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Cruz AM, Perez H, Jantzi M, Liu L, Hirdes JP. Pan-Canadian estimates of the prevalence and risks associated with critical wandering among home care clients. Alzheimers Dement 2024. [PMID: 39175391 DOI: 10.1002/alz.14195] [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: 09/22/2023] [Revised: 05/06/2024] [Accepted: 07/24/2024] [Indexed: 08/24/2024]
Abstract
INTRODUCTION We used clinical assessment records to provide pan-Canadian estimates of the prevalence and risks associated with recent (within the last 3 days) critical wandering among home care clients, with and without dementia. METHODS The data source is interRAI Home Care (interRAI HC) assessments. The population was all long-stay home care clients assessed between 2004 and 2021 in seven Canadian provinces and territories (N = 1,598,191). We tested associations between wandering and cognition and dementia diagnoses using chi-square tests and logistic regression. RESULTS Approximately 84% of the sample was over the age of 65. The overall rate of recent wandering was 3.0%. Dementia diagnosis was strongly associated with two to four times higher rates in the prevalence of recent critical wandering. DISCUSSION InterRAI HC offers insights into the wandering risk of home care clients. This information should be used to manage risks in the community and could be shared with first responders. HIGHLIGHTS In all the study regions combined, the rate of recent wandering is 3.0%. Dementia was associated with 18 times greater prevalence of recent critical wandering. Home care clients at risk of wandering have complex clinical profiles that pose important risks for their health and well-being. Collaboration and information sharing between search and rescue and health professions is essential for managing risks related to critical wandering.
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Affiliation(s)
- Antonio Miguel Cruz
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
- Glenrose Rehabilitation Research, Innovation & Technology (GRRIT), Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada
- Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada
| | - Hector Perez
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada
| | - Micaela Jantzi
- interRAI Canada, School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Lili Liu
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada
| | - John P Hirdes
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada
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Lin X, Chen Z, Zhao Q, Zhou X. Benefit-finding profiles and comparison of caregiving ability among informal caregivers of patients with lung cancer: A latent profile analysis. Asia Pac J Oncol Nurs 2024; 11:100480. [PMID: 38779178 PMCID: PMC11109306 DOI: 10.1016/j.apjon.2024.100480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 03/24/2024] [Indexed: 05/25/2024] Open
Abstract
Objective This study aimed to explore the benefit finding (BF) profiles among informal caregivers of patients with lung cancer, identify demographic and disease characteristics, and analyze differences in caregiving ability between profiles. Methods This cross-sectional study utilized convenience sampling to select 272 informal caregivers of patients with lung cancer from a tertiary care hospital in Guangzhou, China. The research instruments used included the Demographic and Disease Characteristics Questionnaire, the revised version of the BF Scale, and the Chinese version of the Family Caregiver Task Inventory. Data analysis was performed using latent profile analysis, chi-square test, Fisher's exact probability test, Kruskal-Wallis test, and multivariate logistic regression. Results (1) BF can be divided into three profiles: "high benefit-family and personal growth" (Profile 1, 7.7%), "moderate benefit-unclear perception" (Profile 2, 44.9%), and "low benefit-coping ability deficient" (Profile 3, 47.4%). (2) Having a cocaregiver and a disease duration of 6-12 months were more likely to belong to Profile 1; caregivers of patients aged 40-60 years tended to belong to Profile 2; caregivers of older patients with disease duration > 12 months and clinical stage II or III were more likely to belong to Profile 3. (3) There were significant differences in the total score of caregiving ability and the scores of each dimension among the different BF profiles (P < 0.001), and the caregiving abilities of Profile 1 and Profile 2 were higher than those of Profile 3. Conclusions There was heterogeneity in BF among informal caregivers of patients with lung cancer. Healthcare professionals can identify the key profiles of lung-cancer caregivers based on characteristics such as age, clinical stage, disease duration, and cocaregiver status and enhance their caregiving ability through targeted nursing guidance.
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Affiliation(s)
- Xiaoyuan Lin
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, China
| | - Ziqing Chen
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, China
| | - Qi Zhao
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, China
| | - Xiaozhou Zhou
- Department of Nursing, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
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Aldridge Z, Dening KH. Incontinence in people living with dementia. Br J Community Nurs 2024; 29:S8-S14. [PMID: 38728161 DOI: 10.12968/bjcn.2024.29.sup5.s8] [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: 05/12/2024]
Abstract
Dementia and incontinence are both prevalent in older age; yet, neither are an inevitable or normal part of ageing. It has been recognised that there is a skills and knowledge gap in professionals assessing and managing incontinence for people living with dementia. All too often, assumptions are made that incontinence is a symptom of dementia and that nothing can be done if a person living with dementia experiences episodes of incontinence. While dementia may impact on a person's ability to remain continent, it may not be the sole cause, and there may be treatments and strategies that can reduce the incidence in those affected. Therefore, a person-centred continence assessment should be undertaken to promote continence and reduce the impact of incontinence for people living with dementia and those who care for them. This paper will highlight some of the issues that are important for health and social care professionals to explore and identify, assess and manage incontinence to improve outcomes for families affected by dementia.
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Affiliation(s)
- Zena Aldridge
- Registered Mental Health Nurse; Independent Dementia Nurse Consultant
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Wang J, Liu W, Li X, Ma Y, Zhao Q, Lü Y, Xiao M. Examining the Social Networks Types and Their Effects on Caregiving Experience of Family Caregivers for Individuals With Dementia: A Mixed-Methods Study. Innov Aging 2024; 8:igae040. [PMID: 38859823 PMCID: PMC11163924 DOI: 10.1093/geroni/igae040] [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] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Indexed: 06/12/2024] Open
Abstract
Background and Objectives Social networks are crucial to personal health, particularly among caregivers of individuals with dementia; however, different types of social networks among caregivers of those with dementia and how these differences are associated with caregiver burden and positive appraisal, remain underexamined. This study aims to depict dementia caregivers' social network types, related factors, and impact on caregiving experiences. Research Design and Methods A questionnaire-based survey was conducted with a total of 237 family caregivers of individuals with dementia nested additional semistructured interviews conducted with 14 caregivers in Chongqing, China. A quantitative study was designed to collect data on personal and situational information, social networks, caregiver burden, and positive aspects of caregiving. Qualitative data were collected via semistructured interviews. Latent class analysis and multivariate regression analyses were applied to quantitative data, and inductive content analysis to qualitative data. Results The 3 social network types-family-limited (n = 39, 16.46%), family-dominant (n = 99, 41.77%), and diverse network (n = 99, 41.77%)-differed in age and sex of caregivers and individuals with dementia, stage of dementia, and caregiving intensity. Caregivers in family-dominant networks had a lower caregiver burden (β= -0.299, p = .003) and greater positive aspects of caregiving (β= 0.228, p = .021) than those in family-limited networks. Three themes-accessibility, reciprocity, and reliance-emerged as facilitators and barriers when asking for support. Caregivers frequently cited the perception of economic, practical, and emotional support, yet reported a lack of adequate formal support from healthcare providers. Discussion and Implication Family caregivers of individuals with dementia have different social network types that vary considerably among sociocultural contexts and perceive various types of support from social networks. Solid family networks and diverse social networks are contributors to long-term dementia care.
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Affiliation(s)
- Jun Wang
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Weichu Liu
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xuelian Li
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yingzhuo Ma
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qinghua Zhao
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yang Lü
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Mingzhao Xiao
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Bradbury B, Chester H, Santer M, Morrison L, Fader M, Ward J, Manthorpe J, Murphy C. Healthcare professionals' experiences and views of providing continence support and advice to people living at home with dementia: "That's a carer's job". BMC Geriatr 2024; 24:213. [PMID: 38424477 PMCID: PMC10905774 DOI: 10.1186/s12877-024-04830-8] [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: 11/23/2023] [Accepted: 02/20/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND People living with dementia at home and their family carers often feel unsupported by healthcare professionals in managing continence problems. In turn, primary and community-based healthcare professionals have reported lacking specific knowledge on dementia-continence. This study aimed to understand more about healthcare professionals' experiences and views of supporting people living with dementia experiencing continence problems, as part of developing acceptable resources. Having a nuanced understanding of unmet need would facilitate the design of engaging resources that enable healthcare professionals to provide more effective continence support to people living with dementia at home. METHODS Semi-structured interviews were conducted with a range of healthcare professionals (n = 31) working in primary and community care in the South of England in 2023. Transcribed interviews were uploaded to NVivo 12, then analysed inductively and deductively using a thematic framework. RESULTS Continence-related conversations were avoided by many healthcare professionals due to lack of dementia-continence specific knowledge. Many considered that continence problems of people living with dementia were largely outside their remit once a physical cause had been ruled out. This contributed to a lack of priority and proactivity in raising the subject of continence in their consultations. Challenges to providing support included limited consultation time and lack of access to specialist services with availability to support individuals. CONCLUSION There is substantial scope to support primary and community-based healthcare professionals in their provision of continence-related support and advice to people living at home with dementia. This includes addressing knowledge deficits, enhancing confidence and instilling a sense of accomplishment.
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Affiliation(s)
- Barbara Bradbury
- School of Health Sciences, University of Southampton, Southampton General Hospital, Tremona Road, Shirley, SO16 6YD, UK.
| | - Helen Chester
- NIHR Policy Research Unit in Health and Social Care Workforce, The Policy Institute, King's College London, Virginia Woolf Building, 22 Kingsway, London, WC2B 6LE, UK
| | - Miriam Santer
- Primary Care Research Centre, School of Primary Care, Population Sciences and Medical Education (PPM), Faculty of Medicine, University of Southampton, Aldermoor Health Centre, Southampton, SO16 5ST, UK
| | - Leanne Morrison
- Department of Psychology, Faculty of Environmental and Life Sciences, Primary Care Research Centre, Faculty of Medicine, University of Southampton, Highfield Campus, Southampton, SO17 1BJ, UK
| | - Mandy Fader
- University of Southampton, B67, West Highfield Campus, University Road, Southampton, SO17 1BJ, UK
| | - Jane Ward
- University of Southampton, B67, West Highfield Campus, University Road, Southampton, SO17 1BJ, UK
| | - Jill Manthorpe
- NIHR Policy Research Unit in Health and Social Care Workforce, The Policy Institute, King's College London, Virginia Woolf Building, 22 Kingsway, London, WC2B 6LE, UK
| | - Catherine Murphy
- School of Health Sciences, University of Southampton, Southampton General Hospital, Tremona Road, Shirley, SO16 6YD, UK
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Jerez-Roig J, Farrés-Godayol P, Yildirim M, Escribà-Salvans A, Moreno-Martin P, Goutan-Roura E, Rierola-Fochs S, Romero-Mas M, Booth J, Skelton DA, Giné-Garriga M, Minobes-Molina E. Prevalence of urinary incontinence and associated factors in nursing homes: a multicentre cross-sectional study. BMC Geriatr 2024; 24:169. [PMID: 38368318 PMCID: PMC10874568 DOI: 10.1186/s12877-024-04748-1] [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: 05/26/2023] [Accepted: 01/25/2024] [Indexed: 02/19/2024] Open
Abstract
BACKGROUND Urinary incontinence (UI) is a common geriatric syndrome with high health and socio-economic impacts in nursing home (NH) residents. OBJECTIVES To estimate the prevalence and types of UI and its associated factors in older people living in NHs in Central Catalonia (Spain). We also determined the proportion of residents who were receiving behavioural strategies to prevent/manage UI. DESIGN AND SETTING Cross-sectional study in 5 NHs conducted from January to March 2020. METHODS We included consenting residents aged 65 + permanently living in the NHs. Residents who were hospitalized, in a coma or palliative care were excluded. UI was assessed using Section H of the Minimum Data Set. Sociodemographic and health-related variables were examined. Descriptive, bivariate, and multivariate (logistic regression) analyses were performed. RESULTS We included 132 subjects (82.6% women), mean age of 85.2 (SD = 7.4) years. The prevalence of UI was 76.5% (95% CI: 68.60-82.93). The most common type was functional UI (45.5%), followed by urgency UI (11.4%). Only 46.2% of residents received at least one behavioural strategy to manage UI. Most sedentary behaviour (SB) variables presented a p-value lower than 0.001 in the bivariate analyses, but none remained in the final model. Moderate-severe cognitive impairment (OR = 4.44, p =.003), anticholinergic activity (OR = 3.50, p =.004) and risk of sarcopenia using SARC-F (OR = 2.75, p =.041) were associated with UI. CONCLUSIONS The prevalence of UI was high in this sample of NH residents compared to the literature, yet less than half received prompted voiding as a strategy to prevent/reduce UI.UI was associated with cognitive impairment, anticholinergic activity, and risk of sarcopenia.
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Affiliation(s)
- Javier Jerez-Roig
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), C. Sagrada Família, 7, Barcelona, Vic, 08500, Spain
- Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS- CC), Barcelona, Vic, Spain
| | - Pau Farrés-Godayol
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), C. Sagrada Família, 7, Barcelona, Vic, 08500, Spain.
- Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS- CC), Barcelona, Vic, Spain.
| | - Meltem Yildirim
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), C. Sagrada Família, 7, Barcelona, Vic, 08500, Spain
- Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS- CC), Barcelona, Vic, Spain
| | - Anna Escribà-Salvans
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), C. Sagrada Família, 7, Barcelona, Vic, 08500, Spain
- Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS- CC), Barcelona, Vic, Spain
| | - Pau Moreno-Martin
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), C. Sagrada Família, 7, Barcelona, Vic, 08500, Spain
- Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS- CC), Barcelona, Vic, Spain
| | - Ester Goutan-Roura
- Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS- CC), Barcelona, Vic, Spain
- Research group on Tissue Repair and Regeneration Laboratory (TR2Lab), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic- Central University of Catalonia (UVic-UCC), Barcelona, Spain
| | - Sandra Rierola-Fochs
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), C. Sagrada Família, 7, Barcelona, Vic, 08500, Spain
- Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS- CC), Barcelona, Vic, Spain
| | - Montse Romero-Mas
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), C. Sagrada Família, 7, Barcelona, Vic, 08500, Spain
- Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS- CC), Barcelona, Vic, Spain
| | - Joanne Booth
- Research Centre for Health (ReaCH), School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Dawn A Skelton
- Research Centre for Health (ReaCH), School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Maria Giné-Garriga
- Blanquerna Faculty of Psychology, Education and Sport Sciences, Ramon Llull University, Barcelona, Spain
- Blanquerna Faculty of Health Sciences, Ramon Llull University, Barcelona, Spain
| | - Eduard Minobes-Molina
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), C. Sagrada Família, 7, Barcelona, Vic, 08500, Spain
- Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS- CC), Barcelona, Vic, Spain
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Aldridge Z, Elsegood L, Murray S, Wileman A. Identifying incontinence and promoting continence in people living with dementia. Nurs Older People 2023:e1451. [PMID: 37990584 DOI: 10.7748/nop.2023.e1451] [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: 08/17/2023] [Indexed: 11/23/2023]
Abstract
Urinary and faecal incontinence are more prevalent among older people but, like dementia, incontinence is not a normal or inevitable part of ageing. The number of people living with dementia who experience continence issues is likely to be underestimated because many people avoid reporting them as a result of embarrassment and stigma, or because they think incontinence is an inevitable symptom of dementia and that nothing can be done about it. Increased awareness and understanding of the relationship between dementia and incontinence is needed so that nurses can persuade people living with dementia and their family carers to discuss continence issues, assess their needs and provide support. There are several practical strategies that can reduce the incidence of incontinence, counter its negative effects and promote continence in people living with dementia.
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Murphy C, De Laine C, Macaulay M, Fader M. A qualitative study of continence service provision for people living with dementia at home in the UK: Still inadequate? PLoS One 2022; 17:e0268900. [PMID: 35617347 PMCID: PMC9135215 DOI: 10.1371/journal.pone.0268900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 05/10/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Incontinence is a major problem for people with dementia (PWD) and their family/friend caregivers, often causing substantial harm, including residential care admission. The incontinence needs of PWD are complex and different from those of people without dementia. The aim of this study was to investigate carer and nurse perceptions of continence service provision and potential improvements. Methods A secondary analysis of qualitative data was undertaken. Semi-structured interviews (n = 45) were undertaken with PWD, family caregivers and healthcare professionals (continence or dementia nurses) in the UK. PWD and caregivers were recruited via www.joindementiaresearch.nihr.ac.uk and via dementia/carer groups. Nurses were recruited via their employers. Framework analysis was used. The COREQ Research guideline statement assists reporting. Results Four themes were found. Firstly, there was a lack of awareness of the service and waiting time. Many caregivers were unaware of continence services and dementia nurses often viewed it as a pad provision service. Caregivers reported long waits not meeting their urgent needs. Secondly, product provision was often inadequate. Most caregivers self-purchased all or many products and substantial variation in product provision was found. The number of products provided was often inadequate. Thirdly, a sense that “nothing can be done” was observed by some nurses and caregivers. Caregivers believed that, if nothing else, care information should be provided. Finally, suggestions for improvements were made, including proactive service signposting, joint clinics with dementia services, improved information before crisis point, dementia training for continence nurses and improved product provision. Conclusion Continence service inadequacies for PWD and caregivers have been reported for many years. This study demonstrates service provision remains unsatisfactory in the UK. Stakeholders propose a range of service improvements. It highlights that listening to the voices of PWD, caregivers and nurses is crucial for services seeking to improve continence services for PWD living at home.
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Affiliation(s)
- Cathy Murphy
- School of Health Sciences, University of Southampton, Southampton, United Kingdom
- * E-mail:
| | - Christine De Laine
- School of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Margaret Macaulay
- School of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Mandy Fader
- School of Health Sciences, University of Southampton, Southampton, United Kingdom
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Singh S, Gray A, Shepperd S, Stott DJ, Ellis G, Hemsley A, Khanna P, Ramsay S, Schiff R, Tsiachristas A, Wilkinson A, Young J. Is comprehensive geriatric assessment hospital at home a cost-effective alternative to hospital admission for older people? Age Ageing 2022; 51:afab220. [PMID: 34969074 PMCID: PMC8753046 DOI: 10.1093/ageing/afab220] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/15/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND hospital level healthcare in the home guided by comprehensive geriatric assessment (CGA) might provide a less costly alternative to hospitalisation for older people. OBJECTIVE to determine the cost-effectiveness of CGA admission avoidance hospital at home (HAH) compared with hospital admission. DESIGN/INTERVENTION a cost-effectiveness study alongside a randomised trial of CGA in an admission avoidance HAH setting, compared with admission to hospital. PARTICIPANTS/SETTING older people considered for a hospital admission in nine locations across the UK were randomised using a 2:1 randomisation schedule to admission avoidance HAH with CGA (N = 700), or admission to hospital with CGA when available (N = 355). MEASUREMENTS quality adjusted life years, resource use and costs at baseline and 6 months; incremental cost-effectiveness ratios were calculated. The main analysis used complete cases. RESULTS adjusting for baseline covariates, HAH was less costly than admission to hospital from a health and social care perspective (mean -£2,265, 95% CI: -4,279 to -252), and remained less costly with the addition of informal care costs (mean difference -£2,840, 95% CI: -5,495 to -185). There was no difference in quality adjusted survival. Using multiple imputation for missing data, the mean difference in health and social care costs widened to -£2,458 (95% CI: -4,977 to 61) and societal costs remained significantly lower (-£3,083, 95% CI: -5,880 to -287). There was little change to quality adjusted survival. CONCLUSIONS CGA HAH is a cost-effective alternative to admission to hospital for selected older people.
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Affiliation(s)
- Surya Singh
- Health Economics Research Centre, Nuffield Department of Population Health Sciences, Richard Doll Building, Old Road Campus, University of Oxford, Oxford OX3 7LF, UK
| | - Alastair Gray
- Health Economics Research Centre, Nuffield Department of Population Health Sciences, Richard Doll Building, Old Road Campus, University of Oxford, Oxford OX3 7LF, UK
| | - Sasha Shepperd
- Nuffield Department of Population Health Sciences, Richard Doll Building, Old Road Campus, University of Oxford, Oxford OX3 7LF, UK
| | - David J Stott
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, New Lister Building Glasgow Royal Infirmary G31 2ER, Glasgow, UK
| | - Graham Ellis
- University Hospital Monklands, NHS Lanarkshire, Monkscourt Avenue, Airdrie, ML6 0JS, UK
| | - Anthony Hemsley
- Royal Devon and Exeter NHS Foundation Trust, Exeter, Devon EX2 5DW, UK
| | - Pradeep Khanna
- Aneurin Bevan University Health Board, Newport, South Wales, NP20 4SZ, UK
| | - Scott Ramsay
- St John’s Hospital, NHS Lothian, Howden W Rd, Howden, Livingston EH54 6PP, UK
| | - Rebekah Schiff
- Guy’s and St Thomas’ NHS Foundation Trust, Westminster Bridge Rd, Bishop's, London SE1 7EH, UK
| | - Apostolos Tsiachristas
- Health Economics Research Centre, Nuffield Department of Population Health Sciences, Richard Doll Building, Old Road Campus, University of Oxford, Oxford OX3 7LF, UK
| | - Angela Wilkinson
- Victoria Hospital, NHS Fife, Hayfield Rd, Kirkcaldy, KY2 5AH, UK
| | - John Young
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford Royal Infirmary, Duckworth Lane, Bradford, BD9 6RJ, UK
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Navigating through incontinence: A qualitative systematic review and meta-aggregation of the experiences of family caregivers. Int J Nurs Stud 2021; 123:104062. [PMID: 34461378 DOI: 10.1016/j.ijnurstu.2021.104062] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 06/30/2021] [Accepted: 08/08/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Community dwelling older adults who are care dependent are highly affected by incontinence, resulting in substantial informal caregiver burden. Understanding the experiences of these caregivers is needed to develop supportive programs that reduce caregiver burden and rates of institutionalization for care recipients. OBJECTIVES This systematic review aimed to critically appraise and synthesize the qualitative literature on the perceptions, experiences, and consequences of informal caregivers managing incontinence in community dwelling older adults. DESIGN A qualitative evidence synthesis using meta-aggregation. DATA SOURCES CINAHL, Embase, Ovid Medline, PsycInfo, Scopus, and ProQuest Dissertations and Theses. REVIEW METHODS A comprehensive search was conducted to identify qualitative studies of all designs, published in English from January 1970 to November 2020, reporting on the experiences of unpaid adult family members or friends providing care at home to an adult aged 60 or older with urinary and/or fecal incontinence. Screening, data extraction, and quality appraisal were conducted independently by two reviewers, with disagreements resolved by consensus with all team members. Joanna Briggs Institute (JBI) processes were used to assess study quality, and the dependability and credibility of both study findings and synthesized findings. All articles included met predetermined criteria. RESULTS Database searches yielded 1165 references, of which 117 full-text documents were screened. Seven articles of moderate to high methodological quality met eligibility criteria and were included. Studies occurred in nine countries with 134 participants who were mostly female spouses of the care recipient. From these eligible studies, 49 findings were extracted with 35 equivocal or credible findings eligible for meta-aggregation. Findings were synthesized into the following four categories: 1) emotional responses, 2) physical, financial, and social consequences, 3) family roles and caregiver support, and 4) management and coping strategies. CONCLUSIONS Informal caregivers experience many physical, psychosocial, and financial challenges in caring for an older family member with incontinence. Educational and supportive programs for managing incontinence should be multi-component and tailored to meet the individual needs of informal caregivers. Future research should incorporate strategies to cope with emotional responses and offer practical strategies for managing incontinence. PROSPERO REGISTRATION CRD42017069185.
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