies published in the last 10 years (2013-2023). RESULTS A total of 160 articles were obtained, 15 being finally selected. It is observed that anticipatory grief is defined as an ambiguous process since it appeared before the death of the sick family member. Being a female caregiver, spouse of a family member with dementia, having a closer relationship with him and/or having an important responsibility in care, are associated with a greater chance of experiencing anticipatory grief. In relation to the person cared for, if he or she is in a severe phase of the disease, is younger, and/or presents problematic behaviours, there is also greater anticipatory grief in the family caregiver. Anticipatory grief has a significant impact on caregivers' physical, psychological, and social health, being associated with greater burden, depressive symptomatology, and social isolation. CONCLUSIONS Anticipatory grief turns out to be a relevant concept in the context of dementia, being necessary to include it in intervention programs for this population.
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Affiliation(s)
- Isabel Bermejo Gómez
- Departamento de Psicología Biológica y de la Salud, Facultad de Psicología, Universidad Autónoma de Madrid, Madrid, España.
| | - Laura Gallego-Alberto
- Departamento de Psicología Biológica y de la Salud, Facultad de Psicología, Universidad Autónoma de Madrid, Madrid, España
| | - Andrés Losada Baltar
- Departamento de Psicología, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Madrid, España
| | - Laura Mérida Herrera
- Departamento de Psicología Biológica y de la Salud, Facultad de Psicología, Universidad Autónoma de Madrid, Madrid, España
| | - Inés García Batalloso
- Departamento de Psicología Biológica y de la Salud, Facultad de Psicología, Universidad Autónoma de Madrid, Madrid, España
| | - María Márquez-González
- Departamento de Psicología Biológica y de la Salud, Facultad de Psicología, Universidad Autónoma de Madrid, Madrid, España
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Meziane-Damnée S, Bayle C, Pino M, Lenoir H, Cantegreil I, Rigaud AS. [A psycho-educational program for family caregivers of people with Alzheimer's disease entering an institution]. SOINS. GERONTOLOGIE 2023; 28:20-23. [PMID: 37328202 DOI: 10.1016/j.sger.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
The caregiver of a loved one suffering from a chronic pathology (Alzheimer's disease, Parkinson's disease, stroke, etc.) can be in psychological distress at all stages of the disease, including when the loved one enters an institution. We have designed and implemented a psycho-educational program for family caregivers of institutionalized patients. A preliminary study showed that this program was feasible, gave satisfaction to the caregivers and improved their understanding of the functioning of the institution, their communication with the professionals of the institution and their relationship with their relative in the institution. The program allowed caregivers to find their place within the institution by redefining their role.
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Affiliation(s)
- Souad Meziane-Damnée
- Université Paris Cité, Maladie d'Alzheimer, F-75013 Paris, France; Service gériatrie 1 et 2, AP-HP, Hôpital Broca, F-75013 Paris, France.
| | - Catherine Bayle
- Service gériatrie 1 et 2, AP-HP, Hôpital Broca, F-75013 Paris, France
| | - Maribel Pino
- Université Paris Cité, Maladie d'Alzheimer, F-75013 Paris, France; Service gériatrie 1 et 2, AP-HP, Hôpital Broca, F-75013 Paris, France
| | - Hermine Lenoir
- Université Paris Cité, Maladie d'Alzheimer, F-75013 Paris, France; Service gériatrie 1 et 2, AP-HP, Hôpital Broca, F-75013 Paris, France
| | - Inge Cantegreil
- Université Paris Cité, Maladie d'Alzheimer, F-75013 Paris, France; Service gériatrie 1 et 2, AP-HP, Hôpital Broca, F-75013 Paris, France
| | - Anne-Sophie Rigaud
- Université Paris Cité, Maladie d'Alzheimer, F-75013 Paris, France; Service gériatrie 1 et 2, AP-HP, Hôpital Broca, F-75013 Paris, France
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12
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Cho SH, Choi HS. Effect of Types of Dementia Care on Quality of Life and Mental Health Factors in Caregivers of Patients with Dementia: A Cross-Sectional Study. Healthcare (Basel) 2023; 11:healthcare11091245. [PMID: 37174787 PMCID: PMC10178038 DOI: 10.3390/healthcare11091245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
In Eastern cultures, particularly in South Korea, caregiving for dementia patients at home is common, yet even after facility placement, families may experience ongoing burden due to cultural factors. The aim of this study was to examine the burden experienced by caregivers of dementia patients, considering cultural factors influencing in-home care and facility-based care. Using a cross-sectional study design, we compared the quality of life, depression, subjective happiness, and subjective health of family caregivers providing in-home care (FCHC) and informal family caregivers (IFCGs). Data from the 2019 Community Health Survey conducted by the Korea Disease Control and Prevention Agency (KDCA) that met the study criteria were selected and statistically analyzed. The results showed that psychological/emotional and economic burdens were the primary burden factors for both FCHC and IFCGs. Statistically significant differences were found between the two groups in terms of quality of life, depression, subjective happiness, and subjective health. Specifically, FCHC demonstrated a lower quality of life, and both groups experienced moderate to severe depression, indicating the need for mental health management for caregivers of individuals with dementia. As not all FCHC can be transitioned to IFCGs, interventions tailored to specific caregiving types should be developed to improve the quality of life, depression, subjective happiness, and subjective health of caregivers of individuals with dementia.
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Affiliation(s)
- Seung-Hyun Cho
- Department of Occupational Therapy, College of Health Sciences and Social Welfare, Woosuk University, Wanju 55338, Republic of Korea
| | - Hyun-Se Choi
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea
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13
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Mitchell LL, Horn B, Stabler H, Birkeland RW, Peterson CM, Albers EA, Gaugler JE. Caring for a Relative With Dementia in Long-Term Care During the COVID-19 Pandemic: A Prospective Longitudinal Study. Innov Aging 2023; 7:igad034. [PMID: 37213326 PMCID: PMC10195573 DOI: 10.1093/geroni/igad034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Indexed: 05/23/2023] Open
Abstract
Background and Objectives The coronavirus disease 2019 (COVID-19) pandemic introduced unprecedented threats and disruptions for caregivers of people with dementia living in residential long-term care (LTC) facilities. Qualitative and cross-sectional studies have reported substantial negative effects of the pandemic on dementia caregivers' well-being, but little to no prospective research has examined the impact of COVID-19 on caregiver well-being using pre-pandemic assessments. The present study used longitudinal data from an ongoing randomized controlled trial of a psychosocial intervention to support family caregivers whose relatives had entered LTC. Research Design and Methods Data collection began in 2016 and continued through 2021. Caregivers (N = 132) completed up to 7 assessments measuring their depressive symptoms, self-efficacy, and burden. Results Latent growth curve models testing preregistered hypotheses revealed no significant effects of the pandemic on caregiver outcomes on average, though caregivers varied in terms of individual intercepts and slopes. Furthermore, factors such as caregiver-care recipient relationship closeness, care recipient's COVID-19 infection status, and caregivers' ratings of LTC facilities' COVID-19 policies did not significantly moderate trajectories of well-being. Discussion and Implications Findings highlight the heterogeneity of caregivers' experiences during the pandemic, and suggest caution when interpreting cross-sectional findings on the impacts of the COVID-19 pandemic on caregiver well-being and distress.
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Affiliation(s)
- Lauren L Mitchell
- Department of Psychology & Neuroscience, Emmanuel College, Boston, Massachusetts, USA
| | - Brenna Horn
- School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Henry Stabler
- School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Robyn W Birkeland
- School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Colleen M Peterson
- Transportation Research Institute, University of Michigan, Ann Arbor, Michigan, USA
| | - Elle A Albers
- School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Joseph E Gaugler
- School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
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14
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Robinson O, Fisher A. Experiences of moving an older parent into a care home or nursing home in the UK: a qualitative study. CURRENT PSYCHOLOGY 2023:1-12. [PMID: 37359665 PMCID: PMC10037379 DOI: 10.1007/s12144-023-04538-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2023] [Indexed: 03/26/2023]
Abstract
The study explored the personal experiences of individuals making the decision to move an older parent into a residential care facility via retrospective narrative. It aimed to gain an understanding of how individuals experienced this transition, the emotions they felt at specific moments throughout the transition, and the perceived effect it had on their psychological wellbeing. 13 semi-structured video interviews were conducted online with individuals who had been active in the decision of moving an older parent into a care home or nursing home. The data was analysed using thematic analysis, along with relational analysis to explore relations between themes. Findings informed 8 different themes, which were subsumed under three meta-themes of The Decision Process, Conflicting Emotions and Reflective Evaluation. It was found that the decision was recalled as a complex and often stressful negotiation between multiple stakeholders, that emotions ranged from grief to guilt and relief, and that reflections emphasised the positive that had come out of the transition. The results from this study provide valuable insights into the uniqueness of this transition from the perspective of relatives and the range of emotions experienced at different stages of the transition.
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Affiliation(s)
- Oliver Robinson
- School of Human Sciences, University of Greenwich, London, SE10 9LS UK
| | - Amy Fisher
- School of Human Sciences, University of Greenwich, London, SE10 9LS UK
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15
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Takechi H, Hara N, Eguchi K, Inomata S, Okura Y, Shibuya M, Yoshino H, Ogawa N, Suzuki M. Dynamics of Interaction among Professionals, Informal Supporters, and Family Caregivers of People with Dementia along the Dementia Care Pathway: A Nationwide Survey in Japan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5044. [PMID: 36981952 PMCID: PMC10049111 DOI: 10.3390/ijerph20065044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/09/2023] [Accepted: 03/09/2023] [Indexed: 06/18/2023]
Abstract
This study aims to clarify the dynamics of information provision and human interaction to satisfy the needs of family caregivers. A questionnaire survey consisting of items on information received at and after diagnosis, persons and resources consulted, needs, and caregiver-oriented outcomes was conducted. Among the respondents, 2295 individuals who were caring for people with dementia were divided into quartiles by the time after diagnosis, and differences were statistically analyzed. The time after diagnosis in the first to fourth quartiles was 0.73 ± 0.4, 2.52 ± 0.49, 4.89 ± 0.73, and 10.82 ± 3.7 years, respectively. The number of persons consulted by family caregivers increased significantly from the first to the fourth quartiles (p < 0.001). During this time, attributes of professionals and informal supporters changed depending on the quartile. As time progressed, acceptance of the diagnosis increased, but so did its impact on the lives of family caregivers. These findings revealed differences over time in what family caregivers wanted and the dynamics of interactions that filled their needs. Informal supporters accounted for a significant proportion of the total resources. However, many family caregivers thought the information and support were insufficient. Thus, continuous reform of the care pathway is needed.
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Affiliation(s)
- Hajime Takechi
- Department of Geriatrics and Cognitive Disorders, School of Medicine, Fujita Health University, Toyoake 470-1192, Aichi, Japan
| | - Naoko Hara
- Department of Gerontological Nursing, Niigata College of Nursing, 240 Shinnan-cho, Joetsu 943-0147, Niigata, Japan
| | - Kyoko Eguchi
- Faculty of Nursing, Shumei University, 1-1 Daigaku-cho, Yachiyo City 270-0003, Chiba, Japan
| | - Shoko Inomata
- Department of Nursing, Akita University Hospital, 44-2 Hasunuma Hiroomote, Akita-shi 010-8543, Akita, Japan
| | - Yuki Okura
- Department of Gerontological Nursing, Niigata College of Nursing, 240 Shinnan-cho, Joetsu 943-0147, Niigata, Japan
| | - Miwa Shibuya
- School of Cultural and Social Studies, The Graduate University for Advanced Studies, Osaka 565-8511, Osaka, Japan
| | - Hiroshi Yoshino
- Department of Geriatrics and Cognitive Disorders, School of Medicine, Fujita Health University, Toyoake 470-1192, Aichi, Japan
| | - Noriyuki Ogawa
- Department of Occupational Therapy, Faculty of Health Sciences, Kyoto Tachibana University, 34 Oyakeyamada-cho, Yamashina-ku, Kyoto City 607-8175, Kyoto, Japan
| | - Morio Suzuki
- Alzheimer’s Association Japan, 811-3 Seimei-cho, Kamigyoku, Kyoto City 602-8222, Kyoto, Japan
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16
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[Guilt and well-being in institutionalized family caregivers of dependent elderly people]. Rev Esp Geriatr Gerontol 2023; 58:84-88. [PMID: 36922298 DOI: 10.1016/j.regg.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 02/04/2023] [Accepted: 02/07/2023] [Indexed: 03/14/2023]
Abstract
INTRODUCTION AND OBJECTIVE The experience of family caregivers after nursing home admission has received much less attention, probably because many caregivers experience an initial sense of initial emotional relief. However, for some caregivers nursing home admission is a stressor despite the reduced physical burden of caregiving. Caregiver distress following institutionalization has been related to the new burdens and challenges encountered in the nursing home. Ambivalence and guilt related to the institutionalization decision have been identified as sources of stress. Therefore, this study examined the effect of guilt and well-being on the perceived stress of family caregivers of institutionalized dependent persons. MATERIALS AND METHODS Two hundred and one family caregivers of institutionalized persons in a nursing home (La Rioja, Spain) participated. Perceived stress, caregiving guilt and subjective well-being, sociodemographic and caregiving-related variables were assessed. Linear regression analyses and correlations between variables were performed. RESULTS Guilt and five dimensions of well-being (anxiety, vitality, self-control and depression, except general health) significantly predicted stress (R2adj=.552 (F (6, 198)=41.71, P<.001)). The effect size was large (95% CI=.461). CONCLUSIONS Paying attention to family caregivers' feelings of guilt during institutionalization is important. This will enable the design and implementation of psychosocial interventions that improve caregiver adjustment immediately after institutionalization.
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17
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Couprie C, van der Steen JT. Talking about Meaning and Loss with Relatives of Persons with Dementia: An Ethnographic Study in a Nursing Home. Geriatrics (Basel) 2023; 8:geriatrics8010023. [PMID: 36826365 PMCID: PMC9956037 DOI: 10.3390/geriatrics8010023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/26/2023] [Accepted: 01/28/2023] [Indexed: 02/08/2023] Open
Abstract
Advance care planning (ACP) can help prepare for future losses and decisions to be taken. However, relatives of persons with dementia may wait for healthcare professionals to initiate ACP conversations which may not adequately address their individual information needs. To evaluate inducing and enhancing conversations about meaning and loss, we conducted an ethnographic study on nurse-led ACP conversations using a question prompt list (QPL) on six dementia wards of a nursing home in the Netherlands from January to September 2021. Staff received training in using the QPL, with information and sample questions to inspire relatives to ask their questions, in particular on meaning and loss. Thematic analysis was applied to transcribed interviews and memos of observations. Nursing staff in particular was concerned about having to be available to answer questions continuously. Relatives used the study as an opportunity to get in touch with professionals, and they saw the QPL as an acknowledgement of their needs. There was a mismatch in that staff wished to discuss care goals and complete a care plan, but the relatives wanted to (first) address practical matters. A QPL can be helpful to conversations about meaning and loss, but nursing staff need dedicated time and substantial training. Joint agenda setting before the conversation may help resolve a mismatch in the preferred topics and timing of conversations.
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Affiliation(s)
- Caroline Couprie
- Department of Theology and Religion Studies, Spiritual Care, VU Amsterdam, De Boelelaan 1105, 1081 HV Amsterdam, The Netherlands
- Pieter van Foreest, Kalfjeslaan 2, 2623 AA Delft, The Netherlands
- Correspondence:
| | - Jenny T. van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Gebouw 3, 2300 RC Leiden, The Netherlands
- Department of Primary and Community Care and Radboudumc Alzheimer Center, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
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18
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Skudlik S, Hirt J, Döringer T, Thalhammer R, Lüftl K, Prodinger B, Müller M. Challenges and care strategies associated with the admission to nursing homes in Germany: a scoping review. BMC Nurs 2023; 22:5. [PMID: 36600231 DOI: 10.1186/s12912-022-01139-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 12/06/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The admission to a nursing home is a critical life-event for affected persons as well as their families. Admission related processes are lacking adequate participation of older people and their families. To improve transitions to nursing homes, context- and country-specific knowledge about the current practice is needed. Hence, our aim was to summarize available evidence on challenges and care strategies associated with the admission to nursing homes in Germany. METHODS We conducted a scoping review and searched eight major international and German-specific electronic databases for journal articles and grey literature published in German or English language since 1995. Further inclusion criteria were focus on challenges or care strategies in the context of nursing home admissions of older persons and comprehensive and replicable information on methods and results. Posters, only-abstract publications and articles dealing with mixed populations including younger adults were excluded. Challenges and care strategies were identified and analysed by structured content analysis using the TRANSCIT model. RESULTS Twelve studies of 1,384 records were finally included. Among those, seven were qualitative studies, three quantitative observational studies and two mixed methods studies. As major challenges neglected participation of older people, psychosocial burden among family caregivers, inadequate professional cooperation and a lack of shared decision-making and evidence-based practice were identified. Identified care strategies included strengthening shared decision-making and evidence-based practice, improvement in professional cooperation, introduction of specialized transitional care staff and enabling participation for older people. CONCLUSION Although the process of nursing home admission is considered challenging and tends to neglect the needs of older people, little research is available for the German health care system. The perspective of the older people seems to be underrepresented, as most of the studies focused on caregivers and health professionals. Reported care strategies addressed important challenges, however, these were not developed and evaluated in a comprehensive and systematic way. Future research is needed to examine perspectives of all the involved groups to gain a comprehensive picture of the needs and challenges. Interventions based on existing care strategies should be systematically developed and evaluated to provide the basis of adequate support for older persons and their informal caregivers.
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Affiliation(s)
- Stefanie Skudlik
- Centre for Research, Development and Technology Transfer, Rosenheim Technical University of Applied Sciences, Rosenheim, Germany.
| | - Julian Hirt
- International Graduate Academy, Medical Faculty, Institute for Health and Nursing Science, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
- Institute for Applied Nursing Science, Department of Health, Eastern Switzerland University of Applied Sciences (Formerly FHS St. Gallen), St. Gallen, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Tobias Döringer
- Centre for Research, Development and Technology Transfer, Rosenheim Technical University of Applied Sciences, Rosenheim, Germany
- Faculty of Applied Health and Social Sciences, Rosenheim Technical University of Applied Sciences, Rosenheim, Germany
| | - Regina Thalhammer
- Centre for Research, Development and Technology Transfer, Rosenheim Technical University of Applied Sciences, Rosenheim, Germany
| | - Katharina Lüftl
- Centre for Research, Development and Technology Transfer, Rosenheim Technical University of Applied Sciences, Rosenheim, Germany
- Faculty of Applied Health and Social Sciences, Rosenheim Technical University of Applied Sciences, Rosenheim, Germany
| | - Birgit Prodinger
- Centre for Research, Development and Technology Transfer, Rosenheim Technical University of Applied Sciences, Rosenheim, Germany
- Faculty of Applied Health and Social Sciences, Rosenheim Technical University of Applied Sciences, Rosenheim, Germany
| | - Martin Müller
- Centre for Research, Development and Technology Transfer, Rosenheim Technical University of Applied Sciences, Rosenheim, Germany
- Department for Primary Care and Health Services Research, Medical Faculty, Nursing Science and Interprofessional Care, Heidelberg University, Heidelberg, Germany
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19
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Atoyebi O, Eng JJ, Routhier F, Bird ML, Mortenson WB. A systematic review of systematic reviews of needs of family caregivers of older adults with dementia. Eur J Ageing 2022; 19:381-396. [PMID: 36052180 PMCID: PMC9424446 DOI: 10.1007/s10433-021-00680-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2021] [Indexed: 11/25/2022] Open
Abstract
Family caregivers provide vital assistance to older adults living with dementia. An accurate assessment of the needs of caregivers supports the development and provision of appropriate solutions to address these needs. This review of systematic reviews analyzes and synthesizes the needs identified by family caregivers. We conducted a systematic review of systematic reviews using the AMSTAR guideline. Electronic databases were searched for systematic reviews on the needs of caregivers in the context of dementia using a combination of keywords and medical subject headings. Records resulting from the search were screened by two reviewers. Data on the needs of caregivers were extracted from the articles and analyzed using a narrative synthesis approach. Out of the 17 potentially eligible systematic reviews obtained initially, 6 met the inclusion criteria. In total, 20 main needs were identified in the reviews included in this study. The need for information and social support were prominent in this review. Factors such as gender, resources available to the caregiver and the care recipient's health status may influence caregivers' needs. Interventions can be tailored toward addressing the most prominent needs of caregivers such as adequate information and resources and available programs may further accommodate and offer need-tailored support to them.
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Affiliation(s)
- Oladele Atoyebi
- Rehabilitation Sciences Program, University of British Columbia, Vancouver, BC Canada
- GF Strong Rehabilitation Research Program, University of British Columbia, Vancouver, BC Canada
| | - Janice J. Eng
- GF Strong Rehabilitation Research Program, University of British Columbia, Vancouver, BC Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, BC Canada
| | - François Routhier
- Department of Rehabilitation, Université Laval, Quebec City, QC Canada
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Centre Intégré de Santé Et de Services Sociaux de la Capitale-Nationale, Quebec City, QC Canada
| | - Marie-Louise Bird
- GF Strong Rehabilitation Research Program, University of British Columbia, Vancouver, BC Canada
- School of Health Sciences, University of Tasmania, Newnham, TAS Australia
| | - W. Ben Mortenson
- GF Strong Rehabilitation Research Program, University of British Columbia, Vancouver, BC Canada
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC Canada
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20
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Gettel CJ, Falvey JR, Gifford A, Hoang L, Christensen LA, Hwang U, Shah MN. Emergency Department Care Transitions for Patients With Cognitive Impairment: A Scoping Review. J Am Med Dir Assoc 2022; 23:1313.e1-1313.e13. [PMID: 35247358 PMCID: PMC9378565 DOI: 10.1016/j.jamda.2022.01.076] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/26/2022] [Accepted: 01/26/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVES We aimed to describe emergency department (ED) care transition interventions delivered to older adults with cognitive impairment, identify relevant patient-centered outcomes, and determine priority research areas for future investigation. DESIGN Systematic scoping review. SETTING AND PARTICIPANTS ED patients with cognitive impairment and/or their care partners. METHODS Informed by the clinical questions, we conducted systematic electronic searches of medical research databases for relevant publications following published guidelines. The results were presented to a stakeholder group representing ED-based and non-ED-based clinicians, individuals living with cognitive impairment, care partners, and advocacy organizations. After discussion, they voted on potential research areas to prioritize for future investigations. RESULTS From 3848 publications identified, 78 eligible studies underwent full text review, and 10 articles were abstracted. Common ED-to-community care transition interventions for older adults with cognitive impairment included interdisciplinary geriatric assessments, home visits from medical personnel, and telephone follow-ups. Intervention effects were mixed, with improvements observed in 30-day ED revisit rates but most largely ineffective at promoting connections to outpatient care or improving secondary outcomes such as physical function. Outcomes identified as important to adults with cognitive impairment and their care partners included care coordination between providers and inclusion of care partners in care management within the ED setting. The highest priority research area for future investigation identified by stakeholders was identifying strategies to tailor ED-to-community care transitions for adults living with cognitive impairment complicated by other vulnerabilities such as social isolation or economic disadvantage. CONCLUSIONS AND IMPLICATIONS This scoping review identified key gaps in ED-to-community care transition interventions delivered to older adults with cognitive impairment. Combined with a stakeholder assessment and prioritization, it identified relevant patient-centered outcomes and clarifies priority areas for future investigation to improve ED care for individuals with impaired cognition, an area of critical need given the current population trends.
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Affiliation(s)
- Cameron J Gettel
- Department of Emergency Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA.
| | - Jason R Falvey
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, USA; Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Angela Gifford
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Ly Hoang
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | | | - Ula Hwang
- Department of Emergency Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Manish N Shah
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, USA; Department of Medicine (Geriatrics and Gerontology), University of Wisconsin-Madison, Madison, WI, USA; Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, USA; Center for Health Disparities Research, University of Wisconsin-Madison, Madison, WI, USA; Wisconsin Alzheimer's Disease Research Center, University of Wisconsin-Madison, Madison, WI, USA
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21
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Kinchin I, Edwards L, Adrion E, Chen Y, Ashour A, Leroi I, Brugulat‐Serrat A, Phillips J, Masterson F, Kochovska S. Care partner needs of people with neurodegenerative disorders: What are the needs, and how well do the current assessment tools capture these needs? A systematic meta-review. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5764. [PMID: 35665539 PMCID: PMC9328373 DOI: 10.1002/gps.5764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 05/12/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVES The burden on care partners, particularly once dementia emerges, is among the greatest of all caregiving groups. This meta-review aimed to (1) synthesis evidence on the self-reported needs of care partners supporting people living with neurodegenerative disorders; (2) compare the needs according to care partner and care recipient characteristics; and (3) determine the face validity of existing care partner needs assessment tools. METHODS We conducted a systematic review of reviews involving a thematic synthesis of care partner needs and differences in needs according to demographic and other characteristics. We then conducted a gap analysis by identifying the themes of needs from existing needs assessment tools specific to dementia and cross-matching them with the needs derived from the thematic synthesis. RESULTS Drawing on 17 published reviews, the identified range of needs fell into four key themes: (1) knowledge and information, (2) physical, social and emotional support, (3) care partner self-care, and (4) care recipient needs. Needs may differ according to disease trajectory, relationship to the care recipient, and the demographic characteristics of the care partner and recipient. The 'captured needs' range between 8% and 66% across all the included needs assessment tools. CONCLUSIONS Current tools do not fully or adequately capture the self-identified needs of care partners of people living with neurodegenerative disorders. Given the high burden on care partners, which has been further exacerbated by the COVID-19 (SARS CoV-2) pandemic, the needs assessment tools should align with the self-reported needs of care partners throughout the caregiving trajectory to better understand unmet needs and target supportive interventions.
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Affiliation(s)
- Irina Kinchin
- Centre for Health Policy and ManagementTrinity College DublinUniversity of DublinDublinIreland
- Global Brain Health InstituteUniversity of Dublin/University of California San FranciscoDublinIreland
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT) CentreUniversity of Technology SydneyUltimoNew South WalesAustralia
| | - Layla Edwards
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT) CentreUniversity of Technology SydneyUltimoNew South WalesAustralia
| | - Emily Adrion
- Global Brain Health InstituteUniversity of Dublin/University of California San FranciscoDublinIreland
- Global Health Policy Unit, Social PolicyUniversity of EdinburghEdinburghUK
| | - Yaohua Chen
- Global Brain Health InstituteUniversity of Dublin/University of California San FranciscoDublinIreland
- Univ.Lille, Inserm UMR‐S1172, Lille Neurosciences & Cognition, Degenerative and Vascular Cognitive DisordersDepartment of GeriatricsCHU Lille, LiCENDLilleFrance
| | - Aya Ashour
- Global Brain Health InstituteUniversity of Dublin/University of California San FranciscoDublinIreland
- Department of NeurologyAin Shams UniversityCairoEgypt
| | - Iracema Leroi
- Global Brain Health InstituteUniversity of Dublin/University of California San FranciscoDublinIreland
| | - Anna Brugulat‐Serrat
- Global Brain Health InstituteUniversity of Dublin/University of California San FranciscoDublinIreland
- Barcelonaβeta Brain Research Center (BBRC)Pasqual Maragall FoundationBarcelonaSpain
- Hospital del Mar Medical Research Institute (IMIM)BarcelonaSpain
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES)MadridSpain
| | - Jane Phillips
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT) CentreUniversity of Technology SydneyUltimoNew South WalesAustralia
- School of NursingQueensland University of TechnologyBrsibaneQueenslandAustralia
| | - Fiona Masterson
- Family Carers Ireland Research Advisory NetworkDublinIreland
| | - Slavica Kochovska
- Faculty of Science, Medicine and HealthUniversity of WollongongWollongongNew South WalesAustralia
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22
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Camões-Costa V, Loganathan J, Barton C, Chakraborty S, Hewitt A, Lin X, Brijnath B. Factors contributing to the mental health outcomes of carers during the transition of their family member to residential aged care: a systematic search and narrative review. BMC Geriatr 2022; 22:433. [PMID: 35581539 PMCID: PMC9115935 DOI: 10.1186/s12877-022-03105-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 04/19/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES The transition of an older family member into a residential aged care facility (RACF) is often challenging for both the person being admitted and their family carer. This review aimed to identify the protective and contributing factors to adverse mental health outcomes among family carers following the decision to move a family member to a RACF. METHOD A search of CINAHL, PubMed and PsycINFO was conducted for empirical papers published in English between 2004 and 2019, exploring the mental health or quality of life (QoL) of family carers of those recently admitted, or considering admission, to a RACF. Articles were reviewed by two authors for inclusion. RESULTS Twenty-three studies met the inclusion criteria. Pre-existing depressive symptoms and poor subjective health were related to adverse mental health outcomes following admission. Information from the facility, support to change roles, and factors related to carer's health and demographics, were associated with changes in the mental health outcomes of carers during the transition of their relative to a RACF. Key protective factors of carer's mental health outcomes following the transition of their relative to a RACF are flow and transparency of information between carer and the facility staff, and staff efforts to involve carers in providing emotional support to their relative, in monitoring care, and advocating for their quality of life. CONCLUSION There is evidence to suggest factors such lack of flow and transparency of information between carer and the facility staff may predispose carers to poor mental health and QoL following the transition of a relative to a RACF. Key protective factors of carer's mental health following admission are staff efforts to involve carers in providing emotional support to their relative, in monitoring care, and advocating for their quality of life. This review also indicates that the combination of factors that puts family carers more at risk of poor mental health and lower quality of life throughout the transition period. Policy and practice should follow recommendations that consider a combination of the above factors when addressing the needs of family carers before and after admission of an older person to RACF.
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Affiliation(s)
- Vera Camões-Costa
- Department of General Practice, Monash University, Building 1, 270 Ferntree Gully Road, Notting Hill, VIC, 3168, Australia.
| | - Jayasree Loganathan
- Department of General Practice, Monash University, Building 1, 270 Ferntree Gully Road, Notting Hill, VIC, 3168, Australia
| | - Chris Barton
- Department of General Practice, Monash University, Building 1, 270 Ferntree Gully Road, Notting Hill, VIC, 3168, Australia
| | - Samantha Chakraborty
- Department of General Practice, Monash University, Building 1, 270 Ferntree Gully Road, Notting Hill, VIC, 3168, Australia
| | - Alana Hewitt
- Department of Occupational Therapy, Monash University, Frankston, Victoria, Australia
| | - Xiaoping Lin
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Bianca Brijnath
- Department of General Practice, Monash University, Building 1, 270 Ferntree Gully Road, Notting Hill, VIC, 3168, Australia
- National Ageing Research Institute Ltd, Parkville, Australia
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia
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Groenendaal M, Smaling HJ, Achterberg WP, Caljouw MA. Maintaining meaningful activities for persons with dementia during transitions of care: A systematic review. Geriatr Nurs 2022; 44:176-183. [DOI: 10.1016/j.gerinurse.2022.01.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 01/27/2022] [Accepted: 01/28/2022] [Indexed: 12/21/2022]
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Mitchell LL, Albers EA, Birkeland RW, Peterson CM, Stabler H, Horn B, Cha J, Drake A, Gaugler JE. Caring for a Relative With Dementia in Long-Term Care During COVID-19. J Am Med Dir Assoc 2022; 23:428-433.e1. [PMID: 34929196 PMCID: PMC8677585 DOI: 10.1016/j.jamda.2021.11.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 11/10/2021] [Accepted: 11/25/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVES The COVID-19 pandemic created unique stressors for caregivers of persons with dementia living in long-term care (LTC) facilities. The purpose of this qualitative study was to identify the challenges associated with caring for a relative with dementia in LTC during the pandemic, as well as resources, strategies, and practices caregivers found helpful in coping with COVID-19. DESIGN This study was conducted within the context of an ongoing randomized controlled trial of a psychosocial intervention to support caregivers. Open-ended survey responses (n = 125) and semistructured interviews with a subset of the sample (n = 20) collected between June 2020 and June 2021 explored caregivers' experiences during COVID-19. SETTING AND PARTICIPANTS Participants included 125 family caregivers of persons with dementia living in residential LTC. METHODS Thematic analysis was used to identify themes capturing caregivers' experiences. RESULTS In addition to concerns about COVID-19 infection, participants reported key challenges such as the difficulty of maintaining contact with relatives because of visiting restrictions, lack of information about relatives' health and well-being, worries about overburdened LTC staff, impossibility of returning relatives home from the LTC facility, and fears about relatives dying alone. Participants also identified resources, strategies, and practices that they perceived as helpful, including effective infection prevention within the LTC facility, good communication with LTC staff, and creative strategies for connecting with their relatives. CONCLUSIONS AND IMPLICATIONS This qualitative analysis informs recommendations for practice within LTC facilities, as well as supports that may help caregivers manage stressful situations in the context of COVID-19. Vaccination and testing protocols should be implemented to maximize family caregivers' opportunities for in-person contact with relatives in LTC, as alternative visiting modalities were often unsatisfactory or unfeasible. Informing caregivers regularly about individual residents' needs and status is crucial. Supports for bereaved caregivers should address complicated grief and feelings of loss.
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Affiliation(s)
- Lauren L Mitchell
- Department of Psychology & Neuroscience, Emmanuel College, Boston, MA, USA.
| | | | - Robyn W Birkeland
- School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | | | - Henry Stabler
- School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Brenna Horn
- School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Jinhee Cha
- School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Anna Drake
- Department of Psychology & Neuroscience, Emmanuel College, Boston, MA, USA
| | - Joseph E Gaugler
- School of Public Health, University of Minnesota, Minneapolis, MN, USA
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25
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Groenvynck L, de Boer B, Beaulen A, de Vries E, Hamers JPH, van Achterberg T, van Rossum E, Khemai C, Meijers JMM, Verbeek H. The paradoxes experienced by informal caregivers of people with dementia during the transition from home to a nursing home. Age Ageing 2022. [PMCID: PMC8824707 DOI: 10.1093/ageing/afab241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background The transition from home to a nursing home is a common care process experienced by older persons with dementia and their informal caregivers. This transition process is often experienced as fragmented and is paired with negative outcomes for both older persons (e.g. mortality) and informal caregivers (e.g. grief). Due to the central role that informal caregivers play, it is crucial to capture their experiences throughout all phases of the transition. Methods A secondary data analysis was conducted using an interpretative phenomenological design. A total of 24 informal caregivers of older persons with dementia, moving to a nursing home, participated in in-depth interviews. Data were collected between February 2018 and July 2018 in the Netherlands. Data were analysed using Interpretative Phenomenological Analysis. Results The transition experiences are characterised by three paradoxes: (i) contradicting emotions during the transition process; (ii) the need for a timely transition versus the need to postpone the transition process and (iii) the need for involvement versus the need for distance. All paradoxes are influenced by the healthcare system. Conclusions The identified paradoxes show the impact of the healthcare system and the importance of timely planning/preparing for this transition on the experiences of informal caregivers. In addition, it provides healthcare professionals insight into the thought processes of informal caregivers. Future research can use these paradoxes as a foundation to develop innovations aiming to improve the transition process from home to a nursing home for informal caregivers and, consequently, older persons.
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Affiliation(s)
- Lindsay Groenvynck
- Maastricht University, Care and Public Health Research Institute, Department of Health Services Research, Maastricht, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
- KU Leuven, Department of Public Health and Primary Care, Academic Center for Nursing and Midwifery, Leuven, Belgium
| | - Bram de Boer
- Maastricht University, Care and Public Health Research Institute, Department of Health Services Research, Maastricht, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Audrey Beaulen
- Maastricht University, Care and Public Health Research Institute, Department of Health Services Research, Maastricht, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Erica de Vries
- Maastricht University, Care and Public Health Research Institute, Department of Health Services Research, Maastricht, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Jan P H Hamers
- Maastricht University, Care and Public Health Research Institute, Department of Health Services Research, Maastricht, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Theo van Achterberg
- KU Leuven, Department of Public Health and Primary Care, Academic Center for Nursing and Midwifery, Leuven, Belgium
| | - Erik van Rossum
- Maastricht University, Care and Public Health Research Institute, Department of Health Services Research, Maastricht, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
- Zuyd University of Applied Sciences, Academy of Nursing, Research Center on Community Care, Heerlen, The Netherlands
| | - Chandni Khemai
- Maastricht University, Care and Public Health Research Institute, Department of Health Services Research, Maastricht, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Judith M M Meijers
- Maastricht University, Care and Public Health Research Institute, Department of Health Services Research, Maastricht, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
- Zuyderland Care, Zuyderland Medical Center, 6162 BG Sittard-Geleen, The Netherlands
| | - Hilde Verbeek
- Maastricht University, Care and Public Health Research Institute, Department of Health Services Research, Maastricht, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
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Naunton Morgan B, Windle G, Sharp R, Lamers C. eHealth/ online interventions for informal carers of people with dementia in the community: An umbrella review (Preprint). J Med Internet Res 2022; 24:e36727. [PMID: 35867388 PMCID: PMC9356334 DOI: 10.2196/36727] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/25/2022] [Accepted: 05/28/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Gill Windle
- School of Medical and Health Sciences, Bangor University, Bangor, United Kingdom
| | | | - Carolien Lamers
- North Wales Clinical Psychology Programme, Bangor University, Bangor, United Kingdom
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27
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Gaudet K, Couture M, Ducharme F, Saïas T. Caregiver Emotions When Choosing A Living Environment for A Person with Dementia: A Qualitative Study on Social Workers' Perspectives. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2022; 65:78-96. [PMID: 34080529 DOI: 10.1080/01634372.2021.1936330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 05/25/2021] [Accepted: 05/25/2021] [Indexed: 06/12/2023]
Abstract
Social workers often address the emotional needs of family caregivers, which are particularly salient during the decision-making process regarding the choice of a living environment for a relative with dementia. In most home care settings, an assessment of caregivers' needs is not part of routine practices. This study aims to describe the intervention strategies adopted by social workers in relation to caregivers' emotions during their decision-making process. A qualitative research design was adopted. Seven social workers were recruited from three health and community service facilities in Montreal, Canada. One group and three individual semi-structured interviews were conducted. Data was analyzed using Miles, Huberman and Saldaña's method (2013). Seven intervention strategies were identified: investigating emotions, acknowledging emotions, encouraging caregivers to carry on their role, focusing on the rational aspects of the decision, mitigating prejudices against nursing homes, mediating family dynamics and acting upon families' needs. Some of these strategies are aimed at social workers meeting the demands of their jobs whilst others are centered around soothing caregiver emotions. These results can inform support services and future interventions by grounding them in the realities of service providers.
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Affiliation(s)
- K Gaudet
- Department of Psychology, Université De Montréal, Montréal, Canada
| | - M Couture
- Department of Psychology, Université De Sherbrooke, Sherbrooke, Canada
- Integrated Health and Social Services University Network for West-Central Montreal, Centre for Research and Expertise in Social Gerontology (CREGÉS), Montréal, Canada
| | - F Ducharme
- Faculty of Nursing, Université De Montréal, Montréal, Canada
- Montreal Geriatrics University Institute Research Center, Montréal, Canada
| | - T Saïas
- Department of Psychology,Université du Québec à Montréal, Canada
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28
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Lee K, Chung J, Meyer KN, Dionne-Odom JN. Unmet needs and health-related quality of life of dementia family caregivers transitioning from home to long-term care: A scoping review. Geriatr Nurs 2021; 43:254-264. [PMID: 34953331 DOI: 10.1016/j.gerinurse.2021.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/05/2021] [Accepted: 12/07/2021] [Indexed: 01/07/2023]
Abstract
This scoping review is to identify experiences, unmet needs, and health-related quality of life (HRQoL) of family caregivers transitioning their care recipients with dementia into long-term care (LTC). The methodological framework of Arksey and O'Malley guided the review. Themes from nineteen selected studies were organized around three categories. First, caregiver experiences during LTC placement featured challenges around placement decision-making and distress and changes in relationships and responsibilities. Second, unmet needs of caregivers were desired emotional support and information about transitions. Finally, caregivers' HRQoL varies around transition. Family caregivers experience unique challenges and can have unmet needs during the LTC placement of their care recipients with dementia. Findings suggest the need for interventions that teach skills, care planning, assistance with conflict resolution, communication training, and guidance finding services and resources.
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Affiliation(s)
- Kyungmi Lee
- School of Nursing, The University of Alabama at Birmingham, Alabama, United States.
| | - Jane Chung
- School of Nursing, Virginia Commonwealth University, Virginia, United States
| | - Kylie Nicole Meyer
- School of Nursing, University of Texas Health Center San Antonio, Texas, United States
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29
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Brooks D, Beattie E, Fielding E, Wyles K, Edwards H. Long-term care placement: The transitional support needs and preferences of spousal dementia caregivers. DEMENTIA 2021; 21:794-809. [PMID: 34870490 DOI: 10.1177/14713012211056461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVES Many spousal caregivers experience stress, depression, loneliness, guilt and grief when placing a partner with dementia into long-term care. However, there is little research about their transitional support experiences, needs and preferences. This study aimed to gain a deeper understanding of these issues from spousal caregiver and long-term care facility staff perspectives, to inform subsequent support and intervention development. RESEARCH DESIGN AND METHODS Semi-structured interviews and small group discussions were held separately with spousal caregivers (n = 9) and care facility staff (n = 11). Criterion and variation sampling aimed to ensure a range of experiences and perspectives. The 'Framework' approach was utilised for data analysis. Interpretation was with respect to underpinning models of stress-grief process in dementia caregiving. FINDINGS A range of informational, psychoeducational and psychosocial supports were identified to help spousal caregivers cope better with the stressors and losses experienced throughout the transition from home to long-term care. Improved education about disease progression, information relating to long-term care provision, peer support and dementia-specific grief counselling were deemed important. Opportunities for better support within care facilities were also identified. Support should be tailored to individual needs and preferences. DISCUSSION AND IMPLICATIONS The findings suggest a supportive care framework be developed, encompassing the trajectory from assessment for and admission into long-term care to end-of-life and post-bereavement support. Spousal caregivers should have their support needs assessed by trained health or social care professionals and be offered a range of support options as appropriate.
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Affiliation(s)
- Deborah Brooks
- Dementia Centre for Research Collaboration, 1969Queensland University of Technology, Brisbane, Queensland, Australia
| | - Elizabeth Beattie
- Dementia Centre for Research Collaboration, 1969Queensland University of Technology, Brisbane, Queensland, Australia
| | - Elaine Fielding
- Dementia Centre for Research Collaboration, 1969Queensland University of Technology, Brisbane, Queensland, Australia
| | - Katy Wyles
- Dementia Centre for Research Collaboration, 1969Queensland University of Technology, Brisbane, Queensland, Australia
| | - Helen Edwards
- Faculty of Health, 1969Queensland University of Technology, Brisbane, Queensland, Australia
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30
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Harper AE, Terhorst L, Moscirella M, Turner RL, Piersol CV, Leland NE. The experiences, priorities, and perceptions of informal caregivers of people with dementia in nursing homes: A scoping review. DEMENTIA 2021; 20:2746-2765. [PMID: 33899537 DOI: 10.1177/14713012211012606] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Person-centered care has been shown to increase desired outcomes for people with dementia, yet informal caregivers' dissatisfaction with care is often reported. For those living in a nursing home, informal caregivers are uniquely situated to provide key insights into the individual's care. However, little is known of the informal caregivers' perspective, which hinders efforts to improve their satisfaction with person-centered nursing home care. Thus, we examined the comprehensive experiences, priorities, and perceptions of informal caregivers of nursing home residents with dementia. METHODS In collaboration with stakeholders, a scoping review of Medline (Ovid), EMBASE.com, CINAHL (EBSCO), the Cochrane Library (Wiley), and PsycINFO (Ovid) databases from January 2000 to July 2020 was conducted. Data were extracted reflecting the experiences, priorities, and preferences of caregivers of people with dementia residing in nursing homes. RESULTS We identified 114 articles that revealed nine themes: (1) communication, (2) transition to nursing home, (3) quality of care, (4) quality of life, (5) informal caregiver role, (6) knowledge of dementia, (7) end-of-life preferences, (8) medication use to manage neuropsychiatric behaviors, and (9) finances. CONCLUSION Informal caregivers described aspects of care that led to both positive and negative experiences with and perceptions of nursing home care. The shortcomings in communication were discussed most frequently, indicating a high priority area. While researchers define the identified themes individually, informal caregivers perceive them to be interwoven as they relate to person-centered care delivery. Although we did not assess the quality of included articles, by identifying themes relevant to caregivers' perspectives of nursing home care, our findings may help to inform efforts to optimize caregivers' satisfaction with nursing home care for residents with dementia.
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Affiliation(s)
- Alexandra E Harper
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, 6614University of Pittsburgh, Pittsburgh, PA, USA
| | - Lauren Terhorst
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, 6614University of Pittsburgh, Pittsburgh, PA, USA
| | - Marybeth Moscirella
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, 6614University of Pittsburgh, Pittsburgh, PA, USA
| | - Rose L Turner
- Health Sciences Library System, 499478University of Pittsburgh, Pittsburgh, PA, USA
| | - Catherine V Piersol
- Department of Occupational Therapy, Jefferson College of Rehabilitation Sciences, 6559Thomas Jefferson University, Philadelphia, PA, USA
| | - Natalie E Leland
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, 6614University of Pittsburgh, Pittsburgh, PA, USA
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Rostad HM, Skinner MS, Larsen TW, Sogstad MKR. Sammenheng i kommunale helse- og omsorgstjenester – hvor mye flytter eldre mellom ulike tilbud i kommunen? TIDSSKRIFT FOR OMSORGSFORSKNING 2021. [DOI: 10.18261/issn.2387-5984-2021-02-04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Abstract
Multiple transitions across care settings can be disruptive for older adults with dementia and their care partners, and can lead to fragmented care with adverse outcomes. This scoping review was conducted to identify and classify care trajectories across multiple settings for people with dementia, and to understand the prevalence of multiple transitions and associated factors at the individual and organizational levels. Searches of three databases, limited to peer-reviewed studies published between 2007 and 2017, provided 33 articles for inclusion. We identified 26 distinct care trajectories. Common trajectories involved hospital readmission or discharge from hospital to long-term care. Factors associated with transitions were identified mainly at the level of demographic and medical characteristics. Findings suggest a need for investing in stronger community-based systems of care that may reduce transitions. Further research is recommended to address knowledge gaps about complex and longitudinal care trajectories and trajectories experienced by sub-populations of people living with dementia.
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33
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Ahlström G, Markeling NS, Liljenberg U, Rosén H. Breaking Up and a New Beginning When One's Partner Goes into a Nursing Home: An Interview Study. Healthcare (Basel) 2021; 9:healthcare9060672. [PMID: 34199811 PMCID: PMC8226602 DOI: 10.3390/healthcare9060672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/27/2021] [Accepted: 05/31/2021] [Indexed: 11/16/2022] Open
Abstract
In aging societies worldwide, spouses take on great responsibility for care when their partner continues to live at home. Nursing home placement occurs when the partner becomes too frail due to multimorbidity, and this will cause a change in the spouse’s life. This study aimed to explore the spouse’s experience of their partner’s move to a nursing home. Two interviews were conducted at 9-month intervals within the project entitled “Implementation of Knowledge-Based Palliative Care in Nursing Homes”. Thirteen spouses from both urban and rural areas were included, with an age-range of 60–86 years (median 72). Qualitative content analysis was performed. The main findings were captured in two themes: Breaking up of close coexistence and Towards a new form of daily life. The first encompassed processing loneliness, separation and grief, exhaustion, increased burden, and a sense of guilt. The second encompassed a sense of freedom, relief, acceptance, support and comfort. Professionals in both home care and nursing home care need to develop and provide a support programme conveying knowledge of the transition process to prevent poor quality of life and depression among the spouses. Such a programme should be adaptable to individual needs and should ideally be drawn up in consultation with both partners.
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Affiliation(s)
- Gerd Ahlström
- Department of Health Sciences, Faculty of Medicine, Lund University, 221 00 Lund, Sweden;
- Correspondence: ; Tel.: +46-702-747767
| | | | | | - Helena Rosén
- Department of Health Sciences, Faculty of Medicine, Lund University, 221 00 Lund, Sweden;
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34
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Chan CY, Cheung G, Martinez-Ruiz A, Chau PYK, Wang K, Yeoh EK, Wong ELY. Caregiving burnout of community-dwelling people with dementia in Hong Kong and New Zealand: a cross-sectional study. BMC Geriatr 2021; 21:261. [PMID: 33879099 PMCID: PMC8059033 DOI: 10.1186/s12877-021-02153-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 03/14/2021] [Indexed: 11/10/2022] Open
Abstract
Background Informal caregiving for people with dementia can negatively impact caregivers’ health. In Asia-Pacific regions, growing dementia incidence has made caregiver burnout a pressing public health issue. A cross-sectional study with a representative sample helps to understand how caregivers experience burnout throughout this region. We explored the prevalence and contributing factors of burnout of caregivers of community-dwelling older people with dementia in Hong Kong (HK), China, and New Zealand (NZ) in this study. Methods Analysis of interRAI Home Care Assessment data for care-recipients (aged ≥65 with Alzheimer’s disease/other dementia) who had applied for government-funded community services and their caregivers was conducted. The sample comprised 9976 predominately Chinese in HK and 16,725 predominantly European in NZ from 2013 to 2016. Caregiver burnout rates for HK and NZ were calculated. Logistic regression was used to determine the adjusted odds ratio (AOR) of the significant factors associated with caregiver burnout in both regions. Results Caregiver burnout was present in 15.5 and 13.9% of the sample in HK and NZ respectively. Cross-regional differences in contributing factors to burnout were found. Care-recipients’ ADL dependency, fall history, and cohabitation with primary caregiver were significant contributing factors in NZ, while primary caregiver being child was found to be significant in HK. Some common contributing factors were observed in both regions, including care-recipients having behavioural problem, primary caregiver being spouse, providing activities-of-daily-living (ADL) care, and delivering more than 21 h of care every week. In HK, allied-health services (physiotherapy, occupational therapy and speech therapy) protected caregiver from burnout. Interaction analysis showed that allied-health service attenuates the risk of burnout contributed by care-recipient’s older age (85+), cohabitation with child, ADL dependency, mood problem, and ADL care provision by caregivers. Conclusions This study highlights differences in service delivery models, family structures and cultural values that may explain the cross-regional differences in dementia caregiving experience in NZ and HK. Characteristics of caregiving dyads and their allied-health service utilization are important contributing factors to caregiver burnout. A standardized needs assessment for caregivers could help policymakers and healthcare practitioners to identify caregiving dyads who are at risk of burnout and provide early intervention. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02153-6.
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Affiliation(s)
- Crystal Y Chan
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Gary Cheung
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Adrian Martinez-Ruiz
- Instituto Nacional De Geriatría, Mexico City, Mexico.,Department of Population Health, University of Auckland, Auckland, New Zealand
| | - Patsy Y K Chau
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Kailu Wang
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - E K Yeoh
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Eliza L Y Wong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
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Köhler K, Dreyer J, Hochgraeber I, von Kutzleben M, Pinkert C, Roes M, Holle B. Towards a middle-range theory of 'Stability of home-based care arrangements for people living with dementia' (SoCA-Dem): findings from a meta-study on mixed research. BMJ Open 2021; 11:e042515. [PMID: 33853798 PMCID: PMC8054086 DOI: 10.1136/bmjopen-2020-042515] [Citation(s) in RCA: 9] [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: 12/15/2022] Open
Abstract
BACKGROUND Most people with dementia and their informal carers live at home and strive to create a stable care situation for as long as possible. This preference of dyads is consistent with the global policy of ageing in place. Therefore, we aimed to develop a middle-range theory of stability guided by two research questions: How is stability of home-based care arrangements for people living with dementia constituted? What are the essential factors influencing stability? METHODS Within the 'Stability of home-based care arrangements for people living with dementia' project (SoCA project) at the German Center for Neurodegenerative Diseases (DZNE), we conducted a meta-study on mixed research. The analytical steps of meta-data analysis, meta-method and meta-theory are merged in an integrative synthesis. Eligible publications were identified through systematic database searches (MEDLINE, CINAHL and PsycINFO; last searched on 3 January 2017), backward/forward citation tracking and snowballing. All publications were screened against predefined inclusion criteria and evaluated through a quality appraisal. The analytical approach was thematic synthesis. RESULTS 99 publications were included. The middle-range theory conceptualises stability as a complex phenomenon comprising three components including eight concepts that are dynamically inter-related. The conceptual model visualises: (1) the trajectory of the dementia care arrangement, which involves a cyclic process of change and balancing over time; (2) the characteristics of the care arrangement, including needs, the carer role, the dyadic relationship and resources; and (3) the context, which is determined by society and culture and the respective healthcare system. The relevance of each concept in relation to stability changes over time. The forming of each concept is actively shaped by the informal carer. DISCUSSION This middle-range theory provides a thorough understanding of the stability of home-based care arrangements for people living with dementia and can be used to guide future research and practice. OTHER This meta-study was funded by the DZNE and registered in PROSPERO (registration number CRD42016041727).
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Affiliation(s)
- Kerstin Köhler
- German Centre for Neurodegenerative Diseases (DZNE), Witten, Germany
- Faculty of Health, Department of Nursing Science, Witten/Herdecke University (UW/H), Witten, Germany
| | - Jan Dreyer
- German Centre for Neurodegenerative Diseases (DZNE), Witten, Germany
- Faculty of Health, Department of Nursing Science, Witten/Herdecke University (UW/H), Witten, Germany
| | - Iris Hochgraeber
- German Centre for Neurodegenerative Diseases (DZNE), Witten, Germany
- Faculty of Health, Department of Nursing Science, Witten/Herdecke University (UW/H), Witten, Germany
| | - Milena von Kutzleben
- Department of Health Services Research, School of Medicine and Health Sciences, University of Oldenburg, Oldenburg, Germany
| | - Christiane Pinkert
- German Centre for Neurodegenerative Diseases (DZNE), Witten, Germany
- Faculty of Health, Department of Nursing Science, Witten/Herdecke University (UW/H), Witten, Germany
| | - Martina Roes
- German Centre for Neurodegenerative Diseases (DZNE), Witten, Germany
- Faculty of Health, Department of Nursing Science, Witten/Herdecke University (UW/H), Witten, Germany
| | - Bernhard Holle
- German Centre for Neurodegenerative Diseases (DZNE), Witten, Germany
- Faculty of Health, Department of Nursing Science, Witten/Herdecke University (UW/H), Witten, Germany
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Groenvynck L, Fakha A, de Boer B, Hamers JPH, van Achterberg T, van Rossum E, Verbeek H. Interventions to Improve the Transition from Home to a Nursing Home: A Scoping Review. THE GERONTOLOGIST 2021; 62:e369-e383. [PMID: 33704485 PMCID: PMC9372886 DOI: 10.1093/geront/gnab036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives The transition from home to a nursing home is a stressful event for both older persons and informal caregivers. Currently, this transition process is often fragmented, which can create a vicious cycle of health care-related events. Knowledge of existing care interventions can prevent or break this cycle. This project aims to summarize existing interventions for improving transitional care, identifying their effectiveness and key components. Research Design and Methods A scoping review was performed within the European TRANS-SENIOR consortium. The databases PubMed, EMBASE (Excerpta Medica Database), PsycINFO, Medline, and CINAHL (Cumulated Index to Nursing and Allied Health Literature) were searched. Studies were included if they described interventions designed to improve the transition from home to a nursing home. Results 17 studies were identified, describing 13 interventions. The majority of these interventions focused on nursing home adjustment with 1 study including the entire transition pathway. The study identified 8 multicomponent and 5 single-component interventions. From the multicomponent interventions, 7 main components were identified: education, relationships/communication, improving emotional well-being, personalized care, continuity of care, support provision, and ad hoc counseling. The study outcomes were heterogeneous, making them difficult to compare. The study outcomes varied, with studies often reporting nonsignificant changes for the main outcome measures. Discussion and Implications There is a mismatch between the theory on optimal transitional care and current transitional care interventions, as they often lack a comprehensive approach. This research is the first step toward a uniform definition of optimal transitional care and a tool to improve/develop (future) transitional care initiatives on the pathway from home to a nursing home.
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Affiliation(s)
- Lindsay Groenvynck
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.,Department of Public Health and Primary Care, Academic Center for Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | - Amal Fakha
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.,Department of Public Health and Primary Care, Academic Center for Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | - Bram de Boer
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.,Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Jan P H Hamers
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.,Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Theo van Achterberg
- Department of Public Health and Primary Care, Academic Center for Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | - Erik van Rossum
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands.,Academy of Nursing, Research Center on Community Care, Zuyd University of Applied Sciences, Heerlen, The Netherlands
| | - Hilde Verbeek
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.,Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
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De Poli C, Oyebode JR, Binns C, Glover R, Airoldi M. Effectiveness-implementation hybrid type 2 study evaluating an intervention to support 'information work' in dementia care: an implementation study protocol. BMJ Open 2020; 10:e038397. [PMID: 33293389 PMCID: PMC7725094 DOI: 10.1136/bmjopen-2020-038397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Patients with long-term conditions consistently report a lack of information around services and support available to them. This unmet need for information is significant among people with dementia and family carers. A quality improvement intervention is being carried out to tackle this issue as part of a co-creation initiative in the North East of England (UK). The intervention consists of the dissemination (via the local Community Mental Health Services for Older People) of a leaflet about services available to people with dementia and their family carers in the study site. This protocol is reported in accordance with the Standards for Reporting Implementation Studies. METHODS AND ANALYSIS This effectiveness-implementation hybrid type 2 study aims at understanding (1) the unfolding and outcomes of the implementation strategy, (2) the outcomes of the intervention (for people with dementia and family carers, staff implementing the intervention and local service providers) and (3) the contribution of co-creation to the design and implementation of the intervention and its outcomes. The prospective theory of change of the intervention articulated by local stakeholders is used as a reference framework against which to assess the implementation and outcomes of the intervention. Evaluation data will be collected through in-depth interviews with people with dementia and family carers receiving the intervention, staff implementing the intervention and managers from local service providers. Referral data from local service providers will be collected to triangulate the interview data. A focus group with key stakeholders will support the sense-making of findings. The realist configuration of mechanism-context-outcome, operationalised using an information behaviour model, will inform data analysis and interpretation. ETHICS AND DISSEMINATION Ethical and research governance approvals have been obtained from the West Midlands-South Birmingham Research Ethics Committee. The results of the study will be submitted for publication in peer-reviewed journals and disseminated through conferences.
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Affiliation(s)
- Chiara De Poli
- Department of Social Policy and Department of Management, London School of Economics and Political Science, London, UK
| | - Jan R Oyebode
- School of Dementia Studies, University of Bradford, Bradford, West Yorkshire, UK
| | | | - Richard Glover
- NHS North of England Commissioning Support Unit, Durham, UK
| | - Mara Airoldi
- Blavatnik School of Government, University of Oxford, Oxford, UK
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Groenvynck L, de Boer B, Hamers JPH, van Achterberg T, van Rossum E, Verbeek H. Toward a Partnership in the Transition from Home to a Nursing Home: The TRANSCIT Model. J Am Med Dir Assoc 2020; 22:351-356. [PMID: 33223451 DOI: 10.1016/j.jamda.2020.09.041] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/28/2020] [Accepted: 09/28/2020] [Indexed: 11/15/2022]
Abstract
The transition from home to a nursing home can be stressful and traumatic for both older persons and informal caregivers and is often associated with negative outcomes. Additionally, transitional care interventions often lack a comprehensive approach, possibly leading to fragmented care. To avoid this fragmentation and to optimize transitional care, a comprehensive and theory-based model is fundamental. It should include the needs of both older persons and informal caregivers. Therefore, this study, conducted within the European TRANS-SENIOR research consortium, proposes a model to optimize the transition from home to a nursing home, based on the experiences of older persons and informal caregivers. These experiences were captured by conducting a literature review with relevant literature retrieved from the databases CINAHL and PubMed. Studies were included if older persons and/or informal caregivers identified the experiences, needs, barriers, or facilitators during the transition from home to a nursing home. Subsequently, the data extracted from the included studies were mapped to the different stages of transition (pre-transition, mid-transition, and post-transition), creating the TRANSCIT-model. Finally, results were discussed with an expert panel, leading to a final proposed TRANSCIT model. The TRANSCIT model identified that older people and informal caregivers expressed an overall need for partnership during the transition from home to a nursing home. Moreover, it identified 4 key components throughout the transition trajectory (ie, pre-, mid-, and post-transition): (1) support, (2) communication, (3) information, and (4) time. The TRANSCIT model could advise policy makers, practitioners, and researchers on the development and evaluation of (future) transitional care interventions. It can be a guideline reckoning the needs of older people and their informal caregivers, emphasizing the need for a partnership, consequently reducing fragmentation in transitional care and optimizing the transition from home to a nursing home.
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Affiliation(s)
- Lindsay Groenvynck
- Faculty of Health Medicine and Life Sciences, Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Living Lab of Ageing and Long Term Care, Maastricht University, Maastricht, the Netherlands; KU Leuven Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Leuven, Belgium.
| | - Bram de Boer
- Faculty of Health Medicine and Life Sciences, Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Living Lab of Ageing and Long Term Care, Maastricht University, Maastricht, the Netherlands
| | - Jan P H Hamers
- Faculty of Health Medicine and Life Sciences, Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Living Lab of Ageing and Long Term Care, Maastricht University, Maastricht, the Netherlands
| | - Theo van Achterberg
- KU Leuven Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Leuven, Belgium
| | - Erik van Rossum
- Faculty of Health Medicine and Life Sciences, Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Living Lab of Ageing and Long Term Care, Maastricht University, Maastricht, the Netherlands; Academy of Nursing, Research Centre on Community Care, Zuyd University of Applied Sciences, Heerlen, the Netherlands
| | - Hilde Verbeek
- Faculty of Health Medicine and Life Sciences, Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Living Lab of Ageing and Long Term Care, Maastricht University, Maastricht, the Netherlands
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Frias CE, Risco E, Zabalegui A. Psychoeducational intervention on burden and emotional well-being addressed to informal caregivers of people with dementia. Psychogeriatrics 2020; 20:900-909. [PMID: 33015927 DOI: 10.1111/psyg.12616] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/24/2020] [Accepted: 09/02/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND In dementia it is necessary that a family member become an informal caregiver. This labour has social, physical and emotional repercussions on the caregiver's health. The objective was to assesses the impact of the INFOSA-DEM intervention on burden and emotional well-being among caregivers of people with dementia, evaluating the effects at 3 and 6 months. METHOD We adopted an experimental, non-randomised design with an intervention group and a control group. The intervention group received the intervention and the control group received usual care. The study was carried out in the catchment areas of three centres specialising in the care of people with cognitive impairment in the province of Barcelona. RESULTS At 3 months, there was an improvement with respect to burden in the intervention group with a significant worsening (P < 0.012) in the control group. Similarly, a positive effect on emotional well-being was observed in the intervention group compared with a small negative effect among controls. CONCLUSIONS Programs addressed to informal caregivers based on psychoeducational and cognitive-behavioural therapies are effective in improving quality of life and emotional well-being, and in reducing burden, with a positive effect on the quality of care provided at home.
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Affiliation(s)
- Cindy E Frias
- Department of Nursing, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Ester Risco
- Hospital Pere I Virgili of Barcelona, Barcelona, Spain
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Physicians and Family Caregivers: Two Perspectives of Physicians' Roles in Long-Term Care. J Am Med Dir Assoc 2020; 22:1088-1095. [PMID: 32994118 DOI: 10.1016/j.jamda.2020.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 08/10/2020] [Accepted: 08/10/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVES We explored the roles of attending physicians of long-term care (LTC) residents in supporting their family caregivers (FCGs). DESIGN In this mixed-methods study, we conducted surveys and focus group interviews with physicians and FCGs. SETTING AND PARTICIPANTS There were 78 FCGs and 18 physicians in the survey, and 18 FCGs and 9 physicians in the focus groups. They were recruited from 5 urban LTC settings. RESULTS Although 83.3% of physicians reported they had experience caring for FCGs, 71.8% of FCGs perceived they had not received support from the physicians. There was no statistically significant difference between the FCGs' and physicians' mean responses to the mirrored survey questions. Both groups gave similar ratings, means neutral and agree indicative of ambivalence, on physician's knowledge to identify FCGs who need assistance, ability to assess FCG stress, and aid those experiencing distress and needing advocacy. Analysis of the focus groups revealed the overarching theme: ambiguity about the LTC residents' physicians' role in supporting FCGs. Although physicians noted that residents and families come as a unit, there was ambivalence about the physician's role in supporting FCGs. FCG roles in LTC are also vague. There were 3 sub-themes: "accord on the surface"; "tension in the interface"; and "smoothing the relationship." Both groups thought FCG medical care was beyond the purview of the resident's physician. Physicians and FCGs provided different explanations for the tensions in the FCG/physician interface. Physicians attributed tension to FCG stress and inadequate knowledge, whereas FCGs thought physicians' communication could be improved. Suggestions to smooth the relationship were to align FCG expectations to reality of LTC and different staffing models. CONCLUSIONS AND IMPLICATIONS Family physicians, policy makers, and FCGs will need to work on polices to ensure LTC physicians' roles in supporting FCGs and FCGs' roles in LTC are delineated and supported.
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Pritty B, De Boos D, Moghaddam N. Factors influencing the transition experience of carers for persons with dementia, when the person with dementia moves into residential care: systematic review and meta-synthesis. Aging Ment Health 2020; 24:1371-1380. [PMID: 30977396 DOI: 10.1080/13607863.2019.1602591] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Aims: To understand factors influencing the experience of carers for people with dementia, when that person moves from living in the community to living in residential care. Specifically, we aimed to identify facilitators and inhibitors of carer adjustment during this transition.Method: A systematic search of CINAHL, EMBASE, PubMed, and PsycINFO databases was conducted. Nine qualitative articles published between 2001 and 2017, based on the experiences of 141 carers, were included. Thematic analysis was applied to the data, with the concepts of transition inhibitors and facilitators being used to structure the analytic process.Results: Analysis produced five themes, representing factors that could affect carer experiences of the focal transition-process: modifying the difficulty of this process according to their presence or absence. The themes were (1) Connection, pertaining to the carer feeling connected to the person with dementia and professionals during this transition; (2) Informed & Informing, relating to exchange of information between the carer and facility staff or health professionals; (3) The facility: welcoming & skilful, dealing with carer perceptions of the facility and their confidence in the staff; (4) It's What You Make of It, discussing the meaning the carer made of the admission and the impact this had; and (5) Sharing Responsibility, addressing how carers were affected by the perceived sharing of responsibility for care-provision.Conclusions: A supportive network has a significant role to play in facilitating this transition for carers. However, further research into what carers would find useful during this time is needed.
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Affiliation(s)
- Beth Pritty
- Department of Clinical Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Danielle De Boos
- Department of Clinical Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Nima Moghaddam
- Department of Clinical Psychology, University of Lincoln, Lincoln, UK
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Holt Clemmensen T, Hein Lauridsen H, Andersen-Ranberg K, Kaae Kristensen H. Informal carers' support needs when caring for a person with dementia - A scoping literature review. Scand J Caring Sci 2020; 35:685-700. [PMID: 32781496 DOI: 10.1111/scs.12898] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/26/2020] [Accepted: 07/14/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND Informal carers of people with dementia report having unmet needs for support and few supportive interventions have been shown to be effective. There is a need to develop needs assessment instruments and supportive interventions with a holistic and person-centred approach to meet the various and complex needs of carers. The aim of this study was to provide an overview of carers' support needs when caring for people with dementia with the objectives to map and synthesise knowledge on key concepts of carers' support needs. METHODS A scoping review methodology was used. A literature search was conducted in PsycINFO, CINAHL, PubMed and EMBASE between January 2007 and October 2019. Three authors independently selected articles meeting the inclusion criteria, and data were extracted using a matrix developed for that purpose. Inductive content analysis was used to synthesise key concepts of carers' support needs. RESULTS The search identified 2748 articles after removing duplicates, and 122 articles were included in the mapping of carers' support needs. Synthesising carers' support needs indicated that the full extent of support needs emerges in the interaction between the carer and the person cared for and that it is possible to categorise support needs into four key concepts related to: 1) the carer as a person, 2) managing being a carer, 3) providing care, and 4) knowledge of dementia. CONCLUSION The findings of this study help to map a framework describing carers' support needs that may guide the development of future needs assessment instruments and supportive interventions.
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Affiliation(s)
- Trine Holt Clemmensen
- Health Sciences Research Centre, UCL University College, Odense, Denmark.,Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Henrik Hein Lauridsen
- Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Karen Andersen-Ranberg
- Department of Public Health, University of Southern Denmark, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Hanne Kaae Kristensen
- Health Sciences Research Centre, UCL University College, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Duggleby W, O'Rourke H, Swindle J, Peacock S, McAiney C, Baxter P, Thompson G, Dubé V, Nekolaichuk C, Ghosh S, Holroyd-Leduc J. Study protocol: pragmatic randomized control trial of my tools 4 care- in care (MT4C-in care) a web-based tool for family Carers of persons with dementia residing in long term care. BMC Geriatr 2020; 20:285. [PMID: 32778059 PMCID: PMC7418203 DOI: 10.1186/s12877-020-01690-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 08/03/2020] [Indexed: 11/10/2022] Open
Abstract
Background When a family member resides in long term care facility (LTC), family carers continue caregiving and have been found to have decreases in mental health. The aim of My Tools 4 Care – In Care (an online intervention) is to support carers of persons living with dementia residing in LTC through transitions and increase their self-efficacy, hope, social support and mental health. This article comprises the protocol for a study to evaluate My Tools 4 Care-In Care (MT4C-In Care) by asking the following research questions:
Is there a 2 month (immediately post-intervention) and 4 month (2 months post-intervention) increase in mental health, general self-efficacy, social support and hope, and decrease in grief and loneliness, in carers of a person living with dementia residing in LTC using MT4C-In CARE compared to an educational control group? Do carers of persons living with dementia residing in LTC perceive My Tools 4 Care- In Care helps them with the transitions they experience?
Methods This study is a single blinded pragmatic mixed methods randomized controlled trial. Approximately 280 family carers of older persons (65 years of age and older) with dementia residing in LTC will be recruited for this study. Data will be collected at three time points: baseline, 2 month, and 4 months. Based on the feasibility study, we hypothesize that participants using MT4C-In Care will report significant increases in hope, general self-efficacy, social support and mental health quality of life, and significant decreases in grief and loneliness from baseline, as compared to an educational control group. To determine differences between groups and over time, generalized estimating equations analysis will be used. Qualitative descriptive analysis will be used to further evaluate MT4C-In Care and if it supports carers through transitions. Discussion Data collection will begin in four Canadian provinces (Alberta, Manitoba, Ontario and Saskatchewan) in February 2020 and is expected to be completed in June 2021. The results will inform policy and practice as MT4C-In Care can be revised for local contexts and posted on websites such as those hosted by the Alzheimer Society of Canada. Trial registration NCT04226872 ClinicalTrials.gov Registered 09 January 2020 Protocol Version #2 Feb 19, 2020.
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Affiliation(s)
- Wendy Duggleby
- Faculty of Nursing, University of Alberta, Level 3 Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada.
| | - Hannah O'Rourke
- Faculty of Nursing, University of Alberta, Level 3 Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Jennifer Swindle
- Faculty of Nursing, University of Alberta, Level 3 Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Shelley Peacock
- College of Nursing, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK, S7N 2Z4, Canada
| | - Carrie McAiney
- Schlegel-UW Research Institute for Aging, School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - Pamela Baxter
- School of Nursing, McMaster University, 1280 Main St. W, Hamilton, ON, L8S 4K1, Canada
| | - Genevieve Thompson
- College of Nursing, Faculty of Health Sciences, University of Manitoba, 89 Curry Place, Winnipeg, MB, R3T 2N2, Canada
| | - Véronique Dubé
- Faculty of Nursing, Université de Montréal Marguerite d'Youville Research, Université de Montréal, PO Box 6128, Centre-ville Station, Montréal, QC, H3C 3J7, Canada
| | - Cheryl Nekolaichuk
- Department of Oncology, University of Alberta, c/o Palliative Institute, DC 404, 1090 Youville Drive, Edmonton, AB, T6L 0A3, Canada
| | - Sunita Ghosh
- Departments of Medical Oncology and Mathematical and Statistical Sciences, University of Alberta, Edmonton, Canada.,Alberta Health Services-Cancer Control, 0058 Cross Cancer Institute, 11560 University Ave, Edmonton, AB, T6G 1Z2, Canada
| | - Jayna Holroyd-Leduc
- Division of Geriatric Medicine, Departments of Medicine and Community Health Sciences, University of Calgary, 1403 - 29th Street NW, Calgary, AB, T2N2T9, Canada
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Duggleby W, Peacock S, Ploeg J, Swindle J, Kaewwilai L, Lee H. Qualitative Research and Its Importance in Adapting Interventions. QUALITATIVE HEALTH RESEARCH 2020; 30:1605-1613. [PMID: 32458731 DOI: 10.1177/1049732320920229] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Systematic approaches are essential when adapting interventions, so the adapted intervention is feasible, acceptable, and holds promise for positive outcomes in the new target population and/or setting. Qualitative research is critical to this process. The purpose of this article is to provide an example of how qualitative research was used to guide the adaptation a web-based intervention for family carers of persons with dementia residing in long-term care (LTC) and to discuss challenges associated with using qualitative methodologies in this regard. Four steps are outlined: (a) choosing an intervention to adapt, (b) validating the conceptual framework of the intervention, (c) revising the intervention, and (d) conducting a feasibility study. Challenges with respect to decontextualization and subjective reality are discussed, with suggestions provided on how to overcome them. The result of this process was a feasible and acceptable web-based intervention to support family carers of persons with dementia residing in LTC.
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Affiliation(s)
| | | | - Jenny Ploeg
- McMaster University, Hamilton, Ontario, Canada
| | | | | | - HeunJung Lee
- University of Alberta, Edmonton, Alberta, Canada
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Carter G, Monaghan C, Santin O. What is known from the existing literature about peer support interventions for carers of individuals living with dementia: A scoping review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:1134-1151. [PMID: 31919974 DOI: 10.1111/hsc.12944] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 12/16/2019] [Accepted: 12/16/2019] [Indexed: 06/10/2023]
Abstract
This scoping review comprehensively describes evidence of using peer support to assist informal carers of individuals with dementia (any type). A systematic search of 11 databases (CINAHL, Cochrane Library, Medline, Embase, PsychInfo, Web of Science, Scopus, Science Direct, ProQuest, TRIP and PubMed) was conducted for research published between 2007-2017 focussing on informal dementia carers, and research designs with interventions incorporating or consisting exclusively of peer support. Authors worked independently to screen retrieved articles, review applicability and extract data. Thirty-six research papers (representing 28 original studies) were identified, from these, two modes of delivery were demonstrated: 12 studies provided the intervention online, and the remainder face-to-face. The review indicated that peer support is of potential benefit to carers if it is delivered via either mode. It is not clear what components may or may not be effective as results provided a mixed landscape of differing intervention effectiveness due to the wide variation in outcome measurements. Trial design using a multi-component intervention was the predominant choice, with the most common components being Information Sharing and Non-Healthcare Professional Support for both delivery modes. The burden/anxiety/depression compendium and health and well-being were the most frequently measured outcomes; perceived level of support was one of the least. The peer support interventions identified included various components, demonstrating no true best practice model. Nonetheless, they can be offered successfully online or face-to-face. This provides a unique opportunity to develop and supply tailored peer support interventions for informal dementia carers to ensure their specific needs are met. Further work is required to construct and evaluate the effectiveness of targeted peer-led support whether online or face-to-face to meet the individual needs of dementia carers.
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Affiliation(s)
- Gillian Carter
- School of Nursing and Midwifery, Queen's University, Belfast, UK
| | | | - Olinda Santin
- School of Nursing and Midwifery, Queen's University, Belfast, UK
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Parmar J, Anderson S, Abbasi M, Ahmadinejad S, Brémault-Phillips S, Chan K, Charles L, Dobbs BM, Khera AS, Stickney-Lee J, Tian PGJ. Support for family caregivers: A scoping review of family physician's perspectives on their role in supporting family caregivers. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:716-733. [PMID: 31858674 DOI: 10.1111/hsc.12928] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/26/2019] [Accepted: 11/21/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Jasneet Parmar
- Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
- Covenant Health-Network of Excellence in Seniors' Health and Wellness, Edmonton, AB, Canada
- Grey Nuns Community Hospital, Marguerite Health Services Centre, Edmonton, AB, Canada
| | - Sharon Anderson
- Covenant Health-Network of Excellence in Seniors' Health and Wellness, Edmonton, AB, Canada
- Grey Nuns Community Hospital, Marguerite Health Services Centre, Edmonton, AB, Canada
| | - Marjan Abbasi
- Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
| | - Saeed Ahmadinejad
- Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
| | - Suzette Brémault-Phillips
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, AB, Canada
| | - Karenn Chan
- Department of Family Medicine, Division of Care of the Elderly, University of Alberta, Edmonton, AB, Canada
| | - Lesley Charles
- Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
- Care of the Elderly, Glenrose Rehabilitation Hospital-East, Edmonton, AB, Canada
| | - Bonnie M Dobbs
- Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
- Department of Family Medicine, Division of Care of the Elderly, University of Alberta, Edmonton, AB, Canada
- Medically At-Risk Driver Centre, University of Alberta, Edmonton, AB, Canada
| | - Amandeep Sheny Khera
- Department of Family Medicine, Division of Care of the Elderly, University of Alberta, Edmonton, AB, Canada
| | - Jennifer Stickney-Lee
- Supportive Living for AHS in the Edmonton Zone, Site Chief for Geriatrics at the Sturgeon Community Hospital, Edmonton, AB, Canada
| | - Peter George J Tian
- Department of Family Medicine, Division of Care of the Elderly, University of Alberta, Edmonton, AB, Canada
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A qualitative systematic review of factors affecting caregivers’ decision-making for care setting placements for individuals with dementia. Geriatr Nurs 2020; 41:172-180. [DOI: 10.1016/j.gerinurse.2019.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 08/30/2019] [Accepted: 09/04/2019] [Indexed: 11/19/2022]
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Cottrell L, Duggleby W, Ploeg J, McAiney C, Peacock S, Ghosh S, Holroyd-Leduc JM, Nekolaichuk C, Forbes D, Paragg J, Swindle J. Using focus groups to explore caregiver transitions and needs after placement of family members living with dementia in 24-hour care homes. Aging Ment Health 2020; 24:227-232. [PMID: 30588823 DOI: 10.1080/13607863.2018.1531369] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: Family caregivers (defined broadly as family and friends) of persons with dementia are challenged to cope with myriad stressors and changes that occur along the dementia trajectory. The purpose of this study was to explore the transitions experienced by caregivers of persons with dementia after their relative relocated to a 24-hour care home.Method: Qualitative thematic and conversational analysis were used: themes were co-created and modes of speech and syntactical patterns analysed to expose discourses related to caregiving after placement in 24-hour care homes.Results: Four main themes were co-constructed from the data analysis: living with loss, relinquishing, redefining the caregiving role, and rediscovering and recreating a new self.Discussion: Caregiving continues after placement of family members with dementia in 24-hour care homes. Caregivers are at-risk group and require ongoing support throughout the caregiving journey. Study participants reported that navigation skills such as relationship building, communication, and advocacy were particularly salient to the post-placement period, when navigating the complex health care environment was a significant obstacle. Ultimately, findings from these focus groups will be used to inform an online intervention to support caregivers of a family member with dementia residing in a 24-hour care home.
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Affiliation(s)
- L Cottrell
- Faculty of Nursing, The University of Alberta, Edmonton, Canada
| | - W Duggleby
- Faculty of Nursing, The University of Alberta, Edmonton, Canada
| | - J Ploeg
- School of Nursing, McMaster University, Hamilton, Canada
| | - C McAiney
- Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - S Peacock
- College of Nursing, University of Saskatchewan, Saskatchewan, Canada
| | - S Ghosh
- Department of Medical Oncology/Department of Mathematical & Statistical Sciences, The University of Alberta, Edmonton, Canada
| | - J M Holroyd-Leduc
- Department of Medicine & Community Health Sciences, University of Calgary, Alberta, Canada
| | - C Nekolaichuk
- Faculty of Medicine & Dentistry, The University of Alberta, Edmonton, Canada
| | - D Forbes
- Faculty of Nursing, The University of Alberta, Edmonton, Canada
| | - J Paragg
- Faculty of Nursing, The University of Alberta, Edmonton, Canada
| | - J Swindle
- Faculty of Nursing, The University of Alberta, Edmonton, Canada
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Abstract
BACKGROUND The number of people living with dementia (PWD) is increasing worldwide, corresponding with an increasing number of caregivers for PWD. This study aims to identify and describe the literature surrounding the needs of caregivers of PWD and the solutions identified to meet these needs. METHOD A literature search was performed in: PsycInfo, Medline, CINAHL, SCIELO and LILACS, January 2007-January 2018. Two independent reviewers evaluated 1,661 abstracts, and full-text screening was subsequently performed for 55 articles. The scoping review consisted of 31 studies, which were evaluated according to sociodemographic characteristics, methodological approach, and caregiver's experiences, realities, and needs. To help extract and organize reported caregiver needs, we used the C.A.R.E. Tool as a guiding framework. RESULTS Thirty-one studies were identified. The most common needs were related to personal health (58% emotional health; 32% physical health) and receiving help from others (55%). Solutions from the articles reviewed primarily concerned information gaps (55%) and the education/learning needs of caregivers (52%). CONCLUSION This review identified the needs of caregivers of PWD. Caregivers' personal health emerged as a key area of need, while provision of information was identified as a key area of support. Future studies should explore the changes that occur in needs over the caregiving trajectory and consider comparing caregivers' needs across different countries.
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McKibben L, Brazil K, Hudson P, McLaughlin D. Informational needs of family caregivers of people with intellectual disability who require palliative care: a two-phase integrative review of the literature. Int J Palliat Nurs 2019; 25:4-18. [PMID: 30676158 DOI: 10.12968/ijpn.2019.25.1.4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND: People with intellectual disabilities are living longer, with increasingly complex needs and their family caregivers may have a broad scope of unmet needs. AIMS: To identify the most common needs of family caregivers, to identify gaps in the literature, and distinguish the information needs of family caregivers of people with intellectual disabilities who require palliative care. METHODS: This two phase literature review used five electronic databases (CINAHL, PsycINFO, Medline, Cochrane and Pubmed). Phase 1 involved a review of systematic reviews of the needs of family caregivers across healthcare settings. Phase 2 explored the commonly reported information needs from phase 1, in relation to family caregivers of people with intellectual disability who require palliative care. There was no research explicit to the information needs of these family caregivers. FINDINGS: This review reveals potential information needs which may exist, guided by the palliative caregiving literature; alluding to information needs surrounding the disease, finances, and psychological or practical support. CONCLUSION: It is surmised that a greater scope of informational need exists for this population and further research is pertinent for international healthcare settings.
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Affiliation(s)
- Laurie McKibben
- PhD graduate, School of Nursing and Midwifery, Queen's University Belfast, UK
| | - Kevin Brazil
- Professor, School of Nursing and Midwifery, Queen's University Belfast, UK
| | - Peter Hudson
- Professor, Centre for Palliative Care, Centre for Palliative Care, St Vincent's Hospital and The University of Melbourne, Fitzroy, Victoria, Australia
| | - Dorry McLaughlin
- Lecturer, School of Nursing and Midwifery, Queen's University Belfast, UK
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