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Demiris G, Oliver DP, Washington KT, Chadwick C, Voigt JD, Brotherton S, Naylor MD. Examining spoken words and acoustic features of therapy sessions to understand family caregivers’ anxiety and quality of life. Int J Med Inform 2022; 160:104716. [PMID: 35183870 PMCID: PMC8902633 DOI: 10.1016/j.ijmedinf.2022.104716] [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: 06/15/2021] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Speech and language cues are considered significant data sources that can reveal insights into one's behavior and well-being. The goal of this study is to evaluate how different machine learning (ML) classifiers trained both on the spoken word and acoustic features during live conversations between family caregivers and a therapist, correlate to anxiety and quality of life (QoL) as assessed by validated instruments. METHODS The dataset comprised of 124 audio-recorded and professionally transcribed discussions between family caregivers of hospice patients and a therapist, of challenges they faced in their caregiving role, and standardized assessments of self-reported QoL and anxiety. We custom-built and trained an Automated Speech Recognition (ASR) system on older adult voices and created a logistic regression-based classifier that incorporated audio-based features. The classification process automated the QoL scoring and display of the score in real time, replacing hand-coding for self-reported assessments with a machine learning identified classifier. FINDINGS Of the 124 audio files and their transcripts, 87 of these transcripts (70%) were selected to serve as the training set, holding the remaining 30% of the data for evaluation. For anxiety, the results of adding the dimension of sound and an automated speech-to-text transcription outperformed the prior classifier trained only on human-rendered transcriptions. Specifically, precision improved from 86% to 92%, accuracy from 81% to 89%, and recall from 78% to 88%. INTERPRETATION Classifiers can be developed through ML techniques which can indicate improvements in QoL measures with a reasonable degree of accuracy. Examining the content, sound of the voice and context of the conversation provides insights into additional factors affecting anxiety and QoL that could be addressed in tailored therapy and the design of conversational agents serving as therapy chatbots.
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Affiliation(s)
- George Demiris
- School of Nursing, University of Pennsylvania, Philadelphia, PA, United States.
| | | | | | | | | | | | - Mary D Naylor
- School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
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2
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Pople CB, Meng Y, Li DZ, Bigioni L, Davidson B, Vecchio LM, Hamani C, Rabin JS, Lipsman N. Neuromodulation in the Treatment of Alzheimer's Disease: Current and Emerging Approaches. J Alzheimers Dis 2021; 78:1299-1313. [PMID: 33164935 DOI: 10.3233/jad-200913] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Neuromodulation as a treatment strategy for psychiatric and neurological diseases has grown in popularity in recent years, with the approval of repetitive transcranial magnetic stimulation (rTMS) for the treatment of depression being one such example. These approaches offer new hope in the treatment of diseases that have proven largely intractable to traditional pharmacological approaches. For this reason, neuromodulation is increasingly being explored for the treatment of Alzheimer's disease. However, such approaches have variable, and, in many cases, very limited evidence for safety and efficacy, with most human evidence obtained in small clinical trials. Here we review work in animal models and humans with Alzheimer's disease exploring emerging neuromodulation modalities. Approaches reviewed include deep brain stimulation, transcranial magnetic stimulation, transcranial electrical stimulation, ultrasound stimulation, photobiomodulation, and visual or auditory stimulation. In doing so, we clarify the current evidence for these approaches in treating Alzheimer's disease and identify specific areas where additional work is needed to facilitate their clinical translation.
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Affiliation(s)
- Christopher B Pople
- Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Ying Meng
- Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, ON, Canada.,Division of Neurosurgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Daniel Z Li
- Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Luca Bigioni
- Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Benjamin Davidson
- Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, ON, Canada.,Division of Neurosurgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Laura M Vecchio
- Biological Sciences Platform, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Clement Hamani
- Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, ON, Canada.,Division of Neurosurgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Jennifer S Rabin
- Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, ON, Canada.,Department of Medicine (Neurology), University of Toronto, Toronto, Ontario, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto ON, Canada
| | - Nir Lipsman
- Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, ON, Canada.,Division of Neurosurgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Wakisaka Y, Matsuo R, Nakamura K, Ago T, Kamouchi M, Kitazono T. Pre-Stroke Cholinesterase Inhibitor Treatment Is Beneficially Associated with Functional Outcome in Patients with Acute Ischemic Stroke and Pre-Stroke Dementia: The Fukuoka Stroke Registry. Cerebrovasc Dis 2021; 50:390-396. [PMID: 33744892 DOI: 10.1159/000514368] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 01/02/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Pre-stroke dementia is significantly associated with poor stroke outcome. Cholinesterase inhibitors (ChEIs) might reduce the risk of stroke in patients with dementia. However, the association between pre-stroke ChEI treatment and stroke outcome remains unresolved. Therefore, we aimed to determine this association in patients with acute ischemic stroke and pre-stroke dementia. METHODS We enrolled 805 patients with pre-stroke dementia among 13,167 with ischemic stroke within 7 days of onset who were registered in the Fukuoka Stroke Registry between June 2007 and May 2019 and were independent in basic activities of daily living (ADLs) before admission. Primary and secondary study outcomes were poor functional outcome (modified Rankin Scale [mRS] score: 3-6) at 3 months after stroke onset and neurological deterioration (≥2-point increase in the NIH Stroke Scale [NIHSS] during hospitalization), respectively. Logistic regression analysis was used to evaluate associations between pre-stroke ChEI treatment and study outcomes. To improve covariate imbalance, we further conducted a propensity score (PS)-matched cohort study. RESULTS Among the participants, 212 (26.3%) had pre-stroke ChEI treatment. Treatment was negatively associated with poor functional outcome (odds ratio: 0.68 [95% confidence interval: 0.46-0.99]) and neurological deterioration (0.52 [0.31-0.88]) after adjusting for potential confounding factors. In the PS-matched cohort study, the same trends were observed between pre-stroke ChEI treatment and poor functional outcome (0.61 [0.40-0.92]) and between the treatment and neurological deterioration (0.47 [0.25-0.86]). CONCLUSIONS Our findings suggest that pre-stroke ChEI treatment is associated with reduced risks for poor functional outcome and neurological deterioration after acute ischemic stroke in patients with pre-stroke dementia who are independent in basic ADLs before the onset of stroke.
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Affiliation(s)
- Yoshinobu Wakisaka
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan,
| | - Ryu Matsuo
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kuniyuki Nakamura
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tetsuro Ago
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masahiro Kamouchi
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Pothiban L, Srirat C, Wongpakaran N, Pankong O. Quality of life and the associated factors among family caregivers of older people with dementia in Thailand. Nurs Health Sci 2020; 22:913-920. [PMID: 32483932 DOI: 10.1111/nhs.12746] [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: 10/14/2019] [Revised: 05/20/2020] [Accepted: 05/26/2020] [Indexed: 11/28/2022]
Abstract
Long-term care for older people with dementia can adversely impact a family caregiver's life. A decrease in their quality of life may compromise the quality of care they provide to older people and their own quality of life. The samples include 76 family caregivers of older people with dementia in Thailand. Six questionnaires and the EuroQoL Five Dimensions Questionnaire were used in data collection. Descriptive and inferential statistics were used in data analysis. The findings revealed that quality of life of family caregivers was at a high level. Experiences of close relationships between care dyads and perceived social support were positively related to family caregiver's quality of life, whereas perceived stress and burden were negatively related. Perceived social support and experiences of close relationships might be predictors of family caregiver's quality of life. High quality of life levels among Thai family caregivers of older people with dementia were influenced by high perceived social support and high experiences of close relationships. An intervention focusing on modifying such predicting factors may effectively help maintain quality of life of these family caregivers.
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Affiliation(s)
- Linchong Pothiban
- Medical Nursing Department, Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand
| | - Chomphoonut Srirat
- Medical Nursing Department, Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand
| | - Nahathai Wongpakaran
- Geriatric Psychiatry Unit, Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Orawan Pankong
- Adult and Gerontological Nursing Unit, Boromarajonani Nursing College, Praputhabat, Saraburi, Thailand
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5
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Rathnayake S, Moyle W, Jones CJ, Calleja P. Development of an mHealth application for family carers of people with dementia: A study protocol. Collegian 2019. [DOI: 10.1016/j.colegn.2018.07.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Farina N, Page TE, Daley S, Brown A, Bowling A, Basset T, Livingston G, Knapp M, Murray J, Banerjee S. Factors associated with the quality of life of family carers of people with dementia: A systematic review. Alzheimers Dement 2017; 13:572-581. [DOI: 10.1016/j.jalz.2016.12.010] [Citation(s) in RCA: 143] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 12/03/2016] [Accepted: 12/21/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Nicolas Farina
- Centre for Dementia Studies Brighton and Sussex Medical School Brighton UK
| | | | - Stephanie Daley
- Centre for Dementia Studies Brighton and Sussex Medical School Brighton UK
| | - Anna Brown
- School of Psychology University of Kent Canterbury UK
| | - Ann Bowling
- Health Sciences University of Southampton Southampton UK
| | - Thurstine Basset
- Lived Experience Advisory Panel Sussex Partnership NHS Foundation Trust Hove UK
| | | | - Martin Knapp
- Department of Social Policy London School of Economics London UK
| | - Joanna Murray
- Institute of Psychiatry, Psychology & Neuroscience King's College London London UK
| | - Sube Banerjee
- Centre for Dementia Studies Brighton and Sussex Medical School Brighton UK
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Tiwari A, Lao L, Wang AXM, Cheung DST, So MKP, Yu DSF, Lum TYS, Yuk Fung HYK, Yeung JWF, Zhang ZJ. Self-administered acupressure for symptom management among Chinese family caregivers with caregiver stress: a randomized, wait-list controlled trial. Altern Ther Health Med 2016; 16:424. [PMID: 27793197 PMCID: PMC5084390 DOI: 10.1186/s12906-016-1409-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 10/20/2016] [Indexed: 11/10/2022]
Abstract
Background Caregiving can be stressful, potentially creating physical and psychological strain. Substantial evidence has shown that family caregivers suffer from significant health problems arising from the demands of caregiving. Although there are programs supporting caregivers, there is little evidence regarding their effectiveness. Acupressure is an ancient Chinese healing method designed to restore the flow of Qi (vital energy) by applying external pressure to acupoints. A randomized, wait-list controlled trial was developed to evaluate the effectiveness of a self-administered acupressure intervention on caregiver stress (primary objective) and stress-related symptoms of fatigue, insomnia, depression, and health-related quality of life (secondary objectives) in Chinese caregivers of older family members. Methods Two hundred Chinese participants, aged ≥ 21 years, who are the primary caregivers of an older family member and screen positive for caregiver stress and symptoms of fatigue/insomnia/depression will be recruited from a community setting in Hong Kong. Subjects will be randomized to receive either an immediate treatment condition (self-administered acupressure intervention) or a wait-list control condition. The self-administered acupressure intervention will include (i) an individual learning and practice session twice a week for 2 weeks, (ii) a home follow-up visit once a week for 2 weeks, and (iii) 15-min self-practice twice a day for 6 weeks. The wait-list control group will receive the same acupressure training after the intervention group has completed the intervention. We hypothesize that Chinese family caregivers in the intervention group will have lower levels of caregiver stress, fatigue, insomnia, depression, and higher health-related quality of life after completion of the intervention than participants in the wait-list control group. Discussion This study will provide evidence for the effectiveness of self-administered acupressure in reducing stress and improving symptoms of fatigue, insomnia, depression, and health-related quality of life in Chinese family caregivers. The findings will inform the design of interventions to relieve negative health effects of caregiving. Furthermore, the results can raise community awareness and serve as a basis for policymaking, planning, and allocation of resources regarding empowerment of family caregivers for self-care. Trial registration Current Controlled Trials NCT02526446. Registered August 10, 2015.
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8
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Chiu YC, Lee YN, Wang PC, Chang TH, Li CL, Hsu WC, Lee SH. Family caregivers' sleep disturbance and its associations with multilevel stressors when caring for patients with dementia. Aging Ment Health 2015; 18:92-101. [PMID: 24053456 DOI: 10.1080/13607863.2013.837141] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE We tested a stress process model of multilevel stressors on sleep disturbance for family caregivers (FCG) of persons with dementia (PWD). METHODS For this cross-sectional study, trained research assistants collected data from a purposive sample of 180 PWD-FCG dyads at two teaching hospitals, two local hospitals, and two community long-term care service programs in northern Taiwan. PWDs' neuropsychiatric symptoms were assessed using the Chinese Neuropsychiatric Inventory (CNPI), FCGs' distress by CNPI Caregiver Distress Scale, physical fatigue by Visual Analogue for Fatigue Scale, mental fatigue by Attentional Function Index, depressive symptoms by the Center for Epidemiological Studies Depression Scale - Short Form, and sleep disturbance by the General Sleep Disturbance Scale. RESULTS FCGs' most prevalent sleep disturbance problems were sleep quality problems (99.4%). Hierarchical regression models revealed that FCGs' sleep disturbance was predicted by their physical fatigue, their depressive symptoms, and the synergistic effect of physical fatigue and depressive symptoms in the final model, explaining 57.8% of the variance. CONCLUSIONS This study supports the model that development of caregivers' sleep problems may depend on their depression, fatigue, and the synergistic effects of these two variables. These findings suggest that clinicians should educate FCGs about self-care and offer strategies for dealing with a cluster of symptoms when maintaining sleep hygiene.
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Affiliation(s)
- Yi-Chen Chiu
- a Graduate Institute of Nursing & Healthy Aging Research Center , College of Medicine, Chang Gung University , Taoyuan , Taiwan
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Matthews JT, Lingler JH, Campbell GB, Hunsaker AE, Hu L, Pires BR, Hebert M, Schulz R. Usability of a Wearable Camera System for Dementia Family Caregivers. JOURNAL OF HEALTHCARE ENGINEERING 2015; 6:213-38. [PMID: 26288888 PMCID: PMC4545579 DOI: 10.1260/2040-2295.6.2.213] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Health care providers typically rely on family caregivers (CG) of persons with dementia (PWD) to describe difficult behaviors manifested by their underlying disease. Although invaluable, such reports may be selective or biased during brief medical encounters. Our team explored the usability of a wearable camera system with 9 caregiving dyads (CGs: 3 males, 6 females, 67.00 ± 14.95 years; PWDs: 2 males, 7 females, 80.00 ± 3.81 years, MMSE 17.33 ± 8.86) who recorded 79 salient events over a combined total of 140 hours of data capture, from 3 to 7 days of wear per CG. Prior to using the system, CGs assessed its benefits to be worth the invasion of privacy; post-wear privacy concerns did not differ significantly. CGs rated the system easy to learn to use, although cumbersome and obtrusive. Few negative reactions by PWDs were reported or evident in resulting video. Our findings suggest that CGs can and will wear a camera system to reveal their daily caregiving challenges to health care providers.
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Affiliation(s)
- Judith T. Matthews
- University Center for Social and Urban Research, University of Pittsburgh
- School of Nursing, University of Pittsburgh
| | - Jennifer H. Lingler
- School of Nursing, University of Pittsburgh
- Alzheimer Disease Research Center, University of Pittsburgh
| | | | - Amanda E. Hunsaker
- University Center for Social and Urban Research, University of Pittsburgh
- School of Social Work, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lu Hu
- School of Nursing, University of Pittsburgh
| | - Bernardo R. Pires
- The Robotics Institute, School of Computer Science, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Martial Hebert
- The Robotics Institute, School of Computer Science, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Richard Schulz
- University Center for Social and Urban Research, University of Pittsburgh
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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Tran M, Bédard M, Dubois S, Weaver B, Molloy DW. The influences of psychotic symptoms on the activities of daily living of individuals with Alzheimer disease: a longitudinal analysis. Aging Ment Health 2014; 17:738-47. [PMID: 23425341 DOI: 10.1080/13607863.2013.770446] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Psychotic symptoms associated with Alzheimer Disease (AD) contribute to excess functional dependence. Longitudinal studies have generally examined the association between rates of functional decline and the occurrence of psychotic symptoms from either a single evaluation or from multiple evaluations rather than through changes in frequency and severity of symptoms. Although the presence or absence of psychotic symptoms at initial or follow-up examinations may be associated with changes in functional status, the nature of the relationship between changes in these domains cannot be inferred. We examine the association between changes in the frequency of psychotic symptoms and changes in dependence in activities of daily living (ADL) over a period ranging from 1 to 74 months (median = 17.7). METHOD Data from a cohort of 234 individuals referred to a memory clinic were analyzed using multilevel linear regression. Information on ADL, behavioral and psychological symptoms, depression, and cognition was collected. RESULTS An increase in the frequency of psychotic symptoms had a unique influence on the deterioration of basic ADL, after controlling for demographic variables, changes in cognition, depression, and other behavioral and psychological symptoms (B = -.017, p = .003). However, changes in psychotic symptoms did not significantly contribute to declines in the ability to perform instrumental ADL (B = -.008, p = .439). CONCLUSION Changes in psychotic symptoms may influence basic but not instrumental ADL over time. These findings may have ramifications for studies and treatment plans for individuals with AD who demonstrate psychotic symptoms.
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Affiliation(s)
- M Tran
- Complex Care Services, St. Joseph's Care Group, Thunder Bay, Ontario, Canada.
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Andrew EVW, Cohen J, Evans N, Meñaca A, Harding R, Higginson I, Pool R, Gysels M. Social-cultural factors in end-of-life care in Belgium: a scoping of the research literature. Palliat Med 2013; 27:131-43. [PMID: 22143040 DOI: 10.1177/0269216311429619] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND As end-of-life (EoL) care expands across Europe and the world, service developments are increasingly studied. The sociocultural context in which such changes take place, however, is often neglected in research. AIM To explore sociocultural factors in EoL care in Belgium as represented by the literature. DESIGN A scoping of the empirical research literature following a systematic search procedure with a focus on thematic analysis based on the literature findings. DATA SOURCES Searches were carried out in eight electronic databases, five journals, reference lists, and grey literature (through September 2010). Articles informing about sociocultural issues in EoL care were included. RESULTS One hundred and fifteen original studies met the inclusion criteria, the majority (107) published between 2000 and 2010. Four major themes were: Setting; Caregivers; Communication; and Medical EoL Decisions (the largest category). Minority Ethnic Groups was an emerging theme. Gaps included: research in Wallonia and Brussels; the role and experiences of informal caregivers; issues of access to palliative care; and experiences of minority ethnic groups. There was a paucity of in-depth qualitative studies. CONCLUSIONS Various sociocultural factors influence the provision of EoL care in Belgium. This country provides a unique opportunity to witness how euthanasia is put into practice when legalized, in a context where palliative care is also highly developed and where many health care institutions have Catholic affiliation, providing an important example to others. Attention to how the sociocultural context affects EoL care adds to the current evidence base of service provision, which is essential in the further development of EoL care.
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Affiliation(s)
- Erin V W Andrew
- Barcelona Centre for International Health Research (CRESIB, Hospital Clínic - Universitat de Barcelona), Barcelona, Spain.
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Álvarez-Tello M, Casado-Mejía R, Ortega-Calvo M, Ruiz-Arias E. [Overload in the informal caregivers of patients with multiple comorbidities in an urban area]. ENFERMERIA CLINICA 2012. [PMID: 23183159 DOI: 10.1016/j.enfcli.2012.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The aim of the study was, to determine the profile of the family caregiver of patients with multiple pathologies, identify factors associated with overload, and construct predictive models using items from the Caregiver Strain Index (CSI). METHOD A cross-sectional study of caregivers of patients with multiple comorbidities who attended an urban health centre. Data were collected from health records and questionnaires (Barthel index, Pfeiffer index, and CSI). Statistical analysis was performed using measures of central tendency and dispersion, and by building multivariate models with binary logistic regression with the CSI items as predictors (program R version 2.14.0). RESULTS The sample included 67 caregivers, with a mean age of 64.69 years (standard deviation=12.71, median 62 years), of whom 74.6% were women, 35.8% were wives, and 32.8% were daughters. The level of dependence of the patients cared for was total/severe in 77.6%, and moderate in 12% (Barthel), and 47.8% had some level of cognitive impairment (Pfeiffer). A CSI equal or greater than 7 was seen in 47.8% of caregivers, identifying life problems in more than 40% of them such as, restriction of social life, physical exertion, discomfort with change, bad behaviour, personal and family emotional changes, and sleep disturbances. Item 4 of the CSI, analysing the social restriction, was the one that showed a greater significance in the predictive multivariate model. Item 12 (economic burden) was the most significant with age in patients with cognitive impairment. CONCLUSIONS Women tend to take the role of caregiver at an earlier age than men in the urban environment studied, and items from CSI showed that items 4 (social restrictions) and 12 (economic burden) have more significance in the predictive models constructed with Binary Logistic Regression.
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Affiliation(s)
- Margarita Álvarez-Tello
- Centro de Salud Inmaculada Vieira Fuentes «Las Letanías», Distrito Sanitario Sevilla, Servicio Andaluz de Salud, Sevilla, España.
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Caregiving burden and out-of-home mobility of cognitively impaired care-recipients based on GPS tracking. Int Psychogeriatr 2012; 24:1836-45. [PMID: 22874772 DOI: 10.1017/s1041610212001135] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Out-of-home mobility refers to the realization of trips outside the home, by foot or by other means of transportation. Although out-of-home mobility is important for the well-being of older people with cognitive impairment, its importance for their caregivers is not clear. This study aims to clarify the relationship between caregiving burden and out-of-home mobility of care-recipients using Global Positioning Systems (GPS) technology. METHODS Seventy-six dyads (care-recipients and caregivers) were recruited from a psychogeriatric center, where they underwent cognitive assessment, followed by psychosocial interviews at home. Care-recipients received GPS tracking kits to carry for a period of four weeks, whenever they left home. Mobility data and diagnostic and psychosocial data were examined in relation to caregiver burden. RESULTS The strongest predictors of burden were care-recipients' lower cognitive status and more time spent walking out-of-home. An interaction was found between cognitive status and time spent walking in relation to caregiver burden. The relationship between walking and burden was stronger among caregivers of care-recipients with dementia than caregivers of care-recipients with no cognitive impairment or mild cognitive impairment. Care-recipients' behavioral and emotional states were also positively related to caregiver burden. CONCLUSIONS The findings stress the importance of maintaining older persons' out-of-home mobility during cognitive decline.
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Garces SBB, Krug MDR, Hansen D, Brunelli AV, Costa FTLD, Rosa CB, Bianchi PD, Mattos CMZD, Seibel R. Avaliação da resiliência do cuidador de idosos com Alzheimer. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2012. [DOI: 10.1590/s1809-98232012000200016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Esta pesquisa observacional do tipo estudo de caso descritivo teve o objetivo de avaliar a resiliência de cuidadores de idosos demenciados com Alzheimer. Como instrumento, utilizou-se questionário para traçar o perfil do cuidador; protocolo bipolar para avaliar o estado subjetivo de fadiga; o SRQ - Self Report Questionnaire para avaliação do estresse; o inventário de Zarit para a sobrecarga e protocolo para a resiliência dos seis cuidadores que participaram do estudo. As variáveis quantitativas foram descritas em função de sua média e variância. Para as associações, utilizaram-se Correlação de Pearson e o Teste do Chi-Quadrado. O nível de significância adotado foi de p < 0,05. Os resultados indicaram que 83,3% dos cuidadores são femininos e 16,7%, masculinos; sendo quatro (66,7%) filhos e dois (33,3%) cônjuges. Observou-se que o estado de saúde de quatro cuidadores piorou, passando de um estado regular para ruim, em um período de cinco anos. Um (16,7%) cuidador dedica 20 horas do seu tempo ao cuidado e, para os demais (83,3%), a exigência é de 24 horas. Dos seis cuidadores, quatro demonstram probabilidade de desenvolver transtornos psiquiátricos e dois, não. E ainda, 66,7% dos cuidadores não apresentam sobrecarga, enquanto 33,3% acham-se com sobrecarga intensa. Embora alguns se mostrem fatigados e sobrecarregados, a maioria (83,3%) demonstra alta disposição à resiliência. Houve associação significativa entre resiliência e idade (p< 0,050), a qual expressa quanto maior a idade do cuidador maior a resiliência.
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Välimäki TH, Vehviläinen-Julkunen KM, Pietilä AMK, Pirttilä TA. Caregiver depression is associated with a low sense of coherence and health-related quality of life. Aging Ment Health 2009; 13:799-807. [PMID: 19888700 DOI: 10.1080/13607860903046487] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The main objective is to examine the sense of coherence (SOC) of spouse caregivers. The aim was further investigate the association of SOC, health-related quality of life (HRQoL), depressive symptoms, distress and how severity of Alzheimer's disease (AD) affects SOC. METHOD 17O patient-spouse caregiver dyads in which the patient has recently diagnosed mild AD. Caregivers completed SOC scale (SOC-29), HRQoL (15D), Beck depression and general health questionnaire scale. The assessment of AD-related symptoms was made using mini mental state examination, clinical dementia rating, neuropsychiatric inventory and functional performance using activities of daily living (ADCS-ADL) scale. RESULTS Male caregivers' SOC was significantly higher than female caregivers. The main predictor for low SOC was depression, with 37% of spousal caregivers reporting depressive symptoms. Women reported more depressive symptoms and distress. Caregivers' HRQoL was as high as 0.8714, and a significant correlation was found between SOC and depression, r = -0.632 and distress r = -0.579. Furthermore, significant correlations were found between HRQoL and depression (r = -0.572) and distress (r = -0.568). The main predictors for high HRQoL were female gender and low distress. CONCLUSION Spouse caregivers with low SOC seem to be a vulnerable group of caregivers. The many negative effects of perceived health accumulate in these caregivers during the very early phases of the caregiving process. Vulnerable caregivers need to be recognized at the time of AD diagnosis so that they can receive psychological support and counselling in addition to prevent morbidity in these caregivers.
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Affiliation(s)
- Tarja H Välimäki
- Department of Nursing Science, University of Kuopio, 70211 Kuopio, Finland.
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Paula JDAD, Roque FP, Araújo FSD. Qualidade de vida em cuidadores de idosos portadores de demência de Alzheimer. JORNAL BRASILEIRO DE PSIQUIATRIA 2008. [DOI: 10.1590/s0047-20852008000400011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVO: Realizar revisão sistemática da literatura acerca da QV dos cuidadores de idosos com DA. MÉTODOS: Revisão sistemática de literatura por meio do PubMed e da MedLine entre os anos de 1997 e 2008, utilizando os termos quality of life, caregivers, Alzheimer disease. RESULTADOS: Dezesseis estudos entre 274 publicações iniciais e 39 artigos posteriormente incluídos pelas referências bibliográficas foram avaliados. A QV dos cuidadores dos idosos demenciados, na maioria dos estudos, estava comprometida negativamente. Diversos fatores interferem na QV do cuidador, desde a gravidade da doença até alterações comportamentais que esses idosos possam vir a apresentar. CONCLUSÃO: É necessária a realização de mais estudos direcionados a esse tema, a fim de buscar estratégias para melhora da QV desse cuidador.
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