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Handley M, Wheeler C, Duddy C, Wong G, Birt L, Fox C, Moniz-Cook E, Hackmann C, Teague B, West J. Operationalising the Recovery College model with people living with dementia: a realist review. Aging Ment Health 2024; 28:1078-1089. [PMID: 38850259 PMCID: PMC11262432 DOI: 10.1080/13607863.2024.2356878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 05/13/2024] [Indexed: 06/10/2024]
Abstract
OBJECTIVES Post-diagnostic support is a significant factor in facilitating personal recovery following a diagnosis of dementia, but access is often inconsistent and insufficient. Recovery Colleges offer peer-led, co-produced courses that can support people to have meaningful lives and have been adapted for use in the context of dementia. A realist review was conducted to understand the application and sustainability of Recovery College dementia courses. METHOD An iterative, five-step process combined literature published to 2023 with knowledge from stakeholders with lived and professional experience of dementia involved with Recovery College dementia courses (PROSPERO registration CRD42021293687). RESULTS Thirty-five documents and discussions with 19 stakeholders were used to build the initial programme theory comprising of 24 context-mechanism-outcome configurations. Reoccurring factors included: attending to aspects of co-production and course delivery to ensure they promoted inclusion and were not compromised by organisational pressures; how stigma impacted access to course opportunities; and embedding personal recovery principles throughout course development to be relevant for people living with dementia and those who support them. CONCLUSION People struggling to reconcile their future alongside dementia need practical and emotional support to access and benefit from Recovery College dementia courses, ways to achieve this will be explored through a realist evaluation.
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Affiliation(s)
- Melanie Handley
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK
| | - Charlotte Wheeler
- Research and Development, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Claire Duddy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Linda Birt
- School of Health Science University of East Anglia, Norwich, UK
- School of Healthcare, University of Leicester, Leicester, UK
| | - Chris Fox
- Medical School, University of Exeter, Exeter, UK
| | | | - Corinna Hackmann
- Research and Development, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
- Norwich Medical School, The University of East Anglia, Norwich, UK
| | - Bonnie Teague
- Research and Development, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
- Norwich Medical School, The University of East Anglia, Norwich, UK
| | - Juniper West
- Research and Development, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
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Lou Y, Vu T, Piechota A, Monin JK. Emotion regulation in people living with dementia and their spouses: the role of neuropsychiatric symptoms. Aging Ment Health 2024:1-8. [PMID: 38940472 DOI: 10.1080/13607863.2024.2367038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 06/06/2024] [Indexed: 06/29/2024]
Abstract
OBJECTIVES People with dementia (PwD) and their care partners (CP) may have difficulties in emotion regulation, and individual differences in emotion regulation may be related to PwD's neuropsychiatric symptoms. This study explores whether there is self-awareness of PwD's difficulties in emotion regulation and whether CP's emotion regulation relates to the PwD's neuropsychiatric symptoms, potentially revealing bias or interpersonal effects. METHOD We used data from the Wish Outcome Obstacle Plan Study with a sample of 45 PwD and their spousal CP (n = 90 individuals). Multivariate linear regression models were used to investigate the associations between the CP-reported neuropsychiatric symptoms in PwD and self-reports of emotion regulation in both dyad members, net of sociodemographic and health factors. Separate analyses were conducted for each neuropsychiatric subsyndrome and each domain of difficulties in emotion regulation. RESULTS Increasing severity of neuropsychiatric symptoms was associated with higher difficulties in emotion regulation in PwD (ß = 1.23, p < 0.05), but not with CP's difficulties in emotion regulation. When CP reported more severe neuropsychiatric symptoms in PwD, PwD reported that they had difficulties in accepting emotions, controlling impulses, goal-directed behaviors, and accessing emotion regulation strategies, but not in emotion awareness and clarification. Proxy-reports of hyperactivity and psychosis subsyndromes are significantly related to PwD's self-reported difficulties in emotion regulation. CONCLUSION PwD reported difficulties in emotion regulation at the early stage of dementia. Proxy-reported neuropsychiatric symptoms may capture PwD's emotion regulation capability and not be biased by CP's difficulties in emotion regulation.
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Affiliation(s)
- Yifan Lou
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Thi Vu
- Yale School of Public Health, New Haven, CT, USA
| | - Amanda Piechota
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
| | - Joan K Monin
- Yale School of Public Health, New Haven, CT, USA
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Martyr A, Gamble LD, Hunt A, Quinn C, Morris RG, Henderson C, Allan L, Opdebeeck C, Charlwood C, Jones RW, Pentecost C, Kopelman MD, Thom JM, Matthews FE, Clare L. Differences in trajectories of quality of life according to type of dementia: 6-year longitudinal findings from the IDEAL programme. BMC Med 2024; 22:265. [PMID: 38915081 PMCID: PMC11197262 DOI: 10.1186/s12916-024-03492-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 06/17/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND People with different types of dementia may have distinct symptoms and experiences that affect their quality of life. This study investigated whether quality of life varied across types of dementia and over time. METHODS The participants were 1555 people with mild-to-moderate dementia and 1327 carers from the IDEAL longitudinal cohort study, recruited from clinical services. As many as possible were followed for up to 6 years. Diagnoses included were Alzheimer's disease, vascular dementia, mixed Alzheimer's and vascular dementia, Parkinson's disease dementia, dementia with Lewy bodies, and frontotemporal dementia. Self- and informant-rated versions of the Quality of Life in Alzheimer's Disease scale were used. A joint model, incorporating a mixed effects model with random effects and a survival model to account for dropout, was used to examine whether quality of life varied by dementia type at the time of diagnosis and how trajectories changed over time. RESULTS The strongest associations between dementia type and quality of life were seen around the time of diagnosis. For both self-ratings and informant ratings, people with Parkinson's disease dementia or dementia with Lewy bodies had lower quality of life scores. Over time there was little change in self-rated scores across all dementia types (- 0.15 points per year). Informant-rated scores declined over time (- 1.63 points per year), with the greatest decline seen in ratings by informants for people with dementia with Lewy bodies (- 2.18 points per year). CONCLUSIONS Self-rated quality of life scores were relatively stable over time whilst informant ratings showed a steeper decline. People with Parkinson's disease dementia or dementia with Lewy bodies report particularly low levels of quality of life, indicating the importance of greater attention to the needs of these groups.
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Affiliation(s)
- Anthony Martyr
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
| | - Laura D Gamble
- Population Health Sciences Institute, Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle Upon Tyne, UK.
| | - Anna Hunt
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
| | - Catherine Quinn
- Centre for Applied Dementia Studies, Bradford University, Bradford, UK
- Wolfson Centre for Applied Health Research, Bradford, UK
| | - Robin G Morris
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Catherine Henderson
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Louise Allan
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
- NIHR Applied Research Collaboration South-West Peninsula, Exeter, UK
| | - Carol Opdebeeck
- Department of Psychology, Manchester Metropolitan University, Manchester, UK
| | - Catherine Charlwood
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
- NIHR Applied Research Collaboration South-West Peninsula, Exeter, UK
| | - Roy W Jones
- Research Institute for the Care of Older People (RICE), Bath, UK
| | - Claire Pentecost
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
| | - Michael D Kopelman
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jeanette M Thom
- School of Health Sciences, The University of Sydney, Sydney, Australia
| | - Fiona E Matthews
- Population Health Sciences Institute, Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle Upon Tyne, UK
- Institute for Clinical and Applied Health Research, Hull York Medical School, University of Hull, Hull, UK
| | - Linda Clare
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
- NIHR Applied Research Collaboration South-West Peninsula, Exeter, UK
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Clare L, Gamble LD, Martyr A, Henderson C, Knapp M, Matthews FE. Living Alone With Mild-to-Moderate Dementia Over a Two-Year Period: Longitudinal Findings From the IDEAL Cohort. Am J Geriatr Psychiatry 2024:S1064-7481(24)00352-X. [PMID: 38897833 DOI: 10.1016/j.jagp.2024.05.012] [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] [Received: 10/03/2023] [Revised: 05/15/2024] [Accepted: 05/29/2024] [Indexed: 06/21/2024]
Abstract
OBJECTIVES To compare the experiences of people with dementia living alone or with others and how these may change over two years. DESIGN We analysed longitudinal data from three assessment waves, one year apart, in the British IDEAL cohort. SETTING Participants with mild-to-moderate dementia were recruited through National Health Service providers, where possible with a family caregiver, and interviewed at home. PARTICIPANTS The current analyses include 281 people with dementia living alone and 1,244 living with others at baseline; follow-up data were available for 200 and 965 respectively at time 2 and 144 and 696 respectively at time 3. For those living alone, 140 nonresident caregivers contributed at baseline, 102 at time 2 and 81 at time 3. For those living with others, 1,127 family caregivers contributed at baseline, 876 at time 2 and 670 at time 3. MEASUREMENTS Assessments covered: cognitive and functional ability; self-reported perceptions of health, mood, social engagement, quality of life, satisfaction with life and well-being; use of in-home and community care; and transitions into residential care. RESULTS People living alone tended to have better cognitive and functional ability and were more frequent users of in-home care. However, they experienced poorer physical, social, and psychological health and reduced quality of life, satisfaction with life, and well-being. These differences persisted over time and rates of transition into residential care were higher. CONCLUSIONS To facilitate continuing in place for people with dementia living alone, a dual focus on supporting functional ability and addressing psychosocial needs is essential in the context of an enabling policy framework.
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Affiliation(s)
- Linda Clare
- University of Exeter Medical School, University of Exeter, (L.C, A.M), Exeter, UK; NIHR Applied Research Collaboration South-West Peninsula, (L.C), Exeter, UK.
| | - Laura D Gamble
- Population Health Sciences Institute, Newcastle University, (L.D.G, F.E.M) Newcastle, UK
| | - Anthony Martyr
- University of Exeter Medical School, University of Exeter, (L.C, A.M), Exeter, UK
| | - Catherine Henderson
- Care Policy and Evaluation Centre, London School of Economics and Political Science, (C.H, M.K), London, UK
| | - Martin Knapp
- Care Policy and Evaluation Centre, London School of Economics and Political Science, (C.H, M.K), London, UK
| | - Fiona E Matthews
- Population Health Sciences Institute, Newcastle University, (L.D.G, F.E.M) Newcastle, UK; Institute for Clinical and Applied Health Research, Hull York Medical School, (F.E.M), University of Hull, Hull, UK
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Rippon I, Victor CR, Martyr A, Matthews FE, Quinn C, Rusted JM, Jones RW, Collins R, van Horik J, Pentecost C, Allan L, Clare L. Dyadic perspectives on loneliness and social isolation among people with dementia and spousal carers: findings from the IDEAL programme. Aging Ment Health 2024; 28:891-899. [PMID: 38079334 DOI: 10.1080/13607863.2023.2286618] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 11/03/2023] [Indexed: 06/04/2024]
Abstract
OBJECTIVES This study aims to investigate the impact of self and partner experiences of loneliness and social isolation on life satisfaction in people with dementia and their spousal carers. METHODS We used data from 1042 dementia caregiving dyads in the Improving the experience of Dementia and Enhancing Active Life (IDEAL) programme cohort. Loneliness was measured using the six-item De Jong Gierveld loneliness scale and social isolation using the six-item Lubben Social Network Scale. Data were analysed using the Actor-Partner Interdependence Model framework. RESULTS Self-rated loneliness was associated with poorer life satisfaction for both people with dementia and carers. The initial partner effects observed between the loneliness of the carer and the life satisfaction of the person with dementia and between social isolation reported by the person with dementia and life satisfaction of the carer were reduced to nonsignificance once the quality of the relationship between them was considered. DISCUSSION Experiencing greater loneliness and social isolation is linked with reduced life satisfaction for people with dementia and carers. However, having a positive view of the quality of the relationship between them reduced the impact of loneliness and social isolation on life satisfaction. Findings suggest the need to consider the experiences of both the person with dementia and the carer when investigating the impact of loneliness and social isolation. Individual interventions to mitigate loneliness or isolation may enhance life satisfaction for both partners and not simply the intervention recipient.
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Affiliation(s)
- Isla Rippon
- Department of Health Sciences, College of Medicine, Health and Life Sciences, Brunel University London, Uxbridge, UK
| | - Christina R Victor
- Department of Health Sciences, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, UK
| | - Anthony Martyr
- REACH: The Centre for Research in Ageing and Cognitive Health, Faculty of Health and Life Sciences University of Exeter Medical School, Exeter, UK, Exeter, UK
| | - Fiona E Matthews
- Department of Health Sciences, College of Medicine, Health and Life Sciences, Brunel University London, Uxbridge, UK
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
| | - Catherine Quinn
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
- Wolfson Centre for Applied Health Research, Bradford, UK
| | | | - Roy W Jones
- RICE - The Research Institute for the Care of Older People, Royal United Hospitals, Bath, UK
| | - Rachel Collins
- REACH: The Centre for Research in Ageing and Cognitive Health, Faculty of Health and Life Sciences University of Exeter Medical School, Exeter, UK, Exeter, UK
| | - Jayden van Horik
- REACH: The Centre for Research in Ageing and Cognitive Health, Faculty of Health and Life Sciences University of Exeter Medical School, Exeter, UK, Exeter, UK
- Exeter Clinical Trials Unit, University of Exeter Medical School, Exeter, UK
| | - Claire Pentecost
- REACH: The Centre for Research in Ageing and Cognitive Health, Faculty of Health and Life Sciences University of Exeter Medical School, Exeter, UK, Exeter, UK
| | - Louise Allan
- REACH: The Centre for Research in Ageing and Cognitive Health, Faculty of Health and Life Sciences University of Exeter Medical School, Exeter, UK, Exeter, UK
- NIHR Applied Research Collaboration South-West Peninsula, Exeter, UK
| | - Linda Clare
- REACH: The Centre for Research in Ageing and Cognitive Health, Faculty of Health and Life Sciences University of Exeter Medical School, Exeter, UK, Exeter, UK
- NIHR Applied Research Collaboration South-West Peninsula, Exeter, UK
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Hevink M, Linden I, de Vugt M, Brodaty H, Low LF, Phillipson L, Jeon YH, Gresham M, Doucet S, Luke A, Vedel I, McAiney C, Szcześniak D, Błaszkiewicz M, Rymaszewska J, Verhey F, Wolfs C. Moving forward with dementia: an explorative cross-country qualitative study into post-diagnostic experiences. Aging Ment Health 2024:1-10. [PMID: 38656033 DOI: 10.1080/13607863.2024.2342968] [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] [Received: 11/03/2023] [Accepted: 04/08/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVES This explorative cross-country qualitative study aims to describe experiences of receiving a dementia diagnosis and experiences of support following a diagnosis in Australia, Canada, the Netherlands and Poland. METHOD Qualitative study using projective techniques during online focus groups, online and telephone interviews with people with dementia and caregivers. RESULTS Twenty-three people with dementia and 53 caregivers participated. Qualitative content analysis revealed five themes; (1) 'Coming to terms with dementia' helped people deal with complex emotions to move forward. (3) 'The social network as a source of support' and (4) 'The challenges and realities of formal support' and impacted 'Coming to terms with dementia'. (2) 'Navigating life with dementia as a caregiver' highlights caregiver burden and was impacted by (4) 'The challenges and realities of formal support'. People were (5) 'Self-caring and preparing for tomorrow' as they focused on maintaining current health whilst planning the future. Despite differences in healthcare and post-diagnostic support systems, there were more similarities across countries than differences. CONCLUSION Across countries, formal support and support from friends and family are crucial for people with dementia and caregivers to come to terms with dementia and maintain carer wellbeing to ultimately live well with dementia.
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Affiliation(s)
- Maud Hevink
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands
| | - Iris Linden
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands
| | - Marjolein de Vugt
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands
| | - Henry Brodaty
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
| | - Lee-Fay Low
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Lyn Phillipson
- School of Health and Society, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia
| | - Yun-Hee Jeon
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Meredith Gresham
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
| | - Shelly Doucet
- Department of Nursing and Health Sciences, The Centre for Research in Integrated Care, University of New Brunswick, Saint John, Canada
| | - Alison Luke
- Department of Nursing and Health Sciences, The Centre for Research in Integrated Care, University of New Brunswick, Saint John, Canada
| | - Isabelle Vedel
- Department of Family Medicine, McGill University, Lady Davis Institute, Jewish General Hospital, Montreal, Canada
| | - Carrie McAiney
- School of Public Health Sciences, University of Waterloo and Schlegel-UW Research Institute for Aging, Waterloo, Canada
| | - Dorota Szcześniak
- Department of Psychiatry, Wroclaw Medical University, Wrocław, Poland
| | | | | | - Frans Verhey
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands
| | - Claire Wolfs
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands
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Sabatini S, Martyr A, Hunt A, Gamble LD, Matthews FE, Thom JM, Jones RW, Allan L, Knapp M, Quinn C, Victor C, Pentecost C, Rusted JM, Morris RG, Clare L. Health conditions in spousal caregivers of people with dementia and their relationships with stress, caregiving experiences, and social networks: longitudinal findings from the IDEAL programme. BMC Geriatr 2024; 24:171. [PMID: 38373905 PMCID: PMC10875834 DOI: 10.1186/s12877-024-04707-w] [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: 07/30/2023] [Accepted: 01/13/2024] [Indexed: 02/21/2024] Open
Abstract
OBJECTIVES Longitudinal evidence documenting health conditions in spousal caregivers of people with dementia and whether these influence caregivers' outcomes is scarce. This study explores type and number of health conditions over two years in caregivers of people with dementia and subgroups based on age, sex, education, hours of care, informant-rated functional ability, neuropsychiatric symptoms, cognition of the person with dementia, and length of diagnosis in the person with dementia. It also explores whether over time the number of health conditions is associated with caregivers' stress, positive experiences of caregiving, and social networks METHODS: Longitudinal data from the IDEAL (Improving the experience of Dementia and Enhancing Active Life) cohort were used. Participants comprised spousal caregivers (n = 977) of people with dementia. Self-reported health conditions using the Charlson Comorbidity Index, stress, positive experiences of caregiving, and social network were assessed over two years. Mixed effect models were used RESULTS: On average participants had 1.5 health conditions at baseline; increasing to 2.1 conditions over two years. More health conditions were reported by caregivers who were older, had no formal education, provided 10 + hours of care per day, and/or cared for a person with more neuropsychiatric symptoms at baseline. More baseline health conditions were associated with greater stress at baseline but not with stress over time. Over two years, when caregivers' health conditions increased, their stress increased whereas their social network diminished DISCUSSION: Findings highlight that most caregivers have their own health problems which require management to avoid increased stress and shrinking of social networks.
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Affiliation(s)
- Serena Sabatini
- Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Anthony Martyr
- University of Exeter Medical School, University of Exeter, Exeter, UK.
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK.
| | - Anna Hunt
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Laura D Gamble
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Fiona E Matthews
- Institute for Clinical and Applied Health Research, Hull York Medical School, University of Hull, Hull, UK
| | - Jeanette M Thom
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Roy W Jones
- Research Institute for the Care of Older People (RICE), Bath, UK
| | - Louise Allan
- University of Exeter Medical School, University of Exeter, Exeter, UK
- NIHR Applied Research Collaboration South-West Peninsula, Exeter, UK
| | - Martin Knapp
- London School of Economics and Political Science, London, UK
| | - Catherine Quinn
- Centre for Applied Dementia Studies, Bradford University, Bradford, UK
- Wolfson Centre for Applied Health Research, Bradford, UK
| | - Christina Victor
- College of Health, Medicine and Life Sciences, Department of Health Sciences, Brunel University London, London, UK
| | - Claire Pentecost
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | | | - Robin G Morris
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Linda Clare
- University of Exeter Medical School, University of Exeter, Exeter, UK
- NIHR Applied Research Collaboration South-West Peninsula, Exeter, UK
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Bowness B, Henderson C, Akhter Khan SC, Akiba M, Lawrence V. Participatory research with carers: A systematic review and narrative synthesis. Health Expect 2024; 27:e13940. [PMID: 39102730 PMCID: PMC10734554 DOI: 10.1111/hex.13940] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 11/14/2023] [Accepted: 12/05/2023] [Indexed: 08/07/2024] Open
Abstract
INTRODUCTION As patient and public involvement (PPI) in research has become increasingly common, research-based recommendations on its principles and impacts have been established. The specifics of conducting PPI are likely to differ when involving different groups. Family/informal carers for those with health conditions or disabilities have a lot to contribute to research, but instances of their involvement have yet to be reviewed. OBJECTIVE To systematically review and synthesize studies where family/informal carers have been involved in the research process, to develop an understanding of the benefits, barriers and facilitating factors. METHODS A search of five electronic databases was conducted using a combination of terms relating to carers, involvement and research. A grey literature search, expert consultation and hand-searching were also used. Following screening, data extraction and quality assessment, a narrative synthesis incorporating thematic analysis was conducted. FINDINGS A total of 55 studies met the inclusion criteria, with diverse design and participatory approaches. Four themes were identified, relating to the outcomes, challenges, and practicalities of involving carers: (re) building relationships with carers; carers as equals not afterthoughts; carers have unique experiences; carers create change. Full involvement throughout the research was not always possible, due to barriers from the research world and responsibilities of the caring role. The literature demonstrated ways for carers to contribute in ways that suited them, maximizing their impact, while attending to relationships and power imbalances. CONCLUSION By summarizing the reported instances of carer involvement in research, this review brings together different examples of how successful research partnerships can be built with carers, despite various challenges. Carers are a heterogeneous group, and participatory approaches should be tailored to specific situations. Wider understanding of the challenges of conducting empowering research with carers, and the resources required to address these, are needed. PATIENT AND PUBLIC INVOLVEMENT The initial findings and themes were presented to a group of carers who had been involved in research and whose reflections informed the final synthesis.
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Affiliation(s)
- Bryher Bowness
- King's College London, Institute of PsychiatryPsychology and NeuroscienceLondonUK
| | - Claire Henderson
- King's College London, Institute of PsychiatryPsychology and NeuroscienceLondonUK
| | | | - Mia Akiba
- King's College London, Institute of PsychiatryPsychology and NeuroscienceLondonUK
| | - Vanessa Lawrence
- King's College London, Institute of PsychiatryPsychology and NeuroscienceLondonUK
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Collins R, Martyr A, Hunt A, Quinn C, Pentecost C, Hughes JC, Clare L. Methods and approaches to facilitate inclusion of the views, perspectives and preferences of people with moderate-to-severe dementia in research: A narrative systematic review. Int J Older People Nurs 2024; 19:e12594. [PMID: 38084053 DOI: 10.1111/opn.12594] [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: 02/14/2023] [Revised: 08/17/2023] [Accepted: 11/27/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND The perspectives of people with moderate-to-severe dementia are rarely directly elicited in research studies. OBJECTIVES This systematic review will explore methods and approaches for including the perspectives and preferences of people with moderate-to-severe dementia in research. METHODS AgeLine, CINAHL, Embase, PsycINFO, PubMed, Social Policy and Practice and Web of Science were searched until June 16 2022. Study quality was assessed using the 16-item Quality Assessment Tool. We described specific communication tools, reviewed the evidence for their effectiveness and considered their strengths and limitations. We examined the more general communication skills and techniques applied to support the use of these tools using thematic synthesis. The review protocol was registered with PROSPERO CRD42019130386 and the review was conducted and reported according to PRISMA guidelines. RESULTS Seven studies reported in 11 publications were included. In these studies five specific communication tools were used: Talking Mats, Augmentative and Alternative Communication Flexiboard, generic photographs in combination with a preference placement board, consultation ballot and personalised communication prescriptions. Each tool identified had advantages and disadvantages depending on dementia severity, verbal or physical ability, expense, researcher training requirements and ease of use. Thematic synthesis identified five general approaches to optimising communication that were employed to support use of the tools: ensuring conversations are individual and person-centred, managing external influences, engaging others, creating structure and facilitation skills. CONCLUSION All tools had some utility and there was no clear evidence to support the recommendation of any one specific tool; therefore, researchers are advised to select the tool most appropriate to their context. IMPLICATIONS FOR PRACTICE The findings offer general guidance for researchers and practitioners on how to facilitate communication with people with moderate-to-severe dementia.
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Affiliation(s)
- Rachel Collins
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
| | - Anthony Martyr
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
| | - Anna Hunt
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
| | - Catherine Quinn
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
- Wolfson Centre for Applied Health Research, Bradford, UK
| | - Claire Pentecost
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
| | - Julian C Hughes
- Population Health Science Institute, Bristol Medical School, University of Bristol, Bristol, UK
| | - Linda Clare
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
- NIHR Applied Research Collaboration South West Peninsula, Exeter, UK
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10
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Clare L. Evaluating 'living well' with mild-to-moderate dementia: Co-production and validation of the IDEAL My Life Questionnaire. DEMENTIA 2023; 22:1548-1566. [PMID: 37436256 PMCID: PMC10966933 DOI: 10.1177/14713012231188502] [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] [Indexed: 07/13/2023]
Abstract
OBJECTIVES We aimed to co-produce and validate an accessible, evidence-based questionnaire measuring 'living well' with dementia that reflects the experience of people with mild-to-moderate dementia. METHODS Nine people with dementia formed a co-production group. An initial series of workshops generated the format of the questionnaire and a longlist of items. Preliminary testing with 53 IDEAL cohort participants yielded a shortlist of items. These were tested with 136 IDEAL cohort participants during a further round of data collection and assessed for reliability and validity. The co-production group contributed to decisions throughout and agreed the final version. RESULTS An initial list of 230 items was reduced to 41 for initial testing, 12 for full testing, and 10 for the final version. The 10-item version had good internal consistency and test-retest reliability, and a single factor structure. Analyses showed significant large positive correlations with scores on measures of quality of life, well-being, and satisfaction with life, and expected patterns of association including a significant large negative association with depression scores and no association with cognitive test scores. CONCLUSIONS The co-produced My Life Questionnaire is an accessible and valid measure of 'living well' with dementia suitable for use in a range of contexts.
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Affiliation(s)
- Linda Clare
- Linda Clare, University of Exeter Medical School, St Luke's Campus, Exeter EX1 2LU, UK.
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11
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Kim J, Shin N. Development of the "living well" concept for older people with dementia. BMC Geriatr 2023; 23:611. [PMID: 37773102 PMCID: PMC10542266 DOI: 10.1186/s12877-023-04304-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/10/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND An important goal in dementia care is how people with dementia can be supported in living well. To this end, we need a conceptualization of "living well" that is suitable for older people with dementia and then develop this conceptualization from the perspectives of both older people and caregivers. This study analyzed the concept of "living well" among older people with dementia. METHODS Following Schwartz-Barcott and Kim's hybrid model, this study comprised theoretical, fieldwork, and final analytic phases. In the theoretical phase, we reviewed the extant literature. In the fieldwork phase, we conducted in-depth interviews with 12 participants (five older people with dementia, two family members, and five nurses), followed by qualitative content analysis. In the final analytic phase, we defined the concept of "living well" by comprehensively analyzing the data from the theoretical phase and results from the fieldwork phase. RESULTS We derived physical, mental, and social relationship dimensions of the conceptualization of "living well" for older people with dementia. The physical dimensions were "ability for daily living" and "symptom management." The mental dimensions were "psychological health," "psychological stability," "maintaining identity and growth," and "human dignity." Finally, the social relationship dimensions were "maintaining social relations and community connectivity" and "government support." CONCLUSIONS Our analysis of the concept of "living well" can be used for developing tools and interventions to improve the ability of older people with dementia to live well.
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Affiliation(s)
- Jiyoung Kim
- Department of Nursing, Inha University, 100 Inha-ro, Michuhol-gu, Incheon, 22212, Republic of Korea.
| | - Nayeon Shin
- Unit manager, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
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12
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Hockley A, Moll D, Littlejohns J, Collett Z, Henshall C. Do communication interventions affect the quality-of-life of people with dementia and their families? A systematic review. Aging Ment Health 2023; 27:1666-1675. [PMID: 37079782 DOI: 10.1080/13607863.2023.2202635] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 04/03/2023] [Indexed: 04/22/2023]
Abstract
OBJECTIVES Speech, language and communication difficulties are prevalent in all dementia subtypes and are likely to considerably impact the quality-of-life of people with dementia and their families. Communication interventions provided by trained professionals are recommended for this population, but little is known about their quality-of-life outcomes. This review aims to explore the quality-of-life outcomes of communication-related interventions for people with dementia and their families. METHODS Seven databases were systematically searched. Reference lists from included studies and relevant systematic reviews were also hand-searched. Primary research with quantitative quality-of-life outcomes were included. Narrative analysis was utilised to identify key intervention features and to describe quality-of-life outcomes. RESULTS 1,174 studies were identified. Twelve studies were eligible for inclusion. Studies were heterogeneous in location, participant group, methodologies, interventions and outcome measures. Four studies reported increased quality-of-life for people with dementia following intervention. No studies reported increased quality-of-life for family members. CONCLUSION Further research is needed in this area. The studies which reported improved quality-of-life involved multi-disciplinary approaches to intervention, involvement of family caregivers, and functional communication intervention. However, data is limited so results should be interpreted with caution. The standardised use of a communication-focused quality-of-life outcome measure would improve sensitivity and comparability of future studies.
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Affiliation(s)
- Anna Hockley
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Deborah Moll
- Research and Development, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Jemima Littlejohns
- Research and Development, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Zoe Collett
- Research and Development, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Catherine Henshall
- Research and Development, Oxford Health NHS Foundation Trust, Oxford, UK
- Oxford Institute for Nursing, Midwifery and Allied Health Research, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
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13
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Hillman A, Jones IR, Quinn C, Pentecost C, Stapley S, Charlwood C, Clare L. The precariousness of living with, and caring for people with, dementia: Insights from the IDEAL programme. Soc Sci Med 2023; 331:116098. [PMID: 37480697 DOI: 10.1016/j.socscimed.2023.116098] [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: 11/23/2022] [Revised: 04/17/2023] [Accepted: 07/13/2023] [Indexed: 07/24/2023]
Abstract
This paper uses precarity as a framework to understand the vulnerabilities experienced by those living with or caring for someone living with dementia. Drawing on qualitative interview data from the Improving the Experience of Dementia and Enhancing Active Life (IDEAL) programme, we attend to our participants' reflections on how they manage the condition and the wider circumstances in which this occurs. To interrogate the utility of precarity, we focus on our participants' descriptions of needs and challenges and set these alongside both the wider contexts in which they seek or offer care (formal and informal) and the sets of values attributed to different ways of living with dementia. Building on the work of Portacolone, our analysis identified four interconnected themes: uncertainty; experiences of support and services; independence and personhood; and cumulative pressures and concerns. We develop this analysis by reviewing how our themes reflect, extend, or depart from previously identified markers of precarity and consider the specific ways in which these markers shape the lives of those living with dementia.
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Affiliation(s)
- A Hillman
- Wellcome Centre for Cultures & Environments of Health, University of Exeter, Queen's Building, Streatham Campus, EX4 4QJ, UK.
| | - I R Jones
- Institute for Social and Economic Research and Data (WISERD), Cardiff University, Cardiff, UK.
| | - C Quinn
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK.
| | - C Pentecost
- The Centre for Research in Ageing and Cognitive Health, Faculty of Health and Life Sciences University of Exeter Medical School, Exeter, UK.
| | - S Stapley
- The Centre for Research in Ageing and Cognitive Health, Faculty of Health and Life Sciences University of Exeter Medical School, Exeter, UK.
| | - C Charlwood
- The Centre for Research in Ageing and Cognitive Health, Faculty of Health and Life Sciences University of Exeter Medical School, Exeter, UK.
| | - L Clare
- The Centre for Research in Ageing and Cognitive Health, Faculty of Health and Life Sciences University of Exeter Medical School, Exeter, UK.
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14
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Hunt A, Martyr A, Gamble LD, Morris RG, Thom JM, Pentecost C, Clare L. The associations between personality traits and quality of life, satisfaction with life, and well-being over time in people with dementia and their caregivers: findings from the IDEAL programme. BMC Geriatr 2023; 23:354. [PMID: 37280511 DOI: 10.1186/s12877-023-04075-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 05/27/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Cross-sectional evidence indicates that certain personality traits may influence how well people with dementia and their caregivers are able to live alongside the condition. However, no studies to date have explored these associations longitudinally. The present study aimed to explore whether each of the Five-Factor personality traits were associated with change over two years in perceptions of 'living well' for people with dementia and their caregivers. 'Living well' was conceptualized as a composite of quality of life, satisfaction with life, and subjective well-being. METHODS Data were analyzed from 1487 people with dementia and 1234 caregivers who took part in the IDEAL cohort. Participants were categorized into low, medium, and high groups for each trait using stanine scores. Latent growth curve models investigated associations between these groups and 'living well' scores for each trait at baseline and at 12 and 24 months. Covariates included cognition in people with dementia and stress in caregivers. A Reliable Change Index was calculated against which to evaluate changes in 'living well' scores over time. RESULTS At baseline, neuroticism was negatively associated with 'living well' scores for people with dementia, while conscientiousness, extraversion, openness, and agreeableness were positively associated. For caregivers, neuroticism was negatively associated with 'living well' scores at baseline while conscientiousness and extraversion were positively associated. 'Living well' scores were mostly stable over time with no influence of personality traits on observed changes. CONCLUSIONS Findings suggest that personality traits, particularly neuroticism, have a meaningful impact on how people with dementia and caregivers rate their capability to 'live well' at baseline. Over time 'living well' scores for each personality trait group were largely stable. Studies utilizing longer follow-up periods and more appropriate measures of personality are needed to corroborate and extend the findings of the present study.
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Affiliation(s)
- Anna Hunt
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
| | - Anthony Martyr
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK.
| | - Laura D Gamble
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | - Robin G Morris
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jeanette M Thom
- School of Health Sciences, The University of Sydney, Sydney, Australia
| | - Claire Pentecost
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
| | - Linda Clare
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
- NIHR Applied Research Collaboration South-West Peninsula, Exeter, UK
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15
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Are profiles of social, cultural, and economic capital related to living well with dementia? Longitudinal findings from the IDEAL programme. Soc Sci Med 2023; 317:115603. [PMID: 36527894 DOI: 10.1016/j.socscimed.2022.115603] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 11/19/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022]
Abstract
RATIONALE Research exploring social, cultural, and economic capital among people with dementia is scarce. OBJECTIVE We describe levels of social, cultural, and economic capital in people with dementia at baseline and levels of social and cultural capital 12 and 24 months later. We identify groups of people with dementia having different combinations of capital and explore whether the identified groups differ in personal characteristics at baseline and in quality of life (QoL), satisfaction with life (SwL), and well-being over time. METHOD Baseline, 12-months, and 24-months data from 1537 people with dementia (age, mean = 76.4 years; SD = 8.5; Alzheimer's Disease = 55.4%) enrolled in the IDEAL cohort were analyzed. Social (interactions with friends, civic participation, social participation, neighborhood trust, social network), cultural (education, cultural participation) and economic (annual income) capital, QoL, SwL, well-being, and personal characteristics were assessed. RESULTS Compared to people their age, people with dementia reported slightly lower frequency of interactions with friends, social networks and social support, civic and cultural participation, education, and annual income. However, social engagement, cultural participation, and annual income are low among British older adults. Latent profile analysis identified four groups that, based on their levels of social, cultural, and economic capital were named socially and economically privileged (18.0% of participants); financially secure (21.0% of participants); low capital (36.9% of participants); and very low capital (24.1% of participants). Latent growth curve models showed that over time QoL, SwL, and well-being remained largely stable for all groups. Compared to the low capital group, the socially and economically privileged and financially secure groups had higher QoL and well-being whereas the group with very low capital had poorer QoL, SwL, and well-being. CONCLUSIONS New policies and efforts from the government, philanthropic foundations, the voluntary and primary care sectors are needed to address social, cultural, and economic disadvantage among people with dementia.
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16
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Loneliness among very old people with and without dementia: prevalence and associated factors in a representative sample. Eur J Ageing 2022; 19:1441-1453. [PMID: 36692772 PMCID: PMC9483318 DOI: 10.1007/s10433-022-00729-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2022] [Indexed: 01/26/2023] Open
Abstract
Loneliness and dementia are common among very old (aged ≥ 80 years) people, but whether the prevalence of loneliness differs between very old people with and without dementia is unknown and few studies have investigated associated factors. The aims of the present study were to compare the prevalence of loneliness between people with and without dementia in a representative sample of very old people, and to investigate factors associated with loneliness in the two groups separately. This population-based study was conducted with data on 1176 people aged 85, 90, and ≥ 95 years (mean age 89.0 ± 4.47 years) from the Umeå 85 + /Gerontological Regional Database study conducted in northern Sweden, during year 2000-2017. Structured interviews and assessments were conducted during home visits. Loneliness was assessed using the question "Do you ever feel lonely?." Multivariable logistic regression analysis was conducted to identify factors associated with loneliness in participants with and without dementia. The prevalence of loneliness did not differ between people with and without dementia (50.9% and 46.0%, respectively; p = 0.13). Seven and 24 of 35 variables were univariately associated with the experience of loneliness in participants with and without dementia, respectively. In the final models, living alone and having depressive symptoms were associated with the experience of loneliness in both study groups. In participants without dementia, living in a nursing home was associated with the experience of less loneliness. These findings contribute with important knowledge when developing strategies to reduce loneliness in this growing age group.
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17
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Martyr A, Gamble LD, Nelis SM, Collins R, Alexander CM, Morris RG, Quinn C, Pentecost C, Rusted JM, Victor C, Thom JM, Matthews FE, Clare L. Predictors of Awareness of Functional Ability in People with Dementia: The Contribution of Personality, Cognition, and Neuropsychiatric Symptoms - Findings from the IDEAL Program. Dement Geriatr Cogn Disord 2022; 51:221-232. [PMID: 35533657 DOI: 10.1159/000524607] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/07/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Discrepancy scores reflecting the difference between parallel ratings made by people living with dementia (PwD) in the mild-to-moderate stages and by their informants provide a way to investigate awareness of functional ability in relation to activities of daily living (ADL). METHODS Two measures of ADL (Functional Activities Questionnaire; Dependence Scale) were completed by 1,227 PwD and their informants in the IDEAL cohort study baseline assessment. Self-rated and informant-rated scores were used to calculate discrepancies, which were used as an indicator of awareness of functional ability. Smaller discrepancy scores were considered to reflect greater awareness on the part of PwD. PwD completed questionnaires on depression, personality, comorbidities, neuropsychiatric symptoms, and completed a measure of cognition. Informants provided ratings of stress. Univariable and multiple regressions were used to investigate factors related to ADL discrepancy. RESULTS A similar pattern of associations were found for both ADL discrepancy scores. Smaller discrepancy scores were associated with higher levels of depression, higher neuroticism, fewer neuropsychiatric symptoms, higher comorbidity, lower carer stress, and receipt of less than 1 hour of care per day from the informant. DISCUSSION/CONCLUSION There was a clear pattern of factors that were associated with greater awareness for both measures of functional ability. These factors associated with smaller discrepancy scores could be used to identify PwD who might benefit from targeted interventions to support their independence.
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Affiliation(s)
- Anthony Martyr
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, University of Exeter, St Luke's Campus, Exeter, United Kingdom
| | - Laura D Gamble
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Sharon M Nelis
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, University of Exeter, St Luke's Campus, Exeter, United Kingdom
| | - Rachel Collins
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, University of Exeter, St Luke's Campus, Exeter, United Kingdom
| | - Catherine M Alexander
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, University of Exeter, St Luke's Campus, Exeter, United Kingdom
| | - Robin G Morris
- Department of Psychology, King's College London Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Catherine Quinn
- Centre for Applied Dementia Studies, University of Bradford, Bradford, United Kingdom.,Wolfson Centre for Applied Health Research, Bradford, United Kingdom
| | - Claire Pentecost
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, University of Exeter, St Luke's Campus, Exeter, United Kingdom
| | - Jennifer M Rusted
- School of Psychology, University of Sussex, Brighton, United Kingdom
| | - Christina Victor
- Department of Health Sciences, College of Health, Medicine and Life Sciences, Brunel University London, London, United Kingdom
| | - Jeanette M Thom
- School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Fiona E Matthews
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Linda Clare
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, University of Exeter, St Luke's Campus, Exeter, United Kingdom.,NIHR Applied Research Collaboration South-West Peninsula, Exeter, United Kingdom
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18
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Sabatini S, Martyr A, Ukoumunne OC, Ballard C, Collins R, Pentecost C, Rusted JM, Quinn C, Anstey KJ, Kim S, Corbett A, Brooker H, Clare L. Attitudes toward own aging and cognition among individuals living with and without dementia: findings from the IDEAL programme and the PROTECT study. BMC Geriatr 2022; 22:641. [PMID: 35927646 PMCID: PMC9351129 DOI: 10.1186/s12877-022-03336-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 07/23/2022] [Indexed: 11/24/2022] Open
Abstract
Background It is unclear whether people with dementia (PwD) have more negative attitudes toward own aging (ATOA) than people without dementia and what factors influence ATOA among PwD. We investigated whether PwD have more negative ATOA than individuals without dementia and whether cognition and dementia subtype are associated with ATOA in PwD. Methods Data from the IDEAL and PROTECT studies were used to compare ATOA between 1502 PwD (mean (SD) age = 76.3 (8.5)) and 6377 individuals without dementia (mean (SD) age = 66.1 (7.1)). Linear regressions and ANOVA were used. Results PwD reported slightly more negative ATOA than people without dementia; this relationship disappeared after controlling for depression and self-rated health. In PwD more positive ATOA showed negligible associations with better general cognition, memory performance, verbal fluency, and visuospatial ability. However, after adjusting for covariates only better visuospatial ability predicted more positive ATOA. Additional analyses showed that before and after controlling for covariates, individuals with poorer self-reported visual acuity have more negative ATOA. Amongst dementia subtypes, people with Parkinson’s disease dementia and dementia with Lewy bodies reported most negative ATOA. Conclusions ATOA between PwD and people without dementia do not differ. ATOA in PwD appear to be affected not by cognitive impairment but by other characteristics that vary across dementia subtypes. Among PwD, those with Parkinson’s disease dementia and dementia with Lewy bodies may have higher risk of experiencing negative ATOA due to the motor and visual impairments that they experience. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03336-5.
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Affiliation(s)
- Serena Sabatini
- Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, South Cloisters, St Luke's Campus, University of Exeter, Exeter, EX1 2LU, UK.
| | - Anthony Martyr
- Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, South Cloisters, St Luke's Campus, University of Exeter, Exeter, EX1 2LU, UK
| | - Obioha C Ukoumunne
- NIHR ARC South West Peninsula (PenARC), University of Exeter, Exeter, United Kingdom
| | - Clive Ballard
- Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, South Cloisters, St Luke's Campus, University of Exeter, Exeter, EX1 2LU, UK
| | - Rachel Collins
- Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, South Cloisters, St Luke's Campus, University of Exeter, Exeter, EX1 2LU, UK
| | - Claire Pentecost
- Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, South Cloisters, St Luke's Campus, University of Exeter, Exeter, EX1 2LU, UK
| | | | - Catherine Quinn
- The Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Kaarin J Anstey
- Ageing Futures Institute, University of New South Wales, Sydney, and Neuroscience Research Australia, Sydney, Australia
| | - Sarang Kim
- Wicking Dementia Research & Education Centre, University of Tasmania, Hobart, Australia
| | - Anne Corbett
- Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, South Cloisters, St Luke's Campus, University of Exeter, Exeter, EX1 2LU, UK
| | - Helen Brooker
- Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, South Cloisters, St Luke's Campus, University of Exeter, Exeter, EX1 2LU, UK
| | - Linda Clare
- Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, South Cloisters, St Luke's Campus, University of Exeter, Exeter, EX1 2LU, UK
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19
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Clare L, Gamble LD, Martyr A, Sabatini S, Nelis SM, Quinn C, Pentecost C, Victor C, Jones RW, Jones IR, Knapp M, Litherland R, Morris RG, Rusted JM, Thom JM, Collins R, Henderson C, Matthews FE. Longitudinal Trajectories of Quality of Life Among People With Mild-to-Moderate Dementia: A Latent Growth Model Approach With IDEAL Cohort Study Data. J Gerontol B Psychol Sci Soc Sci 2022; 77:1037-1050. [PMID: 35134935 PMCID: PMC9159063 DOI: 10.1093/geronb/gbac022] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES We aimed to examine change over time in self-rated quality of life (QoL) in people with mild-to-moderate dementia and identify subgroups with distinct QoL trajectories. METHODS We used data from people with mild-to-moderate dementia followed up at 12 and 24 months in the Improving the experience of Dementia and Enhancing Active Life (IDEAL) cohort study (baseline n = 1,537). A latent growth model approach examined mean change over time in QoL, assessed with the QoL-AD scale, and investigated associations of baseline demographic, cognitive, and psychological covariates with the intercept and slope of QoL. We employed growth mixture modeling to identify multiple growth trajectories. RESULTS Overall mean QoL scores were stable and no associations with change over time were observed. Four classes of QoL trajectories were identified: 2 with higher baseline QoL scores, labeled Stable (74.9%) and Declining (7.6%), and 2 with lower baseline QoL scores, labeled Stable Lower (13.7%) and Improving (3.8%). The Declining class had higher baseline levels of depression and loneliness, and lower levels of self-esteem and optimism, than the Stable class. The Stable Lower class was characterized by disadvantage related to social structure, poor physical health, functional disability, and low psychological well-being. The Improving class was similar to the Stable Lower class but had lower cognitive test scores. DISCUSSION Understanding individual trajectories can contribute to personalized care planning. Efforts to prevent decline in perceived QoL should primarily target psychological well-being. Efforts to improve QoL for those with poorer QoL should additionally address functional impairment, isolation, and disadvantage related to social structure.
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Affiliation(s)
- Linda Clare
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
- NIHR Applied Research Collaboration South-West Peninsula, Exeter, UK
| | - Laura D Gamble
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Anthony Martyr
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
| | - Serena Sabatini
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
| | - Sharon M Nelis
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
| | - Catherine Quinn
- Centre for Applied Dementia Studies, Bradford University, Bradford, UK
- Wolfson Centre for Applied Health Research, Bradford, UK
| | - Claire Pentecost
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
| | - Christina Victor
- College of Health, Medicine and Life Sciences, Brunel University London, London, UK
| | - Roy W Jones
- Research Institute for the Care of Older People (RICE), Bath, UK
| | - Ian R Jones
- Wales Institute for Social and Economic Research, Data and Methods, Cardiff University, Cardiff, UK
| | - Martin Knapp
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | | | - Robin G Morris
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | | | - Jeanette M Thom
- School of Health Sciences, University of New South Wales, Sydney, Australia
| | - Rachel Collins
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
| | - Catherine Henderson
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Fiona E Matthews
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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20
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Mountain G, Wright J, Cooper CL, Lee E, Sprange K, Beresford-Dent J, Young T, Walters S, Berry K, Dening T, Loban A, Turton E, Thomas BD, Young EL, Thompson BJ, Crawford B, Craig C, Bowie P, Moniz-Cook E, Foster A. An intervention to promote self-management, independence and self-efficacy in people with early-stage dementia: the Journeying through Dementia RCT. Health Technol Assess 2022; 26:1-152. [PMID: 35536231 DOI: 10.3310/khha0861] [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: 11/22/2022] Open
Abstract
BACKGROUND There are few effective interventions for dementia. AIM To determine the clinical effectiveness and cost-effectiveness of an intervention to promote self-management, independence and self-efficacy in people with early-stage dementia. OBJECTIVES To undertake a randomised controlled trial of the Journeying through Dementia intervention compared with usual care, conduct an internal pilot testing feasibility, assess intervention delivery fidelity and undertake a qualitative exploration of participants' experiences. DESIGN A pragmatic two-arm individually randomised trial analysed by intention to treat. PARTICIPANTS A total of 480 people diagnosed with mild dementia, with capacity to make informed decisions, living in the community and not participating in other studies, and 350 supporters whom they identified, from 13 locations in England, took part. INTERVENTION Those randomised to the Journeying through Dementia intervention (n = 241) were invited to take part in 12 weekly facilitated groups and four one-to-one sessions delivered in the community by secondary care staff, in addition to their usual care. The control group (n = 239) received usual care. Usual care included drug treatment, needs assessment and referral to appropriate services. Usual care at each site was recorded. MAIN OUTCOME MEASURES The primary outcome was Dementia-Related Quality of Life score at 8 months post randomisation, with higher scores representing higher quality of life. Secondary outcomes included resource use, psychological well-being, self-management, instrumental activities of daily living and health-related quality of life. RANDOMISATION AND BLINDING Participants were randomised in a 1 : 1 ratio. Staff conducting outcome assessments were blinded. DATA SOURCES Outcome measures were administered in participants' homes at baseline and at 8 and 12 months post randomisation. Interviews were conducted with participants, participating carers and interventionalists. RESULTS The mean Dementia-Related Quality of Life score at 8 months was 93.3 (standard deviation 13.0) in the intervention arm (n = 191) and 91.9 (standard deviation 14.6) in the control arm (n = 197), with a difference in means of 0.9 (95% confidence interval -1.2 to 3.0; p = 0.380) after adjustment for covariates. This effect size (0.9) was less than the 4 points defined as clinically meaningful. For other outcomes, a difference was found only for Diener's Flourishing Scale (adjusted mean difference 1.2, 95% confidence interval 0.1 to 2.3), in favour of the intervention (i.e. in a positive direction). The Journeying through Dementia intervention cost £608 more than usual care (95% confidence interval £105 to £1179) and had negligible difference in quality-adjusted life-years (-0.003, 95% confidence interval -0.044 to 0.038). Therefore, the Journeying through Dementia intervention had a mean incremental cost per quality-adjusted life-year of -£202,857 (95% confidence interval -£534,733 to £483,739); however, there is considerable uncertainty around this. Assessed fidelity was good. Interviewed participants described receiving some benefit and a minority benefited greatly. However, negative aspects were also raised by a minority. Seventeen per cent of participants in the intervention arm and 15% of participants in the control arm experienced at least one serious adverse event. None of the serious adverse events were classified as related to the intervention. LIMITATIONS Study limitations include recruitment of an active population, delivery challenges and limitations of existing outcome measures. CONCLUSIONS The Journeying through Dementia programme is not clinically effective, is unlikely to be cost-effective and cannot be recommended in its existing format. FUTURE WORK Research should focus on the creation of new outcome measures to assess well-being in dementia and on using elements of the intervention, such as enabling enactment in the community. TRIAL REGISTRATION This trial is registered as ISRCTN17993825. FUNDING This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 24. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Gail Mountain
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Jessica Wright
- Sheffield Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Cindy L Cooper
- Sheffield Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Ellen Lee
- Sheffield Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Kirsty Sprange
- Nottingham Clinical Trials Research Unit, University of Nottingham, Nottingham, UK
| | | | - Tracey Young
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Stephen Walters
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Katherine Berry
- Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Tom Dening
- Division of Psychiatry & Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Amanda Loban
- Sheffield Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Emily Turton
- Sheffield Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Benjamin D Thomas
- Sheffield Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Emma L Young
- Sheffield Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Benjamin J Thompson
- Sheffield Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Bethany Crawford
- Division of Psychiatry & Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Claire Craig
- Art and Design Research Centre, Sheffield Hallam University, Sheffield, UK
| | - Peter Bowie
- Sheffield Health and Social Care NHS Foundation Trust, Sheffield, UK
| | | | - Alexis Foster
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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21
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Impact of Psychotic Symptoms and Concurrent Neuropsychiatric Symptoms on the Quality of Life of People With Dementia Living in Nursing Homes. J Am Med Dir Assoc 2022; 23:1474-1479.e1. [DOI: 10.1016/j.jamda.2022.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 03/18/2022] [Accepted: 03/26/2022] [Indexed: 11/22/2022]
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22
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Talbot CV, Briggs P. The use of digital technologies by people with mild-to-moderate dementia during the COVID-19 pandemic: A positive technology perspective. DEMENTIA 2022; 21:1363-1380. [PMID: 35333111 PMCID: PMC8960751 DOI: 10.1177/14713012221079477] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
A growing body of research has shown that people with dementia are using digital technologies to enhance lived experience. The COVID-19 pandemic has brought new digital opportunities and challenges and so provides a unique opportunity to understand how people with dementia have adapted to this new digital landscape. Semi-structured interviews were conducted with 19 people with dementia and analysed thematically. We generated five themes, showing how participants used digital means to combat the stresses of the pandemic by facilitating social connection, self-actualisation, enhanced well-being and by assisting with activities of daily life. These technologies helped to reduce isolation, provide access to support groups, create opportunities for cognitive stimulation and self-development, and engendered a sense of identity at a time of perceived loss. Despite these benefits, participants also reported challenges regarding cognitive fatigue and usability issues. We recommend that training on how to use digital technologies is co-produced with people with dementia and designers engage with the voices of people with dementia throughout the design process. In turn, this could promote the social connectedness, well-being and self-worth of people with dementia.
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Affiliation(s)
| | - Pam Briggs
- Department of Psychology, 5995Northumbria University, Newcastle upon Tyne, UK
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23
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Collins R, Hunt A, Quinn C, Martyr A, Pentecost C, Clare L. Methods and approaches for enhancing communication with people with moderate-to-severe dementia that can facilitate their inclusion in research and service evaluation: Findings from the IDEAL programme. DEMENTIA 2022; 21:1135-1153. [PMID: 35156412 PMCID: PMC9109550 DOI: 10.1177/14713012211069449] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives Dementia can affect language processing and production, making communication more
difficult. This creates challenges for including the person’s perspective in research
and service evaluation. This study aims to identify methods, tools and approaches that
could facilitate meaningful communication with people with moderate-to-severe dementia
and support the inclusion of their perspectives. Methods This qualitative study was conducted as part of the IDEAL programme and involved
in-depth, semi-structured interviews with 17 dementia research and/or care professionals
with expertise in communication. Transcripts were analysed using framework analysis. Findings Three main themes each with sub-themes were identified: (1) Awareness, knowledge and
experience; (2) Communication approach and (3) Personalization. A person-centred
orientation based on getting to know the participant and developing a bi-directional
exchange formed the fundamental context for effective communication. Building on this
foundation, an approach using pictures, photographs or objects that are meaningful to
the person and appropriate for that person’s preferences and ability could help to
facilitate conversations. The findings were integrated into a diagram illustrating how
the topics covered by the themes interrelate to facilitate communication. Conclusions Useful skills and approaches were identified to help researchers engage and work with
people with moderate-to-severe dementia and ensure their perspective is included. These
covered getting to know the participant, using a variety of tangible tools and
interactional techniques and considering the environment and context of the
conversation.
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Affiliation(s)
- Rachel Collins
- College of Medicine and Health, 3286University of Exeter, Exeter, UK
| | - Anna Hunt
- College of Medicine and Health, 3286University of Exeter, Exeter, UK
| | - Catherine Quinn
- The Centre for Applied Dementia Studies, 1905University of Bradford, Bradford, UK; Wolfson Centre for Applied Health Research, Bradford, UK
| | - Anthony Martyr
- College of Medicine and Health, 3286University of Exeter, Exeter, UK
| | - Claire Pentecost
- College of Medicine and Health, 3286University of Exeter, Exeter, UK
| | - Linda Clare
- College of Medicine and Health, 3286University of Exeter, Exeter, UK; 3286NIHR Applied Research Collaboration South-West Peninsula, Exeter, UK
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24
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Quinn C, Pickett JA, Litherland R, Morris RG, Martyr A, Clare L. Living well with dementia: What is possible and how to promote it. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5627. [PMID: 34564897 PMCID: PMC9292841 DOI: 10.1002/gps.5627] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The focus on living well with dementia encourages a more positive and empowering approach. The right support can improve the experience of living with dementia. An holistic approach to assessing the needs of people with dementia and identifying the factors that impact on their well‐being is essential. Enabling people to live better requires a broad approach that encompasses both health and social systems and the wider community.
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Affiliation(s)
- Catherine Quinn
- Centre for Applied Dementia Studies, Faculty of Health StudiesUniversity of BradfordBradfordUK,Wolfson Centre for Applied Health ResearchBradfordUK
| | | | | | - Robin G. Morris
- King's College Institute of Psychiatry, Psychology and NeuroscienceLondonUK
| | - Anthony Martyr
- REACH: The Centre for Research in Ageing and Cognitive Health, College of Medicine and HealthUniversity of ExeterExeterUK
| | - Linda Clare
- REACH: The Centre for Research in Ageing and Cognitive Health, College of Medicine and HealthUniversity of ExeterExeterUK,NIHR Applied Research Collaboration South‐West PeninsulaExeterUK
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25
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Bacsu JD, Fraser S, Chasteen AL, Cammer A, Grewal KS, Bechard LE, Bethell J, Green S, McGilton KS, Morgan D, O'Rourke HM, Poole L, Spiteri RJ, O'Connell ME. Using Twitter to Examine Stigma Against People with Dementia During COVID-19: Infodemiology Study (Preprint). JMIR Aging 2021; 5:e35677. [PMID: 35290197 PMCID: PMC9015751 DOI: 10.2196/35677] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/14/2022] [Indexed: 12/12/2022] Open
Affiliation(s)
- Juanita-Dawne Bacsu
- Department of Psychology, Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, SK, Canada
| | - Sarah Fraser
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Alison L Chasteen
- Department of Psychology, University of Toronto, Toronto, ON, Canada
| | - Allison Cammer
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada
| | - Karl S Grewal
- Department of Psychology, Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, SK, Canada
| | - Lauren E Bechard
- Department of Kinesiology and Health Sciences, Faculty of Health, University of Waterloo, Waterloo, ON, Canada
| | - Jennifer Bethell
- Knowledge, Innovation, Talent and Everywhere (KITE) - Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Shoshana Green
- Department of Psychology, Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, SK, Canada
| | - Katherine S McGilton
- Knowledge, Innovation, Talent and Everywhere (KITE) - Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Debra Morgan
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, SK, Canada
| | | | - Lisa Poole
- Dementia Advocacy Canada, Calgary, AB, Canada
| | - Raymond J Spiteri
- Department of Computer Science, University of Saskatchewan, Saskatoon, SK, Canada
| | - Megan E O'Connell
- Department of Psychology, Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, SK, Canada
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26
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Abstract
Abstract
It is estimated that a third of people in the United Kingdom with signs of dementia are living without a formal diagnosis. In Wales, the proportion is nearly half. Some explanations for the gap between prevalence of dementia and number of diagnoses include living with a long-term partner/spouse and systemic barriers to diagnosis. This study recruited participants from the Cognitive Function and Ageing Studies-Wales (CFAS-Wales) cohort, randomly selected from people aged over 65 living in two areas of Wales, who met study criteria for a diagnosis of dementia and did not have a record of a formal diagnosis in general practice records. We aimed to understand more about the contexts and circumstances of people who live with and cope with cognitive difficulties without having a formal diagnosis of dementia. We conducted qualitative interviews with six participants and their spouses, and additionally with four family members of three invited people who were unable to take part. Themes were generated using thematic analysis. We present the argument that there is an adaptive response to low service levels and a complex interaction between the expectations of levels of service, perceptions of the legitimacy of cognitive problems and the right to make demands on services. This paper concludes that more could be done to address barriers to diagnosis and treatment services for those living with symptoms of dementia, but that the value placed on diagnosis by some individuals might be lower than anticipated by government policy.
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27
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Living with dementia under COVID-19 restrictions: coping and support needs among people with dementia and carers from the IDEAL cohort. AGEING & SOCIETY 2021. [DOI: 10.1017/s0144686x21001719] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Stringent social restrictions imposed during 2020 to counter the spread of the COVID-19 pandemic could significantly affect the wellbeing and quality of life of people with dementia living in the community and their family carers. We explored the impact of COVID-19 restrictions on people with dementia and family carers in England and considered how negative effects might be mitigated. We conducted semi-structured telephone interviews with 11 people with dementia and 11 family carers who were ongoing participants in the IDEAL cohort during the initial ‘lockdown’ period in May and June 2020, and follow-up interviews with five people with dementia and two carers as restrictions were eased in July. We analysed interview data and triangulated the findings with issues raised in dementia-specific online forums. Findings showed some people with dementia were coping well, but others experienced a range of negative impacts, with varying degrees of improvement as restrictions were eased. The need for clear personalised information relating to COVID-19 and the value of support in the form of regular ‘just checking’ phone calls was emphasised. This exceptional situation provides a natural demonstration of how social and psychological resources shape the potential to ‘live well’ with dementia. While some support is recommended for all, a personalised approach to determine needs and coping ability would ensure that further practical and emotional support is targeted effectively.
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28
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Clare L, Martyr A, Gamble LD, Pentecost C, Collins R, Dawson E, Hunt A, Parker S, Allan L, Burns A, Hillman A, Litherland R, Quinn C, Matthews FE, Victor C. Impact of COVID-19 on 'Living Well' with Mild-to-Moderate Dementia in the Community: Findings from the IDEAL Cohort. J Alzheimers Dis 2021; 85:925-940. [PMID: 34776448 DOI: 10.3233/jad-215095] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Negative impacts of the COVID-19 pandemic on people with dementia have been widely-documented, but most studies have relied on carer reports and few have compared responses to information collected before the pandemic. OBJECTIVE We aimed to explore the impact of the pandemic on community-dwelling individuals with mild-to-moderate dementia and compare responses with pre-pandemic data. METHODS During the second wave of the pandemic, we conducted structured telephone interviews with 173 people with dementia and 242 carers acting as informants, all of whom had previously participated in the IDEAL cohort. Where possible, we benchmarked responses against pre-pandemic data. RESULTS Significant perceived negative impacts were identified in cognitive and functional skills and ability to engage in self-care and manage everyday activities, along with increased levels of loneliness and discontinuity in sense of self and a decline in perceived capability to 'live well'. Compared to pre-pandemic data, there were lower levels of pain, depression, and anxiety, higher levels of optimism, and better satisfaction with family support. There was little impact on physical health, mood, social connections and relationships, or perceptions of neighborhood characteristics. CONCLUSION Efforts to mitigate negative impacts of pandemic-related restrictions and restore quality of life could focus on reablement to address the effects on participation in everyday activities, creating opportunities for social contact to reduce loneliness, and personalized planning to reconnect people with their pre-COVID selves. Such efforts may build on the resilience demonstrated by people with dementia and carers in coping with the pandemic.
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Affiliation(s)
- Linda Clare
- College of Medicine and Health, University of Exeter, Exeter, UK.,NIHR Applied Research Collaboration South-West Peninsula, Exeter, UK
| | - Anthony Martyr
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Laura D Gamble
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Claire Pentecost
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Rachel Collins
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Eleanor Dawson
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Anna Hunt
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Sophie Parker
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Louise Allan
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Alistair Burns
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Alexandra Hillman
- Department of Public Health Policy and Social Sciences, Swansea University, Swansea, Wales, UK
| | | | - Catherine Quinn
- Centre for Applied Dementia Studies, Bradford University, Bradford, UK.,Wolfson Centre for Applied Health Research, Bradford, UK
| | - Fiona E Matthews
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Christina Victor
- College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, UK
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29
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Dourado MCN, Santos RL, Fischer A, Mograbi DC. Modeling Quality of Life in Alzheimer Disease: The Impact of Cognitive, Functional, and Mood Variables in Self and Carers' Perceptions. J Geriatr Psychiatry Neurol 2021; 34:668-674. [PMID: 32762396 DOI: 10.1177/0891988720944235] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Quality of life (QoL) includes complex interactions between objective and subjective factors. Through structural equation modeling, we analyzed people with Alzheimer disease (PwAD) and carers' ratings to identify the factors associated with PwAD QoL. We included 264 PwAD and their carers. Model 1, carers' ratings of PwAD QoL, showed a bidirectional association with worse depressive symptoms, lower functionality, and impairment on awareness being linked. These variables were associated with burden and all of them directly affecting carers' ratings of PwAD QoL. Model 2, PwAD self-reported QoL, had the same bidirectional associations among the same variables with all of them influencing PwAD self-reported QoL. However, the interpretations of these similar associations should be different. The path analysis increased the understanding of the relationship between QoL and cognition, functionality, mood, awareness, and burden. Our findings bring together a number of consistent predictors and confirm their different effects in PwAD and carers' point of view about QoL.
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Affiliation(s)
| | - Raquel Luiza Santos
- Department of Psychology, Universidade do Grande Rio-UNIGRANRIO, Duque de Caxias, Brazil
| | - Anna Fischer
- Department of Psychology, Pontifical Catholic University of Rio de Janeiro, Gávea, Rio de Janeiro, Brazil
| | - Daniel C Mograbi
- Department of Psychology, Pontifical Catholic University of Rio de Janeiro, Gávea, Rio de Janeiro, Brazil.,Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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30
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Abstract
Abstract
Having opportunities to make decisions and choices regarding one's life is crucial when living with dementia. This inter-disciplinary study draws on the concept of relational autonomy to explore how working-age people living dementia seek to influence their lives, and what makes it easier or more difficult for them in their everyday life. The data consist of three focus group discussions conducted with 12 retired adults who developed dementia while still employed. The results illuminate various resources that enable a person to (a) handle their difficulties at work and related consequences with dignity, (b) manage everyday tasks and live a fulfilling life, and (c) fight the stigma associated with (working-age) dementia. Challenges related to these aspects reported by the participants reveal gaps and obstacles that impede the full realisation of the rights of people living with early onset dementia. This research highlights the need for workplace education for different stakeholders, equal and ongoing access to guidance and counselling for younger people who live with dementia, and an effort by society as a whole to eradicate stigma.
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31
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Quinn C, Hart N, Henderson C, Litherland R, Pickett J, Clare L. Developing supportive local communities: Perspectives from people with dementia and caregivers participating in the IDEAL programme. J Aging Soc Policy 2021; 34:839-859. [PMID: 34629015 DOI: 10.1080/08959420.2021.1973341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Communities play an important role in supporting people living with dementia. The aim of this study was to explore what could be changed in the local community to enable those with dementia to live well. People with dementia and carers taking part in the IDEAL programme responded to open-ended questions. Responses from 1,172 people with dementia and 702 caregivers were analyzed using thematic analysis. Four themes were identified: raising awareness, improving access to support services, providing social events and activities, and supporting people to engage in the community. These highlight the role of individuals, resources and the environment in supporting those with dementia. Longer-term investment in services is needed to underpin dementia-inclusive communities.
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Affiliation(s)
- Catherine Quinn
- Associate Professor, Centre for Applied Dementia Studies, Faculty of Health Studies, University of Bradford, Bradford, UK.,Wolfson Centre for Applied Health Research, Bradford, UK
| | | | - Catherine Henderson
- Assistant Professorial Research Fellow, Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | | | - James Pickett
- Hub Development Manager, Health Data Research, London, UK
| | - Linda Clare
- Professor of Clinical Psychology of Ageing and Dementia, REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter, Exeter, UK.,Dementia Theme Lead, NIHR Applied Research Collaboration, Exeter, South-West Peninsula
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32
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Liang J, Jang Y, Aranda MP. Stigmatising beliefs about Alzheimer's disease: Findings from the Asian American Quality of Life Survey. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:1483-1490. [PMID: 33094539 DOI: 10.1111/hsc.13208] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 10/02/2020] [Accepted: 10/07/2020] [Indexed: 06/11/2023]
Abstract
Responding to the public health significance of Alzheimer's Disease (AD) and lack of information on AD-related issues in Asian Americans, the present study examined the prevalence and predictors of three stigmatising beliefs about AD (beliefs that associate AD with a normal process of ageing, family embarrassment and social avoidance) using a sample of Asian Americans representing diverse ethnic groups (Chinese, Asian Indian, Korean, Vietnamese, Filipino and other Asians) and a broad age range (18-98). Guided by the Sociocultural Health Belief Model, multivariate regression models of stigmatising beliefs about AD examined the effect of demographic characteristics (age, gender, marital status, education and ethnicity) and immigration and culture-related variables (proportion of life in the U.S., English proficiency and acculturation). Data came from the 2015 Asian American Quality of Life survey (N = 2,609). Results indicate that the prevalence of stigmatising beliefs about AD varied across ethnicities. More than 63% of Vietnamese associated AD with a normal process of ageing, and about 10% of Chinese reported that they would feel embarrassed if their family member had AD. Logistic regression analyses demonstrated that advanced age, male gender, low education and limited English proficiency increased the odds of reporting one or more stigmatising beliefs about AD. The findings suggest varying degrees of AD-related misconceptions and stigmatisation and call attention to the need for culturally sensitive AD education in Asian communities.
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Affiliation(s)
- Jiaming Liang
- Edward R. Roybal Institute on Aging, Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Yuri Jang
- Edward R. Roybal Institute on Aging, Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - María P Aranda
- Edward R. Roybal Institute on Aging, Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
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33
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Choi A, Ballard C, Martyr A, Collins R, Morris RG, Clare L. The impact of auditory hallucinations on "living well" with dementia: Findings from the IDEAL programme. Int J Geriatr Psychiatry 2021; 36:1370-1377. [PMID: 33734483 DOI: 10.1002/gps.5533] [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] [Received: 02/15/2021] [Accepted: 03/04/2021] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To determine whether auditory hallucinations in community-dwelling people with dementia (PwD) living in the community impacted on quality of life (QoL), subjective wellbeing and life satisfaction. DESIGN Cross-sectional cohort study. SETTINGS AND PARTICIPANTS 1251 community-dwelling PwD and caregivers were included in this study. MEASURES Neuropsychiatric Inventory Questionnaire completed by caregiver interview. Mean differences between the absence and presence of auditory hallucinations were compared to scores on three validated measures of living well: QoL in Alzheimer's disease scale (QoL-AD), World Health Organization-Five Well-being Index and Satisfaction with Life Scale. Analysis of covariance determined the confounding contributions of cognition via Mini-Mental State Examination, depression via Geriatric Depression Scale-10, caregiver stress via Relative Stress Scale and whether antipsychotic drugs were prescribed. RESULTS Auditory hallucinations were associated with lower scores for QoL (p < 0.001, η2 = 0.01), wellbeing (p < 0.001, η2 = 0.02) and life satisfaction (p < 0.001, η2 = 0.01). After controlling for background measures, which were potential confounds, the relationship between auditory hallucinations and QoL (p = 0.04, pη2 = 0.01) and wellbeing (p < 0.000, pη2 = 0.02) remained significant but there was no significant association with life satisfaction. CONCLUSION Auditory hallucinations are associated with lower QoL and wellbeing in PwD living in the community. This has implications for targeted therapies in PwD with psychotic symptoms.
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Affiliation(s)
- Aaron Choi
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Clive Ballard
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Anthony Martyr
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Rachel Collins
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Robin G Morris
- Department of Psychology, King's College London Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Linda Clare
- College of Medicine and Health, University of Exeter, Exeter, UK.,NIHR Applied Research Collaboration South-West Peninsula, University of Exeter, Exeter, UK
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Potter CM, Peters M, Cundell M, McShane R, Fitzpatrick R. Use of the Long-Term Conditions Questionnaire (LTCQ) for monitoring health-related quality of life in people affected by cognitive impairment including dementia: pilot study in UK memory clinic services. Qual Life Res 2021; 30:1641-1652. [PMID: 33575918 PMCID: PMC8178132 DOI: 10.1007/s11136-021-02762-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to validate the Long-Term Conditions Questionnaire (LTCQ) among patients using memory clinic services in England. LTCQ is a short self-administered measure of 'living well with long-term conditions' that has not been previously tested in patients with cognitive impairment. METHODS The mixed-methods study included cognitive interviews to test the comprehensibility and content validity of LTCQ from the patient's perspective, followed by a pilot survey to test the measure's internal consistency, construct validity, structural validity, and responsiveness. Participants were recruited through memory clinics following a diagnosis of mild cognitive impairment or dementia. RESULTS Interview respondents (n = 12) all found LTCQ's content relevant, with only minor formatting modifications required. Among survey respondents (n = 105), most patients (86%) were able to self-report answers to LTCQ. High multimorbidity among the sample was associated with reduced LTCQ and EQ-5D scores. Internal consistency of LTCQ was high (Cronbach's α = 0.93), no floor or ceiling effects were observed, and missing data levels were low. Factor analysis results further supported LTCQ's structural validity, and predicted positive correlation with EQ-5D indicated construct validity. Score changes observed in a four-month follow-up survey (n = 61) are suggestive of LTCQ's responsiveness. CONCLUSION LTCQ is a valid means of assessing health-related quality of life for people living with cognitive impairment (including dementia) in the early period of support following diagnosis. Owing to high levels of multimorbidity in this patient population, LTCQ offers an advantage over dementia-specific measures in capturing the cumulative impact of all LTCs experienced by the patient.
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Affiliation(s)
- Caroline M Potter
- Nuffield Department of Population Health, Health Services Research Unit, University of Oxford, Oxford, UK.
- Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Oxford, Oxford Health NHS Foundation Trust, Oxford, UK.
| | - Michele Peters
- Nuffield Department of Population Health, Health Services Research Unit, University of Oxford, Oxford, UK
| | | | | | - Ray Fitzpatrick
- Nuffield Department of Population Health, Health Services Research Unit, University of Oxford, Oxford, UK
- Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Oxford, Oxford Health NHS Foundation Trust, Oxford, UK
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Relationship between self-perceptions of aging and 'living well' among people with mild-to-moderate dementia: Findings from the ideal programme. Arch Gerontol Geriatr 2021; 94:104328. [PMID: 33465539 DOI: 10.1016/j.archger.2020.104328] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 12/14/2020] [Accepted: 12/19/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVE A primary goal for dementia research is to understand how to best support people to live well with dementia. Among cognitively healthy older individuals, more positive attitudes toward their own aging (ATOA) and/or feeling younger than their chronological age (i.e. having a younger subjective age: SA) are associated with better quality of life (QoL), satisfaction with life (SwL), and well-being (which are indicators of capability to live well), and fewer depressive symptoms. We tested whether people with dementia (PwD) with more positive ATOA and/or with a younger SA report better QoL, SwL, and well-being, and are less likely to experience depression. METHODS We used cross-sectional data from the IDEAL cohort baseline assessment (conducted between 2014 and 2016), comprising 1541 PwD residing in Great Britain [mean (range) age= 76.3 (43 to 98); 43.6% women]. RESULTS More positive ATOA was associated with better QoL, SwL, well-being, and less likelihood of depression. Younger SA was associated with better QoL, SwL, well-being, and less likelihood of depression. CONCLUSIONS More positive ATOA and younger SA may be beneficial psychological resources that enhance capability to live well with dementia. Promoting more positive perceptions of aging at the societal level may help to equip people with the resilience needed to cope well after a diagnosis of dementia, and enhance the support available to people with dementia. Focusing on retained abilities and achievable goals may help to counteract the impact of negative age-related stereotypes on people with dementia, and enhance person-centered care.
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Wu YT, Clare L, Matthews FE. Relationship between depressive symptoms and capability to live well in people with mild to moderate dementia and their carers: results from the Improving the experience of Dementia and Enhancing Active Life (IDEAL) programme. Aging Ment Health 2021; 25:38-45. [PMID: 31565962 DOI: 10.1080/13607863.2019.1671316] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Depression is a common condition in dementia and has a substantial impact on quality of life and wellbeing. There is limited evidence on how depressive symptoms in the person with dementia impact on the carer, and vice versa. The aim of this study is to investigate dyadic relationships between depressive symptoms and capability to live well in both people with dementia and their carers and to examine whether people with dementia who do not have a carer are more vulnerable to the impact of depressive symptoms than those who have a carer. METHODS Using a large cohort study of 1547 community-dwelling people with mild to moderate dementia and 1283 carers in Great Britain, a Bayesian analysis framework was developed to incorporate dyads (N = 981), people with dementia whose carers did not participate (N = 127), people with dementia who did not have a carer (N = 137), and dyads with missing data (N = 302) and estimate actor and partner relationships between depressive symptoms and capability to live well, which was expressed as a latent factor derived from measures of quality of life, life satisfaction and wellbeing. RESULTS Depressive symptoms in people with dementia and carers had negative associations with capability to live well both for the individual and for the partner. Compared to those who had a carer, depressive symptoms had a greater impact on capability to live well in people with dementia who did not had a carer. CONCLUSIONS The impact of depression may extend beyond the person experiencing the symptoms. Future interventions for depressive symptoms should utilise this potential wider impact to understand and optimise treatment effects.
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Affiliation(s)
- Yu-Tzu Wu
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK.,Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Linda Clare
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
| | - Fiona E Matthews
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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Wu YT, Clare L, Jones IR, Nelis SM, Quinn C, Martyr A, Victor CR, Lamont RA, Rippon I, Matthews FE. Perceived and objective availability of green and blue spaces and quality of life in people with dementia: results from the IDEAL programme. Soc Psychiatry Psychiatr Epidemiol 2021; 56:1601-1610. [PMID: 33484297 PMCID: PMC8429369 DOI: 10.1007/s00127-021-02030-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 01/06/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim of this study was to investigate the associations between quality of life and both perceived and objective availability of local green and blue spaces in people with dementia, including potential variation across rural/urban settings and those with/without opportunities to go outdoors. METHODS This study was based on 1540 community-dwelling people with dementia in the Improving the experience of Dementia and Enhancing Active Life (IDEAL) programme. Quality of life was measured by the Quality of Life in Alzheimer's Disease (QoL-AD) scale. A list of 12 types of green and blue spaces was used to measure perceived availability while objective availability was estimated using geographic information system data. Regression modelling was employed to investigate the associations of quality of life with perceived and objective availability of green and blue spaces, adjusting for individual factors and deprivation level. Interaction terms with rural/urban areas or opportunities to go outdoors were fitted to test whether the associations differed across these subgroups. RESULTS Higher QoL-AD scores were associated with higher perceived availability of local green and blue spaces (0.82; 95% CI 0.06, 1.58) but not objective availability. The positive association between perceived availability and quality of life was stronger for urban (1.50; 95% CI 0.52, 2.48) than rural residents but did not differ between participants with and without opportunities to go outdoors. CONCLUSIONS Only perceived availability was related to quality of life in people with dementia. Future research may investigate how people with dementia utilise green and blue spaces and improve dementia-friendliness of these spaces.
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Affiliation(s)
- Yu-Tzu Wu
- Social Epidemiology Research Group, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK. .,Population Health Sciences Institute, Newcastle University, The Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE4 5PL, UK.
| | - Linda Clare
- College of Medicine and Health, University of Exeter, St Luke’s Campus, Exeter, EX1 2LU UK
| | - Ian Rees Jones
- Wales Institute of Social and Economic Research and Data, Cardiff University, Cardiff, CF10 3BB UK
| | - Sharon M. Nelis
- College of Medicine and Health, University of Exeter, St Luke’s Campus, Exeter, EX1 2LU UK
| | - Catherine Quinn
- Centre for Applied Dementia Studies, University of Bradford, Bradford, BD7 1DP UK
| | - Anthony Martyr
- College of Medicine and Health, University of Exeter, St Luke’s Campus, Exeter, EX1 2LU UK
| | - Christina R. Victor
- Department of Clinical Sciences, College of Health and Life Sciences, Brunel University London, Uxbridge, UB8 3PH UK
| | - Ruth A. Lamont
- College of Medicine and Health, University of Exeter, St Luke’s Campus, Exeter, EX1 2LU UK
| | - Isla Rippon
- Department of Clinical Sciences, College of Health and Life Sciences, Brunel University London, Uxbridge, UB8 3PH UK
| | - Fiona E. Matthews
- Population Health Sciences Institute, Newcastle University, The Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE4 5PL UK
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Clare L, Martyr A, Henderson C, Gamble L, Matthews FE, Quinn C, Nelis SM, Rusted J, Thom J, Knapp M, Hart N, Victor C. Living Alone with Mild-To-Moderate Dementia: Findings from the IDEAL Cohort. J Alzheimers Dis 2020; 78:1207-1216. [PMID: 33104029 DOI: 10.3233/jad-200638] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND A significant proportion of people with dementia live alone, but little is known about their specific needs. OBJECTIVE To understand the profile of people living alone with mild-to-moderate dementia in the UK and identify any systematic differences associated with living situation. METHODS We analyzed cross-sectional data from 1,541 people with mild-to-moderate dementia and 1,277 caregivers participating in the IDEAL cohort at the first wave of assessment. RESULTS There were 1,256 (81.5%) people with dementia living with others and 285 (18.5%) living alone, of whom 51 (3% of whole sample) reported little or no informal support. There were relatively few differences associated with living situation and odds ratios were generally small. People living alone were older on average, and more likely to be female, than those living with others. Those living alone were more likely to have higher cognitive ability and self-reported functional ability, and more social contact with those from other households. They were also lonelier, expressed less satisfaction with life, and used home care services and equipment more. There were no differences in symptoms, mood, quality of life, or well-being. CONCLUSION The findings support the view that it is possible to 'live well' with mild-to-moderate dementia while living alone, given appropriate support, including home care and equipment. Nevertheless, it is important to consider how those living alone may be supported to have a more satisfactory experience, and how health and social care services can best respond to their needs.
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Affiliation(s)
- Linda Clare
- REACH: The Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, University of Exeter, St Luke's Campus, Exeter, UK
| | - Anthony Martyr
- REACH: The Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, University of Exeter, St Luke's Campus, Exeter, UK
| | - Catherine Henderson
- Personal Social Services Research Unit>, London School of Economics and Political Science, London, UK
| | - Laura Gamble
- Institute for Health and Society, Newcastle University, Newcastle, UK
| | - Fiona E Matthews
- Institute for Health and Society, Newcastle University, Newcastle, UK
| | - Catherine Quinn
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Sharon M Nelis
- REACH: The Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, University of Exeter, St Luke's Campus, Exeter, UK
| | | | - Jeanette Thom
- School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - Martin Knapp
- Personal Social Services Research Unit>, London School of Economics and Political Science, London, UK
| | - Nicola Hart
- Research Development and Evaluation, Alzheimer's Society, London, UK
| | - Christina Victor
- College of Health and Life Sciences, Brunel University London, London, UK
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Yang B, Yang S, Zhang Y, Liu W, Gan Y, Li Y, Jiang D, Luo Y, Zhao Q. Stressor-Oriented MUlticomponent Intervention and the WeLl-Being of Patients with Alzheimer's Disease: A Randomized Controlled Trial (SOUL-P). J Alzheimers Dis 2020; 79:141-152. [PMID: 33216026 DOI: 10.3233/jad-200652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Patients with Alzheimer's disease (AD) experience various stressors that negatively impact well-being. Most studies have, however, small effect size and are limited by the experiences of severe patients. Therefore, we conducted a single-blind, randomized controlled trial, which has included patients at different stages. OBJECTIVE The stressor-oriented multicomponent program was designed as an intervention for AD patients to enhance well-being. METHODS Patients were randomly assigned to control or SOUL-P conditions according to disease severity. The SOUL-P group received 15 intensive sessions over 6 months and 6 maintenance sessions over a 6-month follow-up by a multidisciplinary team comprising psychologists, occupational therapists, and community nurses. The control group received a similar number of sessions by community nurses. Stress-related outcomes (primary stressors and well-being outcomes) were obtained from in-person baseline and follow-up interviews conducted at 6- and 12-months post-baseline. A treatment compliance survey was conducted at the intervention endpoint for patients. RESULTS Of the 863 patients screened, 218 (25.3%) were eligible. At 6 months, compared to controls, SOUL-P patients had improved quality of life (QoL) (p < 0.001; Cohen d = 0.56), depression (p = 0.020; Cohen d = -0.33), neurobehavioral symptoms (p = 0.034; Cohen d = -0.30), perceived stress (p = 0.030; Cohen d = -0.31), and family conflict (p = 0.026; Cohen d = -0.32). QoL, depression, perceived stress, and family conflict were still significantly different at 12 months. Most patients were satisfied with SOUL-P, while caregivers in the SOUL-P group reported overloading tasks. CONCLUSION SOUL-P may reduce perceived stress and improve psychological outcomes in AD patients. Stressor-based interventions, patient-oriented goals, and a multidisciplinary team are essential features for a successful SOUL-P.
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Affiliation(s)
- Bing Yang
- Nursing Department, Stomatological Hospital of Chongqing Medical University, Yubei District, Chongqing, China
| | - Siyuan Yang
- Nursing Department, the First Affiliated Hospital of Chongqing Medical University, Yuzhong District, Chongqing, China
| | - Yunmei Zhang
- Nursing Department, Stomatological Hospital of Chongqing Medical University, Yubei District, Chongqing, China
| | - Wentao Liu
- Rehabilitation Department, the Affiliated Rehabilitation Hospital of Chongqing Medical University, Jiulongpo District, Chongqing, China
| | - Yao Gan
- Psychiatry Department, the First Affiliated Hospital of Chongqing Medical University, Yuzhong District, Chongqing, China
| | - Yaling Li
- Geriatric Department, the First Affiliated Hospital of Chongqing Medical University, Yuzhong District, Chongqing, China
| | - Dengbi Jiang
- Community Health Center of Daxigou, Yuzhong District, Chongqing, China
| | - Yetao Luo
- Clinical Epidemiology and Biostatistics Department, Children's Hospital affiliated with Chongqing Medical University, Chongqing, China
| | - Qinghua Zhao
- Nursing Department, the First Affiliated Hospital of Chongqing Medical University, Yuzhong District, Chongqing, China
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Opdebeeck C, Katsaris MA, Martyr A, Lamont RA, Pickett JA, Rippon I, Thom JM, Victor C, Clare L. What Are the Benefits of Pet Ownership and Care Among People With Mild-to-Moderate Dementia? Findings From the IDEAL programme. J Appl Gerontol 2020; 40:1559-1567. [PMID: 33025847 PMCID: PMC8564240 DOI: 10.1177/0733464820962619] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Pet ownership has been associated with positive outcomes in many populations, yet
the associations with physical and psychological wellbeing in people with
dementia remain unclear. The current study used baseline data from 1,542 people
living at home with mild-to-moderate dementia from the Improving the experience
of Dementia and Enhancing Active Life (IDEAL) programme. Regression analyses
investigated associations of pet ownership and pet care with self-reports of
walking, loneliness, depression, and quality of life (QoL). After adjusting for
covariates, having any pet was associated with higher likelihood of walking over
3 hr in the last week. Those with a dog and who were involved in its care were
less likely to be lonely than those with no dog. Having any pet but no
involvement in its care was associated with increased depression and decreased
QoL compared with those without a pet. The key factor in the associations was
involvement in the care of the pet by the person with dementia.
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Affiliation(s)
- Carol Opdebeeck
- Manchester Metropolitan University,
UK
- Carol Opdebeeck, Department of Psychology,
Manchester Metropolitan University, Manchester, M15 6GX, UK.
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Victor CR, Rippon I, Nelis SM, Martyr A, Litherland R, Pickett J, Hart N, Henley J, Matthews F, Clare L. Prevalence and determinants of loneliness in people living with dementia: Findings from the IDEAL programme. Int J Geriatr Psychiatry 2020; 35:851-858. [PMID: 32281151 DOI: 10.1002/gps.5305] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 03/25/2020] [Accepted: 03/29/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To establish the prevalence and determinants of loneliness among people living with dementia. METHODS Using data from the baseline wave of the Improving the experience of Dementia and Enhancing Active Life (IDEAL) cohort study, we examined the prevalence and predictors of loneliness in 1547 people with mild-to-moderate dementia. Loneliness was assessed using the six-item De Jong Gierveld loneliness scale. RESULTS About 30.1% of people with dementia reported feeling moderately lonely and 5.2% severely lonely. Depressive symptoms and increased risk of social isolation were associated with both moderate and severe loneliness. Those living alone were more likely to experience severe loneliness as were those reporting poorer quality of life. Marital status was not associated with loneliness nor were dementia diagnosis or cognitive function. CONCLUSIONS This is one of the few large-scale studies to explore the prevalence of and determinants of loneliness among people living with dementia. Social isolation, depression and living alone were associated with experiencing loneliness. Longitudinal studies are needed to determine the directionality of these associations.
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Affiliation(s)
- Christina R Victor
- Department of Clinical Sciences, College of Health and Life Sciences, Brunel University London, Uxbridge, UK
| | - Isla Rippon
- Department of Clinical Sciences, College of Health and Life Sciences, Brunel University London, Uxbridge, UK
| | - Sharon M Nelis
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter, Exeter, UK
| | - Anthony Martyr
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter, Exeter, UK
| | | | | | | | - Josie Henley
- Wales Institute for Social and Economic Research, Data and Methods, Cardiff University, Cardiff, UK
| | - Fiona Matthews
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Linda Clare
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter, Exeter, UK
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Clarke C, Woods B, Moniz-Cook E, Mountain G, Øksnebjerg L, Chattat R, Diaz A, Gove D, Vernooij-Dassen M, Wolverson E. Measuring the well-being of people with dementia: a conceptual scoping review. Health Qual Life Outcomes 2020; 18:249. [PMID: 32709238 PMCID: PMC7382062 DOI: 10.1186/s12955-020-01440-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 06/05/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Enabling people with dementia to 'live well' is a policy and research priority in many countries. However, instruments for measuring outcomes of psychosocial interventions designed to promote well-being in dementia are often derived from a symptom-focused, loss/deficit approach, or from broad quality of life concepts. A pan-European dementia working group called for research on the development of an alternative asset/strengths-based conceptual framework of well-being in dementia. This paper takes forward this recommendation by developing such a framework and using this to map relevant self-report outcome measures. METHODS Three scoping reviews of published studies were conducted iteratively. First, we examined the literature on lived experiences of well-being and quality of life in people with dementia and then the wider dementia literature for application of well-being constructs. The synthesised findings generated conceptual domains of well-being in people with dementia. Corresponding self-report instruments used in dementia research were scoped, categorised within the conceptual framework and their potential value in measuring outcomes for people with dementia was examined. FINDINGS Six conceptual domains for the measurement of well-being and 35 self-report instruments that have been used with people with dementia were identified. Six instruments were developed specifically for people with dementia, five were derived from the gerontological literature and 24 from the well-being literature. Fifteen instruments and one sub-scale have been examined for psychometric properties amongst people with dementia. To date, 20 have been used as outcome measures, with seven measuring change over time. A number of identified instruments utilise traditional retrospective Likert-scaling response formats, limiting their potential for use with some groups of people with dementia. CONCLUSION An assets/strengths-based framework is presented, outlining structural domains for selecting self-report measures of well-being in people with dementia. It provides a foundation for enhancing research into processes and outcomes of psychosocial interventions, including instrument development, more precise matching of intervention aims with outcome measurement, and newer technology-based 'in-the-moment' measurement.
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Affiliation(s)
- Chris Clarke
- Faculty of Health Sciences, University of Hull, Hull, HU6 7RX UK
| | - Bob Woods
- DSDC Wales, Bangor University, Ardudwy, Holyhead Road, Bangor, Gwynedd LL57 2PZ UK
| | - Esme Moniz-Cook
- Faculty of Health Sciences, University of Hull, Hull, HU6 7RX UK
| | - Gail Mountain
- School of Dementia Studies, University of Bradford, Richmond Rd, Bradford, BD7 1DP UK
| | - Laila Øksnebjerg
- Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Section 6922, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - Rabih Chattat
- Department of Psychology Università di Bologna - Via Zamboni, 33 - 40126 Bologna, Italy
| | - Ana Diaz
- Alzheimer Europe, L-1417 14, rue Dicks, Luxembourg
| | - Dianne Gove
- Alzheimer Europe, L-1417 14, rue Dicks, Luxembourg
| | - Myrra Vernooij-Dassen
- Radboud University Medical Centre, Scientific Center for Quality of Healthcare, IQ Healthcare 114, PO Box 9101, 6500HB Nijmegen, The Netherlands
| | - Emma Wolverson
- Faculty of Health Sciences, University of Hull, Hull, HU6 7RX UK
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Sweeney L, Clarke C, Wolverson E. The use of everyday technologies to enhance well-being and enjoyment for people living with dementia: A systematic literature review and narrative synthesis. DEMENTIA 2020; 20:1470-1495. [PMID: 32539471 DOI: 10.1177/1471301220929534] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Everyday technologies, such as laptops and tablets, are often used for enjoyment, pleasure, leisure and social participation. Despite this, whilst considerable research has investigated exploring people's experiences of using assistive technologies, it is not clear how everyday technologies are experienced by individuals living with dementia. The aims of this review were to explore the experiences and views of people living with dementia and carers about using everyday technology to enhance their well-being and enjoyment, social engagement, participation and leisure as well as understand their views about the usability of everyday technology in dementia. METHODS A systematic search of the literature was conducted using the electronic databases: PsycINFO, PsycARTICLES, CINAHL Complete and EThOS. Five qualitative studies and five mixed-method studies were included and synthesised using a narrative approach. The methodological quality of the studies was assessed using the National Institute for Health and Care Excellence Qualitative Quality Appraisal, which uncovered key variation in the quality of the included, synthesised studies. FINDINGS The review suggests that everyday technologies can help support well-being, particularly when technology is used in a group setting and when individuals received the right amount of support to help engage in the technology. Four major themes relating to experiences and views were derived from the findings of the 10 included studies: 'Technology use maintaining a sense of identity', 'Assumptions held by the self and others', 'The importance of others' and 'The usability of technology influencing effective engagement'. CONCLUSIONS Overall, everyday technologies appear to have a positive impact on different aspects of the well-being of people living with dementia. Clinical implications of these findings include supporting opportunities for people living with dementia to use everyday technology for enjoyment and making these technologies more widely available and accessible.
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Affiliation(s)
- Laura Sweeney
- Department of Psychological Health, Wellbeing and Social Work, University of Hull, Hull, UK
| | - Christopher Clarke
- Department of Psychological Health, Wellbeing and Social Work, University of Hull, Hull, UK
| | - Emma Wolverson
- Department of Psychological Health, Wellbeing and Social Work, University of Hull, Hull, UK
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Bayer A. Next steps after diagnosing dementia: interventions to help patients and families. Pract Neurol 2020; 20:294-303. [PMID: 32444477 DOI: 10.1136/practneurol-2019-002416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2020] [Indexed: 11/03/2022]
Abstract
The way that a diagnosis of dementia is delivered to patients, what information is provided and what practical advice and support is arranged has a lasting impact and deserves at least as much attention as the process of assessment and investigation. Individuals and their families require an honest yet sensitive discussion about the nature and cause of their problems, using non-technical language and tailored to their priorities and needs. This should lead on to the provision of good-quality information in an accessible format. Priorities for intervention include medication review, attention to sensory deficits, appropriate pharmacological and nonpharmacological treatment, best use of memory aids and strategies and discussion of driving eligibility, financial entitlement and legal advice. Referral onwards should be made to an appropriate individual or service to provide ongoing emotional and practical support and signposting.
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Affiliation(s)
- Antony Bayer
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
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Wu YT, Nelis SM, Quinn C, Martyr A, Jones IR, Victor CR, Knapp M, Henderson C, Hindle JV, Jones RW, Kopelman MD, Morris RG, Pickett JA, Rusted JM, Thom JM, Litherland R, Matthews FE, Clare L. Factors associated with self- and informant ratings of quality of life, well-being and life satisfaction in people with mild-to-moderate dementia: results from the Improving the experience of Dementia and Enhancing Active Life programme. Age Ageing 2020; 49:446-452. [PMID: 32037460 DOI: 10.1093/ageing/afz177] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 11/13/2019] [Accepted: 12/11/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND a large number of studies have explored factors related to self- and informant ratings of quality of life in people with dementia, but many studies have had relatively small sample sizes and mainly focused on health conditions and dementia symptoms. The aim of this study is to compare self- and informant-rated quality of life, life satisfaction and well-being, and investigate the relationships of the two different rating methods with various social, psychological and health factors, using a large cohort study of community-dwelling people with dementia and carers in Great Britain. METHODS this study included 1,283 dyads of people with mild-to-moderate dementia and their primary carers in the Improving the experience of Dementia and Enhancing Active Life study. Multivariate modelling was used to investigate associations of self- and informant-rated quality of life, life satisfaction and well-being with factors in five domains: psychological characteristics and health; social location; capitals, assets and resources; physical fitness and health; and managing everyday life with dementia. RESULTS people with dementia rated their quality of life, life satisfaction and well-being more highly than did the informants. Despite these differences, the two approaches had similar relationships with social, psychological and physical health factors in the five domains. CONCLUSION although self- and informant ratings differ, they display similar results when focusing on factors associated with quality of life, life satisfaction and well-being. Either self- or informant ratings may offer a reasonable source of information about people with dementia in terms of understanding associated factors.
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Affiliation(s)
- Yu-Tzu Wu
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School and College of Life and Environment Sciences, Exeter, UK
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Sharon M Nelis
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School and College of Life and Environment Sciences, Exeter, UK
| | - Catherine Quinn
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School and College of Life and Environment Sciences, Exeter, UK
- Centre of Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Anthony Martyr
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School and College of Life and Environment Sciences, Exeter, UK
| | - Ian R Jones
- Wales Institute for Social and Economic Research, Data and Methods, Cardiff University, Cardiff, UK
| | - Christina R Victor
- College of Health and Life Sciences, Brunel University London, Uxbridge, UK
| | - Martin Knapp
- Personal Social Services Research Unit, London School of Economics and Political Science, London, UK
| | - Catherine Henderson
- Personal Social Services Research Unit, London School of Economics and Political Science, London, UK
| | - John V Hindle
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School and College of Life and Environment Sciences, Exeter, UK
| | - Roy W Jones
- Research Institute for the Care of Older People (RICE), Bath, UK
| | - Michael D Kopelman
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Robin G Morris
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | | | | | - Jeanette M Thom
- School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | | | - Fiona E Matthews
- Institute for Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Linda Clare
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School and College of Life and Environment Sciences, Exeter, UK
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Clare L, Martyr A, Morris RG, Tippett LJ. Discontinuity in the Subjective Experience of Self Among People with Mild-To-Moderate Dementia Is Associated with Poorer Psychological Health: Findings from the IDEAL Cohort. J Alzheimers Dis 2020; 77:127-138. [PMID: 32804138 PMCID: PMC7592652 DOI: 10.3233/jad-200407] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND The onset and progression of dementia can result in changes in the subjective experience of self, impacting on psychological health. OBJECTIVE We aimed to explore the extent to which people with mild-to-moderate dementia experience discontinuity in the subjective experience of self, and the factors associated with this experience for people with dementia and their family caregivers. METHODS We used data from the baseline assessment of the IDEAL cohort. Discontinuity in the subjective experience of self was assessed by asking participants about their agreement with the statement 'I feel I am the same person that I have always been'. Participants were divided into those who did and did not experience discontinuity, and the two groups were compared in terms of demographic and disease-related characteristics, psychological well-being, measures of 'living well', and caregiver stress. RESULTS Responses to the continuity question were available for 1,465 participants with dementia, of whom 312 (21%) reported experiencing discontinuity. The discontinuity group experienced significantly poorer psychological well-being and had significantly lower scores on measures of 'living well'. There was no clear association with demographic or disease-related characteristics, but some indication of increased caregiver stress. CONCLUSION A significant proportion of people with mild-to-moderate dementia describe experiencing discontinuity in the subjective sense of self, and this is associated with poorer psychological health and reduced ability to 'live well' with the condition. Sensitively asking individuals with dementia about the subjective experience of self may offer a simple means of identifying individuals who are at increased risk of poor well-being.
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Affiliation(s)
- Linda Clare
- REACH: The Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, University of Exeter, St Luke’s Campus, Exeter, UK
| | - Anthony Martyr
- REACH: The Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, University of Exeter, St Luke’s Campus, Exeter, UK
| | - Robin G. Morris
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Lynette J. Tippett
- School of Psychology, The University of Auckland, Auckland, New Zealand
- Centre for Brain Research, The University of Auckland, Auckland, New Zealand
- Brain Research New Zealand, Auckland, New Zealand
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Henderson C, Knapp M, Nelis SM, Quinn C, Martyr A, Wu YT, Jones IR, Victor CR, Pickett JA, Hindle JV, Jones RW, Kopelman MD, Matthews FE, Morris RG, Rusted JM, Thom JM, Clare L. Use and costs of services and unpaid care for people with mild-to-moderate dementia: Baseline results from the IDEAL cohort study. ALZHEIMERS & DEMENTIA-TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2019; 5:685-696. [PMID: 31720369 PMCID: PMC6838500 DOI: 10.1016/j.trci.2019.09.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Introduction We examined 3-month service use and costs of care for people with mild-to-moderate dementia in Great Britain. Methods We analyzed Improving the experience of Dementia and Enhancing Active Life cohort study baseline data on paid care, out-of-pocket expenditure, and unpaid care from participants with dementia (N = 1547) and their carers (N = 1283). In regression analyses, we estimated per-group mean costs of diagnostic and sociodemographic subgroups. Results Use of services apart from primary and outpatient hospital care was low. Unpaid care accounted for three-quarters of total costs (mean, £4008 [standard error, £130] per participant). Most participants (87%) received unpaid care equating to 36 hours weekly. Estimated costs for people with Parkinson's dementia were £8609, £4359 for participants with mixed dementia, and £3484 for those with Alzheimer's disease. Total costs were lower for participants with dementia living alone than living with others (£2484 vs. £4360); costs were lower for female than for male participants (£3607 vs. £4272). Discussion Costs varied by dementia subtype, carer status, and living arrangement. Policy makers should recognize the high costs of unpaid care for people with dementia, who do not always get the support that they need or would like to receive.
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Affiliation(s)
- Catherine Henderson
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Martin Knapp
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Sharon M Nelis
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter, Exeter, UK
| | - Catherine Quinn
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter, Exeter, UK
| | - Anthony Martyr
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter, Exeter, UK
| | - Yu-Tzu Wu
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter, Exeter, UK
| | - Ian R Jones
- Wales Institute for Social and Economic Research, Data and Methods, Cardiff University, Cardiff, UK
| | - Christina R Victor
- College of Health and Life Sciences, Brunel University London, London, UK
| | | | - John V Hindle
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter, Exeter, UK.,College of Health and Life Sciences, Brunel University London, London, UK
| | - Roy W Jones
- The Research Institute for the Care of Older People (RICE), Bath, UK
| | - Michael D Kopelman
- King's College London Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Fiona E Matthews
- Institute for Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Robin G Morris
- King's College London Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | | | - Jeanette M Thom
- School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Linda Clare
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter, Exeter, UK
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Martyr A, Nelis SM, Quinn C, Rusted JM, Morris RG, Clare L. The relationship between perceived functional difficulties and the ability to live well with mild-to-moderate dementia: Findings from the IDEAL programme. Int J Geriatr Psychiatry 2019; 34:1251-1261. [PMID: 31034650 PMCID: PMC6767698 DOI: 10.1002/gps.5128] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 04/19/2019] [Indexed: 01/07/2023]
Abstract
OBJECTIVES The objectives of the study are to investigate how different levels of functional ability relate to quality of life, well-being, and satisfaction with life, conceptualised as reflecting capability to "live well" in people with dementia. METHODS/DESIGN Participants were 1496 people with mild-to-moderate dementia and 1188 informants who completed baseline assessments in the Improving the experience of Dementia and Enhancing Active Life (IDEAL) cohort study. Total self-rated and informant-rated scores on the Functional Activities Questionnaire were split into six ability levels to monitor how poorer functioning impacts the ability to live well. We also investigated the potential influence of sociodemographic and diagnostic variables, depression, cognition, and carer stress. RESULTS Multivariate multiple regression models found that people with dementia who had the greatest functional impairment according to self-ratings and informant ratings had poorer living well scores than those with the least functional impairment. Sociodemographic and diagnostic factors and cognition had little impact on effect sizes. For self-ratings, depression attenuated the relationship between functional ability and living well, whereas carer stress attenuated informant ratings. CONCLUSIONS People with dementia with the least functional impairments had greater capability to live well than those with the most functional impairment. Even subtle perceived difficulties in functional ability had a detrimental effect on the ability of people with dementia to live well. Depression in people with dementia and carer stress in informants influenced these associations, and therefore, these factors should be routinely included in future research studies and clinical assessments.
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Affiliation(s)
- Anthony Martyr
- Centre for Research in Ageing and Cognitive Health, School of PsychologyUniversity of Exeter Medical School and College of Life and Environmental Sciences, St Luke's CampusExeterUK
| | - Sharon M. Nelis
- Centre for Research in Ageing and Cognitive Health, School of PsychologyUniversity of Exeter Medical School and College of Life and Environmental Sciences, St Luke's CampusExeterUK
| | - Catherine Quinn
- Centre for Research in Ageing and Cognitive Health, School of PsychologyUniversity of Exeter Medical School and College of Life and Environmental Sciences, St Luke's CampusExeterUK
- Centre of Applied Dementia StudiesUniversity of BradfordBradfordUK
| | | | - Robin G. Morris
- Department of PsychologyInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| | - Linda Clare
- Centre for Research in Ageing and Cognitive Health, School of PsychologyUniversity of Exeter Medical School and College of Life and Environmental Sciences, St Luke's CampusExeterUK
- Wellcome Centre for Cultures and Environments of HealthUniversity of ExeterExeterUK
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