1
|
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.
Collapse
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
| |
Collapse
|
2
|
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 2024:1-11. [PMID: 38916473 DOI: 10.3928/19404921-20240614-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [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, xx(x), xx-xx.].
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Garnett A, Pollock H, Floriancic N, Prentice K, Donelle L, Hand C, Oudshoorn A, Babenko-Mould Y, Forchuk C. Social Connectedness Between Family Caregivers and Older Adults Living in Long-Term Care Homes in the Context of COVID-19. Can J Aging 2024; 43:33-44. [PMID: 37727879 DOI: 10.1017/s0714980823000351] [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] [Indexed: 09/21/2023] Open
Abstract
The coronavirus disease (COVID-19) pandemic and resulting restrictions on physical access to long-term care homes culminated in health declines for older adults living there and their families. Knowledge gaps exist regarding maintaining social connectedness when physically separated. The study aimed to explore family members' perceptions of the impact that restrictions on physical access to long-term care homes had on the experience of social connectedness between family members and older adults living in long-term care. The method used was a qualitative description, using in-depth semi-structured interviews. Themes arising from inductive qualitative content analysis of 21 interviews with family members included: (a) lack of connection threatening mental, emotional health, and physical health; (b) navigating trust in the unknown; (c) feelings of stress and anxiety for family members; and (d) technology - an asset, but not for everyone. Study findings suggest more emphasis should be placed on supporting social connections between older adults and their families in the context of long-term care beyond COVID-19.
Collapse
Affiliation(s)
- Anna Garnett
- Faculty of Health Sciences, Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
| | - Hannah Pollock
- Faculty of Health Sciences, Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
| | - Natalie Floriancic
- Faculty of Health Sciences, Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
| | - Kristin Prentice
- Health and Rehabilitation Sciences, Faculty of Health Sciences, Western University, London, ON, Canada
| | - Lorie Donelle
- Biobehavioral Health & Nursing Science, College of Nursing, University of South Carolina, Columbia, SC, USA
| | - Carri Hand
- School of Occupational Therapy, Faculty of Health Sciences, Western University, London, ON, Canada
| | - Abe Oudshoorn
- Faculty of Health Sciences, Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
| | - Yolanda Babenko-Mould
- Faculty of Health Sciences, Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
| | - Cheryl Forchuk
- Faculty of Health Sciences, Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Brooks D, Beattie E, Edwards H, Fielding E, Gaugler JE. Pilot Study of the Residential Care Transition Module to Support Australian Spouses of People with Dementia. Clin Gerontol 2022; 45:1130-1143. [PMID: 34962455 DOI: 10.1080/07317115.2021.1988023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Spouses are at risk of poor psychosocial outcomes following placement of their partner with dementia into long-term care. The Residential Care Transition Module (RCTM) is a psychosocial intervention developed in the United States to support carers post-placement. This study aimed to test the RCTM delivered by telephone to Australian spousal carers. METHODS A small-scale RCT [N = 21] was conducted to test feasibility of recruitment, retention, acceptability, and preliminary effects on measures of stress, grief, depression, guilt, quality-of-life, and satisfaction with care, compared to a group receiving printed information. RESULTS The Transition Counselor and study participants considered the intervention delivery, dose, and content as acceptable. Retention was high (91%). At follow-up, significant time effects were found for stress, depression and "nursing home hassles." A significant interaction effect was found for quality-of-life in favor of the comparison group. No effects were found for guilt or overall grief, however a promising result regarding the sub-scale of "acceptance of loss" was found in favor of the RCTM. CONCLUSIONS The delivery of the RCTM to Australian spousal carers was feasible and acceptable. CLINICAL IMPLICATIONS The RCTM shows potential for improving support to spouses of people with dementia following long-term care placement.
Collapse
Affiliation(s)
- Deborah Brooks
- Dementia Centre for Research Collaboration, Queensland University of Technology, Brisbane, Australia
| | - Elizabeth Beattie
- Dementia Centre for Research Collaboration, Queensland University of Technology, Brisbane, Australia
| | - Helen Edwards
- Dementia Centre for Research Collaboration, Queensland University of Technology, Brisbane, Australia
| | - Elaine Fielding
- Dementia Centre for Research Collaboration, Queensland University of Technology, Brisbane, Australia
| | - Joseph E Gaugler
- School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| |
Collapse
|
7
|
Eltaybani S, Yasaka T, Fukui C, Inagaki A, Takaoka M, Suzuki H, Maruyama M, Igarashi A, Noguchi-Watanabe M, Sakka M, Weller C, Yamamoto-Mitani N. Family-oriented interventions in long-term care residential facilities for older people: A scoping review of the characteristics and outcomes. Nurs Forum 2022; 57:800-818. [PMID: 35810335 DOI: 10.1111/nuf.12768] [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: 11/18/2021] [Revised: 04/17/2022] [Accepted: 06/01/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Family-oriented interventions in long-term care (LTC) residential facilities are heterogenous in design, characteristics, and outcomes. OBJECTIVES To synthesize characteristics (e.g., type, provider, and duration) and outcomes of family-oriented interventions in LTC residential facilities. METHODS We followed the JBI methodology and searched seven databases for quantitative, qualitative, and mixed method studies that reported family-oriented interventions in LTC residential settings for older people; defined in this review as ≥60 years. Interventions that included residents, resident families, health professionals, or any combinations of these three were included if the study reported post-intervention assessment of at least one family-related outcome. RESULTS Thirteen studies met the inclusion criteria. Interventions were found to be multifaceted, and education was the most common element. Nurses were the most common intervenors, and most interventions had more than one target (residents, resident families, or staff). Most outcomes were related to family involvement, satisfaction with care, quality of life, communication, symptom management, and shared decision making, and none of the studies reported a negative impact. CONCLUSIONS Family-oriented interventions were associated with high care quality and better resident-staff-family partnership. Staff education and staff-family conversation are relatively cheap interventions to help family involvement, facilitate shared decision-making, and improve family satisfaction.
Collapse
Affiliation(s)
- Sameh Eltaybani
- Department of Gerontological Home Care and Long-term Care Nursing, The University of Tokyo, Tokyo, Japan
| | - Taisuke Yasaka
- Department of Gerontological Home Care and Long-term Care Nursing, The University of Tokyo, Tokyo, Japan
| | - Chie Fukui
- Department of Gerontological Home Care and Long-term Care Nursing, The University of Tokyo, Tokyo, Japan
| | - Asa Inagaki
- Department of Gerontological Home Care and Long-term Care Nursing, The University of Tokyo, Tokyo, Japan
| | - Manami Takaoka
- Department of Gerontological Home Care and Long-term Care Nursing, The University of Tokyo, Tokyo, Japan
| | - Haruno Suzuki
- Department of Gerontological Home Care and Long-term Care Nursing, The University of Tokyo, Tokyo, Japan
| | - Miyuki Maruyama
- Department of Gerontological Home Care and Long-term Care Nursing, The University of Tokyo, Tokyo, Japan
| | - Ayumi Igarashi
- Department of Gerontological Home Care and Long-term Care Nursing, The University of Tokyo, Tokyo, Japan
| | - Maiko Noguchi-Watanabe
- Department of Gerontological Home Care and Long-term Care Nursing, The University of Tokyo, Tokyo, Japan
- Department of Home Care Nursing, Tokyo Medical and Dental University, Tokyo, Japan
| | - Mariko Sakka
- Department of Gerontological Home Care and Long-term Care Nursing, The University of Tokyo, Tokyo, Japan
| | - Carolina Weller
- School of Nursing and Midwifery Monash University, Monash, Australia
| | - Noriko Yamamoto-Mitani
- Department of Gerontological Home Care and Long-term Care Nursing, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Eltaybani S, Yasaka T, Fukui C, Inagaki A, Takaoka M, Suzuki H, Maruyama M, Yamamoto-Mitani N. Family-oriented interventions in long-term care residential settings: a scoping review protocol. JBI Evid Synth 2021; 19:1668-1674. [PMID: 33577233 DOI: 10.11124/jbies-20-00289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES The objective of this review will be to identify the characteristics (eg, type, duration, and provider) of family-oriented interventions in long-term care residential settings. The authors will also identify which outcomes are reported in the literature when implementing family-oriented interventions. INTRODUCTION An array of family-oriented interventions in long-term care residential settings exist. Given the heterogeneity of current literature, mapping characteristics and intended outcomes of family-oriented interventions is an essential step to inform how best to support families of patients in long-term care residential settings. INCLUSION CRITERIA This review will consider studies describing family-oriented interventions for families of elderly patients in long-term care residential settings, with no exclusion based on country, gender, or comorbidities. Interventions that address any family-related issue, such as quality of life, psychological burden, and family involvement in patient care, are eligible for inclusion. Studies will be excluded if the patients are cared for at their own homes or institutionalized care is provided on a temporary basis. Quantitative, qualitative, and mixed method study designs will be considered for inclusion. METHODS A scoping review will be conducted using the JBI methodological approach. Seven databases will be systematically searched: MEDLINE, CINAHL, Scopus, Evidence-Based Medicine Reviews including Cochrane Library, PsycINFO, OpenGrey, and the Grey Literature Report. Citations will be screened against the inclusion criteria by two reviewers independently. Relevant data will be extracted from the included studies, and will be synthesized, summarized, and reported following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. Findings will be published in a peer-reviewed journal.
Collapse
Affiliation(s)
- Sameh Eltaybani
- Department of Gerontological Homecare and Long-Term Care Nursing, Division of Health Science and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Critical Care and Emergency Nursing, Faculty of Nursing, University of Alexandria, Alexandria, Egypt
| | - Taisuke Yasaka
- Department of Gerontological Homecare and Long-Term Care Nursing, Division of Health Science and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Chie Fukui
- Department of Gerontological Homecare and Long-Term Care Nursing, Division of Health Science and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Asa Inagaki
- Department of Gerontological Homecare and Long-Term Care Nursing, Division of Health Science and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Manami Takaoka
- Department of Gerontological Homecare and Long-Term Care Nursing, Division of Health Science and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Haruno Suzuki
- Department of Gerontological Homecare and Long-Term Care Nursing, Division of Health Science and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Miyuki Maruyama
- Department of Gerontological Homecare and Long-Term Care Nursing, Division of Health Science and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Noriko Yamamoto-Mitani
- Department of Gerontological Homecare and Long-Term Care Nursing, Division of Health Science and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
10
|
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.
Collapse
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
| |
Collapse
|
11
|
McMahan RD, Tellez I, Sudore RL. Deconstructing the Complexities of Advance Care Planning Outcomes: What Do We Know and Where Do We Go? A Scoping Review. J Am Geriatr Soc 2020; 69:234-244. [PMID: 32894787 DOI: 10.1111/jgs.16801] [Citation(s) in RCA: 215] [Impact Index Per Article: 53.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/30/2020] [Accepted: 08/02/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND/OBJECTIVES Advance care planning (ACP) has shown benefit in some, but not all, studies. It is important to understand the utility of ACP. We conducted a scoping review to identify promising interventions and outcomes. DESIGN Scoping review. MEASUREMENTS We searched MEDLINE/PubMed, EMBASE, CINAHL, PsycINFO, and Web of Science for ACP randomized controlled trials from January 1, 2010, to March 3, 2020. We used standardized Preferred Reporting Items for Systematic Review and Meta-Analyses methods to chart study characteristics, including a standardized ACP Outcome Framework: Process (e.g., readiness), Action (e.g., communication), Quality of Care (e.g., satisfaction), Health Status (e.g., anxiety), and Healthcare Utilization. Differences between arms of P < .05 were deemed positive. RESULTS Of 1,464 articles, 69 met eligibility; 94% were rated high quality. There were variable definitions, age criteria (≥18 to ≥80 years), diseases (e.g., dementia and cancer), and settings (e.g., outpatient and inpatient). Interventions included facilitated discussions (42%), video only (20%), interactive, multimedia (17%), written only (12%), and clinician training (9%). For written only, 75% of primary outcomes were positive, as were 69% for multimedia programs; 67% for facilitated discussions, 59% for video only, and 57% for clinician training. Overall, 72% of Process and 86% of Action outcomes were positive. For Quality of Care, 88% of outcomes were positive for patient-surrogate/clinician congruence, 100% for patients/surrogate/clinician satisfaction with communication, and 75% for surrogate satisfaction with patients' care, but not for goal concordance. For Health Status outcomes, 100% were positive for reducing surrogate/clinician distress, but not for patient quality of life. Healthcare Utilization data were mixed. CONCLUSION ACP is complex, and trial characteristics were heterogeneous. Outcomes for all ACP interventions were predominantly positive, as were Process and Action outcomes. Although some Quality of Care and Health Status outcomes were mixed, increased patient/surrogate satisfaction with communication and care and decreased surrogate/clinician distress were positive. Further research is needed to appropriately tailor interventions and outcomes for local contexts, set appropriate expectations of ACP outcomes, and standardize across studies.
Collapse
Affiliation(s)
- Ryan D McMahan
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California.,San Francisco Veterans Affairs Health Care System, San Francisco, California
| | - Ismael Tellez
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California.,San Francisco Veterans Affairs Health Care System, San Francisco, California
| | - Rebecca L Sudore
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California.,San Francisco Veterans Affairs Health Care System, San Francisco, California
| |
Collapse
|
12
|
Kokorelias KM, Gignac MAM, Naglie G, Rittenberg N, MacKenzie J, D’Souza S, Cameron JI. A grounded theory study to identify caregiving phases and support needs across the Alzheimer’s disease trajectory. Disabil Rehabil 2020; 44:1050-1059. [DOI: 10.1080/09638288.2020.1788655] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Kristina M. Kokorelias
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Monique A. M. Gignac
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Institute for Work and Health, Toronto, Canada
| | - Gary Naglie
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Rotman Research Institute, Baycrest Health Sciences, Toronto, Canada
| | - Nira Rittenberg
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Jennifer MacKenzie
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada
- Ontario Shores Centre for Mental Health Sciences, Geriatric Transitional Unit, Whitby, Canada
| | - Samantha D’Souza
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Jill I. Cameron
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada
| |
Collapse
|
13
|
Gaugler JE, Statz TL, Birkeland RW, Louwagie KW, Peterson CM, Zmora R, Emery A, McCarron HR, Hepburn K, Whitlatch CJ, Mittelman MS, Roth DL. The ResidentialCare Transition Module: a single-blinded randomized controlled evaluation of a telehealth support intervention for family caregivers of persons with dementia living in residential long-term care. BMC Geriatr 2020; 20:133. [PMID: 32293314 PMCID: PMC7158110 DOI: 10.1186/s12877-020-01542-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 03/29/2020] [Indexed: 11/22/2022] Open
Abstract
Background Families do not fully disengage from care responsibilities following relatives’ admissions to residential long-term (RLTC) care settings such as nursing homes. Caregiver stress, depression, or other key outcomes remain stable or sometimes increase following a relative’s RLTC entry. Some interventions have attempted to increase family involvement after institutionalization, but few rigorous studies have demonstrated whether these interventions are effective in helping families navigate the potential emotional and psychological upheaval presented by relatives’ transitions to RLTC environments. The Residential Care Transition Module (RCTM) provides six formal sessions of consultation (one-to-one and family sessions) over a 4-month period to family caregivers who have admitted a relative to a RLTC setting. Methods In this embedded mixed methods randomized controlled evaluation, family members who have admitted a cognitively impaired relative to a RLTC setting are randomly assigned to the RCTM (n = 120) or a usual care control condition (n = 120). Primary outcomes include reductions in family members’ primary subjective stress and negative mental health outcomes; secondary role strains; and residential care stress. The mixed methods design will allow for an analysis of intervention action mechanisms by “embedding” qualitative components (up to 30 semi-structured interviews) at the conclusion of the 12-month evaluation. Discussion This evaluation will fill an important clinical and research gap by evaluating a psychosocial intervention designed for families following RLTC admission that determines whether and how the RCTM can help families better navigate the emotional and psychological challenges of residential care transitions. Trial registration ClinicalTrials.gov (NCT02915939, prospectively registered).
Collapse
Affiliation(s)
- Joseph E Gaugler
- Division of Health Policy and Management, School 8of Public Health, University of Minnesota, D351 Mayo (MMC 729), 420 Delaware Street S.E, Minneapolis, MN, 55455, USA.
| | - Tamara L Statz
- Division of Health Policy and Management, School 8of Public Health, University of Minnesota, D351 Mayo (MMC 729), 420 Delaware Street S.E, Minneapolis, MN, 55455, USA
| | - Robyn W Birkeland
- Division of Health Policy and Management, School 8of Public Health, University of Minnesota, D351 Mayo (MMC 729), 420 Delaware Street S.E, Minneapolis, MN, 55455, USA
| | - Katie W Louwagie
- Division of Health Policy and Management, School 8of Public Health, University of Minnesota, D351 Mayo (MMC 729), 420 Delaware Street S.E, Minneapolis, MN, 55455, USA
| | - Colleen M Peterson
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Rachel Zmora
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Ann Emery
- Division of Health Policy and Management, School 8of Public Health, University of Minnesota, D351 Mayo (MMC 729), 420 Delaware Street S.E, Minneapolis, MN, 55455, USA
| | - Hayley R McCarron
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Kenneth Hepburn
- Nell Hodgson Woodruff School of Nursing, Emory University Alzheimer's Disease Research Center, Emory University, Atlanta, GA, USA
| | | | - Mary S Mittelman
- Department of Psychiatry, NYU School of Medicine, NYU Langone Health, New York, NY, USA
| | - David L Roth
- Center on Aging and Health, Johns Hopkins University, Baltimore, MD, USA
| |
Collapse
|
14
|
Peacock S, Bayly M, Gibson K, Holtslander L, Thompson G, O'Connell M. Development of a bereavement intervention for spousal carers of persons with dementia: The Reclaiming Yourself tool. DEMENTIA 2020; 20:653-671. [PMID: 32126810 DOI: 10.1177/1471301220909604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A dearth of supportive interventions exists for bereaved spouses who were carers of persons with dementia, despite an identified need for such supports. The purpose of the current work was to develop and evaluate a supportive writing intervention for this population that was informed by the experiences of spouses who were bereaved and was specific to the unique context of dementia. Following development of the Reclaiming Yourself tool, a mixed methods design was utilized to assess its effects on grief, depressive symptoms, and balance between restoration and loss. Fifteen participants residing in Saskatchewan and Manitoba were provided the writing intervention and visited three times approximately four weeks apart, completing quantitative measures (for grief, depressive symptoms, and finding balance) at each visit and an exit interview about the intervention. Paired-sample t-tests illustrated trivial effect sizes and no significant differences in grief, depressive symptoms, or balance orientation, with overall means suggesting low levels of depressive symptoms and grief, and a slight orientation towards restoration. Thematic analysis illustrated benefits from the tool, with participants reporting that it provided a structured approach to grief, was a catalyst for emotional expression, and facilitated reflection. The format and timing of the intervention was not ideal for all participants. Although Reclaiming Yourself did not affect quantitatively measured grief, depressive symptoms, and balance, carers accrued benefits from the tool that align with beneficial processes observed in other writing interventions. While more research on the effectiveness of this tool is needed, such interventions are valuable to support the well-being of carers who are bereaved following the death of a spouse with dementia.
Collapse
Affiliation(s)
| | - Melanie Bayly
- Centre for Canadian Health and Safety in Agriculture, College of Medicine, University of Saskatchewan, Canada
| | - Kirstian Gibson
- Department of Psychology, College of Arts & Science, University of Saskatchewan, Canada
| | - Lorraine Holtslander
- College of Nursing, University of Saskatchewan, Canada; University of the Witwatersrand, South Africa
| | | | - Megan O'Connell
- Department of Psychology, University of Saskatchewan, Canada
| |
Collapse
|
15
|
Brooks D, Fielding E, Beattie E, Edwards H, Hines S. Effectiveness of psychosocial interventions on the psychological health and emotional well-being of family carers of people with dementia following residential care placement: a systematic review. ACTA ACUST UNITED AC 2019; 16:1240-1268. [PMID: 29762315 DOI: 10.11124/jbisrir-2017-003634] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To identify, appraise and synthesize existing evidence regarding the effectiveness of psychosocial interventions on the psychological health and emotional well-being of family carers of people with dementia who have moved into residential care. INTRODUCTION Many carers experience stress, guilt, grief and depression following placement of a relative with dementia into residential care. Psychosocial interventions to support family carers may help to improve psychological health and emotional well-being; however, evidence for such interventions delivered to family carers following placement has yet to be appraised and synthesized. INCLUSION CRITERIA Participant criteria included any family carers of people with dementia who have moved into residential or nursing or long term care. Interventions were included if they were designed to improve the psychological health and emotional well-being of family carers post-placement. Comparators included no intervention, other non-pharmacological intervention or standard/usual care. Outcomes included carer burden, anxiety, stress, depression, guilt, grief and loss, quality of life, or satisfaction with care of the person with dementia. METHODS Key databases (PubMed, CINAHL, PsycINFO) and trials registries (Cochrane, WHO Clinical Trials, UK Clinical Trials) were searched to identify both published and unpublished studies in English from 1990 to 2017. The recommended Joanna Briggs Institute approach to critical appraisal, study selection, data extraction and data synthesis was followed. Data from studies was pooled in statistical meta-analysis where possible, and presented in narrative and tabular form otherwise. RESULTS Four studies were eligible for inclusion. Two studies were randomized controlled trials (RCTs) of individualized multicomponent interventions, and two were cluster RCTs of group multicomponent interventions. Interventions were mostly underpinned by stress appraisal and coping theories. Outcomes measured, measurement tools and length of follow-up varied between the studies. There was high risk of selection, attrition and detection bias.A total of 302 family carers were included. For the individualized interventions, significant improvements were reported for carer guilt (F = 5.00; p = 0.03), role overload (F = 5.00; p = 0.04) and distress (F = 6.13; p = 0.02), but no significant effect was found for satisfaction with the residential care facility. Meta-analyses indicated there was no overall effect at three to four months post-intervention on carer burden (weighted mean difference 2.38; 95% CI -7.72 to 12.48), and depression (weighted mean difference 2.17; 95% CI -5.07 to 9.40). For the group interventions, no significant effects on carer distress were found; however, significant improvements in carer "heartfelt sadness" at three months post-baseline (F = 5.04; p = 0.027) and guilt at six months (F = 4.93; p = 0.029) were reported in one study. CONCLUSIONS Individualized multicomponent psychosocial interventions following residential care placement may be beneficial in improving family carers' role overload, psychological distress and guilt. Group interventions may also improve feelings of guilt and sadness. There is insufficient evidence that individualized or group interventions improve carer depression, burden or satisfaction. However, due to substantial heterogeneity between studies and methodological flaws, the grade of this evidence is very low.Further high quality RCTs that include different groups of carers are recommended. Comparative effects of individualized versus group interventions should be examined as these are likely to have cost implications.
Collapse
Affiliation(s)
- Deborah Brooks
- Dementia Centre for Research Collaboration, Queensland University of Technology, Brisbane, Australia
| | - Elaine Fielding
- Dementia Centre for Research Collaboration, Queensland University of Technology, Brisbane, Australia
| | - Elizabeth Beattie
- Dementia Centre for Research Collaboration, Queensland University of Technology, Brisbane, Australia
| | - Helen Edwards
- Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Sonia Hines
- Queensland Centre for Evidence Based Nursing and Midwifery: a Joanna Briggs Institute Centre of Excellence
| |
Collapse
|
16
|
Stahl ST, Schulz R. Feeling Relieved After the Death of a Family Member With Dementia: Associations With Postbereavement Adjustment. Am J Geriatr Psychiatry 2019; 27:408-416. [PMID: 30503704 PMCID: PMC6431266 DOI: 10.1016/j.jagp.2018.10.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 10/16/2018] [Accepted: 10/30/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE After an extended period of caregiving, the death of a family member with dementia can provide a sense of relief to individuals because caregiving has ended and their loved one is no longer suffering. Little is known about predeath factors associated with feeling relieved after the death of a family member with dementia. This study examined 1) predeath factors associated with caregiver (CG) relief; and 2) whether CG relief is associated with postbereavement adjustment, namely complicated grief and depression symptoms. METHODS Participants were bereaved CGs aged 28-90 years old drawn from the Resources for Enhancing Alzheimer's Caregiver Health (REACH) (N = 223) and Family Caregiver Transition Support (FaCTS) (N = 89) studies. In each sample, demographics were assessed at baseline, and CG relief was assessed at the first follow-up assessment after death. Each study administered a similar bereavement battery to CGs following the death of their care recipients (CRs). RESULTS CGs of late-stage dementia patients (FaCTS) reported more relief compared with CGs of early- to midstage dementia patients (REACH). CGs were more likely to experience relief if they were prepared for their CR's death and if they perceived their CR's death to be a relief to the CR. A multivariate regression model showed that greater CG relief was associated with less complicated grief postbereavement. CG relief was not significantly associated with depression symptoms. CONCLUSION We show prospectively that the caregiving experience impacts feelings of relief, and that feeling relieved facilitates postbereavement adjustment by lessening symptoms of complicated grief.
Collapse
Affiliation(s)
- Sarah T. Stahl
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Richard Schulz
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA.,University Center for Social and Urban Research, University of Pittsburgh, Pittsburgh, PA
| |
Collapse
|
17
|
Paun O, Cothran F. Chronic Grief Management: A Live-Streaming Video, Group-Based Intervention for Family Caregivers of Individuals With Dementia in Long-Term Care. J Psychosoc Nurs Ment Health Serv 2019; 57:17-24. [PMID: 29916525 DOI: 10.3928/02793695-20180601-03] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 05/02/2018] [Indexed: 11/20/2022]
Abstract
Family caregivers of individuals with Alzheimer's disease and related dementias (ADRD) experience long-term mental health effects. Although caregivers who place relatives in long-term care (LTC) experience increased depression, anxiety, and chronic grief post-placement, interventions to improve caregivers' mental health have focused mainly on in-home care. Current researchers previously tested a group-based Chronic Grief Management Intervention (CGMI) with ADRD caregivers of individuals in LTC, with significant effects on caregiver mental health outcomes. In the current study, researchers adapted the CGMI for synchronous online video using Adobe® ConnectTM and iPads® (Chronic Grief Management-A Live-Streaming, Online Intervention [CGMI-V]). Specific aims were to test feasibility of digital delivery of the CGMI-V and explore caregivers' online group experience. Researchers assessed participants at baseline for sociodemographic information and at the end of the program with a four-item satisfaction survey and focus group. Digital delivery of the CGMI-V was feasible and caregiver satisfaction was high. [Journal of Psychosocial Nursing and Mental Health Services, 57(1), 17-24.].
Collapse
|
18
|
Durepos P, Sussman T, Ploeg J, Akhtar-Danesh N, Punia H, Kaasalainen S. What Does Death Preparedness Mean for Family Caregivers of Persons With Dementia? Am J Hosp Palliat Care 2018; 36:436-446. [DOI: 10.1177/1049909118814240] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Purpose: The purpose of this study was to clarify the concept of death preparedness for family caregivers in dementia. Conceptualization was required to support the assessment, promotion, and operationalization (ie, measurement) of death preparedness through palliative care interventions such as advance care planning. Methods: Rodgers evolutionary method of concept analysis was selected to guide this study because of the dynamic nature of death preparedness influenced by context, setting, and time. A comprehensive literature search was conducted. Authors performed constant comparative analysis to identify and interpret surrogate/related concepts, attributes, antecedents, and consequences of death preparedness. Results: Most importantly attributes included (1) knowing and recognizing the symptoms of decline in dementia and what dying looks like; (2) understanding emotions and grief responses; (3) accessing and appraising supports needed to manage and care for dying; (4) organizing affairs and completing tasks in advance; (5) accepting that losses are inevitable and imminent; (6) reflecting on caregiving and finding meaning, “a silver-lining”; and (7) closing, reconciling, and renewing relationship bonds and completing the family member’s life. Discussion: This study contributed a full definition of death preparedness in dementia. Findings aligned with/expanded upon Hebert et al Theoretical Framework of Preparedness for End-of-Life. The use of problem- and emotion-based coping strategies by caregivers with support from health-care providers to promote feelings of death preparedness (including self-efficacy and control) and minimize uncertainty was the implication of this study. Development of a holistic preparedness instrument is underway.
Collapse
Affiliation(s)
- Pamela Durepos
- Faculty of Health Sciences, School of Nursing, McMaster University, Hamilton, Ontario, Canada
- Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada
| | - Tamara Sussman
- Department of Social Work, McGill University, Hamilton, Ontario, Canada
| | - Jenny Ploeg
- Faculty of Health Sciences, School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Noori Akhtar-Danesh
- Faculty of Health Sciences, School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Harveer Punia
- Faculty of Health Sciences, School of Nursing, McMaster University, Hamilton, Ontario, Canada
- Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada
| | - Sharon Kaasalainen
- Faculty of Health Sciences, School of Nursing, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
19
|
Stahl ST, Schulz R. Restorative activities among bereaved caregivers of nursing home patients. Geriatr Nurs 2018; 39:414-418. [PMID: 29477647 DOI: 10.1016/j.gerinurse.2017.12.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 12/11/2017] [Accepted: 12/18/2017] [Indexed: 11/18/2022]
Abstract
This prospective study examined predictors and correlates of restorative activities in recently bereaved caregivers and their relation to post-bereavement adjustment, namely complicated grief. Participants included 89 caregivers (CGs) age 32-87 (M age - 63 years) whose care recipients recently died in a long-term care facility (M time since loss = 107 days). Our findings show that being prepared prior to death enables CGs the opportunity to engage in restorative activities post death. Restorative activities partially mediated the relationship between preparedness prior to death and complicated grief, but this association was attenuated in multivariable models. It is possible that being prepared prior to death allows CGs to engage in restorative activities post-death, which in turn decreases complicated grief. More research is needed in diverse populations of CGs to determine how restorative activities may impact post-bereavement adjustment.
Collapse
Affiliation(s)
- Sarah T Stahl
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA.
| | - Richard Schulz
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA; University Center for Social and Urban Research, University of Pittsburgh, Pittsburgh, PA
| |
Collapse
|
20
|
Tkatch R, Bazarko D, Musich S, Wu L, MacLeod S, Keown K, Hawkins K, Wicker E. A Pilot Online Mindfulness Intervention to Decrease Caregiver Burden and Improve Psychological Well-Being. J Evid Based Complementary Altern Med 2017; 22:736-743. [PMID: 29228806 PMCID: PMC5871316 DOI: 10.1177/2156587217737204] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Interventions to reduce caregiver burden are of great interest as the number of informal family caregivers continues to grow. The purpose of this study was to test the feasibility of an online mindfulness meditation intervention for community-dwelling older adult caregivers and to evaluate its impact on quality of life, caregiver burden, and psychological well-being. A total of 40 caregivers were recruited from 2 community center support groups to participate in an 8-week online mindfulness intervention. Pre and post surveys were administered. Retention rates were high with 55% completing the post surveys and attending at least 5 out of 8 sessions. Matched pairs t test indicated that the intervention reduced caregiver burden, perceived stress, anxiety, and loneliness and improved mental well-being. Online interventions offer flexibility for caregivers regardless of their responsibilities. Future research should expand this opportunity and explore the scalability of online mindfulness interventions.
Collapse
Affiliation(s)
| | | | | | - Lizi Wu
- 1 Advanced Analytics, Optum, Ann Arbor, MI, USA
| | | | - Karen Keown
- 3 UnitedHealth Group, Medicare and Retirement, Minneapolis, MN, USA
| | | | | |
Collapse
|
21
|
Metzelthin SF, Verbakel E, Veenstra MY, van Exel J, Ambergen AW, Kempen GIJM. Positive and negative outcomes of informal caregiving at home and in institutionalised long-term care: a cross-sectional study. BMC Geriatr 2017; 17:232. [PMID: 29017453 PMCID: PMC5635563 DOI: 10.1186/s12877-017-0620-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 10/02/2017] [Indexed: 01/22/2023] Open
Abstract
Background Our ageing society is putting tremendous strain on public health and welfare programs to meet the needs of ageing individuals. Promoting informal caregiving is one way for policymakers to reduce this burden. However, caregiving may be experienced as stressful and is associated with adverse health consequences. While quite a lot of research focuses on caregiving for community-dwelling older adults, little is known about informal care in institutionalised long-term care (ILTC). Therefore, the objectives of this study were: 1) to compare characteristics of informal caregivers and care receivers and caregiver outcomes - at home and in ILTC; 2) to study the association between these characteristics and positive and negative caregiver outcomes; 3) to investigate the moderating effect of the setting (at home vs. ILTC) on these associations. Methods A cross-sectional study was conducted using the TOPICS-MDS DataSet. A total of 5197 Dutch dyads were included. The average age of the care receivers and caregivers was respectively 80.7 years and 63.2 years. Several sociodemographic, health-related and caregiving-related characteristics of care receiver and caregiver and two caregiver outcomes (i.e., subjective burden and care-related quality of life) were included in the analyses. Results Caregivers in both settings experienced comparable levels of subjective burden. Caregivers at home had slightly lower care-related quality of life than caregivers in ILTC. Several care receiver characteristics (i.e., male sex, married/cohabiting, more morbidities/disability, and less self-perceived health/psychological wellbeing) and several caregiver characteristics (i.e., female sex, being younger, living together with the care receiver, more objective burden, less self-perceived health, and more support) were associated with an increase in burden and/or a decrease in care-related quality of life. Some of these associations were stronger for dyads at home compared to dyads in ILTC. Conclusions Informal caregiving does not stop with admission to an ILTC facility. Both settings need an informal caregiving policy, which is (1) tailored to the individual characteristics of care receivers and caregivers; (2) pays attention to the identified risk groups; and (3) reduces the negative caregiver outcomes and emphasizes the positive outcomes at the same time. Electronic supplementary material The online version of this article (10.1186/s12877-017-0620-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Silke F Metzelthin
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD, Maastricht, Netherlands.
| | - Ellen Verbakel
- Department of Sociology, Radboud University, P.O. Box 9104, 6500 HE, Nijmegen, Netherlands
| | | | - Job van Exel
- Erasmus School of Health Policy & Management, Erasmus University, P.O. Box 1738, 3000 DR, Rotterdam, Netherlands
| | - Antonius W Ambergen
- Department of Methodology and Statistics, Faculty of Health, Medicine and Life Sciences, CAPHRI School for Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, Netherlands
| | - Gertrudis I J M Kempen
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD, Maastricht, Netherlands.
| |
Collapse
|
22
|
Malec JF, Van Houtven CH, Tanielian T, Atizado A, Dorn MC. Impact of TBI on caregivers of veterans with TBI: Burden and interventions. Brain Inj 2017; 31:1235-1245. [DOI: 10.1080/02699052.2016.1274778] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- James F. Malec
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, IN, USA
- Rehabilitation Hospital of Indiana, Indianapolis, IN, USA
- Emeritus Professor of Psychology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Adrian Atizado
- DAV National Service & Legislative Headquarters, Washington, DC, USA
| | | |
Collapse
|
23
|
Brooks D, Fielding E, Beattie E, Edwards H, Hines S. Effectiveness of psychosocial interventions on the psychological health and wellbeing of family carers of people with dementia following residential care placement: a systematic review protocol. ACTA ACUST UNITED AC 2017; 15:1228-1235. [DOI: 10.11124/jbisrir-2016-003067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
24
|
Weathers E, O’Caoimh R, Cornally N, Fitzgerald C, Kearns T, Coffey A, Daly E, O’Sullivan R, McGlade C, Molloy D. Advance care planning: A systematic review of randomised controlled trials conducted with older adults. Maturitas 2016; 91:101-9. [DOI: 10.1016/j.maturitas.2016.06.016] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 06/11/2016] [Accepted: 06/22/2016] [Indexed: 10/21/2022]
|
25
|
Ausserhofer D, Deschodt M, De Geest S, van Achterberg T, Meyer G, Verbeek H, Sjetne IS, Malinowska-Lipień I, Griffiths P, Schlüter W, Ellen M, Engberg S. “There's No Place Like Home”: A Scoping Review on the Impact of Homelike Residential Care Models on Resident-, Family-, and Staff-Related Outcomes. J Am Med Dir Assoc 2016; 17:685-93. [DOI: 10.1016/j.jamda.2016.03.009] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 03/15/2016] [Indexed: 11/17/2022]
|
26
|
Schulz R, Boerner K, Klinger J, Rosen J. Preparedness for death and adjustment to bereavement among caregivers of recently placed nursing home residents. J Palliat Med 2014; 18:127-33. [PMID: 25469737 DOI: 10.1089/jpm.2014.0309] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Preparedness for death as a predictor of post-bereavement adjustment has not been studied prospectively. Little is known about pre-death factors associated with feeling prepared prior to the death of a loved one. OBJECTIVE Our aim was to prospectively assess the role of preparedness for death as a predictor of post-bereavement adjustment in informal caregivers (CGs) who experienced the death of their loved one and to identify predictors and correlates of complicated grief, depression, and preparedness for death among informal CGs. METHODS We conducted a prospective, longitudinal study using data collected for a randomized trial testing the efficacy of an intervention for CGs of recently placed care recipients (CRs). Subjects were 217 informal CGs of care recipients recently placed in nursing homes, and they were followed for 18 months. CGs were assessed in person by certified interviewers at 6-month intervals. Eighty-nine CGs experienced the death of their loved one in the course of the study. Measurements used included preparedness for death, advance care planning (ACP), complicated grief, depression, and sociodemographic characteristics. RESULTS CGs who reported feeling more prepared for the death experienced lower levels of complicated grief post-bereavement. A multivariate ordinal logistic regression model showed that spouses as opposed to adult child CGs were less prepared for the death, depressed CGs were less prepared, and patients who engaged in ACP had CGs who felt more prepared. CR overt expressions about wanting to die was also related to higher levels of preparedness in the CG. CONCLUSIONS We show prospectively that preparedness for death facilitates post-bereavement adjustment and identify factors associated with preparedness. ACP can be an effective means for preparing informal CGs for the death of their CRs.
Collapse
Affiliation(s)
- Richard Schulz
- 1 Department of Psychiatry, University of Pittsburgh , Pittsburgh, Pennsylvania
| | | | | | | |
Collapse
|