Massive Open Online Courses: enhancing caregiver education and support about dementia care towards and at end of life

Dementia education and training for the general public: A scoping review

The lack of public awareness and understanding of dementia affects the experiences of people living with dementia and their families. Dementia education and training for the general public have been gradually disseminated. We conducted a systematic scoping review guided by PRISMA-ScR to map existing evidence and identify dementia education and training available to the general public. From the four electronic databases, 41 articles were identified. Dementia education has three main purposes: dementia friendliness (n = 25), early diagnosis/help-seeking (n = 10), and prevention (n = 6). Education aimed at dementia friendliness was delivered in the community (n = 6), schools/universities (n =14), workplaces (n = 2), and online (n = 3). Interventions aimed at early diagnosis and prevention were often conducted in communities with middle-aged and older people or specific ethnic groups. Eleven dementia-friendliness studies reported on the interaction with people living with dementia to reduce stigma. Dementia knowledge, attitudes, and preventive behaviors were assessed as outcomes. Though randomized controlled trials were conducted in early diagnosis and prevention studies via e-learning, they were not performed in dementia-friendliness studies. Therefore, there is a need to further accumulate evidence of dementia education for each of these purposes.

Collaborative Learning through a Virtual Community of Practice in Dementia Care Support: A Scoping Review

The aim of this scoping review was to identify, synthesize, and report research on reflective collaborative learning through virtual communities of practice (vCoP), which, to our knowledge, is scarce. A second aim was to identify, synthesize, and report research on the facilitators and barriers associated with resilience capacity and knowledge acquisition through vCoP. The literature was searched in PsycINFO, CINAHL, Medline, EMBASE, Scopus, and Web of Science. The Preferred Reporting Items for Systematic Reviews (PRISMA) and Meta-Analyses for Scoping Reviews (ScR) framework guided the review. Ten studies were included in the review, seven quantitative and three qualitative studies, written in English and published from January 2017 to February 2022. The data were synthesized using a numerical descriptive summary and qualitative thematic analysis. Two themes: 'knowledge acquisition' and 'strengthening resilience capacity' emerged. The literature synthesis provides evidence of a vCoP as a digital space that supports knowledge acquisition and strengthens resilience for persons with dementia, and their informal and formal caregivers. Hence, the use of vCoP seems to be useful for dementia care support. Further studies including less developed countries are, however, needed to enable generalizability of the concept of vCoP across countries.

Difficulties experienced by caregivers of patients with Alzheimer's Disease in relation to dietary care: integrative review

Objective: To analyze the problems experienced by caregivers of patients with Alzheimer's Disease (AD) in dietary care. Methods: An integrative review was carried out, whose guiding question was "What are the experiences and difficulties reported by caregivers of people with Alzheimer's disease concerning dietary care?". The search occurred in April/2021 in the following databases: MEDLINE, Science Direct, SCOPUS, Web of Science, SciELO, and Lilacs. Publications fromthe last 10 years in English, Portuguese or Spanish were included. Results: Of the 2,418 articles initially found, the titles of 39 seemed to fit the research objectives. Of these, 11 articles were selected for full reading, and 8 were evaluated to answer the research question. A gap in the approach to the problems experienced by caregivers of patients with AD concerning dietary care was observed. Difficulties dealing with reduced appetite, dysphagia, inability to remember eating, mealtime refusal, and food repulsion were reported. Allied to this, caregiver stress was reported. Conclusion: The main problems experienced by caregivers of patients with AD involve reduced appetite, dysphagia, difficulty remembering what they have already eaten, refusal at mealtimes, and food repulsion. Thus, the theme deserves the attention and involvement of health professionals to focus on the most frequent difficulties and teach caregivers to overcome them.

Effects of Disability Severity on the Family Burden of Home-Dwelling Uygur and Kazakh Aged in Rural Western China: Family Function as a Mediator

INTRODUCTION

Caring for the disabled elderly puts heavy burdens on their families. This study aimed to explore family function (FF) as a mediator in the relationship between disability severity (DS) and family burden (FB) of the Uygur and Kazakh home-dwelling disabled elderly cared for by informal caregivers in China.

METHOD

A cross-sectional design with multistage sampling was used to recruit 431 families with Uygur and Kazakh disabled elderly in Bortala, Xinjiang, China. Data were collected using the Activities of Daily Living Scale, Family Burden Interview Schedule, and Family Adaptation, Partnership, Growth, Affection, and Resolve Index Scale and then analyzed using hierarchical regression.

RESULTS

FF had a partial mediating effect on the relationship between DS and FB (β = 0.131; 95% confidence interval [CI] = [0.074, 0.197]; p < .01); the effective rate was 41.46%.

DISCUSSION

Multidisciplinary care teams should implement targeted interventions to improve FF of the disabled elderly to alleviate FB.

Changes to postdiagnostic dementia support in England and Wales during the COVID-19 pandemic: a qualitative study

OBJECTIVES

To explore the impact of COVID-19 on postdiagnostic dementia care and support provision in England and Wales.

DESIGN

Qualitative research using semistructured interviews, via video or telephone conferencing.

SETTING

Services providing postdiagnostic support across health, social care and the third sector.

PARTICIPANTS

21 professionals previously recruited to an ongoing research programme on postdiagnostic dementia care (or colleagues, if unavailable).

RESULTS

Key themes identified from the data were: challenges caused by COVID-19; responses to those challenges, including a widespread shift to remote working; and effects of COVID-19 on future postdiagnostic support. Challenges included changing and sometimes conflicting guidelines; a lack of access to support; identifying and responding to emerging needs; emotional and physical impact of COVID-19; and balancing COVID-19 risk with other risks such as deterioration. Some dementia services closed, while others adapted and continued to provide support thus potentially widening existing inequalities. There were also some unintended positive outcomes, including improved cross-sector and multidisciplinary working between professionals.

CONCLUSION

Delivering postdiagnostic dementia support during COVID-19 required essential adaptations. While some changes were detrimental to service users, others were identified as potentially beneficial and highly likely to become the new 'norm', for example, use of blended approaches, combining virtual and face-to-face work, thus allowing more flexible, integrated care. Our data have implications for policy and practice to improve the response to the lingering effects of COVID-19 as well as creating service provision that is more resilient to future pandemics or other periods of disruption.

Effects of e-Health Training and Social Support Interventions for Informal Caregivers of People with Dementia-A Narrative Review

Along with the burden commonly experienced by informal caregivers (ICs) of people with dementia (PwD), associated with the progressive decline that accompanies dementia, the lockdown due to the public health crisis has had a great negative impact on the emotional wellbeing, physical health, and social relationships of ICs. Support interventions through telemedicine represent an opportunity for ICs to learn the skills required for the care and maintenance of social networks. In this work, a narrative review of the effects of e-health training and social support interventions was carried out. A literature search was conducted using the ProQuest, Ovid, and Scopus databases. Information regarding social support (SS), psychological interventions, and training for the management of medications and behavioral changes was extracted. One hundred and nine studies were included in this review. Forums and training platforms were the main tools for ICs. The most effective platforms to improve SS include the participation of both ICs and health professionals. However, no significant improvements in objective caring skills were identified. Platforms developed specifically for ICs should be based in tools that ICs are familiar with, because many ICs have not yet incorporated Information and Communication Technologies in many activities of their daily lives. Education in the digitalization to ICs of PwD should be one of the priority objectives in telehealth interventions.

Supporting good quality, community-based end-of-life care for people living with dementia: the SEED research programme including feasibility RCT

Background

In the UK, most people with dementia die in the community and they often receive poorer end-of-life care than people with cancer.

Objective

The overall aim of this programme was to support professionals to deliver good-quality, community-based care towards, and at, the end of life for people living with dementia and their families.

Design

The Supporting Excellence in End-of-life care in Dementia (SEED) programme comprised six interlinked workstreams. Workstream 1 examined existing guidance and outcome measures using systematic reviews, identified good practice through a national e-survey and explored outcomes of end-of-life care valued by people with dementia and family carers (n = 57) using a Q-sort study. Workstream 2 explored good-quality end-of-life care in dementia from the perspectives of a range of stakeholders using qualitative methods (119 interviews, 12 focus groups and 256 observation hours). Using data from workstreams 1 and 2, workstream 3 used co-design methods with key stakeholders to develop the SEED intervention. Worksteam 4 was a pilot study of the SEED intervention with an embedded process evaluation. Using a cluster design, we assessed the feasibility and acceptability of recruitment and retention, outcome measures and our intervention. Four general practices were recruited in North East England: two were allocated to the intervention and two provided usual care. Patient recruitment was via general practitioner dementia registers. Outcome data were collected at baseline, 4, 8 and 12 months. Workstream 5 involved economic modelling studies that assessed the potential value of the SEED intervention using a contingent valuation survey of the general public (n = 1002). These data informed an economic decision model to explore how the SEED intervention might influence care. Results of the model were presented in terms of the costs and consequences (e.g. hospitalisations) and, using the contingent valuation data, a cost–benefit analysis. Workstream 6 examined commissioning of end-of-life care in dementia through a narrative review of policy and practice literature, combined with indepth interviews with a national sample of service commissioners (n = 20).

Setting

The workstream 1 survey and workstream 2 included services throughout England. The workstream 1 Q-sort study and workstream 4 pilot trial took place in North East England. For workstream 4, four general practices were recruited; two received the intervention and two provided usual care.

Results

Currently, dementia care and end-of-life care are commissioned separately, with commissioners receiving little formal guidance and training. Examples of good practice rely on non-recurrent funding and leadership from an interested clinician. Seven key components are required for good end-of-life care in dementia: timely planning discussions, recognising end of life and providing supportive care, co-ordinating care, effective working with primary care, managing hospitalisation, continuing care after death, and valuing staff and ongoing learning. Using co-design methods and the theory of change, the seven components were operationalised as a primary care-based, dementia nurse specialist intervention, with a care resource kit to help the dementia nurse specialist improve the knowledge of family and professional carers. The SEED intervention proved feasible and acceptable to all stakeholders, and being located in the general practice was considered beneficial. None of the outcome measures was suitable as the primary outcome for a future trial. The contingent valuation showed that the SEED intervention was valued, with a wider package of care valued more than selected features in isolation. The SEED intervention is unlikely to reduce costs, but this may be offset by the value placed on the SEED intervention by the general public.

Limitations

The biggest challenge to the successful delivery and completion of this research programme was translating the ‘theoretical’ complex intervention into practice in an ever-changing policy and service landscape at national and local levels. A major limitation for a future trial is the lack of a valid and relevant primary outcome measure to evaluate the effectiveness of a complex intervention that influences outcomes for both individuals and systems.

Conclusions

Although the dementia nurse specialist intervention was acceptable, feasible and integrated well with existing care, it is unlikely to reduce costs of care; however, it was highly valued by all stakeholders (professionals, people with dementia and their families) and has the potential to influence outcomes at both an individual and a systems level.

Future work

There is no plan to progress to a full randomised controlled trial of the SEED intervention in its current form. In view of new National Institute for Health and Care Excellence dementia guidance, which now recommends a care co-ordinator for all people with dementia, the feasibility of providing the SEED intervention throughout the illness trajectory should be explored. Appropriate outcome measures to evaluate the effectiveness of such a complex intervention are needed urgently.

Trial registration

Current Controlled Trials ISRCTN21390601.

Funding

This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research, Vol. 8, No. 8. See the NIHR Journals Library website for further project information.