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Håkansson T, Svensson H, Karlsson S. Living with a person with young onset dementia - spousal experience. Int J Qual Stud Health Well-being 2024; 19:2330233. [PMID: 38493492 PMCID: PMC10946261 DOI: 10.1080/17482631.2024.2330233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 03/11/2024] [Indexed: 03/19/2024] Open
Abstract
PURPOSE Being of working age while at the same time needing to help a partner with young onset dementia has specific consequences for spouses. Research to date has been sparse concerning this particular group of spouses. The aim of the study was to explore spouses' everyday experiences when living with a person with young onset dementia. METHOD The study had a descriptive qualitative design with semi-structured interviews with nine spouses. The interviews were analysed using content analysis. RESULT The interviewed spouses experienced emotions that varied from feelings of loneliness, frustration, and worry to peace of mind. They said that they used coping strategies, which included adopting a positive mindset, adapting to inabilities, adopting an avoidant approach, and finding ways to recharge. Spouses also felt that they could use more support, both formal and informal. CONCLUSION The spouse of a person with young onset dementia has a range of emotional experiences and has resourceful ways of handling everyday life. Various types of support are offered to spouses, however, they seemed to desire more from health care services.
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Affiliation(s)
- Tania Håkansson
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Hilda Svensson
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Staffan Karlsson
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
- Faculty of Health Science, Kristianstad University, Kristianstad, Sweden
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Sessions J, Marsden J, Bringloe L, Gilsenan I. Changing the culture around hospital-based nutrition. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2024; 33:S18-S25. [PMID: 38639746 DOI: 10.12968/bjon.2024.33.8.s18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
Following a serious incident and inquest after the death of a patient due to choking at Sheffield Teaching Hospitals NHS Foundation Trust, the Trust put in place an action plan and implemented strategies to reduce the risk of recurrence. Four key actions were identified as essential to try to reduce the risk of a similar event: introduction of a standard operating procedure for mealtimes that included a pre-meal safety 'pause'; use of an electronic communication icon to indicate modified diet/fluid requirements, from emergency department and onward as a patient is transferred; job-specific mealtime safety training; and use of bedside posters with specific dietary requirements (in line with the International Dysphagia Diet Standards Initiative Framework). A new role of Lead Educator for Nutrition was introduced to support the changes and provide training. Changes were also made to the incident reporting system to ensure easy identification of events relating to dysphagia, so that these could be monitored, themes identified and lessons shared. A series of audits following the changes have shown that more staff across disciplines and teams have accessed training on nutrition and hydration practices, wards have increased the use of the icon and posters, and successfully implemented pre-meal safety pauses. The Lead Educator for Nutrition has helped embed learning, and increased awareness and knowledge about nutrition and hydration.
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Affiliation(s)
- Jo Sessions
- Lead Educator for Nutrition, Central Nursing, Sheffield Teaching Hospitals NHS Foundation Trust
| | - Jo Marsden
- Nurse Director, Surgical Services, Sheffield Teaching Hospitals NHS Foundation Trust
| | - Louise Bringloe
- Lead Nurse for Quality and Practice Development, Central Nursing, Sheffield Teaching Hospitals NHS Foundation Trust
| | - Irene Gilsenan
- Practice Development Co-ordinator (Evidence Based Practice) Learning, Education and Development Department, Sheffield Teaching Hospitals NHS Foundation Trust
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Wells I, G-Medhin A, Owen N, Thelwell ELR, Giacco D. Experiences of support received by carers of people who are involuntarily admitted to hospital under the Mental Health Act: qualitative study of carers' perspectives. BJPsych Open 2024; 10:e82. [PMID: 38622966 PMCID: PMC11060084 DOI: 10.1192/bjo.2024.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 02/09/2024] [Accepted: 02/27/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Carers of people who are involuntarily admitted to hospital report feeling isolated and unsupported by services. The Independent Review of the Mental Health Act (MHA) recommended that carers be supported. However, no research has directly explored what type of support carers would find most helpful when a relative/friend is involuntary admitted. AIMS To explore carers' experiences and views around the support they want to receive when their relative/friend is involuntarily admitted under the MHA. METHOD A total of 22 one-to-one interviews with carers were conducted online at three sites across England. Audio recordings of the interviews were transcribed, and data were analysed with thematic analysis. RESULTS Four main themes were identified: (a) heterogeneity in the current support for carers, (b) information about mental health and mental health services, (c) continuous support, and (d) peer support and guidance. Carers reported receiving support from professionals, peers and relatives, but this was unstructured, and the extent of support varied across carers. Carers reported wanting more information about mental health services, and for this information to be consistent. Carers also reported wanting emotional support from a single, continuous person, helping them establish a more personal and sincere connection. Peers were also identified as important in the provision of carer support, allowing carers to feel reassured and understood in their experience. CONCLUSIONS The support received by carers is currently unstructured. To meet the MHA review recommendations, carers of patients who are involuntarily admitted should be allocated a named contact person, ideally with lived experience, to offer information and personal continuity of support.
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Affiliation(s)
- Imogen Wells
- Warwick Medical School, University of Warwick, UK
| | | | - Nicole Owen
- Warwick Medical School, University of Warwick, UK
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Pullen D, Pillay BS, Krüger E. Tube feeding in advanced dementia: Insights from South African speech-language therapists. SOUTH AFRICAN JOURNAL OF COMMUNICATION DISORDERS 2024; 71:e1-e11. [PMID: 38426734 PMCID: PMC10913100 DOI: 10.4102/sajcd.v71i1.970] [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: 03/09/2023] [Revised: 09/18/2023] [Accepted: 09/21/2023] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Speech-language therapists (SLTs) may recommend tube feeding even with minimal research evidence of its effectiveness, and an understanding of SLTs' perceived practices is warranted. OBJECTIVES To qualitatively describe a sample of South African SLTs' perceived practices regarding feeding tube placement in people with advanced dementia. METHOD Semi-structured online interviews were conducted via Microsoft Teams. Eight South African SLTs with a particular interest in advanced dementia, in public and private settings, were recruited. Data were analysed using inductive reflexive thematic analysis. RESULTS Three main themes were identified: (1) factors influencing SLTs' decisions for feeding tube placement in people with advanced dementia; (2) nature of clinical setting and SLTs' decision-making and (3) SLTs' considerations to improve management of people with advanced dementia. Existing local palliative care guidelines were not employed in decisions about tube feeding. Most participants did not recommend tube feeding during end-of-life care. Perceived burden of care influenced participants' decisions about tube feeding. CONCLUSION Speech-language therapists in South Africa likely have an increased reliance on clinical experience rather than recent research and guidelines for decisions about feeding tube placement. Findings accentuate the importance of clinical supervision, mentoring and continuous professional development in the workplace. The findings are an urgent call to action to improve SLTs' overall practices and ethical service delivery for people with advanced dementia and their families.Contribution: Factors and needs regarding SLTs' decision-making about feeding tubes in people with advanced dementia are highlighted.
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Affiliation(s)
- Danette Pullen
- Department of Speech-Language Pathology and Audiology, Faculty of Humanities, University of Pretoria, Pretoria.
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Du Preez J, Celenza A, Etherton-Beer C, Moffat P, Campbell E, Arendts G. Caring for persons with Dementia: a qualitative study of the needs of carers following care recipient discharge from hospital. BMC Palliat Care 2023; 22:200. [PMID: 38087205 PMCID: PMC10717287 DOI: 10.1186/s12904-023-01322-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 12/05/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND A randomised clinical trial titled the Carer End of Life Planning Intervention (CELPI) in people dying with dementia evaluated the effect of carer education and support about palliative care on care recipient outcomes. We present a pre-planned qualitative analysis of data collected during the CELPI trial in which needs of carers randomised to the study intervention group were assessed using a novel instrument (Carer Needs Directed Assessment in Dementia (CANDID). This tool aimed to identify carers' perceptions of their own and their care-recipients' needs and is an important step in identifying support provision for dementia-specific, palliative cares services upon hospital discharge. METHODS The CANDID tool was designed to identify the needs and experiences of primary carers and of their care recipients during the last twelve months of the care recipient's life. The tool consisted of 33 open-ended questions evaluating: symptom management, emergency contacts, advance care planning, carer's perception of the care recipient's future needs, carer's current needs, and a proposed current and future care plan. The researcher's philosophical assumption of interpretative phenomenology informed the study and approach to data collection and analysis. Qualitative data collected during interviews using this tool were thematically analysed in five steps: compiling, disassembling, reassembling, interpreting and concluding. An interpretation of participants' reality emerged from their common experiences and the subjective meanings assigned to actions attached to the phenomena studied. RESULTS Thirty carer participants were included. Analysis identified three major themes: Carers' perceived stressors, systemic barriers to care provision, and future planning. Issues identified included barriers to accessing supports, carer health and division between roles, financial burden, familial conflicts, adquate care in hospital and aged care facilities, concern about future needs, and end-of-life discussions. CONCLUSION The CANDID tool enabled an evaluation of carer needs and concerns. Identifying those needs may inform a referral to palliative care services where the level of management required may be benenficial for both the person living with dementia and their primary carer. TRIAL REGISTRATION Australian Clinical Trials Registration: (ACTRN12619001187134).
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Affiliation(s)
- Janice Du Preez
- Department of Emergency Medicine, Fiona Stanley Hospital, Murdoch, Western, Australia.
- Division of Emergency Medicine, School of Medicine, University of Western Australia, 35 Stirling Hwy, Crawley, WA, 6009, Australia.
| | - Antonio Celenza
- Emergency Department, Sir Charles Gairdner Hospital, Nedlands, Western, Australia
- Division of Emergency Medicine, School of Medicine, University of Western Australia, 35 Stirling Hwy, Crawley, WA, 6009, Australia
| | - Christopher Etherton-Beer
- School of Medicine, University of Western Australia and Department of Geriatric Medicine, Royal Perth Hospital, Perth, Western, Australia
- Division of Emergency Medicine, School of Medicine, University of Western Australia, 35 Stirling Hwy, Crawley, WA, 6009, Australia
| | - Paula Moffat
- Palliative Care Unit, Bethesda Hospital, Claremont, Western, Australia
| | - Elissa Campbell
- Department of Geriatric Acute and Rehabilitation Medicine, Sir Charles Gairdner Hospital, Nedlands, Western, Australia
| | - Glenn Arendts
- Department of Emergency Medicine, Fiona Stanley Hospital, Murdoch, Western, Australia
- Division of Emergency Medicine, School of Medicine, University of Western Australia, 35 Stirling Hwy, Crawley, WA, 6009, Australia
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Anantapong K, Sampson EL, Davies N. A shared decision-making model about care for people with severe dementia: A qualitative study based on nutrition and hydration decisions in acute hospitals. Int J Geriatr Psychiatry 2023; 38:e5884. [PMID: 36750227 PMCID: PMC10108087 DOI: 10.1002/gps.5884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 01/24/2023] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To understand the decision-making processes regarding eating and drinking for hospital patients with severe dementia and use this data to modify a decision-making model about care for people with severe dementia. METHODS From January to May 2021, qualitative semi-structured interviews were conducted with 29 family carers and hospital staff in England who cared for people with severe dementia during hospital admissions. Interviews were transcribed verbatim and analysed using codebook thematic analysis. RESULTS We demonstrated a modified decision-making model consisting of six stages of the decision-making process: (i) identify a decision to be made; (ii) exchange information and recognise emotions; (iii) clarify values and preferences of all involved; (iv) consider feasibility of each choice; (v) share preferred choice and make a final decision; and (vi) deliver the decision, monitor outcomes and renegotiation. From this study, decision-making needed to be shared among all people involved and address holistic needs and personal values of people with dementia and family carers. However, hospital staff often made assumptions about the persons' ability to eat and drink without adequate consultation with family carers. The process was impacted by ward culture, professional practice, and legal framework, which might overlook cultural and personal beliefs of the persons and families. Treatment escalation plans could help inform stepwise treatments, create realistic expectations, and guide future decisions. CONCLUSIONS Our decision-making model provides clear stages of decision-making processes and can be used to guide clinical practice and policy around care decisions for eating and drinking, which is often poorly supported.
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Affiliation(s)
- Kanthee Anantapong
- Marie Curie Palliative Care Research DepartmentUCL Division of PsychiatryUniversity College LondonLondonUK
- Department of PsychiatryFaculty of MedicinePrince of Songkla UniversityHat YaiThailand
| | - Elizabeth L. Sampson
- Marie Curie Palliative Care Research DepartmentUCL Division of PsychiatryUniversity College LondonLondonUK
- Department of Psychological MedicineRoyal London HospitalEast London NHS Foundation TrustLondonUK
| | - Nathan Davies
- Marie Curie Palliative Care Research DepartmentUCL Division of PsychiatryUniversity College LondonLondonUK
- Centre for Ageing Population StudiesResearch Department of Primary Care and Population HealthUniversity College LondonLondonUK
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