Beliefs and practices regarding Alzheimer's disease and related dementias among Filipino home care workers in Israel

Knowledge, attitudes and self-confidence with skills required for providing dementia care in physicians at primary healthcare settings in Vietnam

BACKGROUND

Dementia is a global public health priority. The World Health Organization adopted a Global Action Plan on Dementia, with dementia awareness a priority. This study examined the knowledge, attitudes, and self-confidence with skills required for providing dementia care among primary health care providers in Vietnam.

METHODS

A cross-sectional study was conducted with 405 primary health care providers who worked at commune health stations and district health centers in eight provinces across Vietnam.

RESULTS

The results showed that primary health care providers had poor knowledge and little confidence but more positive attitudes toward dementia care and management.

CONCLUSIONS

The results suggest the training needs for building capacity amongst primary health care providers, which will be critical as Vietnam's population ages.

Knowledge, Awareness, and Attitude of Healthcare Stakeholders on Alzheimer's Disease and Dementia in Qatar

Dementia is characterized by progressive cognitive decline, memory impairment, and disability. Alzheimer's disease (AD) accounts for 60-70% of cases, followed by vascular and mixed dementia. Qatar and the Middle East are at increased risk owing to aging populations and high prevalence of vascular risk factors. Appropriate levels of knowledge, attitudes, and awareness amongst health care professionals (HCPs) are the need of the hour, but literature indicates that these proficiencies may be inadequate, outdated, or markedly heterogenous. In addition to a review of published quantitative surveys investigating similar questions in the Middle East, a pilot cross-sectional online needs-assessment survey was undertaken to gauge these parameters of dementia and AD among healthcare stakeholders in Qatar between 19 April and 16 May 2022. Overall, 229 responses were recorded between physicians (21%), nurses (21%), and medical students (25%), with two-thirds from Qatar. Over half the respondents reported that >10% of their patients were elderly (>60 years). Over 25% reported having contact with >50 patients with dementia or neurodegenerative disease annually. Over 70% had not undertake related education/training in the last 2 years. The knowledge of HCPs regarding dementia and AD was moderate (mean score of 5.3 ± 1.5 out of 7) and their awareness of recent advances in basic disease pathophysiology was lacking. Differences existed across professions and location of respondents. Our findings lay the groundwork for a call-to-action for healthcare institutions to improve dementia care within Qatar and the Middle East region.

Filipino Aging within Global North Diasporas: A Scoping Review

Drawing on international research, this article examines and navigates through the existing social gerontological and ethnogerontological literature to assess how Filipino aging is understood within Global North societies. A scoping review was conducted in 2018 and in 2022 to offer key insights into how Filipinos age in both the ancestral homeland and increasingly within Global North diasporas. While the existing literature on Filipino aging does mirror existing ethnogerontological literature, which heavily focuses on indicators of cognitive, physical and mental health, and access and provision to formal services, the Filipino-specific literature calls attention to emerging dynamics distinctly related to transnational aging, and renegotiated caring dynamics within intergenerational Filipino families and kinship networks. This paper considers a future research agenda of the growing realities for aging Filipino communities across Global North contexts.

Behavioral activation for live-in migrant home care workers and care recipients in Israel: a pilot study

In a growing global trend, individuals are migrating to other countries to live with and care for older adults with dementia. Although this trend addresses the geriatric workforce shortage, workers and older adults often experience distress. In a pilot study in Israel, six migrant care workers participated in a six-week group intervention in which they learned to increase valued, enjoyable activities for themselves and the older adult with whom they lived (behavioral activation). After the intervention, workers reported that they increased activities for themselves and the older adult and were satisfied, and quality of life and sense of achievement showed medium and large effect sizes, respectively. Participants suggested adapting the intervention to an online format for greater access. Although findings are tentative, the study points to promising strategies for migrant home care workers: focusing on the worker and older adult and offering online interventions.

Perceptions and practice behaviors regarding late-life depression among private duty home care workers: a mixed-methods study

Background: This study aimed to examine personal care aides (PCAs)' knowledge, beliefs, and attitudes towards late-life depression and their experience caring for older adults with depression.Method: This study used a mixed-methods convergent parallel design involving an online survey (n = 87) and semi-structured interviews (n = 22). Survey respondents were recruited using convenience sampling and interviewees using purposive sampling from private duty home care agencies in Michigan. Qualitative data analyzed using a technique involving data reduction and open coding. Survey data were analyzed using descriptive statistics.Results: Most PCAs underestimated suicide rate among older adults, overrated self-help ability of the depressed person, underrated difficulty diagnosing depression, and attributed depression to personality flaws. PCAs favored psychotherapy and informal support and generally regarded medication as unhelpful, particularly in mild/moderate depression. Despite these discordances, PCAs' self-reported practice behaviors included strategies (i.e., communication, behavioral, cognitive, emotional regulation, relational, and external) that were largely consistent with the scientific view, particularly relating to behavioral activation. A prominent theme from PCAs' narratives was individualized care, reflected in their assessment of depressive symptoms, attitude towards depression treatment, and strategies caring for clients.Conclusions: Several areas of PCAs' perceptions regarding late-life depression were discordant with the current scientific view, although their practice behaviors were largely consistent with the principles of evidence-based practice for depression. Specialized mental health training, a standard depression care protocol, and higher training standards are essential to mobilize the large number of PCAs to improve the mental health outcomes of hard-to-reach older adults.

Who is informed and who uninformed? Addressing the legal barriers to progress in dementia research and care

Conduct of research is an essential tool for the evaluation and improvement of health services. In Israel, research on persons with dementia is very limited, with the largest portion of such research involving a few surveys and examining risk factors for dementia. Very few studies describe clinical research, and those that do either include participants at early stages of dementia, or rely completely on caregivers' perceptions and experiences, often without reference to any individual with dementia. This dearth of research is due, to a substantial extent, to Ministry of Health regulations which do not permit family proxy consent for research involving persons with dementia. Alternative models for regulation of consent for research exist in other countries, including the U.S., and these allow for proxy consent under certain conditions. This paper presents such a model and its underlying ethical principles. It contends that the current state of affairs, which stands in the way of clinical research concerning persons with advanced dementia, is contrary to the interests of such persons, their caregivers, and Israeli society. Therefore, this paper calls for a change in the present regulations and/or law in the cause of advancing knowledge and improving care for persons with dementia.

Like one of the family? Understanding relationships between migrant live-in care workers and older care recipients in Israel

Frail older people worldwide are increasingly being cared for in their own homes by migrant live-in care workers; however, extant literature on care relationships in this care context is sparse. The purpose of this mixed-methods study was to explore the quality and the nature of care relationships between full-time, live-in migrant care workers and older people in Israel. Quantitative and qualitative data were drawn from a 2014 survey of 116 migrant care workers and 73 older care recipients. Mean scores for four quantitative items relating to care relationships were examined and independent samples t-tests and Pearson correlations were performed, whereas qualitative data were examined using thematic analysis. Credibility of qualitative findings was checked by peer review. Most older people and migrant care workers gave high ratings to the four items. Significant correlations between the two groups were found for their responses on all four relationship items assessed, with only one item (‘get along well’) producing significant t-test differences. Qualitative data provided a deeper understanding of the quantitative ratings of care relationships. Four major qualitative themes emerged as inextricably tied with both groups’ perceptions of positive care relationships. These were: an emotional connection; reciprocity; effective communication; and meeting the older person's care needs. Study findings were interpreted through the theoretical lens of relationship-centred care. Implications of the findings for theory, practice and further research are discussed.

The experiences of Indian migrant care home staff working with people with dementia: a pilot study exploring cultural perspectives

Purpose

– Little is known about migrant Indian care workers working in long-term care facilities for people with dementia in England and the purpose of this paper is to remedy this lack of information in the light of political interest in immigration to the UK and continued staff shortages in parts of the social care sector.

Design/methodology/approach

– This pilot study investigated the experiences of workplace acculturation among 12 migrant Indian care workers who were employed in English care homes. Qualitative face-to-face interviews were conducted in 2013. Analysis of the interviews was conducted using principles of interpretative phenomenological analysis.

Findings

– Following analysis five themes emerged along an acculturation timeline. First, during the first six months of their employment, the migrant care workers recalled feeling vulnerable, seemingly marked by a sense of insecurity and an overwhelming state of cognitive burden within an unfamiliar cultural context. Second, simultaneously, the migrants felt perturbed about their new role as direct care workers. Third, few had been able to draw on their networks of friends and relatives to build up knowledge of their new work environments before starting care home employment. Fourth, two years into the work, although they reported feeling better adapted, psychological and socio-cultural adjustments were still thought to be needed. Fifth, most participants retained their ambition to be recognised as a qualified nurse in the UK and to pursue a nursing career outside the social care sector.

Research limitations/implications

– This is a pilot study in which 12 migrant Indian care home workers were interviewed. Further interviews might provide a greater range of views and experiences. The care homes that participated in this research were in the London region where staff shortages are common in dementia services such as care homes.

Practical implications

– The findings suggest a need for employers and human resource managers to respond to the specific needs of Indian and other migrants working with older people who are resident in care homes. Such responses should reflect the timeline of their acculturation and employers need also to acknowledge and address aspirations to move on to NHS work.

Originality/value

– This study is unique to the best of the authors’ knowledge in addressing Indian care workers specifically as a substantial part of the migrant care workforce in the UK. It offers information about their perceptions and suggests practical human response and managerial initiatives.

General practitioners’ perceptions of the stigma of dementia and the role of reciprocity

A qualitative exploration of the stigma of dementia reported that general practitioners described lack of reciprocity as one way in which people with dementia are perceived within society. This was closely linked to their perception of dementia as a stigma. In this article, we explore whether general practitioners perceive people with dementia as lacking reciprocity and, if so, if this is linked with societal opinions about dementia as a stigma. The implications of both perceptions of people with dementia failing to reciprocate and of stigma for timely diagnosis are explored. Our approach is to follow the thread of reciprocity in the data from our initial study. In this follow-up study, general practitioners’ perceptions of societal views of people with dementia included a perception of a lack of reciprocity specifically linked with; failing to respond to human contact, the absence of an appropriate return on social investment and failing to contribute to, or being a burden on, society. General practitioners reported a link between societal perceptions of lack of reciprocity and stereotypes about advanced dementia, difficulties communicating with people with dementia, and lack of opportunities for people with dementia to reciprocate. General practitioners occupy a key position, they can challenge stereotypes and, with support and targeted training about communicating with people living with dementia, can emphasize the ways in which people with dementia can communicate, thereby enhancing their potential to reciprocate. Such changes have implications for improved care and quality of life through the continued maintenance of social inclusion and perceptions of personhood.

A meta-ethnography of paid dementia care workers' perspectives on their jobs

Background

While much work has been to evaluate paid workers’ perspectives on the care they provide dementia patients, there is no evidence of any systematic review of this topic.

Methods

We conducted a meta-ethnography of the topic “paid dementia care workers’ perspectives on their jobs.” Multiple databases were searched for qualitative work that reported on workers’ opinions and perspectives on their jobs in dementia care, including all settings and types of jobs. A final group of 34 articles were included, and their themes and constructs synthesized using a meta-ethnographic approach developed by Noblit and Hare.

Results

Five overarching themes uncovered: approach to care, education and training, emotional impact of the work, organizational factors, and relationships on the job. We also describe how the themes are related to each other.

Conclusions

Interplay of the theme areas shows the importance of dementia- specific education and training in terms of the approach to care and emotional impact of the work. Closing the gap between policy and practice is critical, but achieving this will require that attention be paid to dementia-specific education for all workers, including care leaders.

Suicidal and depressive symptoms in Filipino home care workers in Israel

The study consisted of a cross sectional sample of 178 Filipino home care workers who completed the Paykel Suicide Scale and the Patient Health Questionnaire-9. Respondents also completed questionnaires about exposure to abuse and perceived social support. Overall, 35% of the sample reported exposure to some type of abuse within their home/work environment. For those reporting low levels of satisfaction with care recipient, higher exposure to major lifetime discrimination was associated with higher SIA, whereas for those reporting high levels of satisfaction with care recipient, there was no relationship between exposure to major lifetime discrimination and SIA. Abuse within the home/work environment was the only predictor of depressive symptoms, with greater abuse being associated with higher levels of depressive symptoms. Filipino home care workers in Israel likely are exposed to moderate levels of abuse and discrimination within the home/work environment as well as within society at large. Because live-in home care workers spend the majority of their time within the home/work environment, their relationship with their care recipients have protective qualities that can serve as a buffer against discrimination. Nevertheless, abusive working conditions within their home/work environment have detrimental effects on their mental health.

Reports of neuropsychiatric symptoms of older care recipients by their family members and their foreign home care workers: results from triadic data

OBJECTIVES

To evaluate reports of neuropsychiatric symptoms (NPS) per family members and round the clock foreign home care workers.

DESIGN, SETTING, AND PARTICIPANTS

A cross-sectional matched sample of family members, foreign home care workers, and care recipients.

MEASUREMENTS

Family members and foreign home care workers completed a measure of NPS. All 3 stakeholders provided a variety of demographic and clinical characteristics.

RESULTS

There was a low agreement between family members and foreign home care workers with regard to reports of depression and disturbing behaviors in care recipient and a good agreement with regard to reports of memory problems. In addition to care recipients' characteristics, family members' characteristics were primarily correlated with family members' reports of NPS and foreign home care workers' characteristics were primarily associated with foreign home care workers' reports of NPS.

CONCLUSIONS

Because much of the evaluation of NPS relies on reports of formal (ie, paid) and informal caregivers (ie, unpaid), clinicians should be aware of the fact that these reports are based in large part on the subjective perception of the caregiver.