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Low LF, Gresham M, Phillipson L. Further development needed: models of post-diagnostic support for people with dementia. Curr Opin Psychiatry 2023; 36:104-111. [PMID: 36705009 DOI: 10.1097/yco.0000000000000848] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE OF REVIEW There is increasing recognition of a service gap immediately after diagnosis for people with dementia and carers. This narrative review of models of post-diagnostic support focuses on recent developments and offers suggestions for future development. We present the current evidence for these models and consider the service components they provide against the recommendations of clinical guidelines and principles underpinning ideal post-diagnostic support. RECENT FINDINGS Models of post-diagnostic support include a short-term support worker, ongoing support worker, centre-based support, primary care management, and specialist dementia clinics. Of these, specialist dementia clinics that include ongoing support workers provide most components of an ideal and timely post-diagnostic support framework, but may be more costly to implement universally. The greatest research evidence is for the benefits of long-term support models, specifically case management, though this does not necessarily include medical care or nonpharmacological interventions. There is sparce evidence for the benefits of short-term support worker models such as dementia advisers for people with dementia and carers. SUMMARY Further development is needed to create whole-system models of dementia support which meet the needs of people with dementia and their carers, are timely, accessible and equitable, and can be implemented universally.
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Affiliation(s)
- Lee-Fay Low
- Faculty of Medicine and Health, University of Sydney
| | - Meredith Gresham
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, UNSW Sydney, Sydney
| | - Lyn Phillipson
- School of Health and Society, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia
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Ardelean A, Redolat R. Supporting Behavioral and Psychological Challenges in Alzheimer Using Technology: A Systematic Review. ACTIVITIES, ADAPTATION & AGING 2023. [DOI: 10.1080/01924788.2023.2172900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Affiliation(s)
- A. Ardelean
- Department of Psychobiology, Faculty of Psychology and Logopedy, Universitat de València, Valencia, Spain
| | - R. Redolat
- Department of Psychobiology, Faculty of Psychology and Logopedy, Universitat de València, Valencia, Spain
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Ishii S, Tanabe K, Ishimaru B, Kitahara K. Impact of COVID-19 on Long-Term Care Service Utilization of Older Home-Dwelling Adults in Japan. J Am Med Dir Assoc 2023; 24:156-163.e23. [PMID: 36592936 PMCID: PMC9742200 DOI: 10.1016/j.jamda.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 11/03/2022] [Accepted: 12/04/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The COVID-19 outbreak severely affected long-term care (LTC) service provision. This study aimed to quantitatively evaluate its impact on the utilization of LTC services by older home-dwelling adults and identify its associated factors. DESIGN A retrospective repeated cross-sectional study. SETTING AND PARTICIPANTS Data from a nationwide LTC Insurance Comprehensive Database comprising monthly claims from January 2019 to September 2020. METHODS Interrupted time series analyses and segmented negative binomial regression were employed to examine changes in use for each of the 15 LTC services. Results of the analyses were synthesized using random effects meta-analysis in 3 service types (home visit, commuting, and short-stay services). RESULTS LTC service use declined in April 2020 when the state of emergency (SOE) was declared, followed by a gradual recovery in June after the SOE was lifted. There was a significant association between decline in LTC service use and SOE, whereas the association between LTC service use and the status of the infection spread was limited. Service type was associated with changes in service utilization, with a more precipitous decline in commuting and short-stay services than in home visiting services during the SOE. Service use by those with dementia was higher than that by those without dementia, particularly in commuting and short-stay services, partially canceling out the decline in service use that occurred during the SOE. CONCLUSIONS AND IMPLICATIONS There was a significant decline in LTC service utilization during the SOE. The decline varied depending on service types and the dementia severity of service users. These findings would help LTC professionals identify vulnerable groups and guide future plans geared toward effective infection prevention while alleviating unfavorable impacts by infection prevention measures. Future studies are required to examine the effects of the LTC service decline on older adults.
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Affiliation(s)
- Shinya Ishii
- Division of the Health for the Elderly, Health and Welfare Bureau for the Elderly, Ministry of Health, Labour and Welfare, Tokyo, Japan.
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Miyawaki CE, Tahija N, McClellan A, Chen NW. Feasibility Study of Caregiver-Provided Life Review: Implementation, Adaptation, and Effects on Care Recipients' Depressive Symptoms. Clin Gerontol 2022:1-12. [PMID: 36369922 DOI: 10.1080/07317115.2022.2144578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This study aimed to examine the feasibility of unpaid, family/friend caregivers conducting life reviews with people with dementia in long-term care and community settings and reported on how we adapted the intervention modality under the COVID-19 pandemic. METHODS Twenty-one caregiver-care recipient dyads completed 6 weekly life review sessions. The intervention format was modified to accommodate COVID-19 restrictions. Primary and secondary outcome measures were analyzed based on repeated measures at baseline and post-intervention. RESULTS Due to the changing nature of the pandemic, we iterated the caregiver training intervention four times to accommodate caregivers' needs while having faced multiple recruitment challenges with care facility residents. Care recipients' depression appeared to have improved (p = .001). CONCLUSIONS Although the COVID-19 pandemic created unique recruitment challenges, all the care recipients seemed to enjoy the life review activities supported by the positive outcomes in gaining socialization opportunities. It may be beneficial to offer a more self-paced intervention modality to ease the burden on caregivers. CLINICAL IMPLICATIONS It appears that unpaid family/friend caregivers can provide life reviews to their loved ones with dementia. Training the caregivers on how to provide life reviews can be an easy, low-risk activity that might ameliorate depressive symptoms in the care recipients.
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Affiliation(s)
| | - Nina Tahija
- Graduate College of Social Work, University of Houston, Houston, Texas, USA
| | - Angela McClellan
- The Diana R. Garland School of Social Work, Baylor University, Waco, Texas, USA
| | - Nai-Wei Chen
- Beaumont Health System, Beaumont Research Institute, Royal Oak, Michigan, USA
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Brungardt A, Cassidy J, LaRoche A, Dulaney S, Sawyer RJ, Possin KL, Lum HD. End-of-Life Experiences Within a Dementia Support Program During COVID-19: Context and Circumstances Surrounding Death During the Pandemic. Am J Hosp Palliat Care 2022:10499091221116140. [PMID: 35848399 PMCID: PMC9294611 DOI: 10.1177/10499091221116140] [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] [Indexed: 11/15/2022] Open
Abstract
Background: Persons with dementia (PWD) and their caregivers are uniquely impacted by the COVID-19 pandemic, including higher risk of mortality for PWD. Objectives: To describe the context and circumstances of deaths of PWD within a dementia support program during the COVID-19 pandemic. Design: Retrospective data collection of PWD deaths between March 1, 2020 and February 28, 2021. Setting/Subjects: Decedents enrolled in Care Ecosystem, a multidisciplinary team model for dementia care at University of California San Francisco, Ochsner Health, and UCHealth. Measurements: Using mixed methods, we analyzed data using descriptive measures and team-based thematic analysis to understand the end-of-life (EOL) experience of PWD-caregiver dyads. Results: Twenty-nine PWD died across three sites. Almost half (45%) were between ages 70-79 and 12 (41%) were women. Eighteen (62%) died at a private residence; two died in the hospital. Hospice was involved for 22 (76%) patients. There were known causes of death for 15 (53%) patients. Only two deaths were directly related to COVID-19 infection. Social isolation was perceived to have a high or very high impact for 12 (41%) decedents. Four qualitative themes were identified: (1) isolation due to the pandemic, (2) changes in use of dementia supports and resources, (3) impact on goals of care decisions, and (4) communication challenges for EOL care coordination. Conclusion: Among PWD and caregivers enrolled in a dementia support program, the COVID-19 pandemic had direct and indirect influences on mortality and EOL experiences of PWD. Caregivers' experiences of caring, decision making, and bereavement were also affected.
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Affiliation(s)
- Adreanne Brungardt
- Division of Geriatric Medicine, Department of Medicine, School of Medicine, 129263University of Colorado, Aurora, CO, USA
| | - Jessica Cassidy
- Division of Geriatric Medicine, Department of Medicine, School of Medicine, 129263University of Colorado, Aurora, CO, USA
| | - Ashley LaRoche
- Department of Neurology, 604328Ochsner Health, New Orleans, LA, USA
| | - Sarah Dulaney
- Memory and Aging Center, Department of Neurology, 271696University of California, San Francisco, San Francisco, CA, USA
| | - R John Sawyer
- Department of Neurology, 604328Ochsner Health, New Orleans, LA, USA
| | - Katherine L Possin
- Memory and Aging Center, Department of Neurology, 271696University of California, San Francisco, San Francisco, CA, USA.,Global Brain Health Institute, 271696University of California, San Francisco, San Francisco, CA, USA; The Trinity College of Dublin, Dublin, Ireland
| | - Hillary D Lum
- Division of Geriatric Medicine, Department of Medicine, School of Medicine, 129263University of Colorado, Aurora, CO, USA
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Kazawa K, Kubo T, Akishita M, Ishii S. The impact of the COVID-19 pandemic on services for community-dwelling adults and people with dementia, and their families' intentions to use those services. Geriatr Gerontol Int 2022; 22:686-688. [PMID: 35848601 PMCID: PMC9349565 DOI: 10.1111/ggi.14440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 06/26/2022] [Accepted: 06/30/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Kana Kazawa
- Department of Medicine for Integrated Approach to Social Inclusion, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Tatsuhiko Kubo
- Department of Public Health and Health Policy, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Masahiro Akishita
- Department of Geriatric Medicine, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Shinya Ishii
- Department of Medicine for Integrated Approach to Social Inclusion, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Dawson WD, Comas-Herrera A. International Dementia Policies and Legacies of the Coronavirus Disease 2019 Pandemic. PUBLIC POLICY & AGING REPORT 2022; 32:72-76. [PMID: 35996432 PMCID: PMC9383947 DOI: 10.1093/ppar/prac008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Indexed: 12/30/2022]
Affiliation(s)
- Walter D Dawson
- Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
- Global Brain Health Institute, University of California, San Francisco (UCSF), San Francisco, California, USA
- Institute on Aging, College of Urban & Public Affairs, Portland State University, Portland, Oregon, USA
| | - Adelina Comas-Herrera
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
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