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Saragosa M, MacEachern E, Chiu M, Weylie S, Schneider K, Maloney ER, Holland J, Kuluski K, Orchanian-Cheff A, Nelson MLA. Mapping the evidence on dementia care pathways - A scoping review. BMC Geriatr 2024; 24:690. [PMID: 39154004 PMCID: PMC11330604 DOI: 10.1186/s12877-024-05250-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 07/25/2024] [Indexed: 08/19/2024] Open
Abstract
BACKGROUND One way of standardizing practice and improving patient safety is by introducing clinical care pathways; however, such pathways are typically geared towards assisting clinicians and healthcare organizations with evidence-based practice. Many dementia care pathways exist with no agreed-upon version of a care pathway and with little data on experiences about their use or outcomes. The objectives of the review were: (1) to identify the dementia care pathway's purpose, methods used to deploy the pathway, and expected user types; (2) to identify the care pathway's core components, expected outcomes, and implications for persons with dementia and their care partners; and (3) determine the extent of involvement by persons with dementia and/or their care partners in developing, implementing, and evaluating the care pathways. METHODS We systematically searched six literature databases for published literature in the English language in September 2023 utilizing Arskey and O'Malley's scoping review framework. RESULTS The findings from the dementia care pathways (n = 13) demonstrated assistance in dementia diagnostic and management practices for clinicians and offered structured care processes in clinical settings. For this reason, these pathways emphasized assessment and interventional post-diagnostic support, with less emphasis on community-based integrated dementia care. CONCLUSION Future dementia care pathway development can seek the involvement of persons with dementia and care partners in designing, implementing and evaluating such pathways, ensuring that outcome measures properly reflect the impact on persons with lived dementia experience and their care partners.
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Affiliation(s)
- Marianne Saragosa
- Science of Care Institute, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, M4M 2B5, Canada.
| | - Evan MacEachern
- Science of Care Institute, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, M4M 2B5, Canada
| | - Mary Chiu
- Ontario Shores Centre for Mental Health Science, Whitby, ON, L1N 5S9, Canada
- Faculty of Health Science, Ontario Tech University, Oshawa, ON, L1H 7K4, Canada
| | - Sean Weylie
- Alzheimer Society Peel, Mississauga, ON, L5G 3N6, Canada
| | | | | | - Jordanne Holland
- Centre for Addiction and Mental Health, Toronto, ON, M6J 1H4, Canada
- Baycrest Health Sciences, Toronto, ON, M6A 2E1, Canada
| | - Kerry Kuluski
- Trillium Health Partners, Mississauga, ON, L5B 1B8, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, M5T 3M6, Canada
| | - Ani Orchanian-Cheff
- Library and Information Services, University Health Network, Toronto, ON, M5G 2C4, Canada
| | - Michelle LA Nelson
- Science of Care Institute, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, M4M 2B5, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, M5T 3M6, Canada
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2
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Ilea P, Ilea I. Administrative burden for patients in U.S. health care settings Post-Affordable Care Act: A scoping review. Soc Sci Med 2024; 345:116686. [PMID: 38368662 DOI: 10.1016/j.socscimed.2024.116686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 01/20/2024] [Accepted: 02/08/2024] [Indexed: 02/20/2024]
Abstract
Administrative burdens are the costs associated with receiving a service or accessing a program. Based on the Herd & Moynihan framework, they occur in three subcategories: learning costs, compliance costs, and psychological costs. Administrative burdens manifest inequitably, more significantly impacting vulnerable populations. Administrative burdens may impact the health of those trying to access services, and in some cases block access to health-promoting services entirely. This scoping review examined studies focused on the impact on patients of administrative burden administrative burden in health care settings in the U.S. following the passage of the Affordable Care Act. We queried databases for empirical literature capturing patient administrative burden, retrieving 1578 records, with 31 articles ultimately eligible for inclusion. Of the 31 included studies, 18 used quantitative methods, nine used qualitative methods, three used mixed methods, and one was a case study. In terms of administrative burden subcategories, most patient outcomes reported were learning (22 studies) and compliance costs (26 studies). Psychological costs were the most rarely reported; all four studies describing psychological costs were qualitative in nature. Only twelve studies connected patient demographic data with administrative burden data, despite previous research suggesting an inequitable burden impact. Additionally, twenty-eight studies assessed administrative burden and only three attempted to reduce it via an intervention, resulting in a lack of data on intervention design and efficacy.
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Affiliation(s)
- Passion Ilea
- Portland State University, School of Social Work, 1800 SW 6th Avenue, Portland, OR, 97201, 503.725.4040, USA.
| | - Ian Ilea
- The Center to Improve Veteran Involvement in Care, Portland VA Research Foundation, USA
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Xie Y, Hamilton M, Peisah C, Anstey KJ, Sinclair C. Navigating Community-Based Aged Care Services From the Consumer Perspective: A Scoping Review. THE GERONTOLOGIST 2024; 64:gnad017. [PMID: 37120292 DOI: 10.1093/geront/gnad017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Indexed: 05/01/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The shift to consumer-directed aged care means that older adults need to play a more active role in navigating the complex aged care system for adequate health and social services. Challenges in the navigation process result in unmet needs and difficulty accessing available resources. This scoping review investigates how aged care navigation is conceptualized in literature and interrogates research on the experiences of older adults navigating community-based aged care services with or without support from their informal carers. RESEARCH DESIGN AND METHODS This review follows the Joanna Briggs Institute methodological guidelines. PubMed, Scopus, and ProQuest were searched for relevant literature published from 2008 to 2021, supplemented by grey literature and manual reference list searching. Data were extracted using a predefined data-extraction table and synthesized with an inductive thematic analysis. RESULTS The current conceptualization of aged care navigation focuses on the support provided to older adults, rather than actions taken by older adults themselves. Thematic analysis from the included studies (n = 26) revealed shared themes (lack of knowledge, social networks as information providers, complex care systems) among older adults and informal carers; unique challenges faced by older adults (difficulties with technology, waiting game), and informal carers (structural burden) in aged care navigation. DISCUSSION AND IMPLICATIONS Findings suggest the need to comprehensively assess individual circumstances including social networks and access to informal carers as predictors of successful navigation. Changes that reduce the complexity of the aged care system and improve coordination will relieve the structural burden experienced by consumers.
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Affiliation(s)
- Yuchen Xie
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
- Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Myra Hamilton
- UNSW Ageing Futures Institute, Sydney, New South Wales, Australia
| | - Carmelle Peisah
- Discipline of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
- Specialty of Psychiatry, University of Sydney, Sydney, New South Wales, Australia
| | - Kaarin J Anstey
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- UNSW Ageing Futures Institute, Sydney, New South Wales, Australia
| | - Craig Sinclair
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
- Neuroscience Research Australia, Sydney, New South Wales, Australia
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Teggart K, Neil-Sztramko SE, Nadarajah A, Wang A, Moore C, Carter N, Adams J, Jain K, Petrie P, Alshaikhahmed A, Yugendranag S, Ganann R. Effectiveness of system navigation programs linking primary care with community-based health and social services: a systematic review. BMC Health Serv Res 2023; 23:450. [PMID: 37158878 PMCID: PMC10165767 DOI: 10.1186/s12913-023-09424-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 04/19/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Fragmented delivery of health and social services can impact access to high-quality, person-centred care. The goal of system navigation is to reduce barriers to healthcare access and improve the quality of care. However, the effectiveness of system navigation remains largely unknown. This systematic review aims to identify the effectiveness of system navigation programs linking primary care with community-based health and social services to improve patient, caregiver, and health system outcomes. METHODS Building on a previous scoping review, PsychInfo, EMBASE, CINAHL, MEDLINE, and Cochrane Clinical Trials Registry were searched for intervention studies published between January 2013 and August 2020. Eligible studies included system navigation or social prescription programs for adults, based in primary care settings. Two independent reviewers completed study selection, critical appraisal, and data extraction. RESULTS Twenty-one studies were included; studies had generally low to moderate risk of bias. System navigation models were lay person-led (n = 10), health professional-led (n = 4), team-based (n = 6), or self-navigation with lay support as needed (n = 1). Evidence from three studies (low risk of bias) suggests that team-based system navigation may result in slightly more appropriate health service utilization compared to baseline or usual care. Evidence from four studies (moderate risk of bias) suggests that either lay person-led or health professional-led system navigation models may improve patient experiences with quality of care compared to usual care. It is unclear whether system navigation models may improve patient-related outcomes (e.g., health-related quality of life, health behaviours). The evidence is very uncertain about the effect of system navigation programs on caregiver, cost-related, or social care outcomes. CONCLUSIONS There is variation in findings across system navigation models linking primary care with community-based health and social services. Team-based system navigation may result in slight improvements in health service utilization. Further research is needed to determine the effects on caregiver and cost-related outcomes.
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Affiliation(s)
- Kylie Teggart
- School of Nursing, Faculty of Health Sciences, McMaster University, 1280 Main St. W, Hamilton, ON, HSC 3N25L8S 4K1, Canada
| | - Sarah E Neil-Sztramko
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, 175 Longwood Rd S, Suite 210a, Hamilton, ON, L8P 0A1, Canada
| | - Abbira Nadarajah
- School of Nursing, Faculty of Health Sciences, McMaster University, 1280 Main St. W, Hamilton, ON, HSC 3N25L8S 4K1, Canada
| | - Amy Wang
- Department of Family Medicine, University of Alberta, 5-16 University Terrace, Edmonton, AB, T6G 2T4, Canada
| | - Caroline Moore
- School of Nursing, Faculty of Health Sciences, McMaster University, 1280 Main St. W, Hamilton, ON, HSC 3N25L8S 4K1, Canada
| | - Nancy Carter
- School of Nursing, Faculty of Health Sciences, McMaster University, 1280 Main St. W, Hamilton, ON, HSC 3N25L8S 4K1, Canada
| | - Janet Adams
- School of Nursing, Faculty of Health Sciences, McMaster University, 1280 Main St. W, Hamilton, ON, HSC 3N25L8S 4K1, Canada
| | - Kamal Jain
- School of Nursing, Faculty of Health Sciences, McMaster University, 1280 Main St. W, Hamilton, ON, HSC 3N25L8S 4K1, Canada
| | - Penelope Petrie
- School of Nursing, Faculty of Health Sciences, McMaster University, 1280 Main St. W, Hamilton, ON, HSC 3N25L8S 4K1, Canada
| | - Aref Alshaikhahmed
- School of Nursing, Faculty of Health Sciences, McMaster University, 1280 Main St. W, Hamilton, ON, HSC 3N25L8S 4K1, Canada
| | - Shreya Yugendranag
- School of Nursing, Faculty of Health Sciences, McMaster University, 1280 Main St. W, Hamilton, ON, HSC 3N25L8S 4K1, Canada
| | - Rebecca Ganann
- School of Nursing, Faculty of Health Sciences, McMaster University, 1280 Main St. W, Hamilton, ON, HSC 3N25L8S 4K1, Canada.
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Ward A, Buffalo L, McDonald C, L'Heureux T, Charles L, Pollard C, Tian PG, Anderson S, Parmar J. Supporting First Nations Family Caregivers and Providers: Family Caregivers', Health and Community Providers', and Leaders' Recommendations. Diseases 2023; 11:diseases11020065. [PMID: 37218878 DOI: 10.3390/diseases11020065] [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: 03/28/2023] [Revised: 04/20/2023] [Accepted: 04/23/2023] [Indexed: 05/24/2023] Open
Abstract
Family caregivers and care providers are increasingly becoming more distressed and reaching a breaking point within current systems of care. First Nations family caregivers and the health and community providers employed in First Nations communities have to cope with colonial, discriminatory practices that have caused intergenerational trauma and a myriad of siloed, disconnected, and difficult-to-navigate federal-, provincial/territorial-, and community-level policies and programs. Indigenous participants in Alberta's Health Advisory Councils described Indigenous family caregivers as having more difficulty accessing support than other Alberta caregivers. In this article, we report on family caregivers', providers', and leaders' recommendations to support First Nations family caregivers and the health and community providers employed in First Nations. We used participatory action research methods in which we drew on Etuaptmumk (the understanding that being in the world is the gift of multiple perspectives) and that Indigenous and non-Indigenous views are complementary. Participants were from two First Nation communities in Alberta and included family caregivers (n = 6), health and community providers (n = 14), and healthcare and community leaders (n = 6). Participants advised that family caregivers needed four types of support: (1) recognize the family caregivers' role and work; (2) enhance navigation and timely access to services, (3) improve home care support and respite, and (4) provide culturally safe care. Participants had four recommendations to support providers: (1) support community providers' health and wellbeing; (2) recruit and retain health and community providers; (3) improve orientation for new providers; and (4) offer providers a comprehensive grounding in cultural awareness. While creating a program or department for family caregivers may be tempting to address caregivers' immediate needs, improving the health of First Nations family caregivers requires a population-based public health approach that focuses on meaningful holistic system change to support family caregivers.
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Affiliation(s)
- Amber Ward
- Faculty of Medicine, University of Victoria, Victoria, BC V6T 1Z3, Canada
| | | | | | - Tanya L'Heureux
- Division of Care of the Elderly, Department of Family Medicine, University of Alberta, Edmonton, AB T6G 2T4, Canada
| | - Lesley Charles
- Division of Care of the Elderly, Department of Family Medicine, University of Alberta, Edmonton, AB T6G 2T4, Canada
| | - Cheryl Pollard
- Faculty of Nursing, University of Regina, Regina, SK S4S 0A2, Canada
| | - Peter G Tian
- Division of Care of the Elderly, Department of Family Medicine, University of Alberta, Edmonton, AB T6G 2T4, Canada
| | - Sharon Anderson
- Division of Care of the Elderly, Department of Family Medicine, University of Alberta, Edmonton, AB T6G 2T4, Canada
| | - Jasneet Parmar
- Division of Care of the Elderly, Department of Family Medicine, University of Alberta, Edmonton, AB T6G 2T4, Canada
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Scott EL, Funk LM. Cumulative Disempowerment: How Families Experience Older Adults' Transitions into Long-Term Residential Care. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2023; 66:433-455. [PMID: 35993142 DOI: 10.1080/01634372.2022.2113489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 08/11/2022] [Accepted: 08/11/2022] [Indexed: 06/15/2023]
Abstract
Although emerging research links family experiences with long-term residential care (LTRC) transitions to structural features of health care systems, existing scholarship inadvertently tends to represent the transition as an individual problem to which families need to adjust. This secondary qualitative analysis of 55 interviews with 22 family members caring for an older adult engages a critical gerontological lens. A concept of cumulative, structural empowerment informs this analysis of families' experiences across a broad continuum of older adults' moves into LTRC. Leading up to transitions, families have little power over home care services, and family members have little control over their involvement in care provision. Some families respond by making choices to refuse publicly provided service options, therein both resisting and reinforcing broader relations of power. Expectations for family involvement in LTRC placement decisions were incongruent with some families' experiences, reinforcing a sense of powerlessness compounded by the speed with which these decisions needed to be made. A broad temporal analysis of transitions highlights LTRC transitions as a process of cumulative family disempowerment connected to broader formal care structures alongside emphases on aging in place and familialism that characterize LTRC as the option of last resort.
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Affiliation(s)
- Erin L Scott
- Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Laura M Funk
- Department of Sociology and Criminology, University of Manitoba, Winnipeg, Canada
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Kelly C, Dansereau L, FitzGerald M, Lee Y, Williams A. Inequities in access to directly-funded home care in Canada: a privilege only afforded to some. BMC Health Serv Res 2023; 23:51. [PMID: 36653820 PMCID: PMC9847438 DOI: 10.1186/s12913-023-09048-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 01/09/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Directly-funded home care (DF) provides government funds to people who need assistance with the activities of daily living, allowing them to arrange their own services. As programs expand globally, many allow DF clients to hire home care agencies to organize their services rather than finding their own workers. In Canada, half of the DF home care programs allow users to purchase agency services. The goal of this research is to describe the role of agency providers in DF home care in Canada and consider potential equity implications for service access from the perspectives of clients and families. METHODS Framed with intersectionality, the study included online focus groups with families and clients (n = 56) in the two Canadian provinces of Alberta and Manitoba between June 2021-April 2022. All transcripts underwent qualitative thematic analysis using open and axial coding techniques. Each transcript was analyzed by two of three possible independent coders using Dedoose qualitative analysis software. RESULTS The article presents five thematic findings. First, the focus groups document high rates of satisfaction with the care regardless of whether the client uses agency providers. Second, agency providers mediate some of the administrative barriers and emotional strain of using DF home care, and this is especially important for family caregivers who are working or have additional care responsibilities. Third, there are out-of-pocket expenses reported by most participants, with agency clients describing administrative fees despite lower pay for the frontline care workers. Fourth, agencies are not generally effective for linguistic and/or cultural matching between workers and families. Finally, we find that DF care programs cannot compensate for a limited informal support network. CONCLUSIONS Clients and families often intentionally choose DF home care after negative experiences with other public service options, yet the results suggest that in some Canadian contexts, DF home care is a privilege only afforded to some. Given the growing inequalities that exist in Canadian society, all public home care options must be open to all who need it, irrespective of ability to pay, degree of social support, or competence in the English language.
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Affiliation(s)
- Christine Kelly
- grid.21613.370000 0004 1936 9609Department of Community Health Sciences, University of Manitoba, Winnipeg, MB Canada
| | - Lisette Dansereau
- grid.21613.370000 0004 1936 9609Department of Community Health Sciences, University of Manitoba, Winnipeg, MB Canada
| | - Maggie FitzGerald
- grid.25152.310000 0001 2154 235XDepartment of Political Studies, University of Saskatchewan, Saskatoon, SK Canada
| | - Yeonjung Lee
- grid.254224.70000 0001 0789 9563Social Welfare, Chung-Ang University, Seoul, South Korea ,grid.22072.350000 0004 1936 7697School of Social Work, University of Calgary, Calgary, AB Canada
| | - Allison Williams
- grid.25073.330000 0004 1936 8227School of Earth, Environment & Society, McMaster University, Hamilton, ON Canada
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Balancing Flexibility and Administrative Burden: Experiences of Family Managers Using Directly Funded Home Care in Manitoba, Canada. Can J Aging 2022; 41:593-604. [PMID: 35403593 DOI: 10.1017/s0714980821000660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Directly funded (DF) home care provides funding to home care recipients to coordinate their own care and supports, and is available across all Canadian provinces. Current research on DF home care focuses on the experiences of adults with disabilities self-directing their own care, but less is known about the experiences of family members managing services for adults 55 years of age and older. This article presents findings from a qualitative analysis of 24 semi-structured interviews with older adults and caregivers using the DF program in Manitoba, Canada, focusing on family manager experiences. We identify three themes in the interview data: (1) DF home care enhances choice and flexibility for older people and their caregivers, (2) choice and flexibility reduce caregiver strain, and (3) agency services reduce administrative burden. We discuss the importance of care relationships and the role of family managers. We recommend that traditional home care systems learn from DF, and that increased administrative support would reduce caregiver strain.
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9
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Gilbert AS, Antoniades J, Croy S, Thodis A, Adams J, Goeman D, Browning C, Kent M, Ellis K, Brijnath B. The experience of structural burden for culturally and linguistically diverse family carers of people living with dementia in Australia. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e4492-e4503. [PMID: 35599431 PMCID: PMC10083988 DOI: 10.1111/hsc.13853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 03/27/2022] [Accepted: 05/05/2022] [Indexed: 06/15/2023]
Abstract
Evidence suggests that family carers of culturally and linguistically diverse (CALD) people living with dementia experience higher stress and unmet need than the general Australian population. These disparities are often framed as the result of CALD communities failing to seek formal support. Challenging this, we draw on the concept of 'structural burden' to explore how the complexity of health and aged systems contribute to the burden that CALD carers experience. We conducted semi-structured interviews with 104 family carers for CALD people with dementia in Australia, followed by thematic analysis of transcripts. Additional to structural burdens encountered by the general older population, CALD carers faced challenges understanding Australia's Anglo-centric aged care system, locating culturally appropriate care and were required to translate the languages and operations of health and aged care systems into terms their family members understood. This burden was mitigated by the presence of ethno-specific organisations and other navigation support. Australia's aged care system has moved towards centralised governance and consumer-directed care provision. This system involves a confusing array of different programmes and levels, bureaucratic applications and long waiting times. Carers' encounters with these systems demonstrates how some CALD people are being left behind by the current aged care system. While ethno-specific services can reduce this burden, not all CALD groups are represented. Consequently, improving access to dementia care among CALD populations requires entry point and navigation support that is culturally appropriate and linguistically accessible.
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Affiliation(s)
- Andrew Simon Gilbert
- National Ageing Research InstituteParkvilleVictoriaAustralia
- La Trobe UniversityBundooraVictoriaAustralia
| | - Josefine Antoniades
- National Ageing Research InstituteParkvilleVictoriaAustralia
- Curtin UniversityBentleyWestern AustraliaAustralia
| | - Samantha Croy
- National Ageing Research InstituteParkvilleVictoriaAustralia
- Murdoch Children's Research InstituteParkvilleVictoriaAustralia
| | - Antonia Thodis
- National Ageing Research InstituteParkvilleVictoriaAustralia
- Swinburne University of TechnologyHawthornVictoriaAustralia
| | - Jon Adams
- University of Technology SydneyUltimoNew South WalesAustralia
| | - Dianne Goeman
- University of NewcastleCallaghanNew South WalesAustralia
- Monash UniversityClaytonVictoriaAustralia
| | - Colette Browning
- Federation UniversityMount HelenVictoriaAustralia
- Australian National UniversityCanberraAustralian Capital TerritoryAustralia
| | - Mike Kent
- Curtin UniversityBentleyWestern AustraliaAustralia
| | - Katie Ellis
- Curtin UniversityBentleyWestern AustraliaAustralia
| | - Bianca Brijnath
- National Ageing Research InstituteParkvilleVictoriaAustralia
- University of Western AustraliaCrawleyWestern AustraliaAustralia
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10
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Bindley K, Lewis J, Travaglia J, DiGiacomo M. Bureaucracy and burden: An Intersectionality-Based Policy Analysis of social welfare policy with consequences for carers of people with life-limiting illness. Palliat Med 2022; 37:543-557. [PMID: 36114642 DOI: 10.1177/02692163221122289] [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
BACKGROUND For informal carers of people with life-limiting illness, social welfare policy related to income support and housing has been associated with varied psychosocial issues, yet remains relatively under-explored. An intersectional approach offers potential to illuminate diverse experiences and implications. AIM To explore the way in which caring in the context of life-limiting illness is framed within welfare policy, to articulate inequities encountered by carers, and to identify policy and practice recommendations. DESIGN The Intersectionality-Based Policy Analysis (IBPA) Framework was used to situate findings of a broader qualitative study. SETTING/PARTICIPANTS Data were collected via semi-structured interviews with participants who were bereaved carers (n = 12), welfare workers (n = 14) and palliative care workers (n = 7), between November 2018 and April 2020, in an Australian region associated with socioeconomic disadvantage. Five elements of IBPA were applied to the products of analysis of this data. RESULTS Use of the IBPA Framework revealed that representations of carers and causes of their welfare needs in policy were underpinned by several assumptions; including that caring and grieving periods are temporary or brief, and that carers have adequate capacity to navigate complex systems. Policy and processes had differentiated consequences for carers, with those occupying certain social locations prone to accumulating disadvantage. CONCLUSIONS This intersectional analysis establishes critical exploration of the framing and consequences of welfare policy for carers of people with life-limiting illness, presented in a novel conceptual model. Implications relate to intersectoral development of structural competency, responsiveness to structurally vulnerable carers in clinical practice, and needed policy changes.
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Affiliation(s)
- Kristin Bindley
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia.,Supportive and Palliative Care, Western Sydney Local Health District, Mount Druitt, NSW, Australia
| | - Joanne Lewis
- School of Nursing and Health, Avondale University, Wahroonga, NSW, Australia.,School of Nursing and Midwifery, University of Technology Sydney, Ultimo, NSW, Australia
| | - Joanne Travaglia
- Health Services Management, School of Public Health, The University of Technology Sydney, Ultimo, NSW, Australia
| | - Michelle DiGiacomo
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
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11
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Kervin LM, Chamberlain SA, Wister AV, Cosco TD. (Older) Adults without advocates: Support for alternative terminology to "elder orphan" in research and clinical contexts. J Am Geriatr Soc 2022; 70:3329-3333. [PMID: 35849529 DOI: 10.1111/jgs.17960] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 06/10/2022] [Accepted: 06/23/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Lucy M Kervin
- Gerontology Research Center, Department of Gerontology, Simon Fraser University, Vancouver, Canada
| | - Stephanie A Chamberlain
- Department of Family Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Andrew V Wister
- Gerontology Research Center, Department of Gerontology, Simon Fraser University, Vancouver, Canada
| | - Theodore D Cosco
- Gerontology Research Center, Department of Gerontology, Simon Fraser University, Vancouver, Canada.,Oxford Institute of Population Ageing, University of Oxford, Oxford, UK
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12
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Pryor TAM, Reynolds KA, Kirby PL, Bernstein MT. An examination of the quality of late-life depression websites on the Internet (Preprint). JMIR Form Res 2022; 6:e36177. [PMID: 36094802 PMCID: PMC9513688 DOI: 10.2196/36177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 04/12/2022] [Accepted: 05/04/2022] [Indexed: 11/25/2022] Open
Abstract
Background The internet can increase the accessibility of mental health information and improve the mental health literacy of older adults. The quality of mental health information on the internet can be inaccurate or biased, leading to misinformation. Objective This study aims to evaluate the quality, usability, and readability of websites providing information concerning depression in later life. Methods Websites were identified through a Google search and evaluated by assessing quality (DISCERN), usability (Patient Education Materials Assessment Tool), and readability (Simple Measure of Gobbledygook). Results The overall quality of late-life depression websites (N=19) was adequate, and the usability and readability were poor. No significant relationship was found between the quality and readability of the websites. Conclusions The websites can be improved by enhancing information quality, usability, and readability related to late-life depression. The use of high-quality websites may improve mental health literacy and shared treatment decision-making for older adults.
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Affiliation(s)
- Teaghan A M Pryor
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - Kristin A Reynolds
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
- Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada
| | - Paige L Kirby
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
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13
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Bindley K, Lewis J, Travaglia J, DiGiacomo M. Caring and Grieving in the Context of Social and Structural Inequity: Experiences of Australian Carers With Social Welfare Needs. QUALITATIVE HEALTH RESEARCH 2022; 32:64-79. [PMID: 34836471 DOI: 10.1177/10497323211046875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Caring for and bereavement following the death of someone with a life-limiting illness may precipitate social welfare needs related to income support and housing. Nevertheless, carer experiences of welfare policy and institutions have not received significant attention. This qualitative study explored experiences of carers who navigated social welfare policy while caring for someone with a life-limiting illness, and in bereavement. In-depth interviews were conducted with 12 bereaved carers in an area associated with socioeconomic disadvantage. Carers differentially encountered precariousness, with some experiencing structural vulnerability. These positionalities appeared to be shaped by policy and process-related burdens, perceptions of the welfare state, and degrees of legitimisation or disenfranchisement of forms of capital and coping orientations. Recommendations that may improve carer experience were identified. Implications relate to the need for an expanded conceptualisation of vulnerability in health and welfare practice, policy that authentically validates caring and grieving, and upstream strategies that address inequity.
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Affiliation(s)
- Kristin Bindley
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, 110561The University of Technology, Ultimo, NSW, Australia
- Supportive and Palliative Care, 1760Western Sydney Local Health District, Mount Druitt NSW, Australia
| | - Joanne Lewis
- Faculty of Health, 110561The University of Technology Sydney, Ultimo, NSW, Australia
- Faculty of Health,110446University of Canberra, Bruce, ACT, Australia
| | - Joanne Travaglia
- Faculty of Health, 110561The University of Technology Sydney, Ultimo, NSW, Australia
| | - Michelle DiGiacomo
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, 110561The University of Technology, Ultimo, NSW, Australia
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14
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Quigley R, Foster M, Harvey D, Ehrlich C. Entering into a system of care: A qualitative study of carers of older community-dwelling Australians. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:319-329. [PMID: 33955616 DOI: 10.1111/hsc.13405] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 03/10/2021] [Accepted: 04/06/2021] [Indexed: 06/12/2023]
Abstract
Informal carers provide the majority of care to older Australians and play an essential role in assisting older people with complex care needs to remain living in their own homes. As such, carers are increasingly faced with systemic responsibilities, including coordinating services across multifaceted health and aged care systems and negotiating treatment and supports. The aim of this study was to explore how systemic complexity and associated work is experienced by carers of older adults and what personal capacities carers draw on in managing the systemic work. A descriptive phenomenological approach guided the research. Semistructured interviews were conducted with 16 carers of community-dwelling older adults with complex care needs recruited through a local health service. Giorgi's phenomenological data analysis methods (1997) was utilised for the data analysis. Two main themes were derived from the analysis: Becoming part of the caring system and Mastering the caring system. The findings indicate that the majority of carers perceived the work of interacting with multiple systems and services as a burden and an onerous obligation. Furthermore, change in the health or social circumstances of the older adult amplified differences in the nature of the systemic work and concomitantly revealed differences in carers' capacities. This paper reveals that the caring system is in some sense disposed to create disparities, as carers' specific capacities were integral to mastering the systemic work. An understanding of informal care work that supports older people to live in the community can assist health care professionals and service providers to better identify carer requirements and assess carer capacity to manage the work.
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Affiliation(s)
- Rachel Quigley
- Griffith University, Brisbane, Australia
- Cairns and Hinterland Hospital and Health Service, Cairns, Queensland, Australia
- College of Medicine and Dentistry, James Cook University, Cairns, Australia
| | - Michele Foster
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Desley Harvey
- Cairns and Hinterland Hospital and Health Service, Cairns, Queensland, Australia
- College of Healthcare Sciences, James Cook University, Cairns, Australia
| | - Carolyn Ehrlich
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
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15
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Wilson E, Caswell G, Pollock K. The 'work' of managing medications when someone is seriously ill and dying at home: A longitudinal qualitative case study of patient and family perspectives'. Palliat Med 2021; 35:1941-1950. [PMID: 34252329 PMCID: PMC8640265 DOI: 10.1177/02692163211030113] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Managing medications can impose difficulties for patients and families which may intensify towards the end of life. Family caregivers are often assumed to be willing and able to support patients with medications, yet little is known about the challenges they experience or how they cope with these. AIM To explore patient and family caregivers' views of managing medications when someone is seriously ill and dying at home. DESIGN A qualitative design underpinned by a social constructionist perspective involving interviews with bereaved family caregivers, patients and current family caregivers. A thematic analysis was undertaken. SETTING/PARTICIPANTS Two English counties. Data reported in this paper were generated across two data sets using: (1) Interviews with bereaved family caregivers (n = 21) of patients who had been cared for at home during the last 6 months of life. (2) Interviews (n = 43) included within longitudinal family focused case studies (n = 20) with patients and current family caregivers followed-up over 4 months. RESULTS The 'work of managing medications' was identified as a central theme across the two data sets, with further subthemes of practical, physical, emotional and knowledge-based work. These are discussed by drawing together ideas of illness work, and how the management of medications can substantially add to the burden placed on patients and families. CONCLUSIONS It is essential to consider the limits of what it is reasonable to ask patients and families to do, especially when fatigued, distressed and under pressure. Focus should be on improving support via greater professional understanding of the work needed to manage medications at home.
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Affiliation(s)
- Eleanor Wilson
- Nottingham Centre for the Advancement of Research in End of Life Care, School of Health Sciences, University of Nottingham Medical School, Queen’s Medical Centre, Nottingham, UK
| | - Glenys Caswell
- Nottingham Centre for the Advancement of Research in End of Life Care, School of Health Sciences, University of Nottingham Medical School, Queen’s Medical Centre, Nottingham, UK
| | - Kristian Pollock
- Nottingham Centre for the Advancement of Research in End of Life Care, School of Health Sciences, University of Nottingham Medical School, Queen’s Medical Centre, Nottingham, UK
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16
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Tyagi S, Luo N, Tan CS, Tan KB, Tan BY, Menon E, Venketasubramanian N, Loh WC, Fan SH, Yang KLT, Chan ASL, Farwin A, Lukman ZB, Koh GCH. Seeking healthcare services post-stroke: a qualitative descriptive study exploring family caregiver and stroke survivor perspectives in an asian setting. BMC Neurol 2021; 21:429. [PMID: 34740323 PMCID: PMC8569985 DOI: 10.1186/s12883-021-02463-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 10/22/2021] [Indexed: 11/10/2022] Open
Abstract
Aim Exploration of the healthcare journey post-stroke is incomplete without acknowledging the crucial role of family caregivers. With limited literature documenting the role of caregivers in the healthcare journey post-stroke, we aimed to describe the healthcare experiences of family caregivers and stroke survivors across different caregiver identities in Singapore. Methods We conducted a qualitative descriptive study involving semi-structured interviews with transcripts analysed using thematic analysis. 26 stroke survivors and 35 family caregivers purposively sampled from multiple settings. Results Findings were summarized into seeking care and experience of healthcare encounters. Seeking care comprised of the following themes: factors influencing seeking care, decision to seek care and role of caregiver in seeking care. Experience of healthcare encounters comprised of the following themes: service around the patient, service with care and role of caregiver in healthcare encounters. Conclusion Multi-dimensional role of caregivers in healthcare experience emerged as a major finding. Unique to our Asian context, as per the participants’ accounts, family caregivers seemed to be central in healthcare decision-making for stroke survivors, with adult-child caregivers commonly reported being engaged in collaborative decision-making. While spousal caregivers preferred a relational healthcare experience, adult-child caregivers preferred a transactional one. Practical implications include equipping caregivers with skillset to make healthcare decisions, provision of supportive decision-making environment for caregivers and reinforcing communication aspects in the medical, nursing and allied healthcare curriculum to improve healthcare experience. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-021-02463-7.
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Affiliation(s)
- Shilpa Tyagi
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, 117549, Singapore, Singapore
| | - Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, 117549, Singapore, Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, 117549, Singapore, Singapore
| | - Kelvin Bryan Tan
- Policy Research & Economics Office, Ministry of Health, Singapore, Singapore
| | | | - Edward Menon
- St. Andrew's Community Hospital, Singapore, Singapore
| | - N Venketasubramanian
- Raffles Neuroscience Centre, Raffles Hospital, Singapore, Singapore.,Singapore National Stroke Association, Singapore, Singapore
| | - Wei Chin Loh
- St. Andrew's Community Hospital, Singapore, Singapore
| | - Shu Hui Fan
- St. Andrew's Community Hospital, Singapore, Singapore
| | | | - Audrey Swee Ling Chan
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, 117549, Singapore, Singapore
| | - Aysha Farwin
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, 117549, Singapore, Singapore
| | - Zunairah Binti Lukman
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, 117549, Singapore, Singapore
| | - Gerald Choon-Huat Koh
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, 117549, Singapore, Singapore.
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17
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Tyagi S, Luo N, Tan CS, Tan KB, Tan BY, Menon E, Venketasubramanian N, Loh WC, Fan SH, Yang KLT, Chan ASL, Farwin A, Lukman ZB, Koh GCH. Support system diversity among family caregivers of stroke survivors: a qualitative study exploring Asian perspectives. BMC Geriatr 2021; 21:594. [PMID: 34696724 PMCID: PMC8543837 DOI: 10.1186/s12877-021-02557-4] [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: 05/24/2021] [Accepted: 10/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Caregiving is a global phenomenon which is bound to increase in tandem with the aging population worldwide. Stroke is a condition common in older people that requires complex caregiving necessitating provision of adequate support to the caregivers. Past literature consists of limited accounts of types and organization of support arrangements needed by different caregivers. We aimed to describe the support system of caregivers of stroke survivors in Singapore, highlighting differences across the different caregiver identities (i.e. spouse, adult-child, etc.). METHODS We conducted a qualitative descriptive study in the community setting involving 61 purposively sampled and recruited stroke survivors and caregivers. Semi-structured interviews were conducted, and transcripts were analysed using thematic analysis. RESULTS Our findings were summarized across the following 4 themes: 1) cultural influence and caregiving; 2) caregiver support system with the following sub-themes: 2.1) dyadic caregiver support type, 2.2) extended caregiver support type, 2.3.) distributed caregiver support type and 2.4) empowering caregiver support type; 3) breaks in care of stroke survivor and 4) complex relationship dynamics. We operationalized the caregiver support system as comprising of type, people and activities that enable the caregiver to participate in caregiving activities sustainably. While spouse caregivers preferred dyadic and extended support systems positioning themselves in a more central caregiving role, adult-child caregivers preferred distributed support system involving family members with paid caregivers playing a more central role. CONCLUSIONS Our findings highlight caregiver identity as a surrogate for the differences in the caregiver support systems. Practical implications include imparting relationship-building skills to the stroke survivor-caregiver dyads to sustain dyadic support system and educating clinicians to include differences in caregiving arrangements of stroke survivors in practising family-centred care.
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Affiliation(s)
- Shilpa Tyagi
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Kelvin Bryan Tan
- Policy Research & Economics Office, Ministry of Health, Singapore, Singapore
| | | | - Edward Menon
- St. Andrew's Community Hospital, Singapore, Singapore
| | - N Venketasubramanian
- Raffles Neuroscience Centre, Raffles Hospital, Singapore, Singapore.,Singapore National Stroke Association, Singapore, Singapore
| | - Wei Chin Loh
- St. Andrew's Community Hospital, Singapore, Singapore
| | - Shu Hui Fan
- St. Andrew's Community Hospital, Singapore, Singapore
| | | | - Audrey Swee Ling Chan
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Aysha Farwin
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Zunairah Binti Lukman
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Gerald Choon-Huat Koh
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore.
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18
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Parmar J, Anderson S, Dobbs B, Tian PGJ, Charles L, Triscott J, Stickney-Lee J, Brémault-Phillips S, Sereda S, Poole L. Neglected Needs of Family Caregivers during the COVID-19 Pandemic and What They Need Now: A Qualitative Study. Diseases 2021; 9:70. [PMID: 34698124 PMCID: PMC8544374 DOI: 10.3390/diseases9040070] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/02/2021] [Accepted: 10/08/2021] [Indexed: 11/16/2022] Open
Abstract
COVID-19 has had a negative impact on family caregivers, whether the care receivers lived with the caregiver, in a separate community home, in supportive living, or in long-term care. This qualitative study examines the points of view of family caregivers who care in diverse settings. Family caregivers were asked to describe what could have been done to support them during the COVID-19 pandemic and to suggest supports they need in the future as the pandemic wanes. Thorne's interpretive qualitative methodology was employed to examine current caregiver concerns. Thirty-two family caregivers participated. Family caregivers thought the under-resourced, continuing care system delayed pandemic planning, and that silos in health and community systems made caregiving more difficult. Family caregivers want their roles to be recognized in policy, and they cite the need for improvements in communication and navigation. The growth in demand for family caregivers and their contributions to the healthcare system make it critical that the family caregiver role be recognized in policy, funding, and practice.
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Affiliation(s)
- Jasneet Parmar
- Division of Care of the Elderly, Department of Family Medicine, University of Alberta, Edmonton, AB T6G 2T4, Canada; (J.P.); (B.D.); (P.G.J.T.); (L.C.); (J.T.); (J.S.-L.)
- Home Living Edmonton Zone, Alberta Health Services, Edmonton, AB T6G 2G4, Canada
| | - Sharon Anderson
- Division of Care of the Elderly, Department of Family Medicine, University of Alberta, Edmonton, AB T6G 2T4, Canada; (J.P.); (B.D.); (P.G.J.T.); (L.C.); (J.T.); (J.S.-L.)
| | - Bonnie Dobbs
- Division of Care of the Elderly, Department of Family Medicine, University of Alberta, Edmonton, AB T6G 2T4, Canada; (J.P.); (B.D.); (P.G.J.T.); (L.C.); (J.T.); (J.S.-L.)
- Medically At-Risk Driver Centre, University of Alberta, Edmonton, AB T6G 2T4, Canada
| | - Peter George J. Tian
- Division of Care of the Elderly, Department of Family Medicine, University of Alberta, Edmonton, AB T6G 2T4, Canada; (J.P.); (B.D.); (P.G.J.T.); (L.C.); (J.T.); (J.S.-L.)
| | - Lesley Charles
- Division of Care of the Elderly, Department of Family Medicine, University of Alberta, Edmonton, AB T6G 2T4, Canada; (J.P.); (B.D.); (P.G.J.T.); (L.C.); (J.T.); (J.S.-L.)
| | - Jean Triscott
- Division of Care of the Elderly, Department of Family Medicine, University of Alberta, Edmonton, AB T6G 2T4, Canada; (J.P.); (B.D.); (P.G.J.T.); (L.C.); (J.T.); (J.S.-L.)
| | - Jennifer Stickney-Lee
- Division of Care of the Elderly, Department of Family Medicine, University of Alberta, Edmonton, AB T6G 2T4, Canada; (J.P.); (B.D.); (P.G.J.T.); (L.C.); (J.T.); (J.S.-L.)
| | | | - Sandy Sereda
- Caregivers Alberta, Edmonton, AB T5B 1R1, Canada;
| | - Lisa Poole
- Dementia Advocacy Canada, Dementia Network Calgary’s Strategic Council, Gordie Howe C.A.R.E.S. & the Brenda Strafford Foundation Dementia Friendly Communities, Calgary, AB T3B 0K7, Canada;
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19
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Pollock K, Wilson E, Caswell G, Latif A, Caswell A, Avery A, Anderson C, Crosby V, Faull C. Family and health-care professionals managing medicines for patients with serious and terminal illness at home: a qualitative study. HEALTH SERVICES AND DELIVERY RESEARCH 2021. [DOI: 10.3310/hsdr09140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
More effective ways of managing symptoms of chronic and terminal illness enable patients to be cared for, and to die, at home. This requires patients and family caregivers to manage complex medicines regimens, including powerful painkillers that can have serious side effects. Little is known about how patients and family caregivers manage the physical and emotional work of managing medicines in the home or the support that they receive from health-care professionals and services.
Objective
To investigate how patients with serious and terminal illness, their family caregivers and the health-care professionals manage complex medication regimens and routines of care in the domestic setting.
Design
A qualitative study involving (1) semistructured interviews and group discussions with 40 health-care professionals and 21 bereaved family caregivers, (2) 20 patient case studies with up to 4 months’ follow-up and (3) two end-of-project stakeholder workshops.
Setting
This took place in Nottinghamshire and Leicestershire, UK.
Results
As patients’ health deteriorated, family caregivers assumed the role of a care co-ordinator, undertaking the everyday work of organising and collecting prescriptions and storing and administering medicines around other care tasks and daily routines. Participants described the difficulties of navigating a complex and fragmented system and the need to remain vigilant about medicines prescribed, especially when changes were made by different professionals. Access to support, resilience and coping capacity are mediated through the resources available to patients, through the relationships that they have with people in their personal and professional networks, and, beyond that, through the wider connections – or disconnections – that these links have with others. Health-care professionals often lacked understanding of the practical and emotional challenges involved. All participants experienced difficulties in communication and organisation within a health-care system that they felt was complicated and poorly co-ordinated. Having a key health professional to support and guide patients and family caregivers through the system was important to a good experience of care.
Limitations
The study achieved diversity in the recruitment of patients, with different characteristics relating to the type of illness and socioeconomic circumstances. However, recruitment of participants from ethnically diverse and disadvantaged or hard-to-reach populations was particularly challenging, and we were unable to include as many participants from these groups as had been originally planned.
Conclusions
The study identified two key and inter-related areas in which patient and family caregiver experience of managing medicines at home in end-of-life care could be improved: (1) reducing work and responsibility for medicines management and (2) improving co-ordination and communication in health care. It is important to be mindful of the need for transparency and open discussion about the extent to which patients and family caregivers can and should be co-opted as proto-professionals in the technically and emotionally demanding tasks of managing medicines at the end of life.
Future work
Priorities for future research include investigating how allocated key professionals could integrate and co-ordinate care and optimise medicines management; the role of domiciliary home care workers in supporting medicines management in end-of-life care; patient and family perspectives and understanding of anticipatory prescribing and their preferences for involvement in decision-making; the experience of medicines management in terminal illness among minority, disadvantaged and hard-to-reach patient groups; and barriers to and facilitators of increased involvement of community pharmacists in palliative and end-of-life care.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 14. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Kristian Pollock
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Eleanor Wilson
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Glenys Caswell
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Asam Latif
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Alan Caswell
- Patient and Public Involvement Representative, Dementia, Frail Older and Palliative Care Patient and Public Involvement Advisory Group, University of Nottingham, Nottingham, UK
| | - Anthony Avery
- School of Medicine, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Claire Anderson
- School of Pharmacy, University of Nottingham, Nottingham, UK
| | - Vincent Crosby
- Nottingham University Hospitals NHS Trust, Nottingham, UK
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20
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Millward K, McGraw C, Aitken LM. The expressed support needs of families of adults who have survived critical illness: A thematic synthesis. Int J Nurs Stud 2021; 122:104048. [PMID: 34392173 DOI: 10.1016/j.ijnurstu.2021.104048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 07/20/2021] [Accepted: 07/20/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Surviving critical illness can result in ongoing psychological, physical and cognitive impairments for both survivors and families. During the time from the critical illness through to the period of adaptation back to community living, families, alongside survivors, have support needs. OBJECTIVES This systematic review aimed to provide an in-depth insight into the expressed support needs of families of adults who survived an admission to an intensive care unit and returned to a home environment. It also aimed to explore how these needs change over time, and what support provisions families perceived to be helpful. METHODS This was a systematic review using thematic synthesis methodology. Predefined searches were conducted in CINAHL, Medline, PsychINFO, SocIndex, EMbase, Academic Search Complete, EThOS and OpenGrey to locate studies published in English from 2000. Two reviewers screened each study against the inclusion criteria. Quality appraisal was undertaken using Joanna Briggs Institute tools. Extracted data were managed in Nvivo12® and analysed to identify descriptive and analytical themes. The Timing it Right Framework was used to frame changes in need across the recovery continuum. RESULTS Thirty-nine studies were included, 30 qualitative, eight quantitative and one mixed methods. Five key family needs were identified across the recovery continuum: for security; to make sense of the situation; finding a balance; holding everything together; and for trust. DISCUSSION Families found the following interventions helpful: written information; care coordination and navigation; input from intensive care staff after discharge to support continuity; and provision of family support groups. Although there are similarities between the needs of families and survivors, there are sufficient differences to warrant the development of processes to identify and address family need throughout the recovery continuum. CONCLUSION More research is required to develop a tool to better identify the needs of families across the recovery continuum, identify gaps in current service provision, and design interventions to meet these needs. STUDY REGISTRATION CRD42019136883 (PROSPERO).
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Affiliation(s)
- Kat Millward
- School of Health Sciences, City, University of London, 10 Northampton Square, London EC1V 0HB, United Kingdom.
| | - Caroline McGraw
- School of Health Sciences, City, University of London, 10 Northampton Square, London EC1V 0HB, United Kingdom.
| | - Leanne M Aitken
- School of Health Sciences, City, University of London, 10 Northampton Square, London EC1V 0HB, United Kingdom.
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21
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Role of the Infusion Nurse: Caring for the Family/Lay Caregiver of Older Adults. JOURNAL OF INFUSION NURSING 2021; 43:255-261. [PMID: 32881812 DOI: 10.1097/nan.0000000000000384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Approximately 43 500 000 family caregivers provide unpaid care to an adult or child. Most caregivers provide care to older adults, most often parents. Caregivers are often ill-prepared to assist their loved ones, creating or increasing caregiving burden and/or risk of compassion fatigue, potentially leading to critical "caregiving tipping points." Identifying families who are experiencing increased burden or risk of compassion fatigue is a skill that nurses, including infusion nurses, who have unique entrée into the caregiving situation, should develop. The purpose of this article is to describe "impending" tipping points before they occur and to offer solutions for how nurses can help caregiving families identify them and access additional supportive services.
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22
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Bindley K, Lewis J, Travaglia J, DiGiacomo M. Social welfare needs of bereaved Australian carers: Implications of insights from palliative care and welfare workers. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:631-642. [PMID: 33704840 DOI: 10.1111/hsc.13339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 11/09/2020] [Accepted: 02/11/2021] [Indexed: 06/12/2023]
Abstract
An individual and psychological emphasis has influenced practice and research on bereavement following informal care provision in the context of life-limiting illness. Consideration of the potential for bereavement to be shaped by intersecting social and structural inequities is needed; and should include an understanding of interactions with government institutions and social policy. This qualitative study employed interpretive description to explore the way in which palliative care workers and welfare sector workers perceive and approach experiences and needs of bereaved carers receiving government income support or housing assistance in Western Sydney, an area associated with recognised socioeconomic disadvantage. A total of 21 palliative care workers within a public health service and welfare workers from two government social welfare services participated in in-depth interviews. Data were analysed using framework analysis. Participants highlighted social welfare policy and related interactions that may impact bereavement, potentially related to financial, housing and employment precariousness. Personal, interpersonal and structural factors perceived to shape the navigation of welfare needs were explored, alongside needed professional and structural changes envisioned by workers. With limited forms of capital, vulnerably positioned carers may encounter difficulties that heighten their precariousness in bereavement. Transactional organisational cultures alongside health and welfare agencies that function in a siloed manner appear to contribute to structural burden for carers, following death due to life-limiting illness. Palliative care and welfare workers also associated elements of their work with bereaved carers with their own experiences of helplessness, frustration and distress. Findings point to a need for the development of interagency strategies in addition to policy underpinned by more nuanced understandings of vulnerability in bereavement, post-caring.
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Affiliation(s)
- Kristin Bindley
- Faculty of Health, The University of Technology Sydney, Ultimo, NSW, Australia
- Supportive and Palliative Care, Western Sydney Local Health District, Mt Druitt, NSW, Australia
| | - Joanne Lewis
- Faculty of Health, The University of Technology Sydney, Ultimo, NSW, Australia
| | - Joanne Travaglia
- Faculty of Health, The University of Technology Sydney, Ultimo, NSW, Australia
| | - Michelle DiGiacomo
- Faculty of Health, The University of Technology Sydney, Ultimo, NSW, Australia
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Brijnath B, Gilbert AS, Antoniades J, Croy S, Kent M, Ellis K, Browning C, Goeman D, Adams J. Boundary-crossers: How providers facilitate ethnic minority families' access to dementia services. J Gerontol B Psychol Sci Soc Sci 2021; 77:396-406. [PMID: 33914086 DOI: 10.1093/geronb/gbab073] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Providers who work closely with ethnic minority people with dementia and their families are pivotal in helping them access services. However, few studies have examined how these providers actually do this work. Using the concept of 'boundary crossers,' this article investigates the strategies applied by these providers to facilitate access to dementia services for ethnic minority people with dementia and their families. METHODS Between 2017 and 2020, in-depth video-recorded interviews were conducted with 27 health, aged care, and community service providers working with ethnic minority people living with dementia across Australia. Interviews were conducted in language and in English, then translated and transcribed verbatim. The data were analyzed thematically. RESULTS Family and community stigma associated with dementia and extra-familial care were significant barriers to families engaging with services. To overcome these barriers, participants worked at the boundaries of culture and dementia, community and systems, strategically using English and other vernaculars, clinical and cultural terminology, building trust and rapport, and assisting with service navigation to improve access. Concurrently, they were cognizant of familial boundaries and were careful to provide services that were culturally appropriate without supplanting the families' role. CONCLUSIONS In negotiating cultural, social, and professional boundaries, providers undertake multidimensional and complex work that involves education, advocacy, negotiation, navigation, creativity, and emotional engagement. This work is largely under-valued but offers a model of care that facilitates social and community development as well as service integration across health, aged care, and social services.
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Affiliation(s)
- Bianca Brijnath
- National Ageing Research Institute, Australia.,School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Australia.,Department of General Practice, Monash University, Australia
| | - Andrew Simon Gilbert
- National Ageing Research Institute, Australia.,Department of Social Inquiry, La Trobe University, Australia
| | - Josefine Antoniades
- National Ageing Research Institute, Australia.,School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Australia
| | - Samantha Croy
- National Ageing Research Institute, Australia.,Murdoch Children's Research Institute, Australia
| | - Mike Kent
- Centre for Culture and Technology, Curtin University, Australia
| | - Katie Ellis
- Centre for Culture and Technology, Curtin University, Australia
| | - Colette Browning
- School of Nursing and Healthcare Professions, Federation University, Australia.,Research School of Population Health, Australian National University, Australia
| | - Dianne Goeman
- School of Medicine and Public Health, University of Newcastle, Australia.,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
| | - Jon Adams
- School of Public Health, Faculty of Health, University of Technology Sydney, Australia
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Bindley K, Lewis J, Travaglia J, DiGiacomo M. Caring precariously: An interpretive description of palliative care and welfare worker perspectives on end of life carers navigating social welfare. Palliat Med 2021; 35:169-178. [PMID: 33112209 DOI: 10.1177/0269216320966492] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Caring at end-of-life is associated with financial burden, economic disadvantage, and psychosocial sequelae. Health and social welfare systems play a significant role in coordinating practical resources and support in this context. However, little is known about social policy and interactions with public institutions that shape experiences of informal carers with social welfare needs at end-of-life. AIM To explore ways in which palliative care and welfare sector workers perceive and approach experiences and needs of the carers of people with life-limiting illnesses who receive government income support or housing assistance, in an area of recognised socioeconomic disadvantage. DESIGN An interpretive descriptive study employed in-depth, qualitative interviews to explore participants' reflections on working with carers of someone with a life-limiting illness. Data were analysed using the framework approach. SETTING/PARTICIPANTS Twenty-one workers employed within three public services in Western Sydney were recruited. RESULTS Workers articulated understandings of welfare policy and its consequences for carers at end-of-life, including precariousness in relation to financial and housing circumstances. Identified resources and barriers to the navigation of social welfare needs by carers were categorised as personal, interpersonal and structural. CONCLUSIONS Caring at end-of-life while navigating welfare needs was seen to be associated with precariousness by participants, particularly for carers positioned in vulnerable social locations. Findings highlighted experiences of burdensome system navigation, inconsistent processes and inequity. Further exploration of structural determinants of experience is needed, including aspects of palliative care and welfare practice and investment in inter-agency infrastructure for supporting carers at end-of-life.
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Affiliation(s)
- Kristin Bindley
- Faculty of Health, The University of Technology Sydney, Ultimo, NSW, Australia.,Supportive and Palliative Care, Western Sydney Local Health District, Mt Druitt, NSW, Australia
| | - Joanne Lewis
- Faculty of Health, The University of Technology Sydney, Ultimo, NSW, Australia
| | - Joanne Travaglia
- Faculty of Health, The University of Technology Sydney, Ultimo, NSW, Australia
| | - Michelle DiGiacomo
- Faculty of Health, The University of Technology Sydney, Ultimo, NSW, Australia
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Brijnath B, Gilbert AS, Kent M, Ellis K, Browning C, Goeman D, Adams J, Antoniades J. Beyond crisis: Enacted sense-making among ethnic minority carers of people with dementia in Australia. DEMENTIA 2020; 20:1910-1924. [DOI: 10.1177/1471301220975641] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The ‘family crisis’ narrative is frequently used in dementia studies to explain ethnic minority families’ pathways to health and aged care and why there is delayed dementia diagnoses in ethnic minority communities. Such narratives may obscure the family carers’ agency in negotiating services and managing personal, social and structural burdens in the lead up to diagnosis. To illuminate agency, this article describes ethnic minority families’ pathways to a dementia diagnosis using the concept of sense-making. Three case studies were drawn from 56 video interviews with family carers of older adults with dementia from Chinese, Arab and Indian backgrounds. Interviews were conducted across Australia from February to August 2018, then translated, transcribed and thematically analysed. Findings suggest families did not enter into formal care because of a crisis, instead navigating fragmented systems and conflicting advice to obtain a dementia diagnosis and access to relevant care. This experience was driven by sense-making (a search for plausible explanations) that involved family carers interpreting discrepant cues in changes to the behaviour of the person with dementia over time, managing conflicting (medical) advice about these discrepancies and reinterpreting their relationships with hindsight. The sense-making concept offers a more constructive hermeneutic than the ‘family crisis’ narrative as it illuminates the agency of carers’ in understanding changed behaviours, negotiating services and managing personal, social and structural barriers pre-diagnosis. The concept also demonstrates the need for a multimodal approach to promoting timely diagnosis of dementia in ethnic minority communities through dementia awareness and literacy campaigns as well as initiatives that address structural inequities.
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Affiliation(s)
- Bianca Brijnath
- National Ageing Research Institute, Australia; School of Occupational Therapy and Social Work, Curtin University, Australia; Department of General Practice, Monash University, Australia
| | - Andrew Simon Gilbert
- National Ageing Research Institute, Australia; Department of Social Inquiry, La Trobe University, Australia
| | - Mike Kent
- Centre for Culture and Technology, Curtin University, Australia
| | - Katie Ellis
- Centre for Culture and Technology, Curtin University, Australia
| | - Colette Browning
- School of Nursing and Healthcare Professions, Federation University, Australia; Centre for Research on Ageing, Health and Wellbeing, Australian National University, Australia
| | - Dianne Goeman
- School of Medicine and Public Health, University of Newcastle, Australia; Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
| | - Jon Adams
- Discipline of Public Health, Faculty of Health, University of Technology Sydney, Australia
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Wyman MF, Liebzeit D, Voils CI, Bowers BJ, Chapman EN, Gilmore-Bykovskyi A, Kennelty KA, Kind AJH, Loosen J, Rogus-Pulia N, Dattalo M. "Hopes and wishes": Goals of high-need, high-cost older patients and their caregivers. PATIENT EDUCATION AND COUNSELING 2020; 103:1428-1434. [PMID: 32098745 PMCID: PMC7286795 DOI: 10.1016/j.pec.2020.02.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 01/20/2020] [Accepted: 02/14/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Integration of patient-identified goals is a critical element of shared decision-making and patient-provider communication. There is limited information on the goals of patients with multiple medical conditions and high healthcare utilization. We aimed to identify and categorize the goals described by "high-need, high-cost" (HNHC) older patients and their caregivers. METHODS Using conventional content analysis, we used data from interviews conducted with 17 HNHC older patients (mean age 72.5 years) and 4 caregivers. RESULTS HNHC older patients and their caregivers used language such as "hopes, wishes, and wants" to describe their goals, which fell into eight categories: alleviating discomfort, having autonomy and control, decreasing treatment burden, maintaining physical functioning and engagement, leaving a legacy, extending life, having satisfying and effective relationships, and experiencing security. CONCLUSION Our results contribute to knowledge of goals of HNHC patients and provides guidance for improving the patient-provider relationship and communication between HNHC older patients and their healthcare providers. PRACTICE IMPLICATIONS Our findings can inform provider efforts to assess patient goals and engage high-need, high-cost older patients in shared decision-making. Further, this study contributes to an improved understanding of HNHC older patients to support continued development of effective care models for this population.
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Affiliation(s)
- Mary F Wyman
- Geriatrics Research, Education and Clinical Center (GRECC), W.S. Middleton Memorial Veterans Hospital, Madison, WI, USA; University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
| | - Daniel Liebzeit
- Geriatrics Research, Education and Clinical Center (GRECC), W.S. Middleton Memorial Veterans Hospital, Madison, WI, USA; School of Nursing, University of Wisconsin, Madison, WI, USA.
| | - Corrine I Voils
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Research Service, W.S. Middleton Memorial Veterans Hospital, Madison, WI, USA.
| | | | - Elizabeth N Chapman
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Geriatrics Research, Education and Clinical Center (GRECC), W.S. Middleton Memorial Veterans Hospital, Madison, WI, USA.
| | - Andrea Gilmore-Bykovskyi
- School of Nursing, University of Wisconsin, Madison, WI, USA; University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Geriatrics Research, Education and Clinical Center (GRECC), W.S. Middleton Memorial Veterans Hospital, Madison, WI, USA.
| | - Korey A Kennelty
- Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
| | - Amy J H Kind
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Geriatrics Research, Education and Clinical Center (GRECC), W.S. Middleton Memorial Veterans Hospital, Madison, WI, USA; Health Services and Care Research Program, Department of Medicine, University of Wisconsin, Madison, WI, USA.
| | - Julia Loosen
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
| | - Nicole Rogus-Pulia
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Geriatrics Research, Education and Clinical Center (GRECC), W.S. Middleton Memorial Veterans Hospital, Madison, WI, USA.
| | - Melissa Dattalo
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Geriatrics Research, Education and Clinical Center (GRECC), W.S. Middleton Memorial Veterans Hospital, Madison, WI, USA.
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Abstract
Development is a cumulative, lifelong process, but strikingly little is known about development in midlife. As a consequence, many misconceptions exist about the nature of midlife and the developmental milestones and challenges faced by middle-aged adults. We first review dominant views and empirical research that has debunked false narratives. Next, we discuss major opportunities and challenges of midlife. This includes the unique constellation of roles and life transitions that are distinct from earlier and later life phases as well as shifting trends in mental and physical health and in family composition. We additionally highlight the importance of (historical shifts in) intergenerational dynamics of middle-aged adults with their aging parents, adult children, and grandchildren; financial vulnerabilities that emerge and often accrue from economic failures and labor market volatility; the shrinking social and health care safety net; and the rising costs of raising children. In doing so, we discuss issues of diversity and note similarities and differences in midlife experiences across race or ethnicity, sexual orientation, and socioeconomic status. We consider midlife as a pivotal period that includes a focus on balancing gains and losses, linking earlier and later life periods, and bridging generations. Finally, we propose possibilities for promoting reversibility and resilience with interventions and policy changes. The suggested agenda for future research promises to reconceptualize midlife as a key period of life, with a concerted effort to focus on the diversity of midlife experiences in order to meet the unprecedented challenges and opportunities in the 2020s and beyond. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | - Denis Gerstorf
- Department of Psychology, Humboldt University Berlin, Germany
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28
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Funk LM, Stajduhar KI, Giesbrecht M, Cloutier D, Williams A, Wolse F. Applying the concept of structural empowerment to interactions between families and home-care nurses. Nurs Inq 2019; 27:e12313. [PMID: 31336409 DOI: 10.1111/nin.12313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 06/19/2019] [Accepted: 06/22/2019] [Indexed: 11/28/2022]
Abstract
Interpretations of family carer empowerment in much nursing research, and in home-care practice and policy, rarely attend explicitly to families' choice or control about the nature, extent or length of their involvement, or control over the impact on their own health. In this article, structural empowerment is used as an analytic lens to examine home-care nurses' interactions with families in one Western Canadian region. Data were collected from 75 hrs of fieldwork in 59 interactions (18 nurses visiting 16 families) and interviews with 12 nurses and 11 family carers. Generally, nurses prioritized client empowerment, and their practice with families appeared oriented to supporting their role and needs as carers (i.e. rather than as unique individuals beyond the caring role), and reinforcing the caring role through validation and recognition. Although families generally expressed appreciation for these interactions, a structural empowerment lens illustrates how the broad context of home care shapes the interpretation and practice of empowerment in ways that can, paradoxically, be disempowering for families. Opportunities to effectively support family choice and control when a client is being cared for at home are discussed.
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Affiliation(s)
- Laura M Funk
- Department of Sociology and Criminology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kelli I Stajduhar
- School of Nursing, University of Victoria, Victoria, British Columbia, Canada.,Institute on Aging and Lifelong Health, University of Victoria, Victoria, British Columbia, Canada
| | - Melissa Giesbrecht
- Institute on Aging and Lifelong Health, University of Victoria, Victoria, British Columbia, Canada
| | - Denise Cloutier
- Institute on Aging and Lifelong Health, University of Victoria, Victoria, British Columbia, Canada.,Department of Geography, University of Victoria, Victoria, British Columbia, Canada
| | - Allison Williams
- School of Geography and Earth Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Faye Wolse
- Institute on Aging and Lifelong Health, University of Victoria, Victoria, British Columbia, Canada
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Meyer K, Gassoumis ZD, Kelly K, Benton D. What Are the Characteristics of Caregivers Logging in for Support Services? Innov Aging 2019; 3:igz006. [PMID: 30949590 PMCID: PMC6441129 DOI: 10.1093/geroni/igz006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Indexed: 11/14/2022] Open
Abstract
Background and Objectives Online service delivery options have the potential to increase access to informational resources among caregivers to older adults. However, it is unknown which caregivers will use online-delivered services over usual service delivery modes (e.g., by phone) when both options are available in social service settings. This is important for service providers to know when making decisions that best serve their communities. Research Design and Methods Guided by Andersen's model of health service utilization, we used step-wise logistic regression models to compare the characteristics of caregivers who used an online information service called FCA CareJourney (FCA CJ) with those who accessed the same services using the usual mode of service delivery (N = 540). Online and usual-care services were available through two social service organizations in California. Results In all, 13.7% of clients used FCA CJ to receive services online. Enabling characteristics were the main predictors of using online-delivered services. Caregivers employed part-time had 3.82 times the odds of using online-delivered services compared to those employed full-time (odds ratio [OR] = 3.82; 95% confidence interval [CI]: 1.58-9.22). Caregivers who learned about services from health care providers had 2.91 times the odds of using FCA CJ as those who learned about services through social services (OR = 2.91; 95% CI: 1.28-6.62). Even among those who learned about services online, 62.2% still accessed services using usual delivery modes. Discussion and Implications Based on differences in the characteristics of caregivers using different service delivery modes and the low uptake of online-delivered services, we suggest online service delivery should supplement, not replace, usual delivery modes in social service settings. At the same time, user rates of online service delivery are likely modifiable. Given the potential for online-delivered programming to expand access to information services for caregivers, we recommend further examination into the effects of marketing online service delivery options to caregivers in novel ways.
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Affiliation(s)
- Kylie Meyer
- School of Nursing, University of Texas Health Science Center at San Antonio
| | - Zachary D Gassoumis
- University of Southern California Leonard Davis School of Gerontology, Los Angeles, California
| | | | - Donna Benton
- University of Southern California Leonard Davis School of Gerontology, Los Angeles, California
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