1
|
Suárez-González A, Savage SA, Alladi S, Amaral-Carvalho V, Arshad F, Camino J, Caramelli P, Comas-Herrera A, Cook J, Cooper C, García Díaz L, Grasso SM, Jokel R, Lavoie M, León T, Priya T, Ramos Franco T, Taylor-Rubin C, Townsend R, Thöne-Otto A, Slachevsky A, Volkmer A, Weidner W, O’Connor CMC. Rehabilitation Services for Young-Onset Dementia: Examples from High- and Low-Middle-Income Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:790. [PMID: 38929036 PMCID: PMC11203756 DOI: 10.3390/ijerph21060790] [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: 05/14/2024] [Revised: 06/05/2024] [Accepted: 06/09/2024] [Indexed: 06/28/2024]
Abstract
The WHO Dementia Global Action Plan states that rehabilitation services for dementia are required to promote health, reduce disability, and maintain quality of life for those living with dementia. Current services, however, are scarce, particularly for people with young-onset dementia (YOD). This article, written by an international group of multidisciplinary dementia specialists, offers a three-part overview to promote the development of rehabilitation services for YOD. Firstly, we provide a synthesis of knowledge on current evidence-based rehabilitative therapies for early-onset Alzheimer's disease (EOAD), behavioural variant frontotemporal dementia (bvFTD), primary progressive aphasia (PPA), and posterior cortical atrophy (PCA). Secondly, we discuss the characteristics of rehabilitation services for YOD, providing examples across three continents for how these services can be embedded in existing settings and the different roles of the rehabilitation multidisciplinary team. Lastly, we conclude by highlighting the potential of telehealth in making rehabilitation services more accessible for people with YOD. Overall, with this paper, we aim to encourage clinical leads to begin introducing at least some rehabilitation into their services, leveraging existing resources and finding support in the collective expertise of the broader multidisciplinary dementia professional community.
Collapse
Affiliation(s)
- Aida Suárez-González
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London (UCL), London WC1N 3BG, UK
| | - Sharon A Savage
- School of Psychological Sciences, College of Engineering, Science and Environment, The University of Newcastle, Callaghan, NSW 2308, Australia;
| | - Suvarna Alladi
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bangalore 560030, India
| | - Viviane Amaral-Carvalho
- Departamento de Neurologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903, SP, Brazil
- Behavioral and Cognitive Neurology Unit, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, MG, Brazil
| | - Faheem Arshad
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bangalore 560030, India
| | - Julieta Camino
- Institute of Health and Social Care, London South Bank University, London SE1 0AA, UK
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich NR4 7TQ, UK
| | - Paulo Caramelli
- Behavioral and Cognitive Neurology Unit, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, MG, Brazil
| | - Adelina Comas-Herrera
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London WC2A 2AZ, UK
| | - Julia Cook
- Herefordshire and Worcestershire Health and Care NHS Trust, Worcester WR5 1JR, UK
| | - Claudia Cooper
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London EC1M 6BQ, UK
| | - Laura García Díaz
- School of Rehabilitation Science, McMaster University, Hamilton, ON L8S 1C7, Canada
| | - Stephanie M. Grasso
- Department of Speech, Language and Hearing Sciences, University of Texas, Austin, TX 78712-1069, USA
| | - Regina Jokel
- Rotman Research Institute, Toronto, ON M6A 2X8, Canada
- Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
- Baycrest Health Sciences, Toronto, ON M6A 2E1, Canada
| | - Monica Lavoie
- Chaire de Recherche sur les Aphasies Primaires Progressives—Fondation de la Famille LEMAIRE, CHU de Québec-Université Laval, Québec, QC G1V 0A6, Canada;
| | - Tomás León
- Memory Unit, Neurology Department, Memory and Neuropsychiatric Center (CMYN), Hospital del Salvador and Faculty of Medicine, University of Chile, Santiago 7500922, Chile
- Department of Psychiatry and Global Brain Health Institute, Trinity College, D02 K104 Dublin, Ireland
| | - Thomas Priya
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bangalore 560029, India;
| | - Teresita Ramos Franco
- Memory Unit, Neurology Department, Memory and Neuropsychiatric Center (CMYN), Hospital del Salvador and Faculty of Medicine, University of Chile, Santiago 7500922, Chile
| | - Cathleen Taylor-Rubin
- Speech Pathology Department, War Memorial Hospital, Sydney, NSW 2024, Australia
- School of Psychological Sciences, Macquarie University, Sydney, NSW 2109, Australia
| | | | - Angelika Thöne-Otto
- Clinic for Cognitive Neurology, University Hospital Leipzig, 04103 Leipzig, Germany
- Max-Planck Institute for Human Cognitive and Brain Sciences, 04103 Leipzig, Germany
| | - Andrea Slachevsky
- Memory Unit, Neurology Department, Memory and Neuropsychiatric Center (CMYN), Hospital del Salvador and Faculty of Medicine, University of Chile, Santiago 7500922, Chile
- Geroscience Center for Brain Health and Metabolism (GERO), Santiago 7500922, Chile
- Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Physiopatology Program—Institute of Biomedical Sciences (ICBM), Neuroscience and East Neuroscience Departments, Faculty of Medicine, University of Chile, Santiago 7500922, Chile
- Neurology and Psychiatry Department, Clínica Alemana-Universidad Desarrollo, Santiago 7650568, Chile
| | - Anna Volkmer
- Division of Psychology and Language Sciences, University College London (UCL), London WC1H 0AP, UK
| | - Wendy Weidner
- Alzheimer’s Disease International, London SE1 4PU, UK
| | - Claire MC O’Connor
- Centre for Positive Ageing, HammondCare, Sydney, NSW 2170, Australia
- School of Psychology, Faculty of Sciences, University of New South Wales, Sydney, NSW 2052, Australia
- Neuroscience Research Australia, Sydney, NSW 2031, Australia
| |
Collapse
|
2
|
Quinn C, Young H, Gridley K, Stamou V, Mason C, Oyebode J. Social care planning and provision for people with young onset dementia and their families: Protocol for the DYNAMIC study. PLoS One 2024; 19:e0297747. [PMID: 38315704 PMCID: PMC10843619 DOI: 10.1371/journal.pone.0297747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 01/09/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Social care is vital to quality of life for people with young onset dementia and their families. Yet care is hugely variable, frequently lacking and poorly coordinated. We aim to establish current practice in English social care for people with young onset dementia and co-produce evidence-based recommendations and resources for improvement. METHODS AND ANALYSIS In Work-Package 1, we will gather qualitative data from 25 people with young onset dementia and/or main supporters residing in England. We will ask them about their experiences of social care (broadly defined, including independent and voluntary sector provision) and suggestions for improvement. In Work-Package 2, we will conduct a short on-line survey with a wide range of staff with a role in adult social care in England. We will find out about current awareness, knowledge and practice and suggestions for improvements. Quantitative and qualitative analysis will provide a picture of current practice. In Work-Package 3, we will use convergence analysis to synthesise the findings from Work-Packages 1 and 2 and present the findings to a stakeholder workshop, to identify feasible priorities for improvement. We will establish what is already known about good practice relating to these key priorities using a scoping review and interviews with professionals. This knowledge will then feed into the co-production of resources and recommendations with key stakeholders to improve social care for people with young onset dementia and their families. DISCUSSION This study seeks to address a gap in our understanding of social care provision for people with young onset dementia and develop recommendations and practical resources for improvements. The findings will help people with young onset dementia and supporters to receive higher quality social care. TRIAL REGISTRATION Study registration number: ISRCTN10653250.
Collapse
Affiliation(s)
- Catherine Quinn
- Centre for Applied Dementia Studies, University of Bradford, Bradford, United Kingdom
- Wolfson Centre for Applied Health Research, Bradford, United Kingdom
| | - Helen Young
- Centre for Applied Dementia Studies, University of Bradford, Bradford, United Kingdom
| | - Kate Gridley
- Social Policy Research Unit, University of York, York, United Kingdom
| | - Vasileios Stamou
- Centre for Applied Dementia Studies, University of Bradford, Bradford, United Kingdom
| | - Clare Mason
- Centre for Applied Dementia Studies, University of Bradford, Bradford, United Kingdom
| | - Jan Oyebode
- Centre for Applied Dementia Studies, University of Bradford, Bradford, United Kingdom
| |
Collapse
|
3
|
Cui X, Wang J, Wu B, Zhao Q, Tang X, Wang J. Interventions for Persons with Young-Onset Dementia and Their Families: A Scoping Review. J Alzheimers Dis 2024; 97:1519-1531. [PMID: 38277297 DOI: 10.3233/jad-231006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
Background Dementia occurring before age 65 is known as young-onset dementia (YOD), with Alzheimer's disease being the most common type. YOD poses unique challenges for persons and families, impacting their working-age years and family responsibilities. Person-centered interventions and services are essential to improve their quality of life and social engagement. Objective This study aims to synthesize non-pharmacological interventions for persons with YOD and their families to inform future targeted interventions. Methods We conducted a systematic literature search across four databases: PubMed, PsycINFO, Scopus, and CINAHL. The included articles were carefully screened, categorized, and synthesized by following Arksey and O'Malley's five stages framework. Results We included 20 studies reported in 24 papers, with 11 studies (14 papers) on persons with YOD and nine studies (10 papers) on families. Quantitative intervention results vary, but qualitative interviews show positive feedback. Stakeholders provided positive evaluations, stating these interventions provided a sense of normalcy, facilitated communication among families, enhanced the independence of persons with YOD, and improved the families' caregiving self-efficacy, thereby reducing care burden and psychological distress. The heterogeneity among the studies posed integration challenges. Conclusions Interventions for YOD can improve the quality of life for both persons with YOD and their families. More extensive intervention studies are urgently needed, especially in developing countries, with a focus on family-centered and life course perspectives. In future intervention research design, a more extensive incorporation of stakeholder involvement is essential for successful implementation. Moreover, the integration of new technologies shows promise as a potential avenue for intervention advancement.
Collapse
Affiliation(s)
- Xiaoyan Cui
- Fudan University School of Nursing, Shanghai, China
| | - Junqiao Wang
- Fudan University School of Nursing, Shanghai, China
| | - Bei Wu
- Rory Meyers College of Nursing, New York University, NY, USA
| | - Qianhua Zhao
- Institute of Neurology, Huashan Hospital, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Huashan Hospital, Fudan University, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Xueting Tang
- Fudan University School of Nursing, Shanghai, China
| | - Jing Wang
- University of New Hampshire, NH, USA
| |
Collapse
|
4
|
Conway E. Use of adapted or modified methods with people with dementia in research: A scoping review. DEMENTIA 2023; 22:1994-2023. [PMID: 37871184 PMCID: PMC10644684 DOI: 10.1177/14713012231205610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
People with dementia are excluded from research due to methodological challenges, stigma, and discrimination. Including perspectives of people with dementia across a spectrum of abilities is essential to understanding their perspectives and experiences. Engaging people living with dementia in qualitative research can require adaptation of methods.Qualitative research is typically considered when researchers seek to understand the perspectives, lived experiences, or opinions of individuals' social reality. This scoping review explores current use of adapted methods with people with dementia in qualitative research, including methods used and impacts on the engagement as it relates to meeting accessibility needs. This review considered rationales for adaptations provided by authors, particularly whether authors identified a human rights or justice rationale for adapting methods to promote accessibility and engagement.This review began with a search of primary studies using qualitative research methods published in English in OECD countries from 2017 to 2022. Two reviewers screened titles and abstracts for inclusion. Full texts were reviewed, and data from included studies were extracted using a pre-determined chart. Content analysis of rationales was conducted and reviewed by all authors. Studies were assessed for findings related to impacts of adapted methods.Twenty-eight studies met inclusion criteria. Adaptations to qualitative research methods ranged from minor changes, such as maintaining a familiar interviewer, to more extensive novel methods such as photo-elicitation techniques. Twenty-seven studies provided a rationale for adapting their methods. No studies assessed impacts of their methodology on engagement or accessibility. Five studies observed that their methodology supported engagement.This review helps understand the breadth of adaptations that researchers have made to qualitative research methods to include people with dementia in research. Research is needed to explore adaptations and their impact on engagement of persons with dementia with a range of abilities and backgrounds.
Collapse
Affiliation(s)
- Emma Conway
- School of Public Health Sciences, University of Waterloo, Canada
| |
Collapse
|
5
|
Oyebode JR, La Fontaine J, Stamou V, O'Malley M, Parkes J, Carter J. Establishing and sustaining high-quality services for people with young onset dementia: the perspective of senior service providers and commissioners. Int Psychogeriatr 2023:1-10. [PMID: 37731261 DOI: 10.1017/s1041610223000443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
OBJECTIVES We aimed to understand the facilitators to developing and sustaining high-quality services for people with young onset dementia (YOD) and their families/supporters. DESIGN This qualitative study used semi-structured interviews with commissioners and service managers, analyzed using inductive thematic analysis. SETTING A purposive sample of providers was selected from diverse areas and contrasting YOD services. PARTICIPANTS Eighteen senior staff from YOD services and two dementia service commissioners took part. MEASUREMENTS For commissioners, key interview topics were experiences of commissioning YOD services, perceived facilitators or barriers, and how future guidance should be structured for ease of use. For service providers, key topics explored experiences of delivering YOD services; what was achievable or challenging; how the service was funded; how it linked with broader provision for YOD in the area; and how guidance should be structured. RESULTS Recorded interviews lasted 30-40 minutes. Seven key facilitators to the development and sustaining of YOD services were identified: having knowledgeable, committed local champions; involvement of people living with YOD and family supporters; initial delivery within existing resources; partnership working within and between sectors; having a reflective, supportive organizational culture; gathering evidence of impact; and having wider support and guidance. CONCLUSIONS Improvements in provision for those with YOD and their families need to be built on understanding of service-level and interpersonal influences as well as on understanding of YOD itself. Our findings highlight a set of facilitators which need to be in place to establish and sustain high-quality YOD services that fit the local context.
Collapse
Affiliation(s)
- Jan Rachel Oyebode
- Centre for Applied Dementia Studies, Faculty of Health Studies, University of Bradford, Bradford, UK
| | - Jenny La Fontaine
- Centre for Applied Dementia Studies, Faculty of Health Studies, University of Bradford, Bradford, UK
| | - Vasileios Stamou
- Centre for Applied Dementia Studies, Faculty of Health Studies, University of Bradford, Bradford, UK
| | - Mary O'Malley
- Centre for Applied Mental Health Research, Faculty of Health and Society, University of Northampton, Northampton, UK
| | - Jacqueline Parkes
- Centre for Applied Mental Health Research, Faculty of Health and Society, University of Northampton, Northampton, UK
| | - Janet Carter
- Division of Psychiatry, Faculty of Brain Sciences, Maple House, University College London, London, UK
| |
Collapse
|
6
|
Lai M, Jeon YH, McKenzie H, Withall A. Journey to Diagnosis of Young-Onset Dementia: A Qualitative Study of People with Young-Onset Dementia and their Family Caregivers in Australia. DEMENTIA 2023:14713012231173013. [PMID: 37126513 DOI: 10.1177/14713012231173013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
OBJECTIVES This study aims to explore the journey to dementia diagnosis and reaction to the diagnosis from the perspective of people with young-onset dementia living in the community from diverse areas in Australia (metropolitan, regional, rural) and their family caregivers. METHODS Semi-structured interviews were conducted with community-dwelling people with early to moderate young-onset Alzheimer's disease (n = 8) or frontotemporal dementia (n = 5) and one person with both Alzheimer's disease and frontotemporal dementia, and family caregivers of community-dwelling people with young-onset Alzheimer's disease and/or frontotemporal dementia (n = 28). This study employed interpretive description. Thematic analysis was conducted for emergent themes, comparisons and interplay between themes. FINDINGS The journey to the diagnosis is characterised as involving an extensive period of the gradual worsening of symptoms, drawn out investigations, and difficulties facing the prospect of a diagnosis of young-onset dementia. Participants with young-onset dementia struggled to manage their symptoms and the process of seeking a diagnosis was often slow due to difficulties during the course of their medical investigations and feeling reluctance to face the possibility of having dementia. Once participants finally received the diagnosis of young-onset dementia, participants with young-onset dementia and their family caregivers experienced feelings of devastation and shock, in some cases denial and avoidance, and even, confirmation and relief at having received a diagnosis. In some instances, participants experienced more than one of these reactions. There was a profound realisation by participants that a diagnosis of young-onset dementia had serious implications on their life and future. CONCLUSION The journey to diagnosis was found to be a drawn-out process and receiving the diagnosis was a shock for both people with young-onset dementia and their family caregivers. The findings highlight the significance of the role healthcare professionals play in both the diagnostic and post-diagnostic journey, particularly in terms of supporting patients with young-onset dementia and their family caregivers.
Collapse
Affiliation(s)
- Michelle Lai
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Yun-Hee Jeon
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Heather McKenzie
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Adrienne Withall
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
| |
Collapse
|
7
|
Abstract
PURPOSE OF REVIEW Young-onset dementia (YOD) refers to a dementia for which symptom onset occurs below the age of 65. This review summarizes the recent literature in this area, focusing on updates in epidemiology, diagnosis and service provision. RECENT FINDINGS In the last year, internationally, the prevalence of YOD was reported as 119 per 100 000, but this may vary according to population types. Although the commonest causes of YOD are Alzheimer's disease (AD) and frontotemporal dementia (FTD), there is increasing recognition that YOD is diagnostically and phenotypically broader than AD and FTD. YOD may be due to many other diseases (e.g. Huntington's disease, vascular dementia) whereas accumulation of the same protein (e.g. amyloid protein) may lead to different phenotypes of Alzheimer's disease (such as posterior cortical atrophy and behavioural-variant/frontal-variant AD). This heterogeneity of phenotypic presentation is also seen in YOD due to known genetic mutations. Biomarkers such as plasma and cerebrospinal fluid proteins, neuroimaging and genetics have shown promise in the early identification of YOD as well as providing further understanding behind the overlap between psychiatric and neurodegenerative conditions occurring in younger people. The management of YOD needs to consider age-specific issues for younger people with dementia and their family networks together with better integration with other health services such as aged, disability and improved access to services and financial assistance. SUMMARY These findings emphasize the need for early identification and appropriate age-specific and person-centred management for people with young-onset dementia.
Collapse
Affiliation(s)
- Samantha M Loi
- Department of Neuropsychiatry, Royal Melbourne Hospital
- Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
| | - Yolande Pijnenburg
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
| | - Dennis Velakoulis
- Department of Neuropsychiatry, Royal Melbourne Hospital
- Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
| |
Collapse
|
8
|
Good practice in needs-based post-diagnostic support for people with young onset dementia: findings from the Angela Project. AGEING & SOCIETY 2023. [DOI: 10.1017/s0144686x22001362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Abstract
Evidence on post-diagnostic support for people with young onset dementia is scarce. Previous studies have employed a problem-focused approach; however, evidence on ‘what works’ in real-life practice is essential to develop recommendations for service design and delivery. This study aimed to provide insight into ‘what works’ from the perspectives of people with young onset dementia and their supporters. We gathered free-text responses on positive service experiences via a UK cross-sectional survey. Inductive thematic analysis was used to identify the objectives of positive services and the needs these met. Follow-up interviews enabled in-depth insights from people with diverse diagnoses, ages and social situations. These were analysed using a template drawn from the survey. The 233 survey respondents gave 856 examples of positive support. Analysis of 24 follow-up interviews led to 16 themes clustered under three superordinate themes: ‘maintaining autonomy’, ‘being myself’ and ‘togetherness’. We found that positive services address the disruptions to sense of agency, selfhood and meaningful relationships that are experienced by those with young onset dementia. The study provides an in-depth understanding of the needs met by positive services for younger people with dementia. Our nuanced findings on good practice can inform age-specific guidelines for young onset dementia and indicate how personalisation can work in practice to help people with young onset dementia to maintain identity, autonomy and connections.
Collapse
|
9
|
Chirico I, Ottoboni G, Linarello S, Ferriani E, Marrocco E, Chattat R. Family experience of young-onset dementia: the perspectives of spouses and children. Aging Ment Health 2022; 26:2243-2251. [PMID: 34842004 DOI: 10.1080/13607863.2021.2008871] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Although young-onset dementia (YOD) affects the whole family system, this population is still under-represented in literature, and no progress in care provision has been made. Hence, additional evidence is necessary to understand how family and social relationships are affected by YOD and care challenges, as to provide recommendations for clinical practice and service improvement from a family perspective. METHOD Family carers were recruited via one memory clinic and the local Alzheimer's Associations in Italy. Semi-structured interviews explored their experiences with YOD, the impact of the condition on their lives, family and social relationships, and the support and care they received. Transcripts were coded by three researchers and analysed using inductive thematic analysis. RESULTS Thirty-eight interviews were conducted with 26 spouses and 12 adult children. Three themes emerged: 1) Problems around diagnosis, 2) Lack of post-diagnostic support, and 3) Living with YOD as a family. Overall, problems occurred across the dementia pathway. Without appropriate support, it was difficult for families to adjust to living with YOD and to the associated changes in family roles and relationships. CONCLUSIONS Since optimal care depends on good family relationships, better support for families in the adaptation to condition would likely benefit patient care while ensuring social inclusion and health equity for vulnerable groups.
Collapse
Affiliation(s)
- Ilaria Chirico
- Department of Psychology, University of Bologna, Bologna, Italy
| | | | - Simona Linarello
- Center for Cognitive Disorders and Dementia, Local Health Care Unit, Bologna, Italy
| | - Elisa Ferriani
- Center for Cognitive Disorders and Dementia, Local Health Care Unit, Bologna, Italy.,Department of Oncology, Local Health Care Unit, Bologna, Italy
| | - Enrica Marrocco
- Center for Cognitive Disorders and Dementia, Local Health Care Unit, Bologna, Italy.,Department of Oncology, Local Health Care Unit, Bologna, Italy
| | - Rabih Chattat
- Department of Psychology, University of Bologna, Bologna, Italy
| |
Collapse
|
10
|
Day S, Couzner L, Laver KE, Withall A, Draper B, Cations M. Cross-sector learning collaboratives can improve post-diagnosis care integration for people with young onset dementia. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e6135-e6144. [PMID: 36177663 DOI: 10.1111/hsc.14051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 08/08/2022] [Accepted: 09/12/2022] [Indexed: 06/16/2023]
Abstract
Post-diagnosis young onset dementia (YOD) care is often fragmented, with services delivered across aged care, healthcare, and social care sectors. The aim of this project was to test the feasibility and potential effectiveness of a learning collaborative implementation strategy for improving the cross-sector integration of care for people with YOD and to generate data to refine the implementation strategy for scaleup. We conducted a longitudinal mixed methods process evaluation and recruited one representative from three Australian aged care organisations, three disability care organisations and three organisations (n = 9) contracted to deliver care navigation services. One representative from each organisation joined a learning collaborative within their local area and completed a six-module online education package incorporating written resources, webinars, collaboration and expert mentoring. Participants identified gaps in services in their region and barriers to care integration and developed a shared plan to implement change. Normalisation Process Theory was applied to understand the acceptability, penetration and sustainability of the implementation strategy as well as barriers and enabling factors. Dementia knowledge measured by the Dementia Knowledge and Awareness Scale was high among the professionals at the start of the implementation period (mean = 39.67, SD = 9.84) and did not change by the end (mean = 39.67, SD = 8.23). Quantitative data demonstrated that clinicians dedicated on average half of the recommended time commitment to the project. However, qualitative data identified that the learning collaborative strategy enhanced commitment to implementing integrated care and promoted action towards integrating previously disparate care services. Participant commitment to the project was influenced by their sense of obligation to their team, and teams that established clear expectations and communication strategies early were able to collaborate and use the implementation plan more effectively (demonstrating collective action). Teams were less likely to engage in the collective action or reflexive monitoring required to improve care integration if they did not feel engaged with their learning collaborative. Learning collaboratives hold promise as a strategy to improve cross-sector service collaboration for people with YOD and their families but must maximise group cohesion and shared commitment to change.
Collapse
Affiliation(s)
- Sally Day
- College of Education, Social Work and Psychology, Flinders University, Adelaide, South Australia, Australia
| | - Leah Couzner
- College of Education, Social Work and Psychology, Flinders University, Adelaide, South Australia, Australia
| | - Kate E Laver
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Adrienne Withall
- School of Public Health and Community Medicine, UNSW Sydney, Adelaide, New South Wales, Australia
| | - Brian Draper
- Discipline of Psychiatry and Mental Health, UNSW Sydney, Adelaide, New South Wales, Australia
| | - Monica Cations
- College of Education, Social Work and Psychology, Flinders University, Adelaide, South Australia, Australia
| |
Collapse
|
11
|
Parkes J, O'Malley M, Stamou V, La Fontaine J, Oyebode JR, Carter J. Lessons learnt from delivering the public and patient involvement forums within a younger onset dementia project. DEMENTIA 2022; 21:2103-2116. [PMID: 35833723 PMCID: PMC9483689 DOI: 10.1177/14713012221110006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Including the ‘voices’ of people living with dementia in a meaningful way is pivotal in
shaping local, national and international health and social dementia care research. The
Alzheimer’s Society (United Kingdom) funded Angela Project (2016–19) was aimed at
improving the diagnosis and post-diagnostic support for younger people living with
dementia. From the outset, the Project Team ensured that the knowledge and expertise of
people living with a younger onset dementia was integral to all decisions taken in respect
to overall project design, implementation, and dissemination processes. This was achieved
by establishing two project public and patient involvement (PPI) forums; a London PPI
Forum and a Bradford-based local PPI Hub. This paper describes how the two groups were
formed; the format of the meetings; and the key points learnt by the Project Team from
involving people with dementia in all aspects of developing and delivering the Angela
Project. Ultimately, the aim is to demonstrate to other researchers in the dementia field
how the perspectives of those with a diagnosis can be included in research studies in an
active and meaningful way.
Collapse
Affiliation(s)
- Jacqueline Parkes
- Faculty of Health Education and Society, 6087The University of Northampton, Northampton, UK
| | - Mary O'Malley
- Faculty of Health Education and Society, 6087The University of Northampton, Northampton, UK
| | - Vasileios Stamou
- Centre for Applied Dementia Studies, 1905University of Bradford, Bradford, UK
| | - Jenny La Fontaine
- Centre for Applied Dementia Studies, 1905University of Bradford, Bradford, UK
| | - Jan R Oyebode
- Centre for Applied Dementia Studies, 1905University of Bradford, Bradford, UK
| | | |
Collapse
|
12
|
Grunberg VA, Bannon SM, Reichman M, Popok PJ, Vranceanu AM. Psychosocial treatment preferences of persons living with young-onset dementia and their partners. DEMENTIA 2021; 21:41-60. [PMID: 34151598 DOI: 10.1177/14713012211027007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Persons living with young-onset dementia and their partners often experience elevated emotional distress as they cope with an unexpected progressive illness during an active life stage (typically ages 45-64 years). Despite their heightened emotional distress, psychosocial resources are both limited and lack the specificity to meet the unique needs of both partners. Our aim was to gain an in-depth understanding of the psychosocial treatment preferences of persons with young-onset dementia and their partners-an important first step in developing a tailored intervention. We conducted semi-structured dyadic interviews with persons with young-onset dementia and their partners (N = 23) and used a hybrid deductive-inductive approach to thematic analysis. We identified 12 themes across four domains: (1) perceptions of available and lacking resources, (2) preferences for program content, (3) preferences for program format, and (4) barriers and facilitators to participation. Couples indicated there is a lack of specific and family-oriented resources, which can create more stress and relationship strain. Couples endorsed support for a virtual, dyadic intervention delivered shortly after diagnosis focused on providing tools to cope with difficult emotions and symptom progression and enhance communication and meaningful daily living. They also identified potential barriers to program participation and offered suggestions to promote engagement. By using a qualitative approach, we were able to gather nuanced information that can be used to directly inform a feasible, accepted, and person-centered psychosocial intervention for persons with young-onset dementia and their partners.
Collapse
Affiliation(s)
- Victoria A Grunberg
- Integrated Brain Health Clinical and Research Program, 2348Department of Psychiatry, Massachusetts General Hospital; 1811Harvard Medical School, Boston, MA, USA
| | - Sarah M Bannon
- Integrated Brain Health Clinical and Research Program, 2348Department of Psychiatry, Massachusetts General Hospital; 1811Harvard Medical School, Boston, MA, USA
| | - Mira Reichman
- Integrated Brain Health Clinical and Research Program, 2348Department of Psychiatry, Massachusetts General Hospital; 1811Harvard Medical School, Boston, MA, USA
| | - Paula J Popok
- Integrated Brain Health Clinical and Research Program, 2348Department of Psychiatry, Massachusetts General Hospital; 1811Harvard Medical School, Boston, MA, USA
| | - Ana-Maria Vranceanu
- Integrated Brain Health Clinical and Research Program, 2348Department of Psychiatry, Massachusetts General Hospital; 1811Harvard Medical School, Boston, MA, USA
| |
Collapse
|