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Stypulkowski K, Anquillare E, Twamley EW, Thayer RE. Feasibility of a Telehealth Compensatory Cognitive Training Program for Older Adults with Mild Cognitive Impairment. Clin Gerontol 2024; 47:17-25. [PMID: 37195804 DOI: 10.1080/07317115.2023.2213694] [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] [Indexed: 05/18/2023]
Abstract
OBJECTIVES Older adults experiencing mild cognitive impairment (MCI) may benefit from compensatory cognitive training (CCT). This study investigated the feasibility of telehealth CCT among older adults with MCI. METHODS Adults age 55+ with MCI (n = 28) and a care partner (n = 18) participated in telehealth CCT. Participants rated sessions' technological interference on an adapted 0-100 session rating scale (higher scores=less interference). Clinicians provided ratings and qualitative feedback on types of interference experienced. Feasibility was assessed by enrollment and completion rates, and through ratings and feedback. RESULTS 6% of contacts declined participation due to telehealth delivery. 24 of 28 participants completed the program, with no dropouts due to telehealth. Participants (M = 81.32, SD = 25.61) and clinicians (M = 76.24, SD = 33.37) rated technological interference as infrequent. Clinicians indicated most interference did not impact sessions, though 4% required rescheduling due to interference. CONCLUSIONS Telehealth delivery was not a barrier to recruitment, enrollment, or completion of CCT. Technological problems were mostly minor. Telehealth CCT could support access to and intervention among older adults with MCI. CLINICAL IMPLICATIONS Telehealth CCT for older adults with MCI was feasible, with mild issues not impacting session completion. Clinicians should be prepared to offer support as technological issues arise, or have dedicated technological support services.
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Affiliation(s)
- Katie Stypulkowski
- Psychology Department, University of Colorado Colorado Springs, Colorado Springs, Colorado, USA
| | - Elizabeth Anquillare
- Psychology Department, University of Colorado Colorado Springs, Colorado Springs, Colorado, USA
| | - Elizabeth W Twamley
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California, USA
| | - Rachel E Thayer
- Psychology Department, University of Colorado Colorado Springs, Colorado Springs, Colorado, USA
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Meyer OL, Zheng S, Alto R, Tran D, Luu S, Vu U, Hinton L, Harvey D. Caregivers of People With Mild Cognitive Impairment and Dementia: Characterizing Social and Psychological Outcomes. Alzheimer Dis Assoc Disord 2024; 38:51-58. [PMID: 38277636 PMCID: PMC10922819 DOI: 10.1097/wad.0000000000000603] [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: 08/08/2023] [Accepted: 12/15/2023] [Indexed: 01/28/2024]
Abstract
OBJECTIVE Little is known about caregiving across the spectrum of cognitive impairment [mild cognitive impairment (MCI) to dementia] and how early life and sociocultural factors affect caregiver health. In this study, we characterized differences between caregivers of those with MCI versus those with dementia. METHODS A total of 158 caregivers were enrolled in this cross-sectional study, most of whom were dementia caregivers (65%). Caregivers completed questionnaires on depressive symptoms, self-rated health (SRH), perceived burden and stress, as well as psychosocial and demographic measures. RESULTS Caregivers of those with MCI reported fewer depressive symptoms and lower stress and burden compared with dementia caregivers. In adjusted analyses caregivers with greater stress reported more depressive symptoms. For SRH, at lower stress levels, having a sibling die before age 18 (ie, early life adversity) was associated with poorer SRH; at higher stress levels, having early life adversity was associated with better SRH. At lower burden levels, more live births were associated with worse SRH; at higher burden levels, more live births were associated with better SRH. CONCLUSIONS Early life factors are relevant for caregivers of those with cognitive impairment and targeted prevention and early intervention may be helpful in alleviating caregiver burden and stress.
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Affiliation(s)
- Oanh L. Meyer
- University of California, Davis, School of Medicine, Sacramento, CA 95817, USA
| | - Shichen Zheng
- University of California, Davis, School of Medicine, Sacramento, CA 95817, USA
| | - Raquel Alto
- Crowell & Moring LLP, Washington, DC, 20004, USA
| | - Duyen Tran
- University of California, Davis, School of Medicine, Sacramento, CA 95817, USA
| | - San Luu
- University of California, Davis, School of Medicine, Sacramento, CA 95817, USA
| | - Uyen Vu
- University of California, Davis, School of Medicine, Sacramento, CA 95817, USA
| | - Ladson Hinton
- University of California, Davis, School of Medicine, Sacramento, CA 95817, USA
| | - Danielle Harvey
- University of California, Davis, School of Medicine, Sacramento, CA 95817, USA
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Blair EM, Reale BK, Zahuranec DB, Forman J, Langa KM, Giordani BJ, Plassman BL, Welsh-Bohmer KA, Wang J, Kollman CD, Levine DA. Influence of mild cognitive impairment on patient and care partner decision-making for acute ischemic stroke. J Stroke Cerebrovasc Dis 2023; 32:107068. [PMID: 37004301 PMCID: PMC10499500 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107068] [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: 12/12/2022] [Revised: 02/28/2023] [Accepted: 03/02/2023] [Indexed: 04/03/2023] Open
Abstract
GOALS Evidence suggests that patients with mild cognitive impairment (MCI) receive fewer treatments for acute ischemic stroke and other cardiovascular diseases than patients with normal cognition. Little is known about how patient and care partner preferences for ischemic stroke treatment differ between the patient population with MCI and the population with normal cognition. This study aimed to understand how patient MCI diagnosis influences patient and care partner decision-making for acute ischemic stroke treatments. METHODS Multi-center qualitative study using in-person semi-structured interviews with 20 MCI and normal cognition patient-care partner dyads using a standard guide. The present study reports results on patient and care partner preferences for a clinical vignette patient to receive three non-invasive treatments (intravenous tissue plasminogen activator, inpatient rehabilitation, and secondary preventive medications) and two invasive treatments (feeding tube and carotid endarterectomy) after acute ischemic stroke. We used qualitative content analysis to identify themes. FINDINGS We identified three major themes: (1) Patients with MCI desired non-invasive treatments after stroke, similar to patients with normal cognition and for similar reasons; (2) Patients with MCI expressed different preferences than patients with normal cognition for two invasive treatments after stroke: carotid endarterectomy and feeding tube placement; and (3) Patients with MCI expressed more skepticism of the stroke treatment options and less decisiveness in decision-making than patients with normal cognition. CONCLUSIONS These results suggest that patient MCI diagnosis may contribute to differences in patient and care partner preferences for invasive treatments after stroke, but not for non-invasive treatments.
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Affiliation(s)
- Emilie M Blair
- Department of Internal Medicine and Cognitive Health Services Research Program, U-M Medical School, Ann Arbor, MI, USA
| | - Bailey K Reale
- Department of Internal Medicine and Cognitive Health Services Research Program, U-M Medical School, Ann Arbor, MI, USA; Lake Erie College of Osteopathic Medicine at Seton Hill, LECOM, Greensburg, PA, USA
| | | | - Jane Forman
- Department of Internal Medicine and Cognitive Health Services Research Program, U-M Medical School, Ann Arbor, MI, USA; VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; Institute for Social Research, U-M, Ann Arbor, MI, USA
| | - Kenneth M Langa
- Department of Internal Medicine and Cognitive Health Services Research Program, U-M Medical School, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, U-M, Ann Arbor, MI, USA; VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; Institute for Social Research, U-M, Ann Arbor, MI, USA
| | - Bruno J Giordani
- Department of Psychiatry and Michigan Alzheimer's Disease Center, U-M, Ann Arbor, MI, USA
| | - Brenda L Plassman
- Department of Psychiatry and Behavioral Science, Duke University School of Medicine, Durham, NC, USA
| | - Kathleen A Welsh-Bohmer
- Department of Psychiatry and Behavioral Science, Duke University School of Medicine, Durham, NC, USA
| | - Jing Wang
- Department of Psychiatry and Behavioral Science, Duke University School of Medicine, Durham, NC, USA
| | | | - Deborah A Levine
- Department of Internal Medicine and Cognitive Health Services Research Program, U-M Medical School, Ann Arbor, MI, USA; Department of Neurology and Stroke Program, U-M, Ann Arbor, MI, USA; VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
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Oshita JY, Gell NM, Stransky ML, Reed NS, MacLean CD. Prevalence and sociodemographic characteristics of US community-dwelling older adults with communication disabilities, using the national health and aging trends survey. JOURNAL OF COMMUNICATION DISORDERS 2023; 102:106316. [PMID: 36870271 PMCID: PMC10236317 DOI: 10.1016/j.jcomdis.2023.106316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Identifying the population-level prevalence of a disability group is a prerequisite to monitoring their inclusion in society. The prevalence and sociodemographic characteristics of older adults with communication disabilities (CDs) are not well established in the literature. In this study we sought to describe the prevalence and sociodemographic characteristics of community-dwelling older adults experiencing difficulties with understanding others or being understand when communicating in their usual language. METHODS We conducted a cross-sectional analysis of the National Health and Aging Trends Survey (2015), a nationally representative survey of Medicare beneficiaries ages ≥ 65 years old (N = 7,029). We calculated survey weight-adjusted prevalence estimates by mutually exclusive subgroups of no, hearing only, expressive-only, cognitive only, multiple CDs, and an aggregate any-CD prevalence. We described race/ethnicity, age, gender, education, marital status, social network size, federal poverty status, and supplemental insurance for all groups. Pearson's chi-squared statistic was used to compare sociodemographic characteristics between the any-CD and no-CD groups. RESULTS An estimated 25.3% (10.7 million) of community-dwelling older adults in the US experienced any-CDs in 2015; approximately 19.9% (8.4 million) experienced only one CD while 5.6% (2.4 million) had multiple. Older adults with CDs were more likely to be of Black race or Hispanic ethnicity as compared to older adults without CDs (Black 10.1 vs. 7.6%; Hispanic: 12.5 vs. 5.4%; P < 0.001). They also had lower educational attainment (Less than high school: 31.0 vs 12.4%; P < 0.001), lower poverty levels (<100% Federal poverty level: 23.5% vs. 11.1%; P < 0.001) and less social supports (Married: 51.3 vs. 61.0%; P < 0.001; Social network ≤ 1 person: 45.3 vs 36.0%; P < 0.001). CONCLUSIONS The proportion of the older adult population experiencing any-CDs is large and disproportionately represented by underserved sociodemographic groups. These findings support greater inclusion of any-CDs into population-level efforts like national surveys, public health goals, health services, and community research aimed at understanding and addressing the access needs of older adults who have disabilities in communication.
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Affiliation(s)
- Jennifer Y Oshita
- Clinical and Translational Sciences Program, University of Vermont, 14 Adsit Court, Burlington, VT 05401, United States.
| | - Nancy M Gell
- Department of Rehabilitation and Movement Science, University of Vermont, United States
| | - Michelle L Stransky
- Center for the Urban Child and Healthy Family, Boston Medical Center, United States
| | - Nicholas S Reed
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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Couch E, Belanger E, Gadbois EA, DePasquale N, Zhang W, Wetle T. "I know that my role is going to change": a mixed-methods study of the relationship between amyloid-β PET scan results and caregiver burden. Aging Clin Exp Res 2023; 35:387-397. [PMID: 36484946 PMCID: PMC9735001 DOI: 10.1007/s40520-022-02314-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/27/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Caregiver burden consists of disease specific and perceived stressors, respectively referred to as objective and subjective indicators of burden, and is associated with negative outcomes. Previous research has found that care partners to persons living with cognitive impairment and elevated levels of amyloid-β, as measured by a positron emission tomography (PET) scan, may experience caregiver burden. AIMS To elucidate the relationship between amyloid scan results and subjective and objective indicators of burden. METHODS A parallel mixed-methods design using survey data from 1338 care partners to persons with mild cognitive impairment (MCI) and dementia who received an amyloid scan from the CARE-IDEAS study; and semi-structured interviews with a subsample of 62 care partners. Logistic regression models were used to investigate objective factors associated with caregiver burden. A thematic analysis of semi-structured interviews was used to investigate subjective indicators by exploring care partners' perceptions of their role following an amyloid scan. RESULTS Elevated amyloid was not associated with burden. However, the scan result influenced participants perceptions of their caregiving role and coping strategies. Care partners to persons with elevated amyloid expected increasing responsibility, whereas partners to persons without elevated amyloid and mild cognitive impairment did not anticipate changes to their role. Care partners to persons with elevated amyloid reported using knowledge gained from the scan to develop coping strategies. All care partners described needing practical and emotional support. CONCLUSIONS Amyloid scans can influence subjective indicators of burden and present the opportunity to identify and address care partners' support needs.
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Affiliation(s)
- Elyse Couch
- grid.40263.330000 0004 1936 9094Center for Gerontology and Healthcare Research, Brown University School of Public Health, Center for Gerontology and Healthcare Research, Providence, RI USA
| | - Emmanuelle Belanger
- grid.40263.330000 0004 1936 9094Center for Gerontology and Healthcare Research, Brown University School of Public Health, Center for Gerontology and Healthcare Research, Providence, RI USA ,grid.40263.330000 0004 1936 9094Department of Health Services, Brown University School of Public Health, Policy & Practice, Providence, RI USA
| | - Emily A. Gadbois
- grid.40263.330000 0004 1936 9094Center for Gerontology and Healthcare Research, Brown University School of Public Health, Center for Gerontology and Healthcare Research, Providence, RI USA
| | - Nicole DePasquale
- grid.26009.3d0000 0004 1936 7961Division of General Internal Medicine, Duke University School of Medicine, Durham, NC USA
| | - Wenhan Zhang
- grid.26009.3d0000 0004 1936 7961Department of Population Health Sciences, Duke University School of Medicine, Durham, NC USA
| | - Terrie Wetle
- grid.40263.330000 0004 1936 9094Center for Gerontology and Healthcare Research, Brown University School of Public Health, Center for Gerontology and Healthcare Research, Providence, RI USA
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6
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Roberto KA, Savla J. Extended Family Caregivers for Persons Living With Dementia. JOURNAL OF FAMILY NURSING 2022; 28:396-407. [PMID: 35960005 PMCID: PMC10112257 DOI: 10.1177/10748407221115455] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Despite changes in the structure of contemporary families, little is known about extended family members-siblings, grandchildren, nieces/nephews, stepkin-who are primary caregivers for a relative living with dementia. Information about these caregivers is needed to help ensure their needs are understood by providers in health care and social service settings. The focus of this research was on the care situations of extended family caregivers and the impact of caregiving on their health and well-being. In Study 1, data from the National Study of Caregiving were used to describe the experiences of 107 extended family caregivers. In Study 2, case study techniques elicited additional information about the experiences of 10 extended family caregivers. Collectively, these caregivers provide care with little or no formal support and occasional help from a small informal network. Caregiving affected their physical and emotional health, depending on the strength of the relationship between the caregiver and the person living with dementia and the type of care provided. Findings contribute new knowledge about extended family caregivers and highlight the important role extended family dementia caregivers play and the challenges they face.
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Lu Y, Liu C, Yu D, Wells Y. Conditions required to ensure successful detection and management of mild cognitive impairment in primary care: A Delphi consultation study in China. Front Public Health 2022; 10:943964. [PMID: 36211650 PMCID: PMC9540221 DOI: 10.3389/fpubh.2022.943964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 09/06/2022] [Indexed: 01/21/2023] Open
Abstract
Objective Detection and management of mild cognitive impairment (MCI) in primary care has been recognized internationally as one of the strategies that can be employed to delay the development of dementia. However, little is known about what role primary care should play. This study aimed to develop a checklist of conditions necessary for successfully detecting and managing mild cognitive impairment in primary care in China. Methods This study employed the Delphi method to establish expert consensus on the conditions required for successfully detecting and managing MCI in primary care in China. Twenty-four experts who specialized in general practice, public health, neuropsychology, or community health service management rated the importance of pre-defined conditions (44 items measuring providers' preparedness, patient engagement, and system support in line with the Chronic Care Model). The degree of consensus among the experts was measured using four indicators: median ≥ 4, mean ≥3.5, Co-efficient of Variance < 0.25, and retention in the checklist required ≥ 80% agreement with a rating of important or essential. The checklist and descriptions of the conditions were revised according to the experts' feedback and then sent out for repeated consultations along with a summary of the results of the previous round of consultations. Consensus was achieved after the second round of consultations, which was completed by 22 of the experts. Results The experts endorsed a checklist of 47 conditions required for successful detection and management of MCI in primary care in China. These conditions were categorized into four domains: prepared general practitioners (17 items), engaged patients (15 items), organizational efforts (11 items), and environmental support (4 items). Conclusions Successful detection and management of MCI in primary care in China requires a dedicated and competent workforce of general practitioners, as well as the engagement of patients and family caregivers. Adequate support from healthcare organizations, health system arrangements, and the broader society is needed to enable effective interactions between general practitioners and patients and efficient delivery of the services required to detect and manage MCI.
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Affiliation(s)
- Yuan Lu
- Department of General Practice, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
- Academic Department of General Practice, Tongji University School of Medicine, Shanghai, China
- Shanghai General Practice and Community Health Development Research Center, Shanghai, China
| | - Chaojie Liu
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Dehua Yu
- Department of General Practice, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China
- Academic Department of General Practice, Tongji University School of Medicine, Shanghai, China
- Shanghai General Practice and Community Health Development Research Center, Shanghai, China
| | - Yvonne Wells
- Lincoln Center for Research on Aging, La Trobe University, Melbourne, VIC, Australia
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Mueller A, Thao L, Condon O, Liebzeit D, Fields B. A Systematic Review of the Needs of Dementia Caregivers Across Care Settings. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2022. [DOI: 10.1177/10848223211056928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The U.S. population of older adults living with dementia is projected to double by 2060. They rely on over 16 million family and unpaid caregivers to provide for their increasingly complex needs and care transitions. Caregivers frequently feel underprepared and without adequate support or access to resources. This systematic review seeks to identify the needs of family and unpaid caregivers of older adults living with dementia across various care settings in the U.S. A systematic search was conducted to identify articles pertaining to the needs of caregivers of older adults living with dementia. The data extraction tool was developed using aspects from the Care Transitions Framework and the Family Caregiver Alliance. Data were organized based on 3 domains of caregiver needs and the care setting(s) of the older adults living with dementia and their caregivers. A total of 31 articles were eligible for inclusion. The majority met the MMAT screening criteria, but more than half only met 2 or less of the 5 quality criteria. Caregivers’ needs were identified in the care settings of home/community-residing, assisted living, long-term care, skilled nursing, and memory care. Most articles either did not specify a care setting or included more than 1 and did not report the findings separately. Caregivers in each care setting, except memory care, identified needs in all 3 of the following domains: (1) social support—formal and informal, (2) confidence, competence, and strengths in the caregiving role, and (3) values and preferences.
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Beatie BE, Mackenzie CS, Funk L, Davidson D, Koven L, Reynolds KA. Caregiver identity in care partners of persons living with mild cognitive impairment. DEMENTIA 2021; 20:2323-2339. [PMID: 33595336 PMCID: PMC8564256 DOI: 10.1177/1471301221994317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Research on caregiver identity in the context of memory impairment has focused primarily
on more advanced stages of the cognitive impairment trajectory (e.g., dementia
caregivers), failing to capture the complex dynamics of early caregiver identity
development (e.g., MCI; mild cognitive impairment caregivers). The aim of this study was
to develop a nuanced understanding of how caregiver identity develops in family and
friends of persons living with MCI. Using constructivist grounded theory (ConGT), this
study explored caregiver identity development from 18 in-depth interviews with spouses
(n = 13), children (n = 3), and friends
(n = 2) of persons recently diagnosed with MCI. The overarching themes
influencing MCI caregiver identity development included MCI changes, care-related
experiences, “caregiver” interpretation, and approach/avoidance coping. These themes
influenced how participants primarily identified, represented as I am a caregiver,
I am not a caregiver, or liminality (i.e., between their
previous identity and a caregiver identity). Irrespective of their current
self-identification, all conveyed thinking about their “future self,” as providing more
intensive care. MCI caregiver identity development in family and friends is a fluid and
evolving process. Nearly all participants had taken on care tasks, yet the majority of
these individuals did not clearly identify as caregivers. Irrespective of how participants
identified, they were engaging in care, and would likely benefit from support with
navigating these changes and their new, ambiguous, and evolving roles.
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Affiliation(s)
- Brooke E Beatie
- Department of Psychology, 194379University of Manitoba, Winnipeg, Manitoba, Canada
| | - Corey S Mackenzie
- Department of Psychology, 194379University of Manitoba, Winnipeg, Manitoba, Canada
| | - Laura Funk
- Department of Sociology and Criminology, 8664University of Manitoba, Winnipeg, Manitoba, Canada
| | - Dylan Davidson
- Department of Psychology, 12359University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lesley Koven
- Department of Clinical Health Psychology, 12359University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kristin A Reynolds
- Department of Psychology, 12359University of Manitoba, Winnipeg, Manitoba, Canada
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Bressan V, Visintini C, Palese A. What do family caregivers of people with dementia need? A mixed-method systematic review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:1942-1960. [PMID: 32542963 DOI: 10.1111/hsc.13048] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 05/10/2020] [Accepted: 05/13/2020] [Indexed: 06/11/2023]
Abstract
Caring for people with dementia is a major challenge for relatives and society worldwide. Understanding the family caregivers' needs is crucial to promote their care-giving role during the disease trajectory. The aim of this mixed-method systematic review was to identify and synthetise the existing literature on the needs of family caregivers of people with dementia at home. PubMed, CINAHL, Cochrane Database of Systematic Reviews and PsycINFO databases were systematically explored to find quantitative, qualitative and mixed-method studies published between 2009 and 2019. A total of 1,196 citations were retrieved and 34 studies were included in the review. The variety of interrelated needs emerged from studies has been summarised in four themes: (a) Being supported, (b) Receiving accessible and personalised information, (c) Being trained and educated to care for their beloved with dementia and (d) Finding a balance. Care-giving for individuals with dementia is an ever-changing process characterised by continuous adjustments to their needs. The majority of a family caregivers' needs are oriented towards receiving support, help in offering daily care and finding a balance between the care-giving role and their own personal needs. For family caregivers, receiving information is a priority to improve their knowledge and to develop coping abilities, care skills and strategies aimed at promoting a balance between care assistance duties and their own needs. They also need social, psychological and emotional support and access to flexible, tailored and timely formal care. Further studies are recommended to detect changes in family caregivers' needs throughout the disease progression in order to tailor formal care offered by social and healthcare services.
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Holt Clemmensen T, Hein Lauridsen H, Andersen-Ranberg K, Kaae Kristensen H. Informal carers' support needs when caring for a person with dementia - A scoping literature review. Scand J Caring Sci 2020; 35:685-700. [PMID: 32781496 DOI: 10.1111/scs.12898] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/26/2020] [Accepted: 07/14/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND Informal carers of people with dementia report having unmet needs for support and few supportive interventions have been shown to be effective. There is a need to develop needs assessment instruments and supportive interventions with a holistic and person-centred approach to meet the various and complex needs of carers. The aim of this study was to provide an overview of carers' support needs when caring for people with dementia with the objectives to map and synthesise knowledge on key concepts of carers' support needs. METHODS A scoping review methodology was used. A literature search was conducted in PsycINFO, CINAHL, PubMed and EMBASE between January 2007 and October 2019. Three authors independently selected articles meeting the inclusion criteria, and data were extracted using a matrix developed for that purpose. Inductive content analysis was used to synthesise key concepts of carers' support needs. RESULTS The search identified 2748 articles after removing duplicates, and 122 articles were included in the mapping of carers' support needs. Synthesising carers' support needs indicated that the full extent of support needs emerges in the interaction between the carer and the person cared for and that it is possible to categorise support needs into four key concepts related to: 1) the carer as a person, 2) managing being a carer, 3) providing care, and 4) knowledge of dementia. CONCLUSION The findings of this study help to map a framework describing carers' support needs that may guide the development of future needs assessment instruments and supportive interventions.
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Affiliation(s)
- Trine Holt Clemmensen
- Health Sciences Research Centre, UCL University College, Odense, Denmark.,Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Henrik Hein Lauridsen
- Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Karen Andersen-Ranberg
- Department of Public Health, University of Southern Denmark, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Hanne Kaae Kristensen
- Health Sciences Research Centre, UCL University College, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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12
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Manley NA, Bayen E, Braley TL, Merrilees J, Clark AM, Zylstra B, Schaffer M, Bayen AM, Possin KL, Miller BL, Schenk AK, Bonasera SJ. Long-term digital device-enabled monitoring of functional status: Implications for management of persons with Alzheimer's disease. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2020; 6:e12017. [PMID: 32548234 PMCID: PMC7293994 DOI: 10.1002/trc2.12017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 02/17/2020] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Informal caregiving is an essential element of health-care delivery. Little data describes how caregivers structure care recipients' lives and impact their functional status. METHODS We performed observational studies of community dwelling persons with dementia (PWD) to measure functional status by simultaneous assessment of physical activity (PA) and lifespace (LS). We present data from two caregiver/care-recipient dyads representing higher and average degrees of caregiver involvement. RESULTS We acquired >42,800 (subject 1); >41,300 (subject 2) PA data points and >154,500 (subject 1); >119,700 (subject 2) LS data points over 15 months of near continuous observation. PA and LS patterns provided insights into the caregiver's role in structuring the PWD's day-to-day function and change in function over time. DISCUSSION We show that device-enabled functional monitoring (FM) can successfully gather and display data at resolutions required for dementia care studies. Objective quantification of individual caregiver/care-recipient dyads provides opportunities to implement patient-centered care.
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Affiliation(s)
- Natalie A. Manley
- Division of Geriatrics, Gerontology, and Palliative MedicineDepartment of Internal MedicineUniversity of Nebraska Medical CenterOmahaNebraskaUSA
| | - Eléonore Bayen
- Memory and Aging Center, Department of NeurologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Tamara L. Braley
- Division of Geriatrics, Gerontology, and Palliative MedicineDepartment of Internal MedicineUniversity of Nebraska Medical CenterOmahaNebraskaUSA
| | - Jennifer Merrilees
- Memory and Aging Center, Department of NeurologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Amy M. Clark
- Division of Geriatrics, Gerontology, and Palliative MedicineDepartment of Internal MedicineUniversity of Nebraska Medical CenterOmahaNebraskaUSA
| | | | - Michael Schaffer
- Memory and Aging Center, Department of NeurologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Alexandre M. Bayen
- Department of Civil and Environmental EngineeringUniversity of California BerkeleyBerkeleyCaliforniaUSA
| | - Katherine L. Possin
- Memory and Aging Center, Department of NeurologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Bruce L. Miller
- Memory and Aging Center, Department of NeurologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | | | - Stephen J. Bonasera
- Division of Geriatrics, Gerontology, and Palliative MedicineDepartment of Internal MedicineUniversity of Nebraska Medical CenterOmahaNebraskaUSA
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Law LLF, Mok VCT, Yau MMK. Effects of functional tasks exercise on cognitive functions of older adults with mild cognitive impairment: a randomized controlled pilot trial. ALZHEIMERS RESEARCH & THERAPY 2019; 11:98. [PMID: 31801630 PMCID: PMC6894271 DOI: 10.1186/s13195-019-0548-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 10/22/2019] [Indexed: 01/27/2023]
Abstract
Background Dementia has been presenting an imminent public health challenge worldwide. Studies have shown a combination of cognitive and physical trainings may have synergistic value for improving cognitive functions. Daily functional tasks are innately cognitive demanding and involve components found in common exercise. Individuals with mild cognitive impairment may demonstrate difficulties with complex activities of daily living. Functional tasks could possibly be used as a means of combined cognitive and exercise training for improving cognitive functions. This pilot aims to validate the effects of functional tasks exercise on cognitive functions and functional status in older adults with mild cognitive impairment. Methods A four-arm, rater-blinded randomized controlled trial. Participants (N = 59) were randomized to either a functional task exercise group, a cognitive training group, an exercise training group, or a waitlist control group for 8 weeks. All outcome measures were undertaken at baseline and post-intervention using Neurobehavioral Cognitive Status Examination, Trail Making Test A and B, Chinese Version Verbal Learning Test, Lawton Instrumental Activities of Daily Living Scale, and Zarit Burden Interview. Results Results of the Kruskal-Wallis one-way ANOVA showed higher improvement in the functional task exercise group with significant between-group differences in memory (p = 0.009) compared to the exercise group and cognitive training group, functional status (p = 0.005) compared to the cognitive training group and waitlist control group, and caregiver burden (p = 0.037) compared to the exercise group and cognitive training group. Conclusion This pilot study showed that functional tasks exercise using simulated functional tasks as a means of combined cognitive and exercise program is feasible and beneficial in improving the memory and functional status of older adults with mild cognitive impairment as well as reducing the care-related burdens of their caregivers. The present findings warrant further well-designed longitudinal studies to examine the sustainability of effects and draw more definitive conclusions. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN 12616001635459. Registered on 25 November 2016.
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Affiliation(s)
- Lawla L F Law
- School of Medical and Health Sciences, Tung Wah College, Block A, 98 Shantung Street, Mongkok, Hong Kong SAR.
| | - Vincent C T Mok
- Therese Pei Fong Chow Research Centre for Prevention of Dementia, Gerald Choa Neuroscience Centre, Lui Che Woo Institute of Innovative Medicine, Division of Neurology, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong. Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong SAR
| | - Matthew M K Yau
- School of Medical and Health Sciences, Tung Wah College, 31 Wylie Road, Homantin, Hong Kong SAR
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14
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Foster NL, Bondi MW, Das R, Foss M, Hershey LA, Koh S, Logan R, Poole C, Shega JW, Sood A, Thothala N, Wicklund M, Yu M, Bennett A, Wang D. Quality improvement in neurology: Mild cognitive impairment quality measurement set. Neurology 2019; 93:705-713. [PMID: 31534026 DOI: 10.1212/wnl.0000000000008259] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 07/30/2019] [Indexed: 02/03/2023] Open
Affiliation(s)
- Norman L Foster
- From the Center for Alzheimer's Care, Imaging and Research, Department of Neurology (N.L.F.), University of Utah, Salt Lake City; Department of Psychiatry (M.W.B., S.K.), University of California San Diego, La Jolla; Veterans Affairs San Diego Healthcare System (M.W.B.), CA; Department of Neurology (R.D., R.L.), University of Texas Southwestern Medical Center, Dallas; Alzheimer's Association (M.F., C.P.), Chicago, IL; Department of Neurology (L.A.H.), University of Oklahoma Health Sciences Center, Oklahoma City; University of Central Florida College of Medicine (J.W.S.), Lake Nona; VITAS Healthcare (J.W.S.), Miami, FL; AMITA Health Neurosciences Institute (A.S.), Elk Grove Village, IL; Department of Medicine (N.T.), Good Samaritan Hospital, Vincennes, IN; Department of Neurology (M.W.), Barrow Neurological Institute, Phoenix, AZ; Alzheimer's Disease and Memory Disorders Clinic, Department of Neurology (M.Y.), Baylor College of Medicine, Houston, TX; American Academy of Neurology (A.B.), Minneapolis, MN; Neurology Department (D.W.), University of Illinois College of Medicine at Peoria; and OSF Saint Francis Medical Center Comprehensive Stroke Center (D.W.), Peoria, IL
| | - Mark W Bondi
- From the Center for Alzheimer's Care, Imaging and Research, Department of Neurology (N.L.F.), University of Utah, Salt Lake City; Department of Psychiatry (M.W.B., S.K.), University of California San Diego, La Jolla; Veterans Affairs San Diego Healthcare System (M.W.B.), CA; Department of Neurology (R.D., R.L.), University of Texas Southwestern Medical Center, Dallas; Alzheimer's Association (M.F., C.P.), Chicago, IL; Department of Neurology (L.A.H.), University of Oklahoma Health Sciences Center, Oklahoma City; University of Central Florida College of Medicine (J.W.S.), Lake Nona; VITAS Healthcare (J.W.S.), Miami, FL; AMITA Health Neurosciences Institute (A.S.), Elk Grove Village, IL; Department of Medicine (N.T.), Good Samaritan Hospital, Vincennes, IN; Department of Neurology (M.W.), Barrow Neurological Institute, Phoenix, AZ; Alzheimer's Disease and Memory Disorders Clinic, Department of Neurology (M.Y.), Baylor College of Medicine, Houston, TX; American Academy of Neurology (A.B.), Minneapolis, MN; Neurology Department (D.W.), University of Illinois College of Medicine at Peoria; and OSF Saint Francis Medical Center Comprehensive Stroke Center (D.W.), Peoria, IL
| | - Rohit Das
- From the Center for Alzheimer's Care, Imaging and Research, Department of Neurology (N.L.F.), University of Utah, Salt Lake City; Department of Psychiatry (M.W.B., S.K.), University of California San Diego, La Jolla; Veterans Affairs San Diego Healthcare System (M.W.B.), CA; Department of Neurology (R.D., R.L.), University of Texas Southwestern Medical Center, Dallas; Alzheimer's Association (M.F., C.P.), Chicago, IL; Department of Neurology (L.A.H.), University of Oklahoma Health Sciences Center, Oklahoma City; University of Central Florida College of Medicine (J.W.S.), Lake Nona; VITAS Healthcare (J.W.S.), Miami, FL; AMITA Health Neurosciences Institute (A.S.), Elk Grove Village, IL; Department of Medicine (N.T.), Good Samaritan Hospital, Vincennes, IN; Department of Neurology (M.W.), Barrow Neurological Institute, Phoenix, AZ; Alzheimer's Disease and Memory Disorders Clinic, Department of Neurology (M.Y.), Baylor College of Medicine, Houston, TX; American Academy of Neurology (A.B.), Minneapolis, MN; Neurology Department (D.W.), University of Illinois College of Medicine at Peoria; and OSF Saint Francis Medical Center Comprehensive Stroke Center (D.W.), Peoria, IL
| | - Mary Foss
- From the Center for Alzheimer's Care, Imaging and Research, Department of Neurology (N.L.F.), University of Utah, Salt Lake City; Department of Psychiatry (M.W.B., S.K.), University of California San Diego, La Jolla; Veterans Affairs San Diego Healthcare System (M.W.B.), CA; Department of Neurology (R.D., R.L.), University of Texas Southwestern Medical Center, Dallas; Alzheimer's Association (M.F., C.P.), Chicago, IL; Department of Neurology (L.A.H.), University of Oklahoma Health Sciences Center, Oklahoma City; University of Central Florida College of Medicine (J.W.S.), Lake Nona; VITAS Healthcare (J.W.S.), Miami, FL; AMITA Health Neurosciences Institute (A.S.), Elk Grove Village, IL; Department of Medicine (N.T.), Good Samaritan Hospital, Vincennes, IN; Department of Neurology (M.W.), Barrow Neurological Institute, Phoenix, AZ; Alzheimer's Disease and Memory Disorders Clinic, Department of Neurology (M.Y.), Baylor College of Medicine, Houston, TX; American Academy of Neurology (A.B.), Minneapolis, MN; Neurology Department (D.W.), University of Illinois College of Medicine at Peoria; and OSF Saint Francis Medical Center Comprehensive Stroke Center (D.W.), Peoria, IL
| | - Linda A Hershey
- From the Center for Alzheimer's Care, Imaging and Research, Department of Neurology (N.L.F.), University of Utah, Salt Lake City; Department of Psychiatry (M.W.B., S.K.), University of California San Diego, La Jolla; Veterans Affairs San Diego Healthcare System (M.W.B.), CA; Department of Neurology (R.D., R.L.), University of Texas Southwestern Medical Center, Dallas; Alzheimer's Association (M.F., C.P.), Chicago, IL; Department of Neurology (L.A.H.), University of Oklahoma Health Sciences Center, Oklahoma City; University of Central Florida College of Medicine (J.W.S.), Lake Nona; VITAS Healthcare (J.W.S.), Miami, FL; AMITA Health Neurosciences Institute (A.S.), Elk Grove Village, IL; Department of Medicine (N.T.), Good Samaritan Hospital, Vincennes, IN; Department of Neurology (M.W.), Barrow Neurological Institute, Phoenix, AZ; Alzheimer's Disease and Memory Disorders Clinic, Department of Neurology (M.Y.), Baylor College of Medicine, Houston, TX; American Academy of Neurology (A.B.), Minneapolis, MN; Neurology Department (D.W.), University of Illinois College of Medicine at Peoria; and OSF Saint Francis Medical Center Comprehensive Stroke Center (D.W.), Peoria, IL
| | - Steve Koh
- From the Center for Alzheimer's Care, Imaging and Research, Department of Neurology (N.L.F.), University of Utah, Salt Lake City; Department of Psychiatry (M.W.B., S.K.), University of California San Diego, La Jolla; Veterans Affairs San Diego Healthcare System (M.W.B.), CA; Department of Neurology (R.D., R.L.), University of Texas Southwestern Medical Center, Dallas; Alzheimer's Association (M.F., C.P.), Chicago, IL; Department of Neurology (L.A.H.), University of Oklahoma Health Sciences Center, Oklahoma City; University of Central Florida College of Medicine (J.W.S.), Lake Nona; VITAS Healthcare (J.W.S.), Miami, FL; AMITA Health Neurosciences Institute (A.S.), Elk Grove Village, IL; Department of Medicine (N.T.), Good Samaritan Hospital, Vincennes, IN; Department of Neurology (M.W.), Barrow Neurological Institute, Phoenix, AZ; Alzheimer's Disease and Memory Disorders Clinic, Department of Neurology (M.Y.), Baylor College of Medicine, Houston, TX; American Academy of Neurology (A.B.), Minneapolis, MN; Neurology Department (D.W.), University of Illinois College of Medicine at Peoria; and OSF Saint Francis Medical Center Comprehensive Stroke Center (D.W.), Peoria, IL
| | - Rebecca Logan
- From the Center for Alzheimer's Care, Imaging and Research, Department of Neurology (N.L.F.), University of Utah, Salt Lake City; Department of Psychiatry (M.W.B., S.K.), University of California San Diego, La Jolla; Veterans Affairs San Diego Healthcare System (M.W.B.), CA; Department of Neurology (R.D., R.L.), University of Texas Southwestern Medical Center, Dallas; Alzheimer's Association (M.F., C.P.), Chicago, IL; Department of Neurology (L.A.H.), University of Oklahoma Health Sciences Center, Oklahoma City; University of Central Florida College of Medicine (J.W.S.), Lake Nona; VITAS Healthcare (J.W.S.), Miami, FL; AMITA Health Neurosciences Institute (A.S.), Elk Grove Village, IL; Department of Medicine (N.T.), Good Samaritan Hospital, Vincennes, IN; Department of Neurology (M.W.), Barrow Neurological Institute, Phoenix, AZ; Alzheimer's Disease and Memory Disorders Clinic, Department of Neurology (M.Y.), Baylor College of Medicine, Houston, TX; American Academy of Neurology (A.B.), Minneapolis, MN; Neurology Department (D.W.), University of Illinois College of Medicine at Peoria; and OSF Saint Francis Medical Center Comprehensive Stroke Center (D.W.), Peoria, IL
| | - Carol Poole
- From the Center for Alzheimer's Care, Imaging and Research, Department of Neurology (N.L.F.), University of Utah, Salt Lake City; Department of Psychiatry (M.W.B., S.K.), University of California San Diego, La Jolla; Veterans Affairs San Diego Healthcare System (M.W.B.), CA; Department of Neurology (R.D., R.L.), University of Texas Southwestern Medical Center, Dallas; Alzheimer's Association (M.F., C.P.), Chicago, IL; Department of Neurology (L.A.H.), University of Oklahoma Health Sciences Center, Oklahoma City; University of Central Florida College of Medicine (J.W.S.), Lake Nona; VITAS Healthcare (J.W.S.), Miami, FL; AMITA Health Neurosciences Institute (A.S.), Elk Grove Village, IL; Department of Medicine (N.T.), Good Samaritan Hospital, Vincennes, IN; Department of Neurology (M.W.), Barrow Neurological Institute, Phoenix, AZ; Alzheimer's Disease and Memory Disorders Clinic, Department of Neurology (M.Y.), Baylor College of Medicine, Houston, TX; American Academy of Neurology (A.B.), Minneapolis, MN; Neurology Department (D.W.), University of Illinois College of Medicine at Peoria; and OSF Saint Francis Medical Center Comprehensive Stroke Center (D.W.), Peoria, IL
| | - Joseph W Shega
- From the Center for Alzheimer's Care, Imaging and Research, Department of Neurology (N.L.F.), University of Utah, Salt Lake City; Department of Psychiatry (M.W.B., S.K.), University of California San Diego, La Jolla; Veterans Affairs San Diego Healthcare System (M.W.B.), CA; Department of Neurology (R.D., R.L.), University of Texas Southwestern Medical Center, Dallas; Alzheimer's Association (M.F., C.P.), Chicago, IL; Department of Neurology (L.A.H.), University of Oklahoma Health Sciences Center, Oklahoma City; University of Central Florida College of Medicine (J.W.S.), Lake Nona; VITAS Healthcare (J.W.S.), Miami, FL; AMITA Health Neurosciences Institute (A.S.), Elk Grove Village, IL; Department of Medicine (N.T.), Good Samaritan Hospital, Vincennes, IN; Department of Neurology (M.W.), Barrow Neurological Institute, Phoenix, AZ; Alzheimer's Disease and Memory Disorders Clinic, Department of Neurology (M.Y.), Baylor College of Medicine, Houston, TX; American Academy of Neurology (A.B.), Minneapolis, MN; Neurology Department (D.W.), University of Illinois College of Medicine at Peoria; and OSF Saint Francis Medical Center Comprehensive Stroke Center (D.W.), Peoria, IL
| | - Ajay Sood
- From the Center for Alzheimer's Care, Imaging and Research, Department of Neurology (N.L.F.), University of Utah, Salt Lake City; Department of Psychiatry (M.W.B., S.K.), University of California San Diego, La Jolla; Veterans Affairs San Diego Healthcare System (M.W.B.), CA; Department of Neurology (R.D., R.L.), University of Texas Southwestern Medical Center, Dallas; Alzheimer's Association (M.F., C.P.), Chicago, IL; Department of Neurology (L.A.H.), University of Oklahoma Health Sciences Center, Oklahoma City; University of Central Florida College of Medicine (J.W.S.), Lake Nona; VITAS Healthcare (J.W.S.), Miami, FL; AMITA Health Neurosciences Institute (A.S.), Elk Grove Village, IL; Department of Medicine (N.T.), Good Samaritan Hospital, Vincennes, IN; Department of Neurology (M.W.), Barrow Neurological Institute, Phoenix, AZ; Alzheimer's Disease and Memory Disorders Clinic, Department of Neurology (M.Y.), Baylor College of Medicine, Houston, TX; American Academy of Neurology (A.B.), Minneapolis, MN; Neurology Department (D.W.), University of Illinois College of Medicine at Peoria; and OSF Saint Francis Medical Center Comprehensive Stroke Center (D.W.), Peoria, IL
| | - Niranjan Thothala
- From the Center for Alzheimer's Care, Imaging and Research, Department of Neurology (N.L.F.), University of Utah, Salt Lake City; Department of Psychiatry (M.W.B., S.K.), University of California San Diego, La Jolla; Veterans Affairs San Diego Healthcare System (M.W.B.), CA; Department of Neurology (R.D., R.L.), University of Texas Southwestern Medical Center, Dallas; Alzheimer's Association (M.F., C.P.), Chicago, IL; Department of Neurology (L.A.H.), University of Oklahoma Health Sciences Center, Oklahoma City; University of Central Florida College of Medicine (J.W.S.), Lake Nona; VITAS Healthcare (J.W.S.), Miami, FL; AMITA Health Neurosciences Institute (A.S.), Elk Grove Village, IL; Department of Medicine (N.T.), Good Samaritan Hospital, Vincennes, IN; Department of Neurology (M.W.), Barrow Neurological Institute, Phoenix, AZ; Alzheimer's Disease and Memory Disorders Clinic, Department of Neurology (M.Y.), Baylor College of Medicine, Houston, TX; American Academy of Neurology (A.B.), Minneapolis, MN; Neurology Department (D.W.), University of Illinois College of Medicine at Peoria; and OSF Saint Francis Medical Center Comprehensive Stroke Center (D.W.), Peoria, IL
| | - Meredith Wicklund
- From the Center for Alzheimer's Care, Imaging and Research, Department of Neurology (N.L.F.), University of Utah, Salt Lake City; Department of Psychiatry (M.W.B., S.K.), University of California San Diego, La Jolla; Veterans Affairs San Diego Healthcare System (M.W.B.), CA; Department of Neurology (R.D., R.L.), University of Texas Southwestern Medical Center, Dallas; Alzheimer's Association (M.F., C.P.), Chicago, IL; Department of Neurology (L.A.H.), University of Oklahoma Health Sciences Center, Oklahoma City; University of Central Florida College of Medicine (J.W.S.), Lake Nona; VITAS Healthcare (J.W.S.), Miami, FL; AMITA Health Neurosciences Institute (A.S.), Elk Grove Village, IL; Department of Medicine (N.T.), Good Samaritan Hospital, Vincennes, IN; Department of Neurology (M.W.), Barrow Neurological Institute, Phoenix, AZ; Alzheimer's Disease and Memory Disorders Clinic, Department of Neurology (M.Y.), Baylor College of Medicine, Houston, TX; American Academy of Neurology (A.B.), Minneapolis, MN; Neurology Department (D.W.), University of Illinois College of Medicine at Peoria; and OSF Saint Francis Medical Center Comprehensive Stroke Center (D.W.), Peoria, IL
| | - Melissa Yu
- From the Center for Alzheimer's Care, Imaging and Research, Department of Neurology (N.L.F.), University of Utah, Salt Lake City; Department of Psychiatry (M.W.B., S.K.), University of California San Diego, La Jolla; Veterans Affairs San Diego Healthcare System (M.W.B.), CA; Department of Neurology (R.D., R.L.), University of Texas Southwestern Medical Center, Dallas; Alzheimer's Association (M.F., C.P.), Chicago, IL; Department of Neurology (L.A.H.), University of Oklahoma Health Sciences Center, Oklahoma City; University of Central Florida College of Medicine (J.W.S.), Lake Nona; VITAS Healthcare (J.W.S.), Miami, FL; AMITA Health Neurosciences Institute (A.S.), Elk Grove Village, IL; Department of Medicine (N.T.), Good Samaritan Hospital, Vincennes, IN; Department of Neurology (M.W.), Barrow Neurological Institute, Phoenix, AZ; Alzheimer's Disease and Memory Disorders Clinic, Department of Neurology (M.Y.), Baylor College of Medicine, Houston, TX; American Academy of Neurology (A.B.), Minneapolis, MN; Neurology Department (D.W.), University of Illinois College of Medicine at Peoria; and OSF Saint Francis Medical Center Comprehensive Stroke Center (D.W.), Peoria, IL
| | - Amy Bennett
- From the Center for Alzheimer's Care, Imaging and Research, Department of Neurology (N.L.F.), University of Utah, Salt Lake City; Department of Psychiatry (M.W.B., S.K.), University of California San Diego, La Jolla; Veterans Affairs San Diego Healthcare System (M.W.B.), CA; Department of Neurology (R.D., R.L.), University of Texas Southwestern Medical Center, Dallas; Alzheimer's Association (M.F., C.P.), Chicago, IL; Department of Neurology (L.A.H.), University of Oklahoma Health Sciences Center, Oklahoma City; University of Central Florida College of Medicine (J.W.S.), Lake Nona; VITAS Healthcare (J.W.S.), Miami, FL; AMITA Health Neurosciences Institute (A.S.), Elk Grove Village, IL; Department of Medicine (N.T.), Good Samaritan Hospital, Vincennes, IN; Department of Neurology (M.W.), Barrow Neurological Institute, Phoenix, AZ; Alzheimer's Disease and Memory Disorders Clinic, Department of Neurology (M.Y.), Baylor College of Medicine, Houston, TX; American Academy of Neurology (A.B.), Minneapolis, MN; Neurology Department (D.W.), University of Illinois College of Medicine at Peoria; and OSF Saint Francis Medical Center Comprehensive Stroke Center (D.W.), Peoria, IL
| | - David Wang
- From the Center for Alzheimer's Care, Imaging and Research, Department of Neurology (N.L.F.), University of Utah, Salt Lake City; Department of Psychiatry (M.W.B., S.K.), University of California San Diego, La Jolla; Veterans Affairs San Diego Healthcare System (M.W.B.), CA; Department of Neurology (R.D., R.L.), University of Texas Southwestern Medical Center, Dallas; Alzheimer's Association (M.F., C.P.), Chicago, IL; Department of Neurology (L.A.H.), University of Oklahoma Health Sciences Center, Oklahoma City; University of Central Florida College of Medicine (J.W.S.), Lake Nona; VITAS Healthcare (J.W.S.), Miami, FL; AMITA Health Neurosciences Institute (A.S.), Elk Grove Village, IL; Department of Medicine (N.T.), Good Samaritan Hospital, Vincennes, IN; Department of Neurology (M.W.), Barrow Neurological Institute, Phoenix, AZ; Alzheimer's Disease and Memory Disorders Clinic, Department of Neurology (M.Y.), Baylor College of Medicine, Houston, TX; American Academy of Neurology (A.B.), Minneapolis, MN; Neurology Department (D.W.), University of Illinois College of Medicine at Peoria; and OSF Saint Francis Medical Center Comprehensive Stroke Center (D.W.), Peoria, IL
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Novais T, Mouchoux C, Kossovsky M, Winterstein L, Delphin-Combe F, Krolak-Salmon P, Dauphinot V. Neurocognitive disorders: what are the prioritized caregiver needs? A consensus obtained by the Delphi method. BMC Health Serv Res 2018; 18:1016. [PMID: 30594202 PMCID: PMC6311000 DOI: 10.1186/s12913-018-3826-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 12/17/2018] [Indexed: 11/17/2022] Open
Abstract
Background The symptoms related to neurocognitive disorders (NCD) may lead to caregiver burden increase. Involving caregivers in research may be an effective way of improving the practicalities and relevance of interventions. The aim of this study was to gather opinion and gain consensus on the caregivers ‘priorities, using a Delphi method and including aspects of needs in pharmaceutical dimension. Methods Observational study using a modified Delphi method. This study was conducted in the Clinical and Research Memory Center of the University Hospital of Lyon (France), between September 2015 and January 2016. The expert panel was composed of 68 informal caregivers of people with subjective cognitive decline or NCD living at home. Results Caregivers assigned a very high importance to the dimension “information needs about their relative’s disease”, i.e. information on the disease, the treatment and the research; and to “coping skills”, i.e. skills related to emotional support, communication, relationship evolution with the relative and skills to cope with behavioural crisis, behavioural and cognitive disorders. The aspect “coping with behavioural disorders” received a high selection rate (83%). Conclusions The main needs selected can be used to design relevant interventions and give guidance to policy to support caregivers. To meet caregiver’s needs, interventions should focus on information about disease and treatment and psychoeducational interventions.
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Affiliation(s)
- Teddy Novais
- EA-7425 HESPER, Health Services and Performance Research, University Lyon, F-69003, Lyon, France. .,Pharmaceutical Unit, Charpennes Hospital, Hospices Civils de Lyon, F-69100, Lyon, France. .,University Lyon 1, F-69000, Lyon, France.
| | - Christelle Mouchoux
- Pharmaceutical Unit, Charpennes Hospital, Hospices Civils de Lyon, F-69100, Lyon, France.,University Lyon 1, F-69000, Lyon, France.,INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Center, Brain Dynamics and Cognition Team, F-69000, Lyon, France
| | - Michel Kossovsky
- Department of Internal medicine, Rehabilitation and Geriatrics, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland
| | - Lucie Winterstein
- Clinical and Research Memory Centre of Lyon (CMRR), Charpennes Hospital, Hospices Civils de Lyon, F-69100, Lyon, France
| | - Floriane Delphin-Combe
- Clinical and Research Memory Centre of Lyon (CMRR), Charpennes Hospital, Hospices Civils de Lyon, F-69100, Lyon, France
| | - Pierre Krolak-Salmon
- University Lyon 1, F-69000, Lyon, France.,INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Center, Brain Dynamics and Cognition Team, F-69000, Lyon, France.,Clinical and Research Memory Centre of Lyon (CMRR), Charpennes Hospital, Hospices Civils de Lyon, F-69100, Lyon, France
| | - V Dauphinot
- Clinical and Research Memory Centre of Lyon (CMRR), Charpennes Hospital, Hospices Civils de Lyon, F-69100, Lyon, France
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Domingues NS, Verreault P, Hudon C. Reducing Burden for Caregivers of Older Adults With Mild Cognitive Impairment: A Systematic Review. Am J Alzheimers Dis Other Demen 2018; 33:401-414. [PMID: 30041535 PMCID: PMC10852519 DOI: 10.1177/1533317518788151] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
BACKGROUND/RATIONALE This systematic review aims to evaluate the efficacy of the nonpharmacological interventions reducing burden, psychological symptoms, and improving quality of life of caregivers of individuals with mild cognitive impairment (MCI). METHOD Databases reviewed included Medline, Cochrane Library, Embase, PsycNet, AgeLine, and ProQuest Dissertations and Theses. Studies using an experimental/quasi-experimental design including nonpharmacological intervention were included. Four studies were included, and no meta-analysis was conducted. RESULTS Calendar training and note-taking (cognitive intervention) significantly decreased caregiver's depressive symptoms and prevented worsening of subjective burden 6 months posttreatment. Daily engagement of meaningful activity combined with problem-solving therapy and educational material reduced depressive symptoms 3 months posttreatment. Moreover, educational intervention and social conversation phone calls decreased caregiver burden 3 months posttreatment. CONCLUSION Studies suggest that nonpharmacological interventions can support caregivers of older adults with MCI, but the few published articles present some bias and are inconclusive. Randomized-controlled trials targeting specifically caregivers are needed to determine the most efficient type of interventions for those individuals.
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Affiliation(s)
- Nélia Sofia Domingues
- CERVO Brain Research Centre, Quebec, Canada
- École de psychologie, Université Laval, Quebec, Canada
| | - Phylicia Verreault
- CERVO Brain Research Centre, Quebec, Canada
- École de psychologie, Université Laval, Quebec, Canada
| | - Carol Hudon
- CERVO Brain Research Centre, Quebec, Canada
- École de psychologie, Université Laval, Quebec, Canada
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Depression and mild cognitive impairment (MCI) among elderly patients with type 2 diabetes mellitus in Pakistan: possible determinants. Int J Diabetes Dev Ctries 2017. [DOI: 10.1007/s13410-017-0600-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Cuc AV, Locke DE, Duncan N, Fields JA, Snyder CH, Hanna S, Lunde A, Smith GE, Chandler M. A pilot randomized trial of two cognitive rehabilitation interventions for mild cognitive impairment: caregiver outcomes. Int J Geriatr Psychiatry 2017; 32:e180-e187. [PMID: 28233343 PMCID: PMC5569000 DOI: 10.1002/gps.4689] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 01/25/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study aims to provide effect size estimates of the impact of two cognitive rehabilitation interventions provided to patients with mild cognitive impairment: computerized brain fitness exercise and memory support system on support partners' outcomes of depression, anxiety, quality of life, and partner burden. METHODS A randomized controlled pilot trial was performed. RESULTS At 6 months, the partners from both treatment groups showed stable to improved depression scores, while partners in an untreated control group showed worsening depression over 6 months. There were no statistically significant differences on anxiety, quality of life, or burden outcomes in this small pilot trial; however, effect sizes were moderate, suggesting that the sample sizes in this pilot study were not adequate to detect statistical significance. CONCLUSION Either form of cognitive rehabilitation may help partners' mood, compared with providing no treatment. However, effect size estimates related to other partner outcomes (i.e., burden, quality of life, and anxiety) suggest that follow-up efficacy trials will need sample sizes of at least 30-100 people per group to accurately determine significance. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
| | | | | | | | | | - Sherrie Hanna
- Mayo Clinic Rochester, Division of Neurocognitive Disorders
| | - Angela Lunde
- Mayo Clinic Rochester, Division of Neurocognitive Disorders
| | - Glenn E. Smith
- University of Florida, Department of Clinical and Health Psychology
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Novais T, Dauphinot V, Krolak-Salmon P, Mouchoux C. How to explore the needs of informal caregivers of individuals with cognitive impairment in Alzheimer's disease or related diseases? A systematic review of quantitative and qualitative studies. BMC Geriatr 2017; 17:86. [PMID: 28415968 PMCID: PMC5393006 DOI: 10.1186/s12877-017-0481-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 04/06/2017] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND This study aims to review the methodologies used to identify the needs, the existing needs assessment instruments and the main topics of needs explored among caregivers of patients with mild cognitive impairment to dementia. METHODS MEDLINE, PsycINFO, The Cochrane Library and Web of science were searched from January 1980 to January 2017. Research studies in English or French were eligible for inclusion if they fulfilled the following criteria: quantitative, qualitative and mixed method studies that used instrument, focus group or semi-structured interviews to assess the informal caregiver's needs in terms of information, coping skills, support and service. RESULTS Seventy studies (n = 39 quantitative studies, n = 25 qualitative studies and n = 6 mixed method studies) met the inclusion criteria and were included. Thirty-six quantitative instruments were identified but only one has been validated for the needs assessment of dementia caregivers: the Carer's Needs Assessment for Dementia (CNA-D). The main areas of needs explored in these instruments were: information, psychosocial, social, psychoeducational and other needs. CONCLUSIONS No instrument has been developed and validated to assess the needs of informal caregivers of patients with cognitive impairment, whatever the stage and the etiology of the disease. As the perceived needs of caregivers may evolve with the progression of the disease and the dementia transition, their needs should be regularly assessed.
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Affiliation(s)
- T Novais
- EA-7425 HESPER, Health Services and Performance Research, University Lyon, F-69003, Lyon, France. .,Clinical Research Centre (CRC) - VCF (Aging - Brain - Frailty), Charpennes Hospital, University Hospital of Lyon, F-69100, Villeurbanne, France. .,Pharmaceutical Unit, Charpennes Hospital, University Hospital of Lyon, F-69100, Villeurbanne, France.
| | - V Dauphinot
- Clinical and Research Memory Centre of Lyon (CMRR), Charpennes Hospital, University Hospital of Lyon, F-69100, Villeurbanne, France
| | - P Krolak-Salmon
- Clinical Research Centre (CRC) - VCF (Aging - Brain - Frailty), Charpennes Hospital, University Hospital of Lyon, F-69100, Villeurbanne, France.,Clinical and Research Memory Centre of Lyon (CMRR), Charpennes Hospital, University Hospital of Lyon, F-69100, Villeurbanne, France.,University Lyon 1, F-69000, Lyon, France.,INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Center, Brain Dynamics and Cognition Team, University Lyon 1, F-69000, Lyon, France
| | - C Mouchoux
- Clinical Research Centre (CRC) - VCF (Aging - Brain - Frailty), Charpennes Hospital, University Hospital of Lyon, F-69100, Villeurbanne, France. .,Pharmaceutical Unit, Charpennes Hospital, University Hospital of Lyon, F-69100, Villeurbanne, France. .,University Lyon 1, F-69000, Lyon, France. .,INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Center, Brain Dynamics and Cognition Team, University Lyon 1, F-69000, Lyon, France.
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Mehl-Madrona L, Mainguy B. Collaborative Management of Neurocognitive Disorders in Primary Care: Explorations of an Attempt at Culture Change. Perm J 2017; 21:16-027. [PMID: 28333613 DOI: 10.7812/tpp/16-027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Minor neurocognitive disorder (MiND; previously mild cognitive impairment) is a transitional zone between normal cognitive function and early stages of major neurocognitive disorder (previously called dementia). Of people with MiND, 5% to 10% progress to major neurocognitive disorder. Simple interventions such as memory activities, balance exercises, and anti-inflammatory diets have been shown to improve cognitive ability. Also, education and support in group settings have proved beneficial for patients with MiND. DESIGN Survey evaluation of outcomes of geriatric consultation and prospective educational study. MAIN OUTCOME MEASURES We collaborated with an academic training program to introduce into primary care the ideas of educational activities and participation in group medical care for people with MiND. Educational programs were developed and presented to family medicine residents and practicing physicians, and their knowledge was assessed before and after education. RESULTS Two group programs were implemented: one at our hospital and one at a local skilled nursing facility. These were initially envisioned as time-limited, but participants insisted on their continuance. Thirty-two different patients attended the groups for at least six sessions. Participants enthusiastically reported positive change on qualitative interviews and showed improvement in cognition, balance, and self-esteem. Family medicine residents and practicing physicians both shifted toward lifestyle medicine and significantly changed their views on the efficacy of treatments. Despite these activities, community physicians making referrals for geriatric consultations did not change their discussions with patients and families about exercise, diet, cognitive enhancement, and socialization for MiND. CONCLUSION Group visits that emphasized support for increased exercise, improved diet, more movement and balance, and cognitive enhancement appear to please and benefit patients with MiND. Physicians are more open to these approaches with training after initial skepticism. A struggle exists to convince the profession that lifestyle change may be beneficial in MiND.
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Affiliation(s)
- Lewis Mehl-Madrona
- Faculty Physician at the Eastern Maine Medical Center Family Medicine Residency in Bangor and Associate Professor of Family Medicine at the Univerity of New England in Augusta, ME. He is also affiliated with the Coyote Institute in Orono, ME.
| | - Barbara Mainguy
- Psychotherapist and Reiki practitioner. She is the Education Director at the Coyote Institute in Orono, ME.
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21
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Lindbergh CA, Dishman RK, Miller LS. Functional Disability in Mild Cognitive Impairment: A Systematic Review and Meta-Analysis. Neuropsychol Rev 2016; 26:129-59. [PMID: 27393566 DOI: 10.1007/s11065-016-9321-5] [Citation(s) in RCA: 121] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 05/12/2016] [Indexed: 02/07/2023]
Abstract
Accumulating evidence suggests that the pre-dementia syndrome mild cognitive impairment (MCI) is characterized by decrements in instrumental activities of daily living (IADL). The current review was a quantitative synthesis of the available literature to objectively characterize IADL disability in MCI while clarifying inconsistencies in findings across studies. It was hypothesized that individuals with MCI would display significantly greater functional impairment relative to cognitively intact controls. Candidate moderators specified a priori included functional assessment approach, MCI subtype, depressive symptoms, and language conducted. Online databases (PubMed/MEDLINE and PsycINFO) and reference lists were searched to identify peer-reviewed publications assessing IADL in MCI compared to normal aging. A total of 151 effect sizes derived from 106 studies met inclusionary criteria (N = 62,260). Random effects models yielded a large overall summary effect size (Hedges' g = 0.76, 95 % confidence interval: 0.68 - 0.83, p < .001) confirmed in multi-level analyses adjusted for nesting of effect sizes within studies (g = 0.78, 95 % confidence interval: 0.69 - 0.87). Functional assessment strategy and MCI subtype were significant moderators of effect size, whereas depressive symptoms and language were not. Results convincingly demonstrate that MCI is associated with significant difficulties in the performance of complex everyday tasks. It appears that functional decline, like cognitive decline, exists on a continuum from healthy aging to dementia onset. Implications for clinical practice and research priorities are discussed.
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Affiliation(s)
- Cutter A Lindbergh
- Department of Psychology, University of Georgia, Athens, GA, 30602, USA.
| | - Rodney K Dishman
- Department of Kinesiology, University of Georgia, Athens, GA, 30602, USA
| | - L Stephen Miller
- Department of Psychology, University of Georgia, Athens, GA, 30602, USA.,Bio-Imaging Research Center, Paul D. Coverdell Center, University of Georgia, Athens, GA, 30602, USA
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22
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van den Dungen P, Moll van Charante EP, van de Ven PM, van Marwijk HWJ, van der Horst HE, van Hout HPJ. Case Finding of Mild Cognitive Impairment and Dementia and Subsequent Care; Results of a Cluster RCT in Primary Care. PLoS One 2016; 11:e0156958. [PMID: 27310616 PMCID: PMC4910994 DOI: 10.1371/journal.pone.0156958] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 05/22/2016] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Despite a call for earlier diagnosis of dementia, the diagnostic yield of case finding and its impact on the mental health of patients and relatives are unclear. This study assessed the effect of a two-component intervention of case finding and subsequent care on these outcomes. METHODS In a cluster RCT we assessed whether education of family physicians (FPs; trial stage 1) resulted in more mild cognitive impairment (MCI) and dementia diagnoses among older persons in whom FPs suspected cognitive decline and whether case finding by a practice nurse and the FP (trial stage 2) added to this number of diagnoses. In addition, we assessed mental health effects of case finding and subsequent care (trial stage 2). FPs of 15 primary care practices (PCPs = clusters) judged the cognitive status of all persons ≥ 65 years. The primary outcome, new MCI and dementia diagnoses by FPs after 12 months as indicated on a list, was assessed among all persons in whom FPs suspected cognitive impairment but without a formal diagnosis of dementia. The secondary outcome, mental health of patients and their relatives, was assessed among persons consenting to participate in trial stage 2. Trial stage 1 consisted of either intervention component 1: training FPs to diagnose MCI and dementia, or control: no training. Trial stage 2 consisted of either intervention component 2: case finding of MCI and dementia and care by a trained nurse and the FP, or control: care as usual. RESULTS Seven PCPs were randomized to the intervention; eight to the control condition. MCI or dementia was diagnosed in 42.3% (138/326) of persons in the intervention, and in 30.5% (98/321) in the control group (estimated difference GEE: 10.8%, OR: 1.51, 95%-CI 0.60-3.76). Among patients and relatives who consented to stage 2 of the trial (n = 145; 25%), there were no differences in mental health between the intervention and control group. CONCLUSIONS We found a non-significant increase in the number of new MCI diagnoses. As we cannot exclude a clinically relevant effect, a larger study is warranted to replicate ours. TRIAL REGISTRATION Nederlands Trial Register NTR3389.
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Affiliation(s)
- Pim van den Dungen
- Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Eric P. Moll van Charante
- Department of General Practice, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Peter M. van de Ven
- Department of Epidemiology and Biostatistics, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Harm W. J. van Marwijk
- Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
- Primary Care Research Centre, Institute of Population Health, University of Manchester, Manchester, United Kingdom
| | - Henriëtte E. van der Horst
- Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Hein P. J. van Hout
- Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
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Desin PJ, Caban-Holt AM, Abner EL, Van Eldik LJ, Schmitt FA. Factors Associated with Unmet Needs among African-American Dementia Care Providers. JOURNAL OF GERONTOLOGY & GERIATRIC RESEARCH 2016; 5. [PMID: 27182464 PMCID: PMC4864855 DOI: 10.4172/2167-7182.1000267] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Racial and ethnic minorities currently comprise 20% of the U.S. population; in 2050, this figure is expected to rise to 42%. As a result, Alzheimer’s disease (AD), the 5th leading cause of death for people aged 65 and older, is likely to increase in these groups. Most dementia caregiving for these populations comes from family and friends, especially among families with lower socioeconomic status. A convenience sample of 30 African-American dementia caregivers was interviewed to determine unmet needs. Participants expressed a limited desire for formal services, such as support groups, legal advice, case management, and homemaker services. Instead, commonly expressed needs were daytime respite care and especially a desire for family and social support. Many caregivers expressed a need for other family members to share responsibility in the process; therefore, methods for caregiver support that address multiple family members in care provision may be beneficial for this group.
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Affiliation(s)
- P J Desin
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky, USA; Graduate Center for Gerontology, University of Kentucky, Lexington, Kentucky, USA
| | - A M Caban-Holt
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky, USA; Department of Behavioral Science, University of Kentucky, Lexington, Kentucky, USA
| | - E L Abner
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky, USA; Department of Epidemiology, University of Kentucky, Lexington, Kentucky, USA
| | - L J Van Eldik
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky, USA; Department of Anatomy and Neurobiology, University of Kentucky, Lexington, Kentucky, USA
| | - F A Schmitt
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky, USA; Department of Neurology, University of Kentucky, Lexington, Kentucky, USA
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24
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Lu YYF, Ellis J, Yang Z, Weaver MT, Bakas T, Austrom MG, Haase JE. Satisfaction With a Family-Focused Intervention for Mild Cognitive Impairment Dyads. J Nurs Scholarsh 2016; 48:334-44. [PMID: 27121662 DOI: 10.1111/jnu.12214] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE This article describes satisfaction that persons with mild cognitive impairment (PwMCI) and their caregivers had with the Daily Enhancement of Meaningful Activity (DEMA) intervention. METHODS This randomized controlled pilot study compared satisfaction (usefulness, ease of use, and acceptability) with DEMA (n = 17 dyads) to an information support (IS) control group (n = 19 dyads). Six biweekly sessions (two in person and four by telephone) were delivered by trained nurses. Data analysis included descriptive statistics, independent-sample t tests, and content analysis. FINDINGS PwMCI receiving DEMA rated their satisfaction significantly higher (p = .033) than did the control group; there was no difference in satisfaction between caregivers across groups. Qualitative interview data supported the usefulness, ease of use, and acceptability of DEMA for both PwMCI and caregivers. CONCLUSIONS Results documented PwMCI's satisfaction with DEMA as implemented by nurses to support PwMCI-caregiver dyads' engagement in meaningful activity. DEMA may need revision to increase satisfaction for caregivers. CLINICAL RELEVANCE The DEMA intervention was evaluated as useful, easy to use, and acceptable to PwMCI and their caregivers based on positive mean ratings. The study findings provide preliminary support of DEMA as a means to improve quality of life by helping to support patient and caregiver engagement in meaningful activities and problem solving.
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Affiliation(s)
- Yvonne Yueh-Feng Lu
- Associate Professor, Department Science of Nursing Care, Indiana University School of Nursing, Indianapolis, IN, USA
| | - Jennifer Ellis
- Indiana University School of Health and Rehabilitation, Indianapolis, IN, USA
| | - Ziyi Yang
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Michael T Weaver
- Professor & Associate Dean for Research & Scholarship, College of Nursing, University of Florida, Gainesville, FL, USA
| | - Tamilyn Bakas
- Professor Emeritus, Indiana University School of Nursing, Indianapolis, IN, and Professor and Jane E. Procter Endowed Chair, College of Nursing, University of Cincinnati, Cincinnati, OH, USA
| | - Mary Guerriero Austrom
- Wesley P Martin Professor of Alzheimer's Disease Education, Department of Psychiatry, Associate Dean for Diversity Affairs, Indiana University School of Medicine, and Director, Outreach, Recruitment and Education Core, Indiana Alzheimer Disease Center (IADC), Indianapolis, IN, USA
| | - Joan E Haase
- Holmquist Professor of Pediatric Oncology Nursing, Department Science of Nursing Care, Indiana University School of Nursing, Indianapolis, IN, USA
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25
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Woolmore-Goodwin S, Kloseck M, Zecevic A, Fogarty J, Gutmanis I. Caring for a Person With Amnestic Mild Cognitive Impairment. Am J Alzheimers Dis Other Demen 2016; 31:124-31. [PMID: 26286393 PMCID: PMC10852912 DOI: 10.1177/1533317515594507] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
While much of the literature on caregiver burden has focused on caregiving for people living with Alzheimer's disease (AD) there is little information on the experience of caring for a loved one living with amnestic Mild Cognitive Impairment (aMCI), the group most likely to convert to AD. A hermeneutic phenomenological approach was used to understand the organizing principles that give experiences of being form and meaning in the lifeworld. Study findings highlight the precarious nature of caregiver role acquisition and the heterogeneity that is present among informal care providers. Specifically, the findings suggest that the wearing of multiple situational masks is required by the carer to cope with accumulated progressive losses suffered as they continually adjust to their new and evolving carer identity. Support groups specific to the carers of those living with aMCI are needed in an effort to remove these masks and to validate this unique caregiving experience.
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Affiliation(s)
| | - Marita Kloseck
- The University of Western Ontario, London, Ontario, Canada
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26
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Votruba KL, Persad C, Giordani B. Patient Mood and Instrumental Activities of Daily Living in Alzheimer Disease: Relationship Between Patient and Caregiver Reports. J Geriatr Psychiatry Neurol 2015; 28:203-9. [PMID: 26071443 DOI: 10.1177/0891988715588829] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2009] [Accepted: 01/28/2015] [Indexed: 11/15/2022]
Abstract
This retrospective study investigated the relationship between self-reports and caregiver perceptions of patients' depressive symptoms and the respective ability of these reports to predict instrumental activities of daily living (IADLs) beyond what is accounted for by cognitive abilities in 71 patients with mild Alzheimer disease. Patients completed the Geriatric Depression Scale-Short Form, and caregivers completed the Behavior Rating Scale for Dementia assessing their perception of patients' depressive symptoms. Caregivers also completed IADL items from the Alzheimer's Disease Cooperative Study Activities of Daily Living Inventory. Cognitive measures included the Mini-Mental State Examination, Logical Memory from the Wechsler Memory Scale III, and Trail Making Test, Part B. The relationship between self-reported depressive symptoms and caregiver report of patients' depressive symptoms showed a trend toward significance (r = .22, P = .06). Measures of depressive symptoms significantly predicted 12.5% of the variance in IADLs performance, beyond that accounted for by patient demographics and cognitive functioning. Interestingly, patients' reports, rather than caregivers', were particularly useful in this prediction.
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Affiliation(s)
- Kristen L Votruba
- Department of Psychiatry, Neuropsychology Section, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Carol Persad
- Department of Psychiatry, Neuropsychology Section, University of Michigan Medical Center, Ann Arbor, MI, USA Michigan Alzheimer's Disease Center (MADC), Ann Arbor, MI, USA
| | - Bruno Giordani
- Department of Psychiatry, Neuropsychology Section, University of Michigan Medical Center, Ann Arbor, MI, USA Michigan Alzheimer's Disease Center (MADC), Ann Arbor, MI, USA
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27
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Ikeda C, Terada S, Oshima E, Hayashi S, Okahisa Y, Takaki M, Inagaki M, Yokota O, Uchitomi Y. Difference in determinants of caregiver burden between amnestic mild cognitive impairment and mild Alzheimer's disease. Psychiatry Res 2015; 226:242-6. [PMID: 25631688 DOI: 10.1016/j.psychres.2014.12.055] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 08/24/2014] [Accepted: 12/27/2014] [Indexed: 11/19/2022]
Abstract
Care for the disabled elderly can be stressful and exhausting, especially in cases of dementia. There have been a number of studies on the dementia caregiver burden, but studies focusing on differences by stages of the disease are rare. The caregiver burden of 85 caregivers of patients with amnestic mild cognitive impairment (aMCI) and 106 caregivers of patients with mild Alzheimer׳s disease (AD) was evaluated by the short version of the Japanese version of the Zarit Burden Interview (sZBI). The caregiver burden in mild AD was more severe than that in aMCI. In mild AD, the risk factors of caregiver burden were neurobehavioral symptoms and disturbances instrumental activities of daily living (IADL), whereas the risk factors in aMCI were neurobehavioral symptoms and memory dysfunction. The severity of dementing disease affects the caregiver burden, and somewhat different factors contribute to the burden at different stages. We should pay attention to different factors in evaluating and reducing the caregiver burden in aMCI and mild AD.
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Affiliation(s)
- Chikako Ikeda
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Seishi Terada
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
| | - Etsuko Oshima
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Satoshi Hayashi
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yuko Okahisa
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Manabu Takaki
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Masatoshi Inagaki
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Osamu Yokota
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yosuke Uchitomi
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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28
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Gervès-Pinquié C, Bellanger MM, Ankri J. Willingness to pay for informal care in France: the value of funding support interventions for caregivers. HEALTH ECONOMICS REVIEW 2014; 4:34. [PMID: 26208934 PMCID: PMC4502075 DOI: 10.1186/s13561-014-0034-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 11/19/2014] [Indexed: 05/22/2023]
Abstract
OBJECTIVES This article aims to assess the relationship between the monetary value of informal care - approximated with the caregiver's willingness to pay to reduce caregiving time - and the caregiver's need of three types of support services: care training, respite care and support group. Developing such services may be the only way to provide sustainable informal care in the future, along with efficient allocation. DATA & METHODS Data used stemmed from two representative national surveys conducted by French National Institute of Statistics and Economic Studies and the French Head Office of Research, Studies, Evaluation and Statistics of the Social Affairs Ministry in 2008. The contingent valuation method was used to approximate the monetary value of informal care. The model was run on 223 informal caregivers of people with Alzheimer's Disease. Statistical analyses were performed using Heckman's two-step estimation strategy, which is known to correct selection bias. RESULTS On average, one hour of informal care was estimated at <euro>12.1. Monetary value of informal care was influenced by the caregiver's need of care training (p<0.01). No similar association was found for respite care or support group. DISCUSSION Since informal caring value increases with caregivers' need of care training, improving caring skills and capabilities through training support is likely to improve its benefits.
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Affiliation(s)
- Chloé Gervès-Pinquié
- />Management des organisations de santé (MOS), Ecole des Hautes Etudes en Santé Publique (EHESP), Avenue du Professeur Léon-Bernard, 35043 Rennes, France
| | - Martine M Bellanger
- />Management des organisations de santé (MOS), Ecole des Hautes Etudes en Santé Publique (EHESP), Avenue du Professeur Léon-Bernard, 35043 Rennes, France
| | - Joel Ankri
- />Laboratoire Santé-Environnement-Vieillissement, Université Versailles-Saint-Quentin, Centre de gérontologie Hôpital Sainte Périne 49 rue Mirabeau, 75016 paris, France
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Abstract
This study compared the correlates of burden for spouse and adult child caregivers at two points in time and assessed whether correlates at T(1) predicted burden at T(2). The sample consisted of 878 caregivers to older adults throughout British Columbia who were prescribed cholinesterase inhibitors. Burden was measured six months after the older adult was prescribed the medication and one year later (n = 759). Findings suggest that adult children experience more burden than spouses at both T(1) and T(2) with adult children but not spouses decreasing their burden over time. Correlates of T(1) burden explained significant amounts of variance, revealing differential correlates for the two groups and the importance of caregiver characteristics over patient characteristics. Burden at T(2) is explained mostly by T(2) factors, plus T(1) burden, suggesting the importance of relatively immediate factors for direct effects on caregiver burden. Indirect effects operated through T(1) burden.
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30
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Seeher KM, Low LF, Reppermund S, Slavin MJ, Draper BM, Kang K, Kochan NA, Trollor JN, Sachdev PS, Brodaty H. Correlates of psychological distress in study partners of older people with and without mild cognitive impairment (MCI) - the Sydney Memory and Ageing Study. Aging Ment Health 2014; 18:694-705. [PMID: 24588692 DOI: 10.1080/13607863.2013.875123] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Psychological effects of supporting someone with mild cognitive impairment (MCI) are often overlooked. We aimed to establish correlates of psychological distress in study partners of individuals with and without nonclinical MCI. METHODS Demographic, psychosocial and health measures were obtained cross-sectionally from 714 participants (39% MCI) and study partners of a longitudinal community-based study on cognitive aging. Study partners (i.e. family members/friends) were categorized as providing support with instrumental everyday activities or not. Psychological distress was measured by the Kessler psychological distress scale. Multiple hierarchical regressions examined determinants of psychological distress within Pearlin's stress process model. RESULTS Psychological distress was generally low and not associated with MCI or whether study partners provided support or not. Instead, distress was greater if participants were male irrespective of study partners' sex and if study partners reported negative reactions to participants' behavioral symptoms, felt burdened by providing support and showed worse coping abilities; overall explaining 37% variance. Self-rated disability and aspects of health-related quality of life explained additional 7%. CONCLUSION Objective impairment measures were not associated with distress in partners or supporters. However, study partners' appraisals of functional and behavioral symptoms were linked to increased distress even in this very mildly affected community cohort.
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Affiliation(s)
- Katrin M Seeher
- a Dementia Collaborative Research Centre, School of Psychiatry, UNSW Medicine , University of New South Wales , Sydney , Australia
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31
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Abstract
We know much about caregiving women compared with caregiving men and caregiving spouses compared with caregiving adult children. We know less about the intersections of relationship and gender. This article explores this intersection through the well-being (burden and self-esteem) of caregivers to family members with dementia. Throughout British Columbia, Canada, 873 caregivers were interviewed in person for on average, over 1½ hours. The results reveal that daughters experience the highest burden but also the highest self-esteem, suggesting the role is less salient for their self-identities. Wives emerge as the most vulnerable of the four groups when both burden and self-esteem are considered. The data confirm the usefulness of the intersectionality framework for understanding co-occupancy of more than one status and indicate that positive cognitive well-being and negative affective well-being can be differentially related. Multivariate analyses confirm the importance of caregiver, not patient, characteristics for burden and self-esteem.
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Affiliation(s)
| | - Carren Dujela
- University of Victoria, Victoria, British Columbia, Canada
| | - André Smith
- University of Victoria, Victoria, British Columbia, Canada
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32
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Abstract
ABSTRACTThe purpose of this study is to develop and extend our understanding of dementia care-giving by introducing a typology of informal care-giving across four different diseases. Care-giving factors were examined with respect to specific dementia presentation in mild cognitive impairment, Alzheimer's disease, dementia with Lewy bodies and Parkinson's disease-associated dementia. Informal care-giving literature in the four diseases was systematically searched to identify specific disease symptoms and resultant care-giving strains and outcomes. Key concepts were extracted and grouped thematically. The first classification, ‘role-shift’, reflects care-giving where cognitive deterioration results in changing roles, uncertainty and relational deprivation among married partners. The second classification, ‘consumed by care-giving’, refers to those caring for persons with dementia-motor decline that greatly increases worry and isolation. Finally, in the ‘service use’ classification, formal support is needed to help care-givers cope with daily responsibilities and behaviour changes. In each case, the dementia presentation uniquely impacts care-giver strains. A major conclusion is that the same support to all care-givers under the umbrella term ‘dementia’ is unwarranted; the development of targeted support is required.
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Ghosh S, Libon D, Lippa C. Mild Cognitive Impairment: A Brief Review and Suggested Clinical Algorithm. Am J Alzheimers Dis Other Demen 2014; 29:293-302. [PMID: 24370618 PMCID: PMC10852630 DOI: 10.1177/1533317513517040] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Mild cognitive impairment (MCI) is a dynamic state between normal cognition and dementia, where interventions can be taken to stop or delay the progression to dementia. It is broadly of 2 types-amnestic, where memory loss is the chief concern and nonamnestic, where it is not. One variant of nonamnestic, dysexecutive, being more prevalent is sometimes known as a separate subtype by itself. Diagnosis of MCI is mostly clinical and is aided by various scales and neuropsychological testing. Functional imaging studies help in early detection and is superior to biomarkers or structural magnetic resonance imaging. Although there is no evidence supporting any pharmacological intervention, cognitive rehabilitation, memory training, and caregiver support play a strong role in limiting and sometimes reversing the ongoing cognitive decline. As the spectrum of MCI is heterogeneous, making the right diagnosis can be a challenging; hence, we need a systematic yet cost-effective algorithm for the timely management of MCI.
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Affiliation(s)
- Sayantani Ghosh
- Department of Neurology, Drexel University College of Medicine, Philadelphia, PA, USA
| | - David Libon
- Department of Neurology, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Carol Lippa
- Department of Neurology, Drexel University College of Medicine, Philadelphia, PA, USA
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Exploring the experiences of people with mild cognitive impairment and their caregivers with particular reference to healthcare - a qualitative study. Int Psychogeriatr 2014; 26:475-85. [PMID: 24284179 DOI: 10.1017/s104161021300207x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The aim of this study was to investigate the experiences of people with mild cognitive impairment (MCI; PWMCI) and their "advocates," particularly within healthcare services. METHODS Semi-structured interviews were conducted with 23 PWMCI diagnosed ≤6 months ago and 20 advocates recruited via patients. The resulting data were content-analyzed. RESULTS PWMCI interviewed rarely reported negative impressions of their general practitioner (GP). Reports regarding memory services were more mixed: positive impressions related to finding the service to be "well run" and the staff "pleasant," negative ones to the assessment process or a perceived lack of feedback. Aside from improved information provision, most PWMCI had no suggestions for improvements to their healthcare. However, these results should be interpreted with caution as many of the PWMCI interviewed displayed evidence of impaired recall and/or insight relating to their condition and healthcare. Advocates generally reported more negative impressions of both contact with the PWMCI's GP (most commonly reporting a "dismissive" attitude) and memory services (with common complaints relating to the assessments used in clinics and lengthy waiting times). This group generally had suggestions for improvements to services - particularly regarding information provision, changes in the assessment process, and improvements in communication by services. CONCLUSIONS To our knowledge, this is the first in-depth study of the difficulties experienced by PWMCI and their advocates which includes the context of healthcare provision. The specific needs of these groups, as described here, as well as those of people with dementia, should be considered when designing memory clinics and other related services.
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Abstract
BACKGROUND The family caregivers of patients with heart failure (HF) report burden and poor quality of life, but little is known about changes in their perceptions over time. OBJECTIVES The aims of this study were (1) to evaluate changes in caregiver burden (perceived time spent and difficulty with caregiving tasks), perceived control, depressive symptoms, anxiety, perceived life changes, and physical and emotional health-related quality of life; (2) to determine differences in perceptions between caregivers of patients with low HF symptoms (New York Heart Association class I and II) and caregivers of patients with high HF symptoms (New York Heart Association class III and IV); and (3) to the estimate time spent performing caregiving tasks. METHODS Sixty-three HF patients and 63 family caregivers were enrolled; 53 caregivers completed the longitudinal study. Data were collected from medical records and interviews conducted by advanced practice nurses at baseline and 4 and 8 months later. RESULTS Caregivers who completed the study had significant improvements in perceived time spent on and difficulty of caregiving tasks from baseline to 4 and 8 months, and depressive symptoms decreased from baseline to 8 months. Perceived life changes resulting from caregiving became more positive from baseline to 4 and 8 months. Perceived control, anxiety, and health-related quality of life did not change. Compared with caregivers of patients with low symptoms, caregivers of patients with high symptoms perceived that they spent more time on tasks and that tasks were more difficult, had higher anxiety, and had poorer physical health-related quality of life. Estimated time in hours spent providing care was high. CONCLUSIONS In this sample, perceptions of the caregiving experience improved over 8 months. Health-related quality of life was moderately poor over the 8 months. Caregivers of patients with more severe HF symptoms may be particularly in need of interventions to reduce time and difficulty of caregiving tasks and improve physical health-related quality of life.
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Joosten-Weyn Banningh LWA, Roelofs SCF, Vernooij-Dassen MJFJ, Prins JB, Olde Rikkert MGM, Kessels RPC. Long-term effects of group therapy for patients with mild cognitive impairment and their significant others: a 6- to 8-month follow-up study. DEMENTIA 2013; 12:81-91. [PMID: 24336664 DOI: 10.1177/1471301211420332] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The present study examines the long-term effects of a 10-session cognitive behavioural group therapy for patients with mild cognitive impairment (MCI) and their significant others 6 to 8 months after completion of the intervention. Forty-seven MCI patients and 47 significant others participated in the follow-up assessment. Results of the RAND-36, Illness Cognition Questionnaire, IQCODE, GDS-15 and Sense of Competence Questionnaire at follow-up were compared with the post-intervention assessment. Our findings showed that the increased level of acceptance in the MCI patients was maintained at follow-up, with an increased insight into their cognitive decline compared with post-intervention assessment (p < 0.001). In both the patients and the significant others, helplessness and wellbeing were worse at follow up (p < 0.05), but sense of competence increased in the significant others (p < 0.05). These results indicate a need for extension of the support after completion of the program, for example by providing regular booster sessions.
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Abuse of people with cognitive impairment by family caregivers in Japan (a cross-sectional study). Psychiatry Res 2013; 209:699-704. [PMID: 23462386 DOI: 10.1016/j.psychres.2013.01.025] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2012] [Revised: 01/11/2013] [Accepted: 01/15/2013] [Indexed: 11/21/2022]
Abstract
Caregiving is often stressful in an aging society. Our research questions were two. First, In Japan, how often does abusive behavior by the caregivers of elders with clinically mild cognitive dysfunction (mild cognitive impairment and clinically mild dementia) occur? Second, what risk factors affect the abusive behavior? We studied 123 Japanese caregivers and care recipients who had been referred to the Memory Clinic at Okayama University Hospital. We used the Japanese version of the modified Conflict Tactics Scale (m-CTS) to measure abusive behaviors. We estimate the prevalence of abusive behavior meeting threshold (m-CTS score of 2 or higher) for abuse case on the modified m-CTS. The prevalence of abusive behavior was 15.4%. Stepwise multiple regression analysis revealed that the sex of caregivers and scores on the Neuropsychiatric Inventory (NPI), Zarit Caregiver Burden scale, and Addenbrooke's Cognitive Examination had significant effects on the m-CTS scores. We demonstrated that in Japan, caregivers of the elderly with even clinically mild cognitive dysfunction exhibit abusive behavior toward them. The severity of the disease might reflect the prevalence of and factors that affect the abusive conflict score.
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Pressler SJ, Martineau A, Grossi J, Giordani B, Koelling TM, Ronis DL, Riley PL, Chou CC, Sullivan BJ, Smith DG. Healthcare resource use among heart failure patients in a randomized pilot study of a cognitive training intervention. Heart Lung 2013; 42:332-8. [PMID: 23809197 PMCID: PMC3781586 DOI: 10.1016/j.hrtlng.2013.05.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Revised: 05/02/2013] [Accepted: 05/05/2013] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To compare healthcare resource use of patients with heart failure (HF) randomized to the cognitive training intervention and to the health education active control intervention in a randomized controlled pilot study. BACKGROUND Cognitive training interventions may be efficacious and improve patients' memory and abilities to perform instrumental activities of daily living and self-care behaviors that may, in turn, lower healthcare resource use, but the influence of these interventions on healthcare resource use is unknown. METHODS Thirty-four HF patients were randomized to the computerized plasticity-based cognitive training intervention called Brain Fitness and to the health education active control intervention and completed the study. The primary outcome variable for the study was memory (recall and delayed recall). The secondary purpose of the study that is the focus of this paper was to compare healthcare resource use between the two groups using the third-party payer perspective. Data were collected at baseline and at 8 and 12 weeks after baseline. Healthcare resources were priced at Medicare payment levels for services and average wholesale price for medications. RESULTS Average costs of visits, procedures, and medications were similar between groups. Average costs of hospitalizations and tests, and therefore total costs, were half as much in the Brain Fitness group as compared to the active control group, but this difference was not significantly different from zero (p = 0.24). CONCLUSIONS Larger randomized controlled trials are needed that include analyses of program costs and costs associated with medical and non-medical services in order to fully evaluate efficacy of this intervention.
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Affiliation(s)
- Susan J. Pressler
- Professor and Associate Dean for Graduate Studies, University of Michigan School of Nursing, 400 N. Ingalls, Ann Arbor, MI, 48109, Phone 734-764-7188
| | | | - Judith Grossi
- Clinical Research Coordinator, University of Michigan School of Medicine, Division of Internal Medicine, Cardiology Cardiovascular Center, 1500 E. Medical Center Drive Ann Arbor, MI 48109, Phone 734-232-6367
| | - Bruno Giordani
- Associate Professor and Director, University of Michigan School of Medicine, Neuropsychology Section, Department of Psychiatry and Department of Neurology, 2101 Commonwealth, Suite C Ann Arbor, MI 48105, Phone 734-764-3169
| | - Todd M. Koelling
- Associate Professor and Medical Director, Heart Failure Program, University of Michigan School of Medicine, Division of Internal Medicine, Cardiology Cardiovascular Center, 1500 E. Medical Center Drive Ann Arbor, MI 48109, Phone 734-764-7440
| | - David L. Ronis
- Research Scientist and Director of Statistical Consulting Team, University of Michigan School of Nursing and Veterans Affairs Center for Clinical Management Research, Department of Veterans Affairs, 400 N. Ingalls, Ann Arbor, MI, 48109, Phone 734-647-0462
| | - Penny L. Riley
- University of Michigan School of Nursing, 400 N. Ingalls, Ann Arbor, MI, 48109, Phone 248-437-3201
| | - Cheng-Chen Chou
- University of Michigan School of Nursing, 400 N. Ingalls, Ann Arbor, MI, 48109, Phone, 886-2-33225398
| | - Barbara J Sullivan
- Clinical Assistant Professor, University of Michigan School of Nursing and University of Michigan Depression Center, Department of Psychiatry, 400 N. Ingalls, Ann Arbor, MI, 48109, Phone 734-647-0179
| | - Dean G. Smith
- Professor and Director of Executive Education and Life-Long Learning, University of Michigan School of Public Health,1415 Washington Heights, Ann Arbor, Michigan 48109, Phone 734-647-6233
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Abstract
BACKGROUND Caregivers of patients with mild cognitive impairment (MCI) already experience a need for increased services comparable to that of individuals caring for Alzheimer's disease patients. However, there have been only a few studies on the MCI caregiver burden. In this study, we examined MCI caregiver burden in a larger number of consecutive outpatients in Japan. METHODS One hundred and four consecutive caregivers of people with MCI participated in this study. The caregiver burden was evaluated by the short version of the Japanese version of the Zarit Burden Interview (sZBI). RESULTS About 20% of the caregivers reported a clinically significant burden. The multiple linear regression analysis showed that the caregiver burden was significantly associated with neurobehavioral symptoms (p < 0.001) and memory problems (p = 0.022) of the patient. CONCLUSIONS The caregiver burden of MCI patients should be given more attention. The management of neurobehavioral symptoms may be important to reduce the burden on caregivers of MCI patients.
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Banningh LWAJW, Vernooij-Dassen MJFJ, Vullings M, Prins JB, Rikkert MGMO, Kessels RPC. Learning to live with a loved one with mild cognitive impairment: effectiveness of a waiting list controlled trial of a group intervention on significant others' sense of competence and well-being. Am J Alzheimers Dis Other Demen 2013; 28:228-38. [PMID: 23528880 PMCID: PMC10852931 DOI: 10.1177/1533317513481093] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This controlled study examines the efficacy of a comprehensive group program aimed at care partners of patients with mild cognitive impairment (MCI), which comprises elements of psychoeducation, cognitive rehabilitation, and cognitive behavioral therapy. Pre- and posttreatment quantitative and qualitative data were collected in the significant others of 84 patients with MCI, 27 of whom had first been assigned to a waiting list, thus serving as their own control group. Also, the significant others rated their sense of competence, well-being, distress, acceptance, helplessness, and awareness. Quantitative data analysis did not reveal statistically significant differences between the control and the intervention condition, but qualitative results suggest that at program completion the significant others reported gains in knowledge, insight, acceptance, and coping skills. In the present sample of significant others, the group intervention was not proven effective. Suggestions for program adjustments and alternative outcome measures are discussed.
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Affiliation(s)
- Liesbeth W. A. Joosten-Weyn Banningh
- Department of Medical Psychology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
- Department of Geriatrics, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
- Radboud Alzheimer Centre, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Myrra J. F. J. Vernooij-Dassen
- Department of Geriatrics, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
- Radboud Alzheimer Centre, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen, Nijmegen, the Netherlands
- Kalorama Foundation, Beek-Ubbergen, the Netherlands
- Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Marjon Vullings
- Department of Medical Psychology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
- Department of Medical Psychology, VieCurie Hospital, Venlo, the Netherlands
| | - Judith B. Prins
- Department of Medical Psychology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Marcel G. M. Olde Rikkert
- Department of Geriatrics, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
- Radboud Alzheimer Centre, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Roy P. C. Kessels
- Department of Medical Psychology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
- Department of Geriatrics, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
- Radboud Alzheimer Centre, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, the Netherlands
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Abstract
The purpose of this pilot was to evaluate the acceptability, feasibility, and potential benefits of the multicomponent, Daily Enhancement of Meaningful Activity (DEMA) intervention, which was tailored to help couples facing mild cognitive impairment (MCI) work together to meet goals, remain engaged in meaningful activities, and adapt to changes over time. Using a single-group design, 10 individuals with MCI and their family caregivers were recruited to participate in the DEMA intervention over 6 biweekly sessions. Data were collected pre-and at 1 week and 3 months postintervention completion rates indicated the program and study procedures were well accepted. Qualitative and quantitative finding indicated positive trends in meaningful activity performance and maintenance of health-related outcomes, as well as high program satisfaction. The DEMA intervention is potentially promising but needs further testing in a randomized clinical trial.
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Affiliation(s)
- Yvonne Yueh-Feng Lu
- Assistant Professor, Adult Health in Nursing, Indiana University School of Nursing, 1111 Middle Drive, NU W407, Indianapolis, IN 46202
| | - Joan E. Haase
- Emily Holmquist Professor, Family Health in Nursing, Indiana University School of Nursing, 1111 Middle Drive, NU E437, Indianapolis, IN 46202
| | - Michael Weaver
- Professor and the Director of Statistical Service, Center for Nursing Research and Scholarship, Department Environment for Health, Indiana University School of Nursing, 1111 Middle Drive, NU 340D, Indianapolis, IN 46202
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Is use of formal community services by older women related to changes in their informal care arrangements? AGEING & SOCIETY 2012. [DOI: 10.1017/s0144686x12000992] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
ABSTRACTThis paper examines how the relationships between the factors (predisposing, enabling and illness) of the 1973 Andersen framework and service use are influenced by changes in the caring role in older women of the 1921–26 cohort of the Australian Longitudinal Study on Women's Health. Outcome variables were the use of three formal community support services: (a) nursing or community health services, (b) home-making services and (c) home maintenance services. Predictor variables were survey wave and the following carer characteristics: level of education, country of birth, age, area of residence, ability to manage on income, need for care, sleep difficulty and changes in caring role. Carer changes were a significant predictor of formal service use. Their inclusion did not attenuate the relationship between the Andersen framework factors and service use, but instead provided a more complete representation of carers' situations. Women were more likely to have used support services if they had changed into or out of co-resident caring or continued to provide co-resident care for a frail, ill or disabled person, needed care themselves, and reported sleep difficulties compared with women who did not provide care. These findings are important because they indicate that support services are particularly relevant to women who are changing their caring role and who are themselves in need of care.
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Abstract
BACKGROUND Mild cognitive impairment (MCI) is a relatively common condition and rates of diagnosis are likely to increase in the near future. Little is known about the experiences of patients with MCI and their carers nor about the most appropriate interventions to support this group. METHODS The existing literature on this topic up to July 2011 was identified via systematic searches of the Embase and Medline databases, the Cochrane Library and relevant sections of the National Electronic Library for Health. The main search term "mild cognitive impairment" was used in combination with other relevant terms. The reference lists of reviewed articles were also examined for any additional papers of significance. Papers identified by this method were examined and those deemed relevant were included in this review. RESULTS Twenty-one suitable papers were identified for inclusion in this review, a relatively small number. The studies reviewed suggest that patients with MCI and their carers face a variety of practical and emotional challenges. No interventional studies of support have been undertaken, but the authors of relevant observational studies have suggested provision of information, psychosocial support and strategies to enhance patient interaction with carers and social contacts. CONCLUSIONS MCI results in significant challenges for both patients and their carers. Further work is required in order to establish the best way to help patients and carers meet these challenges.
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The effects of meditation on perceived stress and related indices of psychological status and sympathetic activation in persons with Alzheimer's disease and their caregivers: a pilot study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2012; 2012:927509. [PMID: 22454689 PMCID: PMC3292237 DOI: 10.1155/2012/927509] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Revised: 12/05/2011] [Accepted: 12/05/2011] [Indexed: 11/24/2022]
Abstract
Objective. To investigate the effects of an 8-week meditation program on perceived stress, sleep, mood, and related outcomes in adults with cognitive impairment and their caregivers. Methods. Community-dwelling adults with a diagnosis of mild cognitive impairment or early-stage Alzheimer's disease, together with their live-in caregivers, were enrolled in the study. After a brief training, participants were asked to meditate for 11 minutes, twice daily for 8 weeks. Major outcomes included measures of perceived stress (Perceived Stress Scale), sleep (General Sleep Disturbance Scale), mood (Profile of Mood States), memory functioning (Memory Functioning Questionnaire), and blood pressure. Participants were assessed pre- and post-intervention. Results. Ten participants (5 of 6 dyads) completed the study. Treatment effects did not vary by participant status; analyses were thus pooled across participants. Adherence was good (meditation sessions completed/week: X = 11.4 ± 1.1). Participants demonstrated improvement in all major outcomes, including perceived stress (P < 0.001), mood (overall, P = 0.07; depression, P = 0.01), sleep (P < 0.04), retrospective memory function (P = 0.04), and blood pressure (systolic, P = 0.004; diastolic, P = 0.065). Conclusions.
Findings of this exploratory trial suggest that an 8-week meditation program may offer an acceptable and effective intervention for
reducing perceived stress and improving certain domains of sleep, mood, and memory in adults with cognitive
impairment and their caregivers.
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Ryan KA, Weldon A, Persad C, Heidebrink JL, Barbas N, Giordani B. Neuropsychiatric symptoms and executive functioning in patients with mild cognitive impairment: relationship to caregiver burden. Dement Geriatr Cogn Disord 2012; 34:206-15. [PMID: 23128102 PMCID: PMC3698846 DOI: 10.1159/000339955] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/04/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Caregivers of patients with mild cognitive impairment (MCI) need similar levels of support services as Alzheimer's disease (AD) caregivers, but it is unclear if this translates to increased caregiver burden. METHODS 135 participants and their caregivers (40 MCI, 55 AD and 40 normal controls, NC) completed questionnaires, and the patients were administered neuropsychological tests. RESULTS The MCI caregivers reported significantly more overall caregiving burden than the NC, but less than the AD. They showed similar levels of emotional, physical and social burden as the AD caregivers. Among the MCI caregivers, the neuropsychiatric symptoms and executive functioning of the patients were related to a greater burden, and the caregivers with a greater burden reported lower life satisfaction and social support, and a greater need for support services. CONCLUSION These results indicate that MCI caregivers are at increased risk for caregiver stress, and they require enhanced assistance and/or education in caring for their loved ones.
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Affiliation(s)
- Kelly A. Ryan
- The University of Michigan Health System, Ann Arbor, Mich., USA
| | - Anne Weldon
- The University of Michigan Health System, Ann Arbor, Mich., USA
| | - Carol Persad
- The University of Michigan Health System, Ann Arbor, Mich., USA
| | - Judith L. Heidebrink
- The University of Michigan Health System, Ann Arbor, Mich., USA
,Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Mich., USA
| | - Nancy Barbas
- The University of Michigan Health System, Ann Arbor, Mich., USA
,Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Mich., USA
| | - Bruno Giordani
- The University of Michigan Health System, Ann Arbor, Mich., USA
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Li H. Unmet Service Needs: A Comparison Between Dementia and Non-Dementia Caregivers. Home Health Care Serv Q 2012; 31:41-59. [DOI: 10.1080/01621424.2011.641921] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Reppermund S, Sachdev PS, Crawford J, Kochan NA, Slavin MJ, Kang K, Trollor JN, Draper B, Brodaty H. The relationship of neuropsychological function to instrumental activities of daily living in mild cognitive impairment. Int J Geriatr Psychiatry 2011; 26:843-52. [PMID: 20845500 DOI: 10.1002/gps.2612] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2010] [Accepted: 07/06/2010] [Indexed: 11/12/2022]
Abstract
OBJECTIVE While activities of daily living are by definition preserved in mild cognitive impairment (MCI), there is evidence of poorer instrumental activities of daily living (IADL) functioning in MCI compared to normal ageing. The aims of the present study were to examine differences in IADL between individuals with MCI and cognitively normal elderly, and to examine the relationships of IADL with cognitive functions. METHODS The sample of 762 community-living participants aged 70-90 were assessed with a comprehensive neuropsychological test battery and with the informant-completed Bayer-Activities of Daily Living Scale (B-ADL). RESULTS Compared to cognitively normal individuals, the MCI group was rated as having more difficulties on the B-ADL and performed worse on cognitive tests. Factor analysis of the B-ADL items yielded two factors, which were labelled 'high cognitive demand' (HCD) and 'low cognitive demand' (LCD). Individuals with MCI scored worse than cognitively normal participants on the HCD factor but similarly on the LCD factor. Men were rated as having more difficulties on the HCD, but not the LCD, factor compared to women. The HCD factor score correlated significantly with all five cognitive domains measured, but the LCD factor correlated significantly only with attention/processing speed and to a lesser extent with executive function. CONCLUSIONS Having more difficulties in IADL, especially those with higher demand on cognitive capacities, was found to be associated with MCI and overall cognitive functioning. This has implications for the definition of MCI, as lack of functional impairment is generally used as a criterion for diagnosis.
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Affiliation(s)
- Simone Reppermund
- Brain and Ageing Research Program, Faculty of Medicine, School of Psychiatry, University of New South Wales, NSW, Australia.
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