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Urbano-Mairena J, De Los Ríos-Calonge J, Postigo-Mota S, Carvajal-Gil J, Silveira-Saraiva ES, Guerra-Bustamante J, Muñoz-Bermejo L. Benefits Perceived by Caregivers of Patients with Alzheimer's Disease on Physical and Emotional Health in an Interdisciplinary Program: A Qualitative Study. Healthcare (Basel) 2024; 12:1414. [PMID: 39057557 PMCID: PMC11275445 DOI: 10.3390/healthcare12141414] [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: 05/10/2024] [Revised: 07/01/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024] Open
Abstract
Alzheimer's disease is the most common type of dementia, severely affecting the families and caregivers who live with those affected. The aim was to explore the physical, psychological, and behavioral benefits for caregivers of people with Alzheimer's disease. Fifteen semi-structured interviews were conducted with informal Alzheimer's caregivers upon completion of the program. Following a discussion on the topics, categories, and codes among the researchers, a consensus was reached to obtain the final themes and categories. Three main categories were obtained: (1) perceived benefits by the participants; (2) applicability of the knowledge; and (3) proposals for improvement. Participants expressed having perceived improvements in their ability to manage emotions and cope with the situation created by the disease, physical capacity, and in their relationships. In this sense, the application of the contents addressed during the intervention became a fundamental tool for the participants' daily lives. This study showed how an interdisciplinary intervention with psychological sessions, health education, and physical activities could be beneficial for improving both the physical and mental health of caregivers.
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Affiliation(s)
- Javier Urbano-Mairena
- Social Impact and Innovation in Health (InHEALTH) Research Group, University Centre of Mérida, University of Extremadura, 06800 Mérida, Spain;
| | - Javier De Los Ríos-Calonge
- Department of Sport Sciences, Sports Research Centre, Miguel Hernández University of Elche, 03202 Elche, Spain;
| | - Salvador Postigo-Mota
- Farmacogenética de Enfermedades Psiquiátricas, Faculty of Medicine, University of Extremadura, 06006 Badajoz, Spain;
| | - Julián Carvajal-Gil
- Social Impact and Innovation in Health (InHEALTH) Research Group, University Centre of Mérida, University of Extremadura, 06800 Mérida, Spain;
| | | | - Joan Guerra-Bustamante
- Physical and Health Literacy and Health-Related Quality of Life (PHYQOL) Research Group, Faculty of Sport Sciences, University of Extremadura, 10003 Cáceres, Spain;
| | - Laura Muñoz-Bermejo
- Social Impact and Innovation in Health (InHEALTH) Research Group, University Centre of Mérida, University of Extremadura, 06800 Mérida, Spain;
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Gupta S, Bhandari SS, Gautam M, Grover S. Clinical practice guidelines on the environment and mental well-being. Indian J Psychiatry 2024; 66:S372-S390. [PMID: 38445269 PMCID: PMC10911325 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_792_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/01/2023] [Accepted: 12/04/2023] [Indexed: 03/07/2024] Open
Affiliation(s)
- Snehil Gupta
- Department of Psychiatry, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Samrat Singh Bhandari
- Department of Psychiatry, Sikkim Manipal Institute of Medical Sciences, Sikkim Manipal University, Gangtok, Sikkim, India
| | - Manaswi Gautam
- Department of Psychiatry, Gautam Hospital and Institute of Behavioural Sciences, Jaipur, Rajasthan, India
| | - Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India E-mail:
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Martínez-Campos A, Compañ-Gabucio LM, Torres-Collado L, Garcia-de la Hera M. Occupational Therapy Interventions for Dementia Caregivers: Scoping Review. Healthcare (Basel) 2022; 10:1764. [PMID: 36141376 PMCID: PMC9498417 DOI: 10.3390/healthcare10091764] [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: 07/21/2022] [Revised: 09/06/2022] [Accepted: 09/09/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND PURPOSE caregivers of people with dementia (PwD) often experience a significant caregiver burden. Occupational Therapy (OT) is a helpful discipline for improving quality of life and other health factors for these caregivers. We conducted a Scoping Review to describe OT interventions for caregivers of PwD. METHODS two authors searched PubMed, Scopus, EMBASE and Web of Science databases and OT journals indexed in the Journal Citation Reports. Terms included in the search strategy were: dementia, Alzheimer, Parkinson, caregivers and OT. We included articles with experimental design in which an OT intervention in caregivers of PwD was carried out, written in Spanish or English and with the full text available. RESULTS a total of 2121 articles were obtained, 31 of which were included; 22 of them described home-based OT interventions: Tailored Activity Program (TAP) (n = 5), Environmental Skill-Building Program (ESP) (n = 4) and Advancing Caregiver Training (ACT) (n = 3) and other household interventions (n = 10); the remaining studies described OT interventions in other settings (n = 9). CONCLUSIONS OT interventions for caregivers of PwD were mainly carried out at home. The most commonly used interventions were TAP focused on caregivers of people with Alzheimer's disease, aimed at lessening the burden, depression and stress experienced by caregivers.
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Affiliation(s)
- Alberto Martínez-Campos
- Unidad de Epidemiología de la Nutrición (EPINUT), Departamento de Salud Pública, Historia de la Ciencia y Ginecología, Universidad Miguel Hernández (UMH), 03550 Alicante, Spain
| | - Laura-María Compañ-Gabucio
- Unidad de Epidemiología de la Nutrición (EPINUT), Departamento de Salud Pública, Historia de la Ciencia y Ginecología, Universidad Miguel Hernández (UMH), 03550 Alicante, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante, ISABIAL, 03010 Alicante, Spain
| | - Laura Torres-Collado
- Unidad de Epidemiología de la Nutrición (EPINUT), Departamento de Salud Pública, Historia de la Ciencia y Ginecología, Universidad Miguel Hernández (UMH), 03550 Alicante, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante, ISABIAL, 03010 Alicante, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28034 Madrid, Spain
| | - Manuela Garcia-de la Hera
- Unidad de Epidemiología de la Nutrición (EPINUT), Departamento de Salud Pública, Historia de la Ciencia y Ginecología, Universidad Miguel Hernández (UMH), 03550 Alicante, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante, ISABIAL, 03010 Alicante, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28034 Madrid, Spain
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Kwon MH, Kim SK. Effects of Client-Centered Occupational Therapy on Behavioral Psychological Symptoms, Social Interaction, Occupational Performance, Quality of Life, and Caregiver Burden among the Individuals with Dementia. Occup Ther Health Care 2022; 37:266-281. [PMID: 35192440 DOI: 10.1080/07380577.2022.2028330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This study aimed to verify the effects of client-centered occupational therapy on individuals with dementia. Twenty participants were randomly assigned to an experimental group (client-centered occupational therapy) and a control group (general occupational therapy). A pretest, post-test, and follow-up tests were used to compare the effects of the intervention. The experimental group had significant changes in all variables, and the control group showed significant differences in verbal social interaction, quality of life, and burden of caregivers (p < 0.05). As a result of repeated measurement variance analysis, it was found that there was a significant effect within the group except for the NPI-Q distress items (p < 0.05), but the effect was not verified in all areas between the groups. Client-centered customized occupational therapy can be more effective than general occupational therapy in problem behavior, social interaction, quality of life, caregiver burden, and occupational performance of individuals with dementia.
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Affiliation(s)
- Mi-Hwa Kwon
- Department of Occupational Therapy, Dongnam Health College, Suwon, Republic of Korea
| | - Su-Kyoung Kim
- Department of Occupational Therapy, Konyang University, Daejeon, Republic of Korea
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Implementation of evidence-based, non-pharmacological interventions addressing behavior and psychological symptoms of dementia: a systematic review focused on implementation strategies. Int Psychogeriatr 2021; 33:947-975. [PMID: 33190660 DOI: 10.1017/s1041610220001702] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study aimed to identify the nature and effects of implementation strategies to increase the use of evidence-based, non-pharmacological interventions designed to reduce the frequency and/or severity of behavioral and psychological symptoms associated with dementia, for people living in the community. DESIGN This was a systematic review of implementation studies. We searched six databases (in January 2019) and hand-searched reference lists of reports. Studies were included if they used quantitative methods evaluating the use of implementation strategies to increase the use of non-pharmacological interventions. These interventions had to have been tested in a randomized controlled trial (RCT) and found to reduce behavioral and psychological symptoms of dementia, for those living in the community. Studies needed to report the effect of the implementation on clinical practice, for example, a change in practice or the adoption of the intervention in community settings. RESULTS Twelve studies were included: 11 one-group pre-post design studies and 1 cluster RCT. All studies reported practice change - the majority implementing a new intervention, with six different types of interventions implemented. All studies reported including using partnerships, new funding, educational strategies, and ongoing support and consultation. Seven implementation studies reported positive outcomes for clients on some aspect of behavior or depression for the person with dementia. CONCLUSIONS Implementation studies using multiple implementation strategies to increase the use of non-pharmacological interventions have demonstrated improvements in behavioral and psychological symptoms common in people with dementia, when provided by clinicians as part of their everyday work routines.
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Clarkson P, Challis D, Hughes J, Roe B, Davies L, Russell I, Orrell M, Poland F, Jolley D, Kapur N, Robinson C, Chester H, Davies S, Sutcliffe C, Peconi J, Pitts R, Fegan G, Islam S, Gillan V, Entwistle C, Beresford R, Abendstern M, Giebel C, Ahmed S, Jasper R, Usman A, Malik B, Hayhurst K. Components, impacts and costs of dementia home support: a research programme including the DESCANT RCT. PROGRAMME GRANTS FOR APPLIED RESEARCH 2021. [DOI: 10.3310/pgfar09060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background
Over half of people with dementia live at home. We know little about what home support could be clinically effective or cost-effective in enabling them to live well.
Objectives
We aimed to (1) review evidence for components of home support, identify their presence in the literature and in services in England, and develop an appropriate economic model; (2) develop and test a practical memory support package in early-stage dementia, test the clinical effectiveness and cost-effectiveness of routine home support in later-stage dementia and design a toolkit based on this evidence; and (3) elicit the preferences of staff, carers and people with dementia for home support inputs and packages, and evaluate the cost-effectiveness of these approaches in early- and later-stage dementia.
Design
We undertook (1) an evidence synthesis, national surveys on the NHS and social care and an economic review; (2) a multicentre pragmatic randomised trial [Dementia Early Stage Cognitive Aids New Trial (DESCANT)] to estimate the clinical effectiveness and cost-effectiveness of providing memory aids and guidance to people with early-stage dementia (the DESCANT intervention), alongside process evaluation and qualitative analysis, an observational study of existing care packages in later-stage dementia along with qualitative analysis, and toolkit development to summarise this evidence; and (3) consultation with experts, staff and carers to explore the balance between informal and paid home support using case vignettes, discrete choice experiments to explore the preferences of people with dementia and carers between home support packages in early- and later-stage dementia, and cost–utility analysis building on trial and observational study.
Setting
The national surveys described Community Mental Health Teams, memory clinics and social care services across England. Recruitment to the trial was through memory services in nine NHS trusts in England and one health board in Wales. Recruitment to the observational study was through social services in 17 local authorities in England. Recruitment for the vignette and preference studies was through memory services, community centres and carers’ organisations.
Participants
People aged > 50 years with dementia within 1 year of first attendance at a memory clinic were eligible for the trial. People aged > 60 years with later-stage dementia within 3 months of a review of care needs were eligible for the observational study. We recruited staff, carers and people with dementia for the vignette and preference studies. All participants had to give written informed consent.
Main outcome measures
The trial and observational study used the Bristol Activities of Daily Living Scale as the primary outcome and also measured quality of life, capability, cognition, general psychological health and carers’ sense of competence.
Methods
Owing to the heterogeneity of interventions, methods and outcome measures, our evidence and economic reviews both used narrative synthesis. The main source of economic studies was the NHS Economic Evaluation Database. We analysed the trial and observational study by linear mixed models. We analysed the trial by ‘treatment allocated’ and used propensity scores to minimise confounding in the observational study.
Results
Our reviews and surveys identified several home support approaches of potential benefit. In early-stage dementia, the DESCANT trial had 468 randomised participants (234 intervention participants and 234 control participants), with 347 participants analysed. We found no significant effect at the primary end point of 6 months of the DESCANT intervention on any of several participant outcome measures. The primary outcome was the Bristol Activities of Daily Living Scale, for which scores range from 0 to 60, with higher scores showing greater dependence. After adjustment for differences at baseline, the mean difference was 0.38, slightly but not significantly favouring the comparator group receiving treatment as usual. The 95% confidence interval ran from –0.89 to 1.65 (p = 0.56). There was no evidence that more intensive care packages in later-stage dementia were more effective than basic care. However, formal home care appeared to help keep people at home. Staff recommended informal care that cost 88% of formal care, but for informal carers this ratio was only 62%. People with dementia preferred social and recreational activities, and carers preferred respite care and regular home care. The DESCANT intervention is probably not cost-effective in early-stage dementia, and intensive care packages are probably not cost-effective in later-stage dementia. From the perspective of the third sector, intermediate intensity packages were cheaper but less effective. Certain elements may be driving these results, notably reduced use of carers’ groups.
Limitations
Our chosen outcome measures may not reflect subtle outcomes valued by people with dementia.
Conclusions
Several approaches preferred by people with dementia and their carers have potential. However, memory aids aiming to affect daily living activities in early-stage dementia or intensive packages compared with basic care in later-stage dementia were not clinically effective or cost-effective.
Future work
Further work needs to identify what people with dementia and their carers prefer and develop more sensitive outcome measures.
Study registration
Current Controlled Trials ISRCTN12591717. The evidence synthesis is registered as PROSPERO CRD42014008890.
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. 9, No. 6. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Paul Clarkson
- Social Care and Society, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - David Challis
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Jane Hughes
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Brenda Roe
- Evidence-based Practice Research Centre, Edge Hill University, Ormskirk, UK
| | - Linda Davies
- Health Economics Research Team, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Ian Russell
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Martin Orrell
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Fiona Poland
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - David Jolley
- Social Care and Society, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Narinder Kapur
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Catherine Robinson
- Social Care and Society, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Helen Chester
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Sue Davies
- Social Care and Society, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Caroline Sutcliffe
- Social Care and Society, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Julie Peconi
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Rosa Pitts
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Greg Fegan
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Saiful Islam
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Vincent Gillan
- Social Care and Society, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Charlotte Entwistle
- Social Care and Society, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Rebecca Beresford
- Social Care and Society, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Michele Abendstern
- Social Care and Society, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Clarissa Giebel
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
| | - Saima Ahmed
- Social Care and Society, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Rowan Jasper
- Social Policy Research Unit, University of York, York, UK
| | - Adeela Usman
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Baber Malik
- Social Care and Society, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Karen Hayhurst
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
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Effects of a Cognitive Rehabilitation Programme on the Independence Performing Activities of Daily Living of Persons with Dementia-A Pilot Randomized Controlled Trial. Brain Sci 2021; 11:brainsci11030319. [PMID: 33802286 PMCID: PMC7998719 DOI: 10.3390/brainsci11030319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 02/20/2021] [Accepted: 02/26/2021] [Indexed: 11/23/2022] Open
Abstract
Background: In all types of dementia, cognitive abilities are affected, behaviour is altered and functional capacity is progressively lost. This cognitive deterioration manifests in the decrease of abilities required to perform the activities of daily living (ADL). The objective of this pilot study was to assess the effect of an Occupational Therapy programme based on the training of ADL through cognitive stimulation on the independence of ADL of persons with dementia. Methods: Institutionalized older adults with major neurocognitive disorder or dementia (N = 58) were randomly allocated to receive either the Occupational Therapy ADL cognitive stimulation programme or conventional Occupational Therapy. The cognitive level and the independence level performing ADL were measured at baseline (week 0), after 5 weeks of treatment (week 5) and after 6 weeks of follow up (week 12). A value of p < 0.05 and α = 0.0025 (Bonferroni correction) was considered as statistically significant. Results: The results obtained showed improvements in the level of independence performing ADLs in the intervention group compared to the control group (p = 0.006). The improvements were seen in relation to feeding (p = 0.001), dressing (p = 0.005) and bladder and bowel incontinence (p = 0.003), the changes observed in feeding are statistically significant. However, those improvements were not maintained after the follow up period. There were no significant changes in relation to the cognitive level (p = 0.741). Conclusions: Occupational Therapy based on ADL cognitive stimulation can have a positive effect, increasing the independence of subjects with major neurocognitive disorder or dementia who are institutionalised.
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Raj SE, Mackintosh S, Fryer C, Stanley M. Home-Based Occupational Therapy for Adults With Dementia and Their Informal Caregivers: A Systematic Review. Am J Occup Ther 2021; 75:7501205060p1-7501205060p27. [PMID: 33399054 DOI: 10.5014/ajot.2020.040782] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE People with dementia require tailored interventions to support participation and performance in their desired occupations, and informal caregivers need interventions that reduce caregiving burden to enable them to continue with their roles. OBJECTIVE This systematic review investigated whether home-based occupational therapy interventions for adults with dementia and their informal caregivers optimized care recipients' performance of daily occupations and reduced caregiving burden and improved caregivers' sense of competence. DATA SOURCES Eight databases were searched from 1946 to November 2019 using MeSH terms, keywords, and subject headings as appropriate for each database. Inclusion criteria were quantitative studies investigating the effects of home-based therapy provided by a qualified occupational therapist for adults with dementia and their informal caregivers. STUDY SELECTION AND DATA COLLECTION Study selection, data collection, and methodological quality assessments using the Critical Appraisal Skills Programme criteria tool were performed independently by two reviewers. Data analysis involved a two-stage process. FINDINGS From 1,229 articles identified through searches, 970 titles and abstracts were screened for eligibility after removal of duplicates. Twenty studies reported in 22 articles were included. Moderate evidence supported interventions provided jointly for adults with dementia and their informal caregivers using a combination of intervention strategies. Included studies demonstrated high risk of bias, particularly in blinding of outcome assessments. CONCLUSIONS AND RELEVANCE Combining individualized interventions framed in client-centeredness can enhance occupational performance for adults with dementia, reduce caregiving burden, and improve informal caregivers' sense of competence. Further research on leisure and home management occupations is warranted. WHAT THIS ARTICLE ADDS The findings provide evidence supporting the effectiveness of home-based occupational therapy for people with dementia and their informal caregivers for consideration by funders of services.
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Affiliation(s)
- Sujatha E Raj
- Sujatha E. Raj, BOT, MSc(OT), is PhD Candidate, UniSA Allied Health & Human Performance, University of South Australia, Adelaide, South Australia, Australia;
| | - Shylie Mackintosh
- Shylie Mackintosh, PhD, MSc, BAppSc(Physio), is Associate Professor and Dean of Allied Health Programs, UniSA Allied Health & Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Caroline Fryer
- Caroline Fryer, PhD, Grad Dip (Clin Epi), BAppSc(Physio), is Senior Lecturer, Physiotherapy Program, UniSA Allied Health & Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Mandy Stanley
- Mandy Stanley, PhD, MSc(OT), BAppSc(OT), is Associate Professor, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
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Alvira C, Cabrera E, Kostov B, Risco E, Farré M, Miguel S, Zabalegui A. Validity and reliability of the Spanish caregiver reaction assessment scale for caregivers of people with dementia. Int J Nurs Pract 2020; 27:e12848. [PMID: 32476205 DOI: 10.1111/ijn.12848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 07/09/2019] [Accepted: 04/17/2020] [Indexed: 01/21/2023]
Abstract
AIM Of the few instruments available to measure the important, positive aspects of caring, the Caregiver Reaction Assessment is regarded as the most suitable, but there is no validated Spanish version. The aim of this study was to translate the Caregiver Reaction Assessment into Spanish and assess its psychometric properties. METHODS The Caregiver Reaction Assessment was translated into Spanish and then back translated. Validation included construct validity, criterion validity and reliability: 287 interviews were conducted with informal caregivers of patients with dementia between November 2010 and April 2012. RESULTS Principal component analysis confirmed the original instrument's five subscales. Criterion validity showed a moderate negative correlation between the impact on health and the EQ-5D (r = -.43), that is, a greater impact on health correlated with lower health-related quality of life. The Caregiver Reaction Assessment showed good internal consistency, with a Cronbach alpha of .804, and good temporal stability for the distinct subscales, with intraclass correlation coefficients varying from .683 to .729 (p < .001). CONCLUSION The Caregiver Reaction Assessment is a reliable, valid instrument for the measurement of the reactions of informal caregivers of patients with dementia, with good psychometric properties.
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Affiliation(s)
- Carmen Alvira
- Department of Nursing, CAP Comte Borrell, CAPSBE, Barcelona, Spain
| | - Esther Cabrera
- School of Health Sciences TecnoCampus, Pompeu Fabra University, Mataró, Spain
| | - Belchin Kostov
- Group for Research in Primary Care, IDIBAPS, Barcelona, Spain
| | - Ester Risco
- Department of Nursing, Hospital Clínic de Barcelona, Spain
| | - Marta Farré
- Department of Nursing, Hospital Clínic de Barcelona, Universitat de Barcelona (UB), Barcelona, Spain
| | - Susana Miguel
- School of Health Sciences Gimbernat i Tomàs Cerdà, UAB, Barcelona, Spain
| | - Adelaida Zabalegui
- School of Health Sciences Gimbernat i Tomàs Cerdà, UAB, Barcelona, Spain
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10
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Swanson R, Robinson KM. Geriatric Rehabilitation: Gait in the Elderly, Fall Prevention and Parkinson Disease. Med Clin North Am 2020; 104:327-343. [PMID: 32035572 DOI: 10.1016/j.mcna.2019.10.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Aging-associated anatomic and physiologic decline begins during the fourth decade of life and progresses over the ensuing decades sometimes to a state of frailty, with the decline amplified when there is deconditioning. Aging-related gait and balance disorders leading to an increased risk of falling can be compensated for with the use of exercise interventions, durable medical equipment, and environmental modifications. Caregiver training is an essential component of geriatric rehabilitation.
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Affiliation(s)
- Randel Swanson
- Department of Physical Medicine and Rehabilitation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Corporal Michael J. Crescenz Veterans Affairs Medical Center, 3800 Woodland Avenue, Philadelphia, PA 19104, USA
| | - Keith M Robinson
- Department of Physical Medicine and Rehabilitation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Corporal Michael J. Crescenz Veterans Affairs Medical Center, 3800 Woodland Avenue, Philadelphia, PA 19104, USA.
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11
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Trivedi DP, Braun A, Dickinson A, Gage H, Hamilton L, Goodman C, Ashaye K, Iliffe S, Manthorpe J. Managing behavioural and psychological symptoms in community dwelling older people with dementia: 1. A systematic review of the effectiveness of interventions. DEMENTIA 2019; 18:2925-2949. [PMID: 29557183 DOI: 10.1177/1471301218762851] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Two-thirds of people living with dementia live at home in the UK and many experience distressing behavioural and psychological symptoms. This systematic review evaluates the effectiveness of non-pharmacological interventions for behavioural and psychological symptoms among community-dwelling people living with dementia. Methods This two-stage review undertook an initial mapping of the literature followed by a systematic review of relevant randomised controlled trials. We searched electronic databases for pertinent studies reporting outcomes from interventions from January 2000 to March 2015 and updated searches in October 2016. We included studies that considered behavioural and psychological symptom management for older people living with dementia who live at home and excluded studies conducted in long-term care settings. This paper presents findings from a narrative synthesis of 48 randomised controlled trials evaluating interventions for people living with dementia alone, family carers alone and patient-carer dyads. Results We retrieved 17,871 de-duplicated records and screened them for potential inclusion. Evidence from 48 randomised controlled trials suggests that family carer training and educational programmes that target problem behaviours and potential triggers can improve outcomes. Nurses and occupational therapists appear to help people with dementia with behavioural and psychological symptoms, but professional comparisons are lacking and there is no shared language about or understanding of behavioural and psychological symptoms amongst professionals, or between professionals and family carers. Conclusions Future research should focus on the effectiveness of components of multi-faceted programmes and their cost effectiveness and include qualitative data to better target interventions for behavioural and psychological symptoms. It is important to consider family carer readiness to use non-pharmacological strategies and to develop a shared language about the inherent needs and communications of behavioural and psychological symptoms.
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Affiliation(s)
| | | | | | | | | | | | - Kunle Ashaye
- Hertfordshire Partnership University NHS Foundation Trust, UK
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Wharton W, Epps F, Kovaleva M, Bridwell L, Tate RC, Dorbin CD, Hepburn K. Photojournalism-Based Intervention Reduces Caregiver Burden and Depression in Alzheimer's Disease Family Caregivers. J Holist Nurs 2019; 37:214-224. [PMID: 30284480 PMCID: PMC11246707 DOI: 10.1177/0898010118801636] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2024]
Abstract
Purpose: Art interventions have demonstrated holistic benefits for persons living with dementia and their caregivers. In this article, we describe the results of a pilot photojournalism program for 10 unpaid caregivers of persons living with dementia, with respect to caregivers' experience in the program and their psychological well-being. Design: Caregivers participated in four sessions led by a professional photojournalist who taught principles of photography. Between the sessions, caregivers took photographs that represented what caregiving meant to them using digital cameras provided in the program. During the sessions, instruction was interspersed with discussion of caregivers' photographs. Method: Caregiver burden and depressive symptoms were measured pre- and postprogram. Qualitative exploration included sessions' observations, viewing caregivers' photographs, and recording caregivers' accompanying comments. Findings: For participants with pre- and postprogram data, caregiver burden decreased significantly (p = .037). For caregivers with pre- and postprogram data, depressive symptoms decreased nonsignificantly (p = .066). Clinically meaningful reductions in caregiver burden and depressive symptoms were attained. Qualitative findings highlighted caregivers' strong engagement with the project, the facilitator, and other participants, and reflection on multiple aspects of their experience. Conclusions: This intervention helped caregivers creatively communicate their experience and demonstrated efficacy in the improvement of caregivers' psychological well-being.
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13
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Dröes RM, van Rijn A, Rus E, Dacier S, Meiland F. Utilization, effect, and benefit of the individualized Meeting Centers Support Program for people with dementia and caregivers. Clin Interv Aging 2019; 14:1527-1553. [PMID: 31692559 PMCID: PMC6717152 DOI: 10.2147/cia.s212852] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 07/04/2019] [Indexed: 12/18/2022] Open
Abstract
PURPOSE There are few interventions on an individual basis to support community-dwelling people with dementia to continue to fulfill their potential in society and to support their informal caregivers via e-Health. This study explored the effectiveness of the individualized Meeting Centers Support Program (iMCSP) consisting of DemenTalent (people with dementia work as volunteers in a society based on their talents), Dementelcoach (telephone coaching), and STAR e-Learning for caregivers, compared to regular MCSP and No day care support. METHOD An explorative randomized controlled trial with pre/post measurements (M0-M6) and two groups (iMCSP and regular MCSP). In addition, a comparison was made between iMCSP and a reference No day care control group. Standardized questionnaires were administered on self-esteem, neuropsychiatric symptoms, experienced autonomy and quality of life of the person with dementia, and on caregiver's sense of competence, quality of life, and happiness. RESULTS The iMCSP interventions resulted in a broader group of participants utilizing the Meeting Centers. Compared to regular MCSP, DemenTalent had a moderate positive effect on neuropsychiatric symptoms, which also proved less severe. Positive affect of participants improved within the DemenTalent and regular MCSP group after six months. Caregivers of DemenTalent participants experienced less emotional impact of neuropsychiatric symptoms. No differences were found in experienced burden, sense of competence, or quality of life in caregivers using iMCSP or regular MCSP. Compared to those receiving No day care support, caregivers of DemenTalent participants and caregivers using Dementelcoach or STAR e-Learning proved happier. Post-hoc analyses, accounting for potential between-group differences in outcome measures at baseline, generally showed results in the same direction. People with dementia and caregivers highly appreciated iMCSP and regular MCSP. CONCLUSION iMCSP can be effectively applied as alternative or additional support via regular Meeting Centers for people with dementia and caregivers who prefer individualized activities/support. DemenTalent decreased the severity of neuropsychiatric symptoms of people with dementia and emotional burden of caregivers. All iMCSP interventions tended to result in caregivers being happier compared to those receiving no support. Larger-scale studies are needed to investigate the effect of iMCSP on other domains of quality of life of participants.
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Affiliation(s)
- Rose-Marie Dröes
- Department of Psychiatry, Amsterdam University Medical Centers, Location Vumc, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Research and Innovation, Regional Mental Health Organization Ggzingeest, Amsterdam, The Netherlands
| | - Annelies van Rijn
- Department of Psychiatry, Amsterdam University Medical Centers, Location Vumc, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Eline Rus
- Department of Clinical Pyschology, Faculty of Behavior and Movement Sciences, VU University, Amsterdam, The Netherlands
| | - Seghoslène Dacier
- Department of Neuropsychology, Faculty of Behavior and Movement Sciences, VU University, Amsterdam, The Netherlands
| | - Franka Meiland
- Department of Psychiatry, Amsterdam University Medical Centers, Location Vumc, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Neuropsychology, Faculty of Behavior and Movement Sciences, VU University, Amsterdam, The Netherlands
- Gerion, Department of General Practice and Elderly Care Medicine, Amsterdam University Medical Centers, Location Vumc, Amsterdam, The Netherlands
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Abstract
OBJECTIVES To describe common areas of threats to patient safety and quality of care when caregivers provide care. Recommendations for caregivers to enable them to provide safe care are included. DATA SOURCES Research-based articles and reports. CONCLUSION The literature is limited in discussion on home safety issues for caregivers. Non cancer-specific literature provides some direction for recommendations for nurses to guide caregivers. IMPLICATIONS FOR NURSING PRACTICE The home environment is an unregulated and uncontrolled site, and the safety risks families take are unknown. Professionals should assess the caregiver's knowledge and ability when providing caregiving guidance to ensure the patient is receiving safe and quality care. Nurses need to stress the importance of providing safe quality care and provide education and community resources.
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15
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Coe Á, Martin M, Stapleton T. Effects of An Occupational Therapy Memory Strategy Education Group Intervention on Irish Older Adults' Self-Management of Everyday Memory Difficulties. Occup Ther Health Care 2019; 33:37-63. [PMID: 30620222 DOI: 10.1080/07380577.2018.1543911] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
An occupational therapy memory strategy education group (MSEG) was developed to assist clients with varying levels of memory impairment to adopt strategies to manage memory impairment in their daily lives. Participants were healthy older adults presenting with subjective memory complaints (SMC, n = 14), mild cognitive impairment (MCI, n = 33), or early stages of dementia (n = 13). Clients and their caregivers attended a one-hour session each week for six weeks. Outcome measures were taken at baseline, two weeks post completion of the group, and at a 3-month follow-up for 47 participants. Statistically significant improvements post-program were scored on the Rivermead Behavioural Memory Test (p = 0.001) and a dementia quality of life measure (p = 0.02), with increased use of external memory aids (p < 0.001) and significant improvements in participants' self-ratings of performance (p < 0.001) and satisfaction with their performance (p < 0.001) using the Canadian Occupational Performance Measure. Findings suggest positive outcomes that were maintained at 3-month follow-up and thus, support the role of occupational therapy in delivering occupation-focused memory strategy programs.
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Affiliation(s)
- Áine Coe
- a Department of Occupational Therapy, Naas General Hospital , Naas , Co. Kildare , Ireland
| | - Mary Martin
- b Department of Medicine , Naas General Hospital , Naas , Co. Kildare , Ireland
| | - Tadhg Stapleton
- c Department of Occupational Therapy, School of Medicine , University of Dublin , Trinity College , Dublin , Ireland
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16
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Woodbridge R, Sullivan MP. Use of the physical environment to support everyday activities for people with dementia: A systematic review. DEMENTIA 2018; 17:533-572. [PMID: 27491332 PMCID: PMC6039869 DOI: 10.1177/1471301216648670] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Difficulty with everyday activities is a key symptom and defining feature of dementia, relating to subjective reports of well-being and overall quality of life. One way to support individuals in their daily activities is by modifying the physical environment to make it easier to interact with during activity performance. This systematic review explores the range of studies available using physical environmental strategies to support performance in everyday activities for people with dementia. Seventy-two relevant studies were identified by the search. Physical environmental strategies included changes to the global environment and to architectural features, use of moveable environmental aids and tailored individual approaches. Strategies supported general everyday activity functioning (N = 19), as well as specific activities, particularly mealtimes (N = 15) and orientation in space (N = 16); however, few studies were found that focused on aspects of personal care such as dressing (N = 1) and showering or the preferred hobbies of individuals (N = 0). Overall, there appeared to be a lack of research within private home environments, and of studies which specify the dementia syndrome or the whole neuropsychological profile of people with dementia. More work is needed to extend theoretical understandings of how people with dementia interact with their environments so that these spaces can be designed to further support activities of daily living performance. Future work in this field could also incorporate the perspectives and preferences of those living with dementia.
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17
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Kovaleva MA, Bilsborough E, Griffiths PC, Nocera J, Higgins M, Epps F, Kilgore K, Lindauer A, Morhardt D, Shah RC, Hepburn K. Testing Tele-Savvy: Protocol for a randomized controlled trial. Res Nurs Health 2018; 41:107-120. [PMID: 29399825 DOI: 10.1002/nur.21859] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 12/22/2017] [Indexed: 11/12/2022]
Abstract
Many informal caregivers of persons with dementia suffer adverse health consequences. Although established psychoeducation programs are known to benefit caregivers, attending in-person programs is challenging for them. To address this challenge, the Savvy Caregiver Program, an evidence-based psychoeducation program with demonstrated effectiveness for caregiving and disease-related outcomes, was transformed into an on-line program, Tele-Savvy. This article describes the rationale for and design of a prospective longitudinal randomized controlled trial (targeted N = 215), currently underway. The trial aims to establish Tele-Savvy's efficacy in (i) reducing the negative effects of caregiving on caregivers; (ii) promoting care recipients' quality of life; (iii) improving caregiver mastery; and to explore (iv) Tele-Savvy's efficacy among caregivers of different races/ethnicities. The mediating role of mastery will be assessed. Participants are randomized to the active condition (immediate Tele-Savvy participation), attention control, or usual care. Participants in the two latter conditions will complete Tele-Savvy 6 months post-baseline. Multilevel mixed effects models will be used to examine changes in outcomes and to model group by time (months since baseline) interactions. The exploratory aim will be addressed using analysis of covariance and qualitative analysis. This trial's results may be used by healthcare and community organizations to implement Tele-Savvy in dementia care, increasing caregivers' access to this evidence-based intervention.
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Affiliation(s)
- Mariya A Kovaleva
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | | | - Patricia C Griffiths
- Emory University Alzheimer's Disease Research Center, Atlanta, Georgia.,Atlanta VA Medical Center, Center for Visual and Neurocognitive Rehabilitation, Atlanta, Georgia.,Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Joe Nocera
- Atlanta VA Medical Center, Center for Visual and Neurocognitive Rehabilitation, Atlanta, Georgia.,Department of Neurology, Emory University School of Medicine, Atlanta, Georgia
| | - Melinda Higgins
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Fayron Epps
- Byrdine F. Lewis College of Nursing & Health Professions, Georgia State University, Atlanta, Georgia
| | - Katie Kilgore
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Allison Lindauer
- Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Portland, Oregon
| | - Darby Morhardt
- Cognitive Neurology and Alzheimer's Disease Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Raj C Shah
- Department of Family Medicine and Rush Alzheimer' Disease Center, Rush Medical College and Rush Graduate College, Rush University Medical Center, Chicago, Illinois
| | - Kenneth Hepburn
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia.,Emory University Alzheimer's Disease Research Center, Atlanta, Georgia
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18
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Giebel CM, Sutcliffe C. Initiating activities of daily living contributes to well-being in people with dementia and their carers. Int J Geriatr Psychiatry 2018; 33:e94-e102. [PMID: 28467006 DOI: 10.1002/gps.4728] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 03/30/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Problems with everyday functioning are linked to reduced well-being in people with dementia (PwD) and their carers. However, previous research has almost solely investigated the performance of everyday activities, and global functioning without analysing individual activities. This study explored how deficits in initiating and performing individual activities were associated with carer burden and poorer quality of life of carers and PwD. METHODS Carers of people with mild dementia were recruited via 10 National Health Service Trusts, as well as through attending six carer support groups. Carers were asked to complete the revised Interview for Deteriorations in Daily Living Activities in Dementia 2 (R-IDDD2), and measures on carer burden, well-being, and person with dementia well-being. Data were analysed using correlation analysis. RESULTS Two hundred and seventy-two carers completed the R-IDDD2. Carers were grouped into those with low or high ratings of well-being based on the mean scores. All but three activities on the initiative and/or performance scale were significantly associated with carer burden and carer and PwD quality of life. Engaging in hobbies and maintaining an active social life were most strongly associated with carer and PwD well-being. Initiating computer use, driving, and medication management were not related to carer burden. CONCLUSIONS Findings from this study can have direct implications for improving care management early in the disease. Post-diagnostic support needs to provide more opportunities for PwD, and their carers, to engage in social groups, whilst interventions targeted at living well with dementia need to particularly improve the initiative of engaging in individual hobbies. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Clarissa M Giebel
- School of Health Sciences, University of East Anglia, Norwich, UK.,Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Caroline Sutcliffe
- Personal Social Services Research Unit, The University of Manchester, Manchester, UK
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19
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Clarkson P, Hughes J, Roe B, Giebel CM, Jolley D, Poland F, Abendstern M, Chester H, Challis D. Systematic review: Effective home support in dementia care, components and impacts - Stage 2, effectiveness of home support interventions. J Adv Nurs 2017; 74:507-527. [DOI: 10.1111/jan.13460] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2017] [Indexed: 01/20/2023]
Affiliation(s)
- Paul Clarkson
- Personal Social Services Research Unit; Division of Population Health; Health Services Research and Primary Care; School of Health Sciences; Faculty of Biology, Medicine and Health; University of Manchester; Manchester Academic Health Science Centre; Manchester UK
| | - Jane Hughes
- Personal Social Services Research Unit; Division of Population Health; Health Services Research and Primary Care; School of Health Sciences; Faculty of Biology, Medicine and Health; University of Manchester; Manchester Academic Health Science Centre; Manchester UK
| | - Brenda Roe
- Faculty of Health & Social Care; Evidence-based Practice Research Centre; Edge Hill University; Ormskirk UK
| | - Clarissa M. Giebel
- Personal Social Services Research Unit; Division of Population Health; Health Services Research and Primary Care; School of Health Sciences; Faculty of Biology, Medicine and Health; University of Manchester; Manchester Academic Health Science Centre; Manchester UK
| | - David Jolley
- Personal Social Services Research Unit; Division of Population Health; Health Services Research and Primary Care; School of Health Sciences; Faculty of Biology, Medicine and Health; University of Manchester; Manchester Academic Health Science Centre; Manchester UK
| | - Fiona Poland
- School of Health Sciences; University of East Anglia; Norwich UK
| | - Michele Abendstern
- Personal Social Services Research Unit; Division of Population Health; Health Services Research and Primary Care; School of Health Sciences; Faculty of Biology, Medicine and Health; University of Manchester; Manchester Academic Health Science Centre; Manchester UK
| | - Helen Chester
- Personal Social Services Research Unit; Division of Population Health; Health Services Research and Primary Care; School of Health Sciences; Faculty of Biology, Medicine and Health; University of Manchester; Manchester Academic Health Science Centre; Manchester UK
| | - David Challis
- Personal Social Services Research Unit; Division of Population Health; Health Services Research and Primary Care; School of Health Sciences; Faculty of Biology, Medicine and Health; University of Manchester; Manchester Academic Health Science Centre; Manchester UK
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20
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Cornelis E, Gorus E, Beyer I, Van Puyvelde K, Lieten S, Versijpt J, Vande Walle N, Aerts G, De Roover K, De Vriendt P. A retrospective study of a multicomponent rehabilitation programme for community-dwelling persons with dementia and their caregivers. Br J Occup Ther 2017. [DOI: 10.1177/0308022617728680] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Introduction This study determined whether the multicomponent rehabilitation programme of a memory clinic had positive outcomes on ameliorating everyday functioning, quality of life, mood and behavioural disturbances of persons with dementia and reducing distress and burden of caregivers. Method A retrospective pre-test–post-test study without control group was conducted on the first cohort of persons with dementia ( n = 30) and their caregivers ( n = 30), who participated in a programme lasting for a maximum of 1 year with 25 1-hour counselling sessions. The assessment contained an evaluation of everyday functioning in basic, instrumental and advanced activities of daily living, cognition, mood, emotional and behavioural disturbances, quality of life and caregiver burden. Results Eight participants dropped out prematurely. For persons with dementia ( n = 22), participating in the programme did not improve everyday functioning and cognition but ameliorated quality of life significantly ( Z = –2.7, p = 0.006, 95% CI (.003–.005)) and stabilized mood, emotional and behavioural disturbances for 60% or more of them. For caregivers ( n = 22), the mild to moderate burden of care remained stable or got better for 63.6% of the caregivers. Conclusion This programme appears to be promising and valuable, and might reduce institutionalization rates. Future explorations are recommended to research how participants evolve and to investigate which participants responded in a positive way.
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Affiliation(s)
- Elise Cornelis
- Occupational Therapist and Gerontologist, Department of Geriatrics, Universitair Ziekenhuis Brussel, Belgium; Frailty in Ageing Research Group (FRIA), Vrije Universiteit Brussel, Belgium; Department of Occupational Therapy, Artevelde University College Ghent, Belgium
| | - Ellen Gorus
- Clinical Psychologist and Gerontologist, Department of Geriatrics, Universitair Ziekenhuis Brussel, Belgium; Frailty in Ageing Research Group (FRIA), Vrije Universiteit Brussel, Belgium; Department of Gerontology (GERO), Vrije Universiteit Brussel, Belgium
| | - Ingo Beyer
- Geriatrician, Department of Geriatrics, Universitair Ziekenhuis Brussel, Belgium; Frailty in Ageing Research Group (FRIA), Vrije Universiteit Brussel, Belgium; Department of Gerontology (GERO), Vrije Universiteit Brussel, Belgium
| | - Katrien Van Puyvelde
- Geriatrician, Frailty in Ageing Research Group (FRIA), Vrije Universiteit Brussel, Belgium
| | - Siddhartha Lieten
- Geriatrician, Department of Geriatrics, Universitair Ziekenhuis Brussel, Belgium; Frailty in Ageing Research Group (FRIA), Vrije Universiteit Brussel, Belgium
| | - Jan Versijpt
- Neurologist, Department of Neurology, Universitair Ziekenhuis Brussel, Belgium
| | - Nathalie Vande Walle
- Geriatrician (MD): Department of Geriatrics, Universitair Ziekenhuis Brussel, Belgium; Frailty in Ageing Research Group (FRIA), Vrije Universiteit Brussel, Belgium
| | - Greet Aerts
- Gerontologist, Frailty in Ageing Research Group (FRIA), Vrije Universiteit Brussel, Belgium
| | - Karen De Roover
- Occupational Therapist, Department of Geriatrics, Universitair Ziekenhuis Brussel, Belgium
| | - Patricia De Vriendt
- Occupational Therapist and Gerontologist, Frailty in Ageing Research Group (FRIA), Vrije Universiteit Brussel, Belgium; Department of Gerontology (GERO), Vrije Universiteit Brussel, Belgium; Department of Occupational Therapy, Artevelde University College Ghent, Belgium
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21
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Giebel CM, Burns A, Challis D. Taking a positive spin: preserved initiative and performance of everyday activities across mild Alzheimer's, vascular and mixed dementia. Int J Geriatr Psychiatry 2017; 32:959-967. [PMID: 27445133 DOI: 10.1002/gps.4553] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 05/03/2016] [Accepted: 06/16/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVES The literature commonly evaluates those daily activities which are impaired in dementia. However, in the mild stages, people with dementia (PwD) are still able to initiate and perform many of those tasks. With a lack of research exploring variations between different dementia diagnoses, this study sought to investigate those daily activities with modest impairments in the mild stages and how these compare between Alzheimer's disease (AD), vascular dementia (VaD) and mixed dementia. METHODS Staff from memory assessment services from nine National Health Service trusts across England identified and approached informal carers of people with mild dementia. Carers completed the newly revised Interview for Deteriorations in Daily Living Activities in Dementia 2 assessing the PwD's initiative and performance of instrumental activities of daily living (IADLs). Data were analysed using analysis of variance and Chi-square tests to compare the maintenance of IADL functioning across AD, VaD, and mixed dementia. RESULTS A total of 160 carers returned the Interview for Deteriorations in Daily Living Activities in Dementia 2, of which 109, 21, and 30 cared for someone with AD, VaD, and mixed dementia, respectively. There were significant variations across subtypes, with AD showing better preserved initiative and performance than VaD for several IADLs. Overall, PwD showed greater preservation of performance than initiative, with tasks such as preparing a hot drink and dressing being best maintained. CONCLUSION Findings can help classify dementia better into subtypes in order to receive bespoke support. It suggests that interventions should primarily address initiative to improve overall functioning. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Clarissa M Giebel
- School of Psychological Sciences, University of Manchester, Manchester, UK.,Personal Social Services Research Unit, University of Manchester, Manchester, UK
| | - Alistair Burns
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - David Challis
- Personal Social Services Research Unit, University of Manchester, Manchester, UK
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22
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Vandepitte S, Van Den Noortgate N, Putman K, Verhaeghe S, Faes K, Annemans L. Effectiveness of Supporting Informal Caregivers of People with Dementia: A Systematic Review of Randomized and Non-Randomized Controlled Trials. J Alzheimers Dis 2017; 52:929-65. [PMID: 27079704 DOI: 10.3233/jad-151011] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Dementia is known as a major public health problem affecting both patients and caregivers, and placing a high financial strain upon society. In community-dwelling patients, it is important to support informal caregivers in order to help them sustain their demanding role. Previous reviews about effectiveness of such supporting strategies often included a small number of studies, focused only on particular supportive types, particular outcomes, or solely on caregivers. OBJECTIVE A general systematic review was conducted investigating effectiveness of different supportive strategies on at least the well-being of the caregiver or the care-recipient. METHODS A systematic literature search was conducted in Web of Science and PubMed. An adapted version of the Downs and Black (1998) checklist was used to assess methodological quality. A new classification was developed to group different types of caregiver support. RESULTS Fifty-three papers met the inclusion criteria. Although 87% of the interventions were to some extent effective, methods and findings were rather inconsistent. Psychoeducational interventions generally lead to positive outcomes for caregivers, and delay permanent institutionalization of care-recipients. Cognitive behavioral therapy decreases dysfunctional thoughts among caregivers. Occupational therapy decreases behavioral problems among patients and improves self-efficacy of caregivers. In general, those interventions tailored on individual level generate better outcomes. Comparative research on respite care was very rare. CONCLUSIONS Despite methodological inconsistency, supporting caregivers appears to be an effective strategy often improving well-being of caregiver or care-recipient and resulting in additional benefits for society. However, there is a need for more research on the (cost)-effectiveness of respite care.
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Affiliation(s)
- Sophie Vandepitte
- Faculty of Medicine and Health Sciences, Department of Public Health, Ghent University, Belgium
| | - Nele Van Den Noortgate
- Faculty of Medicine and Health Sciences, Department of Internal Medicine, Ghent University, Brussels, Belgium
| | - Koen Putman
- Faculty of Medicine and Pharmacy, Department of Medical Sociology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Sofie Verhaeghe
- Faculty of Medicine and Health Sciences, Department of Public Health, Ghent University, Belgium
| | - Kristof Faes
- Faculty of Medicine and Health Sciences, Department of Public Health, Ghent University, Belgium
| | - Lieven Annemans
- Faculty of Medicine and Health Sciences, Department of Public Health, Ghent University, Belgium
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23
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Kovaleva M, Blevins L, Griffiths PC, Hepburn K. An Online Program for Caregivers of Persons Living With Dementia: Lessons Learned. J Appl Gerontol 2017; 38:159-182. [PMID: 28460557 DOI: 10.1177/0733464817705958] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The population of individuals living with dementia and their caregivers and the need to provide caregiver training will increase in the next several decades. In-person caregiver educational programs are delimited by logistical and resource boundaries that could be overcome with online programs. The purpose of this qualitative descriptive study was to explore the acceptability and ways to improve the content and delivery of an online 7-week psychoeducational pilot program-Tele-Savvy. Thirty-six caregivers who completed the pilot were interviewed about their experience with Tele-Savvy and their suggestions for its improvement. Conventional content analysis allowed for the identification of three themes: barriers and facilitators to establishing rapport with participants and instructors, content enrichment and diversification, and structural refinement. These lessons learned directly from the caregivers provide evidence to guide the refinement of analogous online interventions and highlight the need for their wider availability.
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Affiliation(s)
- Mariya Kovaleva
- 1 Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Lindsey Blevins
- 2 Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Patricia C Griffiths
- 3 Atlanta VA Medical Center, Decatur, GA, USA.,4 Emory University School of Medicine, Atlanta, GA, USA.,5 Emory University Alzheimer's Disease Research Center, Atlanta, GA, USA
| | - Kenneth Hepburn
- 1 Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA.,5 Emory University Alzheimer's Disease Research Center, Atlanta, GA, USA
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24
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Ojagbemi A, Owolabi M. Do occupational therapy interventions improve quality of life in persons with dementia? A meta-analysis with implications for future directions. Psychogeriatrics 2017; 17:133-141. [PMID: 27338678 DOI: 10.1111/psyg.12201] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 02/07/2016] [Accepted: 02/09/2016] [Indexed: 11/27/2022]
Abstract
Occupational therapy (OT) interventions have shown positive effects on physical functioning in persons with dementia (PwD). However, their effect on quality of life (QoL) has been inconsistent in individual clinical trials. The present review appraises current evidence for the use of OT interventions in improving QoL of PwD. Records in the Cochrane Database, MEDLINE, EMBASE, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature were searched for relevant citations, and PubMed was searched for in-process articles. Additional searches of the reference lists of retrieved articles were undertaken. Ten studies involving 1002 PwD met the criteria for syntheses. OT intervention produced small non-significant improvements in overall QoL. The evidence from the present review does not support the specific use of OT interventions for the improvement of QoL in PwD under pragmatic clinical conditions at this time. They may be best used as part of a comprehensive range of interventions for PwD. Recommendations are made for future design of OT interventions focusing on the improvement of QoL, which is central to the well-being of PwD.
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Affiliation(s)
- Akin Ojagbemi
- World Health Organization Collaborating Centre for Research and Training in Mental Health, and Substance Abuse and Neuroscience, Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Mayowa Owolabi
- Division of Neurology, Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Giebel CM, Sutcliffe C, Challis D. Hierarchical Decline of the Initiative and Performance of Complex Activities of Daily Living in Dementia. J Geriatr Psychiatry Neurol 2017; 30:96-103. [PMID: 28073326 DOI: 10.1177/0891988716686835] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES While basic activities of daily living hierarchically decline in dementia, little is known about the decline of individual instrumental activities of daily living (IADLs). The objective of this study was to assess initiative and performance deficits in IADLs in dementia. METHODS A total of 581 carers completed the revised Interview for Deterioration in Daily Living Activities in Dementia 2 to rate their relative's everyday functioning. RESULTS Initiating and performing IADLs deteriorated hierarchically, while people with dementia were consistently most impaired in initiating using the computer and managing finances. Initiating preparing a cold or hot meal and managing finances were more impaired than their performance, whereas performing maintaining an active social life for example were more impaired than their initiative. CONCLUSION Findings can help identify the severity of dementia by understanding deficits in initiative and performance. This study has implications for the development of targeted interventions depending on the stage of dementia.
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Affiliation(s)
- Clarissa M Giebel
- 1 School of Health Sciences, University of East Anglia, Norwich, United Kingdom.,2 Division of Neuroscience and Experimental Psychology, The University of Manchester, Manchester, United Kingdom
| | - Caroline Sutcliffe
- 3 Personal Social Services Research Unit, The University of Manchester, Manchester, United Kingdom
| | - David Challis
- 3 Personal Social Services Research Unit, The University of Manchester, Manchester, United Kingdom
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Dröes RM, Chattat R, Diaz A, Gove D, Graff M, Murphy K, Verbeek H, Vernooij-Dassen M, Clare L, Johannessen A, Roes M, Verhey F, Charras K. Social health and dementia: a European consensus on the operationalization of the concept and directions for research and practice. Aging Ment Health 2017; 21:4-17. [PMID: 27869503 DOI: 10.1080/13607863.2016.1254596] [Citation(s) in RCA: 119] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Because the pattern of illnesses changes in an aging population and many people manage to live well with chronic diseases, a group of health care professionals recently proposed reformulating the static WHO definition of health towards a dynamic one based on the ability to physically, mentally and socially adapt and self-manage. This paper is the result of a collaborative action of the INTERDEM Social Health Taskforce to operationalize this new health concept for people with dementia, more specifically the social domain, and to formulate directions for research and practice to promote social health in dementia. METHOD Based on the expertise of the Social Health Taskforce members (N = 54) three groups were formed that worked on operationalizing the three social health dimensions described by Huber et al.: (1) capacity to fulfil potential and obligations; (2) ability to manage life with some degree of independence; (3) participation in social activities. For each dimension also influencing factors, effective interventions and knowledge gaps were inventoried. After a consensus meeting, the operationalizations of the dimensions were reviewed by the European Working Group of People with Dementia (EWGPWD). RESULTS The social health dimensions could be well operationalized for people with dementia and are assessed as very relevant according to the Social Health Taskforce and EWGPWD. Personal (e.g. sense of coherence, competencies), disease-related (e.g. severity of cognitive impairments, comorbidity), social (support from network, stigma) and environmental factors (e.g. enabling design, accessibility) that can influence the person with dementia's social health and many interventions promoting social health were identified. CONCLUSION A consensus-based operationalization of social health in dementia is proposed, and factors that can influence, and interventions that improve, social health in dementia identified. Recommendations are made for research and practice.
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Affiliation(s)
- R M Dröes
- a Department of Psychiatry, Alzheimer Centre , EMGO Institute for Health and Care Research, VU University Medical Centre , Amsterdam , The Netherlands
| | - R Chattat
- b Department of Psychology , University of Bologna , Bologna , Italy
| | - A Diaz
- c Alzheimer Europe , Luxembourg , Luxembourg
| | - D Gove
- c Alzheimer Europe , Luxembourg , Luxembourg
| | - M Graff
- d Radboud University Medical Centre, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Radboud Alzheimer Centre , Nijmegen , The Netherlands
| | - K Murphy
- e School of Nursing and Midwifery, Aras Loyola, National University of Irelands , Galway , Ireland
| | - H Verbeek
- f Research School CAPHRI, Department of Health Services Research , Maastricht University , Maastricht , The Netherlands
| | - M Vernooij-Dassen
- d Radboud University Medical Centre, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Radboud Alzheimer Centre , Nijmegen , The Netherlands
| | - L Clare
- g Centre for Research in Ageing and Cognitive Health (REACH) , School of Psychology, University of Exeter, and PenCLAHRC, University of Exeter Medical School , Exeter , United Kingdom
| | - A Johannessen
- h Norwegian National Advisory Unit on Ageing and Health , VID Specialized University , Oslo , Norway
| | - M Roes
- i German Center for Neurodegenerative Diseases, Department of Nursing Science, Faculty of Health , University of Witten/Herdecke , Witten , Germany
| | - F Verhey
- j Department of Psychiatry and Neuropsychology , Maastricht University , Maastricht , The Netherlands
| | - K Charras
- k Fondation Médéric Alzheimer , Psychosocial Interventions Department , Paris , France
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Zauszniewski JA, Lekhak N, Burant CJ, Underwood PW, Morris DL. Resourcefulness Training for Dementia Caregivers: Establishing Fidelity. West J Nurs Res 2016; 38:1554-1573. [PMID: 27338751 PMCID: PMC5086268 DOI: 10.1177/0193945916655798] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Providing care for an elder with dementia can produce extreme stress that adversely affects caregiver health. Learning to be resourceful, which involves practicing resourcefulness skills using a journal or voice recorder, may reduce caregiver stress. However, before testing the effectiveness of journaling and voice recording as resourcefulness training (RT) practice methods, intervention fidelity should first be established. This pilot trial with 63 women dementia caregivers examined the fidelity of journaling and voice recording and whether allowing a choice between the methods affected RT intervention fidelity. Following RT, Resourcefulness Scale scores were similar for journal and recorder methods but higher for caregivers in the choice versus random condition. Patterns of RT skill use documented in journals or recordings were similar for choice and random conditions and for journal and recorder methods. The results support the implementation fidelity of RT that allows caregivers to choose a method to reinforce their resourcefulness skills.
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Laver K, Cumming R, Dyer S, Agar M, Anstey KJ, Beattie E, Brodaty H, Broe T, Clemson L, Crotty M, Dietz M, Draper B, Flicker L, Friel M, Heuzenroeder L, Koch S, Kurrle S, Nay R, Pond D, Thompson J, Santalucia Y, Whitehead C, Yates M. Evidence-based occupational therapy for people with dementia and their families: What clinical practice guidelines tell us and implications for practice. Aust Occup Ther J 2016; 64:3-10. [PMID: 27699792 DOI: 10.1111/1440-1630.12309] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND/AIM The first evidence-based Clinical Practice Guidelines and Principles of Care for People with Dementia in Australia have been released. The Guidelines detail a number of important evidence-based recommendations for occupational therapists. The aim of this paper is (1) to provide an overview of Guideline development, and (2) to describe the evidence supporting a recommendation for occupational therapy. Common characteristics of effective occupational therapy programmes for people with dementia are described. METHODS Guideline development involved adaptation of existing high-quality guidelines developed overseas and 17 systematic reviews to ensure that the most recent high-quality evidence was included. One of the systematic reviews involved examining the evidence for interventions to promote independence in people with dementia. Specifically, we looked at the evidence for occupational therapy and its effect on activities of daily living, quality of life and carer impact. RESULTS A total of 109 recommendations are included in the Guidelines. Occupational therapy was found to significantly increase independence in activities of daily living and improve quality of life. Effective occupational therapy programmes involve: environmental assessment, problem solving strategies, carer education and interactive carer skills training. CONCLUSION Occupational therapists working with people with dementia in community settings should ensure that their time is spent on those aspects of intervention that are shown to be effective.
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Affiliation(s)
- Kate Laver
- Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia
| | - Robert Cumming
- Guideline Adaptation Committee, Clinical Practice Guidelines for Dementia in Australia, Adelaide, South Australia, Australia
| | - Suzanne Dyer
- Guideline Adaptation Committee, Clinical Practice Guidelines for Dementia in Australia, Adelaide, South Australia, Australia
| | - Meera Agar
- Guideline Adaptation Committee, Clinical Practice Guidelines for Dementia in Australia, Adelaide, South Australia, Australia
| | - Kaarin J Anstey
- Guideline Adaptation Committee, Clinical Practice Guidelines for Dementia in Australia, Adelaide, South Australia, Australia
| | - Elizabeth Beattie
- Guideline Adaptation Committee, Clinical Practice Guidelines for Dementia in Australia, Adelaide, South Australia, Australia
| | - Henry Brodaty
- Guideline Adaptation Committee, Clinical Practice Guidelines for Dementia in Australia, Adelaide, South Australia, Australia
| | - Tony Broe
- Guideline Adaptation Committee, Clinical Practice Guidelines for Dementia in Australia, Adelaide, South Australia, Australia
| | - Lindy Clemson
- Guideline Adaptation Committee, Clinical Practice Guidelines for Dementia in Australia, Adelaide, South Australia, Australia
| | - Maria Crotty
- Guideline Adaptation Committee, Clinical Practice Guidelines for Dementia in Australia, Adelaide, South Australia, Australia
| | - Margaret Dietz
- Guideline Adaptation Committee, Clinical Practice Guidelines for Dementia in Australia, Adelaide, South Australia, Australia
| | - Brian Draper
- Guideline Adaptation Committee, Clinical Practice Guidelines for Dementia in Australia, Adelaide, South Australia, Australia
| | - Leon Flicker
- Guideline Adaptation Committee, Clinical Practice Guidelines for Dementia in Australia, Adelaide, South Australia, Australia
| | - Meg Friel
- Guideline Adaptation Committee, Clinical Practice Guidelines for Dementia in Australia, Adelaide, South Australia, Australia
| | - Louise Heuzenroeder
- Guideline Adaptation Committee, Clinical Practice Guidelines for Dementia in Australia, Adelaide, South Australia, Australia
| | - Susan Koch
- Guideline Adaptation Committee, Clinical Practice Guidelines for Dementia in Australia, Adelaide, South Australia, Australia
| | - Sue Kurrle
- Guideline Adaptation Committee, Clinical Practice Guidelines for Dementia in Australia, Adelaide, South Australia, Australia
| | - Rhonda Nay
- Guideline Adaptation Committee, Clinical Practice Guidelines for Dementia in Australia, Adelaide, South Australia, Australia
| | - Dimity Pond
- Guideline Adaptation Committee, Clinical Practice Guidelines for Dementia in Australia, Adelaide, South Australia, Australia
| | - Jane Thompson
- Guideline Adaptation Committee, Clinical Practice Guidelines for Dementia in Australia, Adelaide, South Australia, Australia
| | - Yvonne Santalucia
- Guideline Adaptation Committee, Clinical Practice Guidelines for Dementia in Australia, Adelaide, South Australia, Australia
| | - Craig Whitehead
- Guideline Adaptation Committee, Clinical Practice Guidelines for Dementia in Australia, Adelaide, South Australia, Australia
| | - Mark Yates
- Guideline Adaptation Committee, Clinical Practice Guidelines for Dementia in Australia, Adelaide, South Australia, Australia
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Laver K, Milte R, Dyer S, Crotty M. A Systematic Review and Meta-Analysis Comparing Carer Focused and Dyadic Multicomponent Interventions for Carers of People With Dementia. J Aging Health 2016; 29:1308-1349. [PMID: 27458254 PMCID: PMC5680909 DOI: 10.1177/0898264316660414] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Objective: The aim of this study was to compare the efficacy of two approaches: multicomponent interventions that focus on working with the carer and dyadic interventions that work with both the carer and the person with dementia. Method: A systematic review involving a search of Medline, EMBASE, and PsycINFO in October 2015 was performed. Randomized controlled trials involving carers of people with dementia and comparing multicomponent interventions with usual care were included. Results: Pooling of all studies demonstrated that multicomponent interventions can reduce depressive symptoms, improve quality of life, reduce carer impact, and reduce behavioral and psychological symptoms of dementia as well as caregiver upset with these symptoms. We were unable to find a significant difference in the effects of dyadic interventions in comparison with carer focused interventions for these outcomes. Discussion: Although effect sizes associated with intervention are small, multicomponent interventions are relatively inexpensive to deliver, acceptable, and widely applicable.
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Affiliation(s)
- Kate Laver
- 1 Flinders University, Adelaide, South Australia, Australia.,2 NHMRC Cognitive Decline Partnership Centre, Australia
| | - Rachel Milte
- 1 Flinders University, Adelaide, South Australia, Australia.,2 NHMRC Cognitive Decline Partnership Centre, Australia
| | - Suzanne Dyer
- 1 Flinders University, Adelaide, South Australia, Australia.,2 NHMRC Cognitive Decline Partnership Centre, Australia
| | - Maria Crotty
- 1 Flinders University, Adelaide, South Australia, Australia.,2 NHMRC Cognitive Decline Partnership Centre, Australia
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Hazzan AA, Shannon H, Ploeg J, Raina P, Gitlin LN, Oremus M. The association between caregiver well-being and care provided to persons with Alzheimer's disease and related disorders. BMC Res Notes 2016; 9:344. [PMID: 27430976 PMCID: PMC4950605 DOI: 10.1186/s13104-016-2150-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 07/06/2016] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Alzheimer's disease and related disorders (ADRD) are some of the leading causes of morbidity in developed nations. Unpaid family caregivers are primarily responsible for providing the care and support needed by persons with ADRD. In the process of caring for their loved ones with ADRD, caregivers often have to deal with multiple challenges, including their own deteriorating well-being and overall quality-of-life (QoL). A recent systematic review showed that very little research has been undertaken to study the relationship between AD caregiver QoL and the level or quality of care that caregivers provide to their loved ones. In this study, we investigate the relationships between caregiver well-being and the care provided to persons with ADRD. METHODS We used 12-month follow-up data from the Philadelphia site (n = 125) of the National Institutes of Health (NIH) multi-site study, Resources for Enhancing Alzheimer's Caregiver Health (REACH I) to examine the relationship between caregiver well-being and the level or quality of care provided while adjusting for important covariates (e.g., age, income, and years since caregiving). Caregivers who participated in REACH I had to be at least 21 years of age and they had to be providing at least 4 h of care per day for 6 months or more to a live-in loved one with ADRD. Linear regression analysis was used to examine the relationships between well-being and the level or quality of care provided to persons with ADRD. RESULTS Of the 255 caregivers who participated in the REACH I study, 125 (49.0 %) remained after 12 months of follow-up. Comparisons of participants at the 12-month follow-up and participants who were lost to follow-up showed that these two sets of participants were not statistically significantly different on any of the variables examined in this study. Linear regression analysis showed that there was no statistically significant association between caregiver well-being and level or quality of care provided. CONCLUSIONS Further research is required to investigate the factors associated with level and quality of care provided to persons with ADRD, and whether caregiver well-being (or QoL in general) is a contributor.
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Affiliation(s)
- Afeez Abiola Hazzan
- />Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
- />Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
| | - Harry Shannon
- />Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
| | - Jenny Ploeg
- />School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
| | - Parminder Raina
- />Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
| | - Laura N. Gitlin
- />Department of Community-Public Health, Center for Innovative Care in Aging, Johns Hopkins School of Nursing, Baltimore, MD 21205 USA
| | - Mark Oremus
- />Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
- />School of Public Health and Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1 Canada
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Bunn F, Goodman C, Pinkney E, Drennan VM. Specialist nursing and community support for the carers of people with dementia living at home: an evidence synthesis. HEALTH & SOCIAL CARE IN THE COMMUNITY 2016; 24:48-67. [PMID: 25684210 DOI: 10.1111/hsc.12189] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/07/2014] [Indexed: 06/04/2023]
Abstract
Specialist nurses are one way of providing support for family carers of people with dementia, but relatively little is known about what these roles achieve, or if they are more effective than roles that do not require a clinical qualification. The aim of this review was to synthesise the literature on the scope and effectiveness of specialist nurses, known as Admiral Nurses, and set this evidence in the context of other community-based initiatives to support family carers of people with dementia. We undertook a systematic review of the literature relating to the scope and effectiveness of Admiral Nurses and a review of reviews of interventions to support the family carers of people with dementia. To identify studies, we searched electronic databases, undertook lateral searches and contacted experts. Searches were undertaken in November 2012. Results are reported narratively with key themes relating to Admiral Nurses identified using thematic synthesis. We included 33 items relating to Admiral Nurses (10 classified as research) and 11 reviews evaluating community-based support for carers of people with dementia. There has been little work to evaluate specific interventions provided by Admiral Nurses, but three overarching thematic categories were identified: (i) relational support, (ii) co-ordinating and personalising support and (iii) challenges and threats to the provision of services by Admiral Nurses. There was an absence of clearly articulated goals and service delivery was subject to needs of the host organisation and the local area. The reviews of community-based support for carers of people with dementia included 155 studies but, in general, evidence that interventions reduced caregiver depression or burden was weak, although psychosocial and educational interventions may reduce depression in carers. Community support for carers of people with dementia, such as that provided by Admiral Nurses, is valued by family carers, but the impact of such initiatives is not clearly established.
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Affiliation(s)
- Frances Bunn
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Claire Goodman
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Emma Pinkney
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Vari M Drennan
- Centre for Health and Social Care Research, Kingston University and St Georges University, London, UK
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Abdelmoneium AO, Alharahsheh ST. Family Home Caregivers for Old Persons in the Arab Region: Perceived Challenges and Policy Implications. ACTA ACUST UNITED AC 2016. [DOI: 10.4236/jss.2016.41019] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Struckmeyer LR, Pickens ND. Home Modifications for People With Alzheimer’s Disease: A Scoping Review. Am J Occup Ther 2015; 70:7001270020p1-9. [DOI: 10.5014/ajot.2015.016089] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
OBJECTIVE. The purpose of this review was twofold: (1) to gain insight into what is known from the literature about home modifications for people with Alzheimer’s disease (AD) and (2) to identify gaps in the literature that could lead to opportunities for research.
METHOD. A systematic scoping review of peer-reviewed articles published from 1994 through 2014 explored home modifications and AD.
RESULTS. Seventeen articles met the inclusion criteria. The three major findings pertain to (1) the caregiver role and caregiver training, (2) a client-centered collaborative approach to assessment and intervention, and (3) modifications for safety and function. Home modifications involved the physical and social environments as well as cognitive strategies at the task level.
CONCLUSION. Opportunities exist for the development of assessment procedures, the exploration of home modifications in the later stages of AD, and the study of home modification needs of people with dementia who live alone.
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Affiliation(s)
- Linda R. Struckmeyer
- Linda R. Struckmeyer, MA, OTR/L, ATP, is Clinical Lecturer, Department of Occupational Therapy, University of Florida, and Doctoral Student, Texas Woman’s University, Dallas;
| | - Noralyn Davel Pickens
- Noralyn Davel Pickens, PhD, OT, is Associate Professor and Associate Director, School of Occupational Therapy, Texas Woman’s University, Dallas
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Occupational therapy for elderly. Evidence mapping of randomised controlled trials from 2004-2012. Z Gerontol Geriatr 2015; 48:52-72. [PMID: 24127052 DOI: 10.1007/s00391-013-0540-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Previous systematic reviews on occupational therapy for elderly included studies until 2003. The present evidence mapping summarizes recent evidence for the efficacy of occupational therapy with older persons based on randomised controlled trials from 2004-2012. METHOD An electronic search in Cochrane and Medline databases identified publications of randomised controlled trials on occupational therapy interventions for persons≥65 years old. Two raters independently extracted data and analysed the quality of samples, interventions and outcome evalutations according to PRISMA criteria. RESULTS In all, 136 abstracts were identified and 48 studies analysed, from these 12 on stroke, 15 on falls and mobility, 7 on dementia, 4 on prevention and 10 on other conditions. Reports of adverse events and evaluations of costs and long-term outcomes are frequently lacking. CONCLUSION The most promising fields for further research are primary and secondary prevention in persons with stroke, falls or mobility problems and tertiary prevention in persons with dementia. Future trials should be conducted and reported according to consented reporting guidelines of the equator network.
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Reilly S, Miranda‐Castillo C, Malouf R, Hoe J, Toot S, Challis D, Orrell M. Case management approaches to home support for people with dementia. Cochrane Database Syst Rev 2015; 1:CD008345. [PMID: 25560977 PMCID: PMC6823260 DOI: 10.1002/14651858.cd008345.pub2] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Over 35 million people are estimated to be living with dementia in the world and the societal costs are very high. Case management is a widely used and strongly promoted complex intervention for organising and co-ordinating care at the level of the individual, with the aim of providing long-term care for people with dementia in the community as an alternative to early admission to a care home or hospital. OBJECTIVES To evaluate the effectiveness of case management approaches to home support for people with dementia, from the perspective of the different people involved (patients, carers, and staff) compared with other forms of treatment, including 'treatment as usual', standard community treatment and other non-case management interventions. SEARCH METHODS We searched the following databases up to 31 December 2013: ALOIS, the Specialised Register of the Cochrane Dementia and Cognitive Improvement Group,The Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL, LILACS, Web of Science (including Science Citation Index Expanded (SCI-EXPANDED) and Social Science Citation Index), Campbell Collaboration/SORO database and the Specialised Register of the Cochrane Effective Practice and Organisation of Care Group. We updated this search in March 2014 but results have not yet been incorporated. SELECTION CRITERIA We include randomised controlled trials (RCTs) of case management interventions for people with dementia living in the community and their carers. We screened interventions to ensure that they focused on planning and co-ordination of care. DATA COLLECTION AND ANALYSIS We used standard methodological procedures as required by The Cochrane Collaboration. Two review authors independently extracted data and made 'Risk of bias' assessments using Cochrane criteria. For continuous outcomes, we used the mean difference (MD) or standardised mean difference (SMD) between groups along with its confidence interval (95% CI). We applied a fixed- or random-effects model as appropriate. For binary or dichotomous data, we generated the corresponding odds ratio (OR) with 95% CI. We assessed heterogeneity by the I² statistic. MAIN RESULTS We include 13 RCTs involving 9615 participants with dementia in the review. Case management interventions in studies varied. We found low to moderate overall risk of bias; 69% of studies were at high risk for performance bias.The case management group were significantly less likely to be institutionalised (admissions to residential or nursing homes) at six months (OR 0.82, 95% CI 0.69 to 0.98, n = 5741, 6 RCTs, I² = 0%, P = 0.02) and at 18 months (OR 0.25, 95% CI 0.10 to 0.61, n = 363, 4 RCTs, I² = 0%, P = 0.003). However, the effects at 10 - 12 months (OR 0.95, 95% CI 0.83 to 1.08, n = 5990, 9 RCTs, I² = 48%, P = 0.39) and 24 months (OR 1.03, 95% CI 0.52 to 2.03, n = 201, 2 RCTs, I² = 0%, P = 0.94) were uncertain. There was evidence from one trial of a reduction in the number of days per month in a residential home or hospital unit in the case management group at six months (MD -5.80, 95% CI -7.93 to -3.67, n = 88, 1 RCT, P < 0.0001) and at 12 months (MD -7.70, 95% CI -9.38 to -6.02, n = 88, 1 RCT, P < 0.0001). One trial reported the length of time until participants were institutionalised at 12 months and the effects were uncertain (hazard ratio (HR): 0.66, 95% CI 0.38 to 1.14, P = 0.14). There was no difference in the number of people admitted to hospital at six (4 RCTs, 439 participants), 12 (5 RCTs, 585 participants) and 18 months (5 RCTs, 613 participants). For mortality at 4 - 6, 12, 18 - 24 and 36 months, and for participants' or carers' quality of life at 4, 6, 12 and 18 months, there were no significant effects. There was some evidence of benefits in carer burden at six months (SMD -0.07, 95% CI -0.12 to -0.01, n = 4601, 4 RCTs, I² = 26%, P = 0.03) but the effects at 12 or 18 months were uncertain. Additionally, some evidence indicated case management was more effective at reducing behaviour disturbance at 18 months (SMD -0.35, 95% CI -0.63 to -0.07, n = 206, 2 RCTs I² = 0%, P = 0.01) but effects were uncertain at four (2 RCTs), six (4 RCTs) or 12 months (5 RCTs).The case management group showed a small significant improvement in carer depression at 18 months (SMD -0.08, 95% CI -0.16 to -0.01, n = 2888, 3 RCTs, I² = 0%, P = 0.03). Conversely, the case management group showed greater improvement in carer well-being in a single study at six months (MD -2.20 CI CI -4.14 to -0.26, n = 65, 1 RCT, P = 0.03) but the effects were uncertain at 12 or 18 months. There was some evidence that case management reduced the total cost of services at 12 months (SMD -0.07, 95% CI -0.12 to -0.02, n = 5276, 2 RCTs, P = 0.01) and incurred lower dollar expenditure for the total three years (MD= -705.00, 95% CI -1170.31 to -239.69, n = 5170, 1 RCT, P = 0.003). Data on a number of outcomes consistently indicated that the intervention group received significantly more community services. AUTHORS' CONCLUSIONS There is some evidence that case management is beneficial at improving some outcomes at certain time points, both in the person with dementia and in their carer. However, there was considerable heterogeneity between the interventions, outcomes measured and time points across the 13 included RCTs. There was some evidence from good-quality studies to suggest that admissions to care homes and overall healthcare costs are reduced in the medium term; however, the results at longer points of follow-up were uncertain. There was not enough evidence to clearly assess whether case management could delay institutionalisation in care homes. There were uncertain results in patient depression, functional abilities and cognition. Further work should be undertaken to investigate what components of case management are associated with improvement in outcomes. Increased consistency in measures of outcome would support future meta-analysis.
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Affiliation(s)
- Siobhan Reilly
- Faculty of Health and Medicine, Lancaster UniversityDivision of Health ResearchC07 Furness BuildingLancasterUKLA1 4YG
| | - Claudia Miranda‐Castillo
- Universidad de ValparaísoEscuela de Psicología, Facultad de MedicinaAv Brasil 2140ValparaísoChile
| | - Reem Malouf
- University of OxfordNational Perinatal Epidemiology Unit (NPEU)Old Road CampusOxfordUKOX3 7LF
| | - Juanita Hoe
- University College LondonMental Health Sciences UnitCharles Bell House67‐73 Riding House StreetLondonUKW1W 7EJ
| | - Sandeep Toot
- North East London NHS Foundation Trust, Goodmayes HospitalResearch and Development DepartmentBarley Lane, GoodmayesEssexLondonUKIG3 8XJ
| | - David Challis
- University of ManchesterPersonal Social Services Research UnitDover Street BuildingOxford RoadManchesterUKM13 9PL
| | - Martin Orrell
- University College LondonMental Health Sciences UnitCharles Bell House67‐73 Riding House StreetLondonUKW1W 7EJ
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Tang Yan HS, Clemson LM, Jarvis F, Laver K. Goal setting with caregivers of adults in the community: a mixed methods systematic review. Disabil Rehabil 2014; 36:1943-63. [PMID: 24856636 DOI: 10.3109/09638288.2014.884173] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To examine how goal setting is used with caregivers of community residing adults and the effect of goal setting practices in improving the outcomes. METHODS A mixed methods systematic review was conducted. The methodological rigour of included studies was critiqued using Cochrane Collaboration's risk of bias assessment tool, Downs and Black checklist and a framework for evaluating qualitative research. Narrative synthesis was created through tabulation and categorisation, visual mapping of the goal setting process, thematic analysis on common goal setting features and critical reflection on the accuracy and robustness of the synthesis. RESULTS Seventeen studies were included: 10 randomised trials, 5 other quantitative studies and two descriptive studies which incorporated qualitative methods. The trials demonstrated a relatively low risk of bias in contrast to the other studies that had varied methodological rigour. No studies isolated the effect of the goal setting process on outcomes and therefore the effectiveness of goal setting could not be evaluated. However, through a narrative synthesis six prominent features of collaborative goal setting were identified. CONCLUSIONS Despite the fact that goal setting is an important component of client-centred care, and the prominence of client-centred care in healthcare discourse, the review uncovered a surprisingly limited number of studies. Goal setting is an elusive process that is of therapeutic value and warrants further investigation. Implications for Rehabilitation The current body of empirical evidence suggests that there are six prominent features of collaborative goal setting with caregivers. The goals that are most important to caregivers are often different to those that are important to clinicians; it is important that caregivers and clinicians agree on goals to maximise adherence to treatment and goal attainment. The quality of evidence for goal setting with caregivers is limited although some intervention trials illustrate the usefulness of collaborative goal setting in contributing to improved outcomes.
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Affiliation(s)
- Heidi Shaunna Tang Yan
- Discipline of Occupational Therapy, Faculty of Health Sciences, The University of Sydney , Lidcombe, NSW , Australia and
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Chan TM, Chen JYR, Ho LI, Lin HP, Hsueh KW, Liu DD, Chen YH, Hsieh AC, Tsai NM, Hueng DY, Tsai ST, Chou PW, Lin SZ, Harn HJ. ADSC Therapy in Neurodegenerative Disorders. Cell Transplant 2014; 23:549-57. [PMID: 24816450 DOI: 10.3727/096368914x678445] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Neurodegenerative disorders, chronic diseases that can severely affect the patient's daily life, include amyotrophic lateral sclerosis, Parkinson's, Alzheimer's, and Huntington's diseases. However, these diseases all have the common characteristic that they are due to degenerative irreversibility, and thus no efficient drugs or therapy methods can mitigate symptoms completely. Stem cell therapy, such as adipose tissue-derived stem cells (ADSCs), is a promising treatment for incurable disorders. In this review, we summarized the previous studies using ADSCs to treat neurodegenerative disorders, as well as their therapeutic mechanisms. We also suggested possible expectations for future human clinical trials involving minimized intracerebroventricular combined with intravenous administration, using different cell lineages to finish complementary therapy as well as change the extracellular matrix to create a homing niche. Depending on successful experiments in relevant neurodegenerative disorders models, this could form the theoretical basis for future human clinical trials.
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Affiliation(s)
- Tzu-Min Chan
- Center for Neuropsychiatry, China Medical University Hospital, Taichung, Taiwan
- Everfront Biotech Inc., New Taipei City, Taiwan
| | | | - Li-Ing Ho
- Department of Respiratory Therapy, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hui-Ping Lin
- Institute of Cellular and System Medicine, National Health Research Institutes, Miaoli, Taiwan
| | - Kuo-Wei Hsueh
- Ph.D. Program for Aging, China Medical University, Taichung, Taiwan
| | - Demeral David Liu
- Department of Dentistry, China Medical University Beigang Hospital, Taiwan
- Department of Dentistry, School of Medicine, China Medical University and Hospital, Taiwan
| | - Yi-Hung Chen
- Graduate Institute of Acupuncture Science, China Medical University, Taichung, Taiwan
| | - An-Cheng Hsieh
- Center for Neuropsychiatry, China Medical University Hospital, Taichung, Taiwan
| | - Nu-Man Tsai
- School of Medical Laboratory and Biotechnology, Chung Shan Medical University, Taichung, Taiwan
- Department of Pathology and Laboratory, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Dueng-Yuan Hueng
- Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, Taiwan
| | - Sheng-Tzeng Tsai
- Department of Neurosurgery, Tzu Chi General Hospital/Tzu Chi University, Hualien, Taiwan
| | - Pei-Wen Chou
- Everfront Biotech Inc., New Taipei City, Taiwan
- Guang Li Biomedicine, Inc., New Taipei City, Taiwan
| | - Shinn-Zong Lin
- Center for Neuropsychiatry, China Medical University Hospital, Taichung, Taiwan
- Everfront Biotech Inc., New Taipei City, Taiwan
- Department of Dentistry, School of Medicine, China Medical University and Hospital, Taiwan
- Department of Neurosurgery, Tainan Municipal An-Nan Hospital, China Medical University, Tainan, Taiwan
- Graduate Institute of Immunology, China Medical University, Taichung, Taiwan
| | - Horng-Jyh Harn
- Department of Medicine, China Medical University, Taichung, Taiwan
- Department of Pathology, China Medical University Hospital, Taichung, Taiwan
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Fraker J, Kales HC, Blazek M, Kavanagh J, Gitlin LN. The role of the occupational therapist in the management of neuropsychiatric symptoms of dementia in clinical settings. Occup Ther Health Care 2014; 28:4-20. [PMID: 24354328 PMCID: PMC4209177 DOI: 10.3109/07380577.2013.867468] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Neuropsychiatric symptoms (NPS) of dementia include aggression, agitation, depression, anxiety, delusions, hallucinations, apathy, and disinhibition. NPS affect dementia patients nearly universally across dementia stages and etiologies. They are associated with poor patient and caregiver outcomes, including increased health care utilization, excess morbidity and mortality, and earlier nursing home placement, as well as caregiver stress, depression and reduced employment. There are no FDA-approved medications for NPS, but it is a common clinical practice to use psychotropic medications such as antipsychotics, to control symptoms; however, antipsychotics show only modest efficacy in improving NPS and have significant risks for patients, including side effects and mortality. Nonpharmacologic treatments are considered first-line by multiple medical bodies and expert consensus, as they show evidence for efficacy and have limited potential for adverse effects. Ideally, nonpharmacological management of NPS in clinical settings occurs in multidisciplinary teams, where occupational therapists play an important collaborative role in the care of the person with dementia. Our group has articulated an evidence-informed structured approach to the management of NPS that can be integrated into diverse practice settings and used by providers of various disciplines. The "DICE" (Describe, Investigate, Create, and Evaluate) approach is inherently patient- and caregiver-centered, as patient and caregiver concerns are integral to each step of the process. DICE offers a clinical reasoning approach through which providers can more efficiently and effectively choose optimal treatment plans. The purpose of this paper is to describe the role of the occupational therapy in using the DICE approach for NPS management.
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Affiliation(s)
- Joyce Fraker
- 1Physical Medicine and Rehabilitation Services, VA Ann Arbor Healthcare System , Ann Arbor, Michigan , USA
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Cohen-Mansfield J. Nonpharmacologic Treatment of Behavioral Disorders in Dementia. Curr Treat Options Neurol 2013; 15:765-85. [DOI: 10.1007/s11940-013-0257-2] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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McGrath M, O'Callaghan C. Occupational therapy and dementia care: a survey of practice in the Republic of Ireland. Aust Occup Ther J 2013; 61:92-101. [PMID: 24689920 DOI: 10.1111/1440-1630.12081] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND/AIM There is a growing body of research to support the role of occupational therapy in dementia care. However, little is known about the extent to which this research is translated into occupational therapy practice. This study addresses this gap by considering current occupational therapy practice in the field of dementia care in Ireland. METHODS A cross-sectional online survey was used to gather data about current practice. Convenience sampling and snowball recruitment techniques were used to recruit occupational therapists. Data were analysed using a combination of descriptive statistics and content analysis. RESULTS Forty-seven therapists responded to the survey. The majority of respondents worked in primary care and provided services for people with early stage or mild dementia. Assessment practices were primarily focussed on cognitive screening and functional performance. Limited attention was paid to occupational participation. Interventions typically addressed environmental modification, assistive devices and compensatory strategies. The ability of therapists to apply research evidence to practice appears to be strongly constrained by practice and organisational demands. CONCLUSION There is a need for a global occupational therapy strategy to support knowledge translation in dementia care. At present although occupational therapists are aware of research evidence they face significant barriers in applying this evidence in practice.
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Affiliation(s)
- Margaret McGrath
- School of Health Sciences, College of Medicine, Nursing and Health Sciences, National University of Ireland, Galway, Ireland
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McLaren AN, Lamantia MA, Callahan CM. Systematic review of non-pharmacologic interventions to delay functional decline in community-dwelling patients with dementia. Aging Ment Health 2013; 17:655-66. [PMID: 23611141 PMCID: PMC3723698 DOI: 10.1080/13607863.2013.781121] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Older adults with dementia experience progressive functional decline, which contributes to caregiver burden and nursing home placement. The goal of this systematic review was to determine if any non-pharmacologic interventions have delayed functional decline among community-dwelling dementia patients. METHOD We completed a systematic literature review to identify controlled clinical trials reporting the impact of non-pharmacologic interventions on any measure of functional impairment or disability among community-dwelling dementia patients. We included studies that reported any proxy-respondent, self-reported, or performance-based standardized assessments. RESULTS We identified 18 published clinical trials that met inclusion criteria and found that study interventions fell into three different groups: occupational therapy, exercise, and multi-faceted ("other") interventions. The three groups of studies tended to vary systematically regarding the conceptual framework for the disabling process, target of intervention, and type of outcome measure. Approximately half the studies were conducted in the United States with mean sample size of 99 (from 27 to 1131) and follow-up periods between three months and two years. Instruments used to measure functional impairment or disability varied widely with 55 instruments across 18 studies. Nine studies reported a statistically significant improvement in functional decline in the intervention group. CONCLUSION The current literature provides clinical trial evidence that non-pharmacologic interventions can delay progression of functional impairment or disability among community-dwelling dementia patients. The clinical significance of this early evidence is uncertain. These early studies provide rationale for larger and longer-term studies to determine if these interventions are sufficiently potent to delay institutionalization.
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Affiliation(s)
- Anne N McLaren
- Indiana University School of Medicine, Indianapolis, IN, USA.
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Kortte KB, Rogalski EJ. Behavioural interventions for enhancing life participation in behavioural variant frontotemporal dementia and primary progressive aphasia. Int Rev Psychiatry 2013; 25:237-45. [PMID: 23611353 PMCID: PMC3659798 DOI: 10.3109/09540261.2012.751017] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Primary progressive aphasia (PPA) and behavioural-variant frontotemporal dementia (bvFTD) are clinical syndromes under the umbrella term 'frontotemporal dementia' (FTD) and are caused by a neurodegenerative disease with an onset most typically in the productive years of adulthood. The cognitive and behavioural impairments associated with FTD interfere with successful engagement in typical life roles, such as parenting, working, and maintenance of interpersonal relationships. There are currently no treatments to stop or slow the degenerative process and there are only very limited medication options for the management of the cognitive-behavioural symptoms. However, alternative, non-pharmacological interventions may offer significant benefit to the quality of life of the diagnosed individual. The goal of this paper is to provide an overview of the approaches available through neurorehabilitation and community-based services that facilitate successful engagement in life activities and promote optimal quality of life for the individuals and families living with FTD. It is hoped that as medical providers become more familiar with behavioural interventions, referrals for services will increase thereby allowing individuals with FTD and their caregivers to learn ways to adapt, adjust, and participate in life to the fullest despite the impairments from this progressive disease.
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Affiliation(s)
- Kathleen B. Kortte
- Department of Physical Medicine and Rehabilitation The Johns Hopkins University School of Medicine
| | - Emily J. Rogalski
- Cognitive Neurology and Alzheimer's Disease Center, Northwestern University Feinberg School of Medicine
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Abstract
BACKGROUND Hip fracture is a serious injury for older adults, usually requiring surgical repair and extensive therapy. Informal caregivers can help older adults make a successful recovery by encouraging them to adhere to the therapy plans and improve their health behaviors. Few resources, however, are available for these caregivers to learn about how to assist their care receivers and cope with their unique caregiving situations. OBJECTIVE The study aims were to develop a comprehensive theory-based online hip fracture resource center (OHRC) for caregivers, Caring for Caregivers, and conducted a feasibility trial. METHODS The OHRC included self-learning modules, discussion boards, Ask the Experts, and a virtual library. The feasibility of the intervention was assessed by usage and usability. The feasibility of the future trial was tested using a one-group pre-post design on 36 caregiver-care receiver dyads recruited from six hospitals. The caregivers used the OHRC for 8 weeks. The impact of the intervention was assessed on both caregivers (primary) and care receivers (secondary). The data were analyzed by descriptive statistics, paired t tests, and content analyses. RESULTS On average, caregivers reviewed five modules and used the discussion board 3.1 times. The mean perceived usability score for the OHRC was 74.04 ± 7.26 (range, 12-84). Exposure to the OHRC significantly improved caregivers' knowledge about the care of hip fracture patients (t = 3.17, p = .004) and eHealth literacy (t = 2.43, p = .002). Changes in other caregiver outcomes (e.g., strain, coping, and social support) and care receiver outcomes (e.g., self-efficacy for exercise and osteoporosis medication adherence) were favorable but not significant. DISCUSSION The findings suggest that the OHRC was user-friendly and could be beneficial for caregivers. Additional larger-scale trials are needed to assess the effectiveness of the intervention on outcomes.
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Parker D, Mills S, Abbey J. Effectiveness of interventions that assist caregivers to support people with dementia living in the community: a systematic review. INT J EVID-BASED HEA 2012; 6:137-72. [PMID: 21631819 DOI: 10.1111/j.1744-1609.2008.00090.x] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Objectives The objective of this review was to assess the effectiveness of interventions that assist caregivers to provide support for people living with dementia in the community. Inclusion criteria Types of participants Adult caregivers who provide support for people with dementia living in the community (non-institutional care). Types of interventions Interventions designed to support caregivers in their role such as skills training, education to assist in caring for a person living with dementia and support groups/programs. Interventions of formal approaches to care designed to support caregivers in their role, care planning, case management and specially designated members of the healthcare team - for example dementia nurse specialist or volunteers trained in caring for someone with dementia. Types of studies This review considered any meta-analyses, systematic reviews, randomised control trials, quasi-experimental studies, cohort studies, case control studies and observational studies without control groups that addressed the effectiveness of interventions that assist caregivers to provide support for people living with dementia in the community. Search strategy The search sought to identify published studies from 2000 to 2005 through the use of electronic databases. Only studies in English were considered for inclusion. The initial search was conducted of the databases, CINAHL, MEDLINE and PsychINFO using search strategies adapted from the Cochrane Dementia and Cognitive Improvement Group. A second more extensive search was then conducted using the appropriate Medical Subject Headings (MeSH) and keywords for other available databases. Finally, hand searching of reference lists of articles retrieved and of core dementia, geriatric and psycho geriatric journals was undertaken. Assessment of quality Methodological quality of each of the articles was assessed by two independent reviewers using appraisal checklist developed by the Joanna Briggs Institute and based on the work of the Cochrane Collaboration and Centre for Reviews and Dissemination. Data collection and analysis Standardised mean differences or weighted mean differences and their 95% confidence intervals were calculated for each included study reported in the meta-analysis. Results from comparable groups of studies were pooled in statistical meta-analysis using Review Manager Software from the Cochrane Collaboration. Heterogeneity between combined studies was tested using standard chi-square test. Where statistical pooling was not appropriate or possible, the findings are summarised in narrative form. Results A comprehensive search of relevant databases, hand searching and cross referencing found 685 articles that were assessed for relevance to the review. Eighty-five papers appeared to meet the inclusion criteria based on title and abstract, and the full paper was retrieved. Of the 85 full papers reviewed, 40 were accepted for inclusion, three were systematic reviews, three were meta-analysis, and the remaining 34 were randomised controlled trials. For the randomised controlled trials that were able to be included in a meta-analysis, standardised mean differences or weighted mean differences and their 95% confidence intervals were calculated for each. Results from comparable groups of studies were pooled in statistical meta-analysis using Review Manager Software and heterogeneity between combined studies was assessed by using the chi-square test. Where statistical pooling was not appropriate or possible, the findings are summarised in narrative form. The results are discussed in two main sections. Firstly it was possible to assess the effectiveness of different types of caregiver interventions on the outcome categories of depression, health, subjective well-being, self-efficacy and burden. Secondly, results are reported by main outcome category. For each of these sections, meta-analysis was conducted where it was possible; otherwise, a narrative summary describes the findings. Effectiveness of intervention type Four categories of intervention were included in the review - psycho-educational, support, multi-component and other. Psycho-educational Thirteen studies used psycho-educational interventions, and all but one showed positive results across a range of outcomes. Eight studies were entered in a meta-analysis. No significant impact of psycho-educational interventions was found for the outcome categories of subjective well-being, self-efficacy or health. However, small but significant results were found for the categories of depression and burden. Support Seven studies discussed support only interventions and two of these showed significant results. These two studies were suitable for meta-analysis and demonstrated a small but significant improvement on caregiver burden. Multi-component Twelve of the studies report multi-component interventions and 10 of these report significant outcomes across a broad range of outcome measures including self-efficacy, depression, subjective well-being and burden. Unfortunately because of the heterogeneity of study designs and outcome measures, no meta-analysis was possible. Other interventions Other interventions included the use of exercise or nutrition which resulted in improvements in psychological distress and health benefits. Case management and a computer aided support intervention provided mixed results. One cognitive behavioural therapy study reported a reduction in anxiety and positive impacts on patient behaviour. Effectiveness of interventions using specific outcome categories In addition to analysis by type of intervention it was possible to analyse results based on some outcome categories that were used across the studies. In particular the impact of interventions on caregiver depression was available for meta-analysis from eight studies. This indicated that multi-component and psycho-educational interventions showed a small but significant positive effect on caregiver depression. Five studies using the outcome category of caregiver burden were entered into a meta-analysis and findings indicated that there were no significant effects of any of interventions. No meta-analysis was possible for the outcome categories of health, self-efficacy or subjective well-being. Implications for practice From this review there is evidence to support the use of well-designed psycho-educational or multi-component interventions for caregivers of people with dementia who live in the community. Factors that appear to positively contribute to effective interventions are those which: • Provide opportunities within the intervention for the person with dementia as well as the caregiver to be involved • Encourage active participation in educational interventions for caregivers • Offer individualised programs rather than group sessions • Provide information on an ongoing basis, with specific information about services and coaching regarding their new role • Target the care recipient particularly by reduction in behaviours Factors which do not appear to have benefit in interventions are those which: • Simply refer caregivers to support groups • Only provide self help materials • Only offer peer support.
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Affiliation(s)
- Deborah Parker
- University of Queensland/Blue Care Research and Practice Development Centre, (Formally of the Dementia Collaborative Research Centre), Queensland University of Technology, Kelvin Grove, Brisbane, Queensland, Australia
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Van't Leven N, Graff MJL, Kaijen M, de Swart BJM, Olde Rikkert MGM, Vernooij-Dassen MJM. Barriers to and facilitators for the use of an evidence-based occupational therapy guideline for older people with dementia and their carers. Int J Geriatr Psychiatry 2012; 27:742-8. [PMID: 21953765 DOI: 10.1002/gps.2782] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Revised: 07/10/2011] [Accepted: 07/11/2011] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Implementing evidence-based guidelines is not a simple task. This study aimed to define barriers to and facilitators for implementing the proven and effective Community Occupational Therapy in Dementia (COTiD) guideline for older people with dementia and their carers. METHODS The qualitative method we used was the grounded theory. We collected data from focus group interviews with 17 occupational therapists (OTs) and telephone interviews with 10 physicians and 4 managers. We analysed the data with the constant comparative method by identifying codes, categories, and main themes. RESULTS The main themes in barriers that OTs encountered were that they did not feel competent in treating older people with dementia at home according to the guideline; they had difficulties prioritising in this complex treatment, both for the client and themselves; and they were unsure about the minimal criteria for guideline adherence. The intensity of this programme was the main barrier. The barriers that confronted physicians and managers were lack of knowledge about occupational therapy and its reimbursement and lack of available trained OTs. For the OTs, the guideline's content and focus, evidence, and external support facilitated the use of the guideline. For physicians and managers, the guideline's evidence base and its benefits for clients and carers were the main facilitators. CONCLUSIONS This study generates knowledge for applying innovations in health care settings. Improvement of the OTs' knowledge and self-confidence is needed for using the guideline. We expect that more competent OTs will motivate their physicians and managers to use this successful COTiD intervention.
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Affiliation(s)
- Netta Van't Leven
- Radboud University Nijmegen Medical Centre, Department IQ Healthcare, Nijmegen Centre for Evidence-Based Practice, Nijmegen, the Netherlands.
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Hall L, Skelton DA. Occupational Therapy for Caregivers of People with Dementia: A Review of the United Kingdom Literature. Br J Occup Ther 2012. [DOI: 10.4276/030802212x13383757345184] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Introduction: Caring for a family member with dementia is associated with a wide range of challenges. The national strategy for caregivers highlights the growing need for health professionals to provide support to caregivers of people with dementia. This review aimed to identify the evidence and current role of occupational therapists in supporting caregivers of people with dementia in the community. Method: All relevant research databases were systematically searched to identify relevant United Kingdom articles. The inclusion criteria included: dated 1999–2010, English language, community based and considered impact of intervention on carer. Findings: Seventeen studies met the inclusion criteria. The identified interventions were delivered by a range of different professionals with a variety of outcome measures. Overall, the methodological quality of the included studies was poor, with only a small number providing evidence of improvement in outcomes as a result of interventions, such as reminiscence and cognitive behavioural therapy. Conclusion: A requirement for more robust research into the impact of interventions on caregivers of people with dementia was identified. There is a dearth of research into the current role of occupational therapists working with these caregivers and a lack of research to support the expansion of this role.
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Affiliation(s)
- Laura Hall
- Occupational Therapist, Derby Hospitals NHS Foundation Trust, Royal Derby Hospital, Uttoxeter New Road, Derby
| | - Dawn A Skelton
- Professor of Ageing and Health, Institute of Applied Health Research, Glasgow Caledonian University, Glasgow
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Schwarzbach C, Förstl H, Nocon M, Mittendorf T. Why is it so difficult to evaluate nursing interventions in dementia? Dement Geriatr Cogn Dis Extra 2012; 2:146-59. [PMID: 22590475 PMCID: PMC3347873 DOI: 10.1159/000335777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Two recent health technology assessment (HTA) reports published in Germany focused on non-pharmacological interventions for patients with dementia. One of the major results was the poor methodological quality of the studies in this field. This paper concisely presents the main quantitative and qualitative findings of the HTA report published by the German Agency for HTA at the Institute of Medical Information and Documentation (dahta@DIMDI), followed by a detailed discussion of the major methodological problems observed for the inclusion criteria, interventions, the setting, number of patients included, duration of observation, comparators, clinical endpoints, health economics, and, most obvious, the impossibility of blinding and eliminating placebo effects for future clinical studies. We conclude with several suggestions addressing these challenges for future research in this field.
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Cognitive and physical rehabilitation of intensive care unit survivors: results of the RETURN randomized controlled pilot investigation. Crit Care Med 2012; 40:1088-97. [PMID: 22080631 DOI: 10.1097/ccm.0b013e3182373115] [Citation(s) in RCA: 193] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Millions of patients who survive medical and surgical general intensive care unit care every year experience newly acquired long-term cognitive impairment and profound physical and functional disabilities. To overcome the current reality in which patients receive inadequate rehabilitation, we devised a multifaceted, in-home, telerehabilitation program implemented using social workers and psychology technicians with the goal of improving cognitive and functional outcomes. METHODS This was a single-site, feasibility, pilot, randomized trial of 21 general medical/surgical intensive care unit survivors (8 controls and 13 intervention patients) with either cognitive or functional impairment at hospital discharge. After discharge, study controls received usual care (sporadic rehabilitation), whereas intervention patients received a combination of in-home cognitive, physical, and functional rehabilitation over a 3-month period via a social worker or master's level psychology technician utilizing telemedicine to allow specialized multidisciplinary treatment. Interventions over 12 wks included six in-person visits for cognitive rehabilitation and six televisits for physical/functional rehabilitation. Outcomes were measured at the completion of the rehabilitation program (i.e., at 3 months), with cognitive functioning as the primary outcome. Analyses were conducted using linear regression to examine differences in 3-month outcomes between treatment groups while adjusting for baseline scores. RESULTS Patients tolerated the program with only one adverse event reported. At baseline both groups were well-matched. At 3-month follow-up, intervention group patients demonstrated significantly improved cognitive executive functioning on the widely used and well-normed Tower test (for planning and strategic thinking) vs. controls (median [interquartile range], 13.0 [11.5-14.0] vs. 7.5 [4.0-8.5]; adjusted p < .01). Intervention group patients also reported better performance (i.e., lower score) on one of the most frequently used measures of functional status (Functional Activities Questionnaire at 3 months vs. controls, 1.0 [0.0 -3.0] vs. 8.0 [6.0-11.8], adjusted p = .04). CONCLUSIONS A multicomponent rehabilitation program for intensive care unit survivors combining cognitive, physical, and functional training appears feasible and possibly effective in improving cognitive performance and functional outcomes in just 3 months. Future investigations with a larger sample size should be conducted to build on this pilot feasibility program and to confirm these results, as well as to elucidate the elements of rehabilitation contributing most to improved outcomes.
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Craig DG. Current Occupational Therapy Publications in Home Health: A Scoping Review. Am J Occup Ther 2012; 66:338-47. [DOI: 10.5014/ajot.2012.003566] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
PURPOSE. Recently, home health services have been a topic of increasing interest. Occupational therapy practice and utilization patterns in home care have not been the subject of recent research.
METHOD. I examined 65 publications addressing current occupational therapy practice in U.S. home health. Articles were analyzed to uncover factors influencing occupational therapy utilization and practice.
RESULTS. Results indicate that research has looked at a variety of typologies and efficacy measures for occupational therapy in home care. However, occupational therapy utilization and practice patterns in home health do not appear to be entirely consistent with research. I identify factors explaining this inconsistency and make research and practice recommendations.
CONCLUSION. Results suggest that system challenges limit the utilization and practice of occupational therapy to deliver expected outcomes in home health practice.
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Affiliation(s)
- Daniel G. Craig
- Daniel G. Craig, MA, OTR/L, MT-BC, is University Fellow, Doctor of Occupational Therapy Program, University of Illinois at Chicago, 6033 North Sheridan Road, 22E, Chicago, IL 60660;
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Ishii S, Streim JE, Saliba D. A Conceptual Framework for Rejection of Care Behaviors: Review of Literature and Analysis of Role of Dementia Severity. J Am Med Dir Assoc 2012; 13:11-23.e1-2. [DOI: 10.1016/j.jamda.2010.11.004] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Revised: 10/31/2010] [Accepted: 11/05/2010] [Indexed: 10/18/2022]
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