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Hauer K, Dutzi I, Werner C, Bauer J, Ullrich P. Delirium Prevention in Early Rehabilitation During Acute Hospitalization and Implementation of Programs Specifically Tailored to Older Patients with Cognitive Impairment: A Scoping Review with Meta-Analysis. J Alzheimers Dis 2024; 97:3-29. [PMID: 38073387 DOI: 10.3233/jad-230644] [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: 01/09/2024]
Abstract
BACKGROUND No systematic review on delirium prevention within early, hospital-based rehabilitation on implementation of approaches specifically tailored for patients with cognitive impairment (PwCI), such as Alzheimer's disease or vascular dementia, has been published despite the high relevance of specific medical care in this vulnerable population. OBJECTIVE To document design and effectiveness of delirium prevention programs by early rehabilitation during acute, hospital-based medical care and implementation of programs specifically tailored to PwCI. METHODS In a three-step approach, we first identified published systematic reviews of hospital-based, early rehabilitation interventions for older persons (>65 years) in relevant databases. In a second step, we screened each single trial of included reviews according to predefined inclusion criteria. In a third step, we analyzed studies with focus on delirium prevention. RESULTS Among n = 25 studies identified, almost all intervention programs did not specifically target cognitive impairment (CI). Interventions were heterogeneous (modules: n = 2-19); almost all study samples were mixed/unspecified for cognitive status with more affected patients excluded. Only one study exclusively included delirium patients, and only one included CI patients. Results of random effect meta-analysis showed significant effects of generic programs to reduce delirium incidence during hospitalization by 41% (p < 0.001, odds ratio, 95% confidence interval: 0.59 [0.49, 0.71] with modest heterogeneity (I2: 30%). CONCLUSIONS Study results document a lack of implementation for delirium prevention programs specifically tailored to PwCI by early, hospital-based rehabilitation. Specifying existing rehab concepts or augmenting them by CI-specific modules may help to develop, optimize, and implement innovative delirium prevention in PwCI in acute medical care.
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Affiliation(s)
- Klaus Hauer
- Geriatric Centre, Heidelberg University Hospital, Agaplesion Bethanien Hospital Heidelberg, Heidelberg, Germany
- Robert Bosch Gesellschaft für Medizinische Forschung mbH, Stuttgart, Germany
| | - Ilona Dutzi
- Geriatric Centre, Heidelberg University Hospital, Agaplesion Bethanien Hospital Heidelberg, Heidelberg, Germany
| | - Christian Werner
- Geriatric Centre, Heidelberg University Hospital, Agaplesion Bethanien Hospital Heidelberg, Heidelberg, Germany
| | - Jürgen Bauer
- Geriatric Centre, Heidelberg University Hospital, Agaplesion Bethanien Hospital Heidelberg, Heidelberg, Germany
| | - Phoebe Ullrich
- Geriatric Centre, Heidelberg University Hospital, Agaplesion Bethanien Hospital Heidelberg, Heidelberg, Germany
- Department of Thoracic Oncology, Thoraxklinik Heidelberg, Heidelberg University Hospital, Heidelberg, Germany
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2
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Chen KX, Hsu PC, Lin JN, Lee FP, Wang JJ. Exploring the Difficulties and Strategies of Family Caregivers in Caring for Patients With Dementia in Acute Care Wards. J Nurs Res 2023; 31:e297. [PMID: 37548951 DOI: 10.1097/jnr.0000000000000575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Providing appropriate care to patients with dementia in acute care settings can be a challenge for healthcare professionals. A key factor is working closely with family caregivers. PURPOSE This study aims to explore the difficulties and strategies involved in caring for patients with dementia who have been admitted to an acute care ward from the perspective of family caregivers. METHODS Exploratory research was conducted using a qualitative data collection approach. Data were collected by means of in-depth interviews carried out with participants. Semistructured interviews were conducted with nine participants. Content analysis was performed to analyze the data. RESULTS A number of themes and subthemes were identified based on the primary research purposes. The first theme is "vicious cycle due to multiple factors," with the following subthemes: (a) communication disturbance, (b) endless worries, (c) inadequate care skills of paid caregivers, and (d) physical and psychological exhaustion. The second theme is "do everything," with the following subthemes: (a) management of the behavioral and psychological symptoms of dementia, (b) constant accompaniment of the patient, and (c) seeking sources of support. CONCLUSIONS/IMPLICATIONS FOR PRACTICE The results may be used to help healthcare professionals better anticipate the difficulties faced by family caregivers while providing assistance to patients with dementia and understand the related strategies they use. Acute care wards should consider the specific needs of family caregivers to ensure patients with dementia receive adequate care from the relevant parties in the ecological care chain during the care process.
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Affiliation(s)
- Ko-Xin Chen
- MS, RN, Doctoral Student, Department of Nursing, College of Medicine, National Cheng Kung University, Taiwan
| | - Pei-Chen Hsu
- MS, RN, Doctoral Student, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Taiwan
| | - Jong-Ni Lin
- PhD, RN, Assistant Professor, Department of Nursing, Da-Yeh University, Taiwan
| | - Feng-Ping Lee
- PhD, RN, Associate Professor, Department of Nursing, California State University, USA
| | - Jing-Jy Wang
- PhD, RN, Professor, Department of Nursing, College of Medicine, National Cheng Kung University, Taiwan
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3
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Gisch UA, Ahlers E, Lee D, Heuser-Collier I, Somasundaram R. A program for volunteers accompanying older patients with cognitive dysfunction to improve the quality of emergency department care: A pilot study. Geriatr Nurs 2022; 48:94-102. [PMID: 36155315 DOI: 10.1016/j.gerinurse.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 12/14/2022]
Abstract
Admission to an emergency department (ED) is challenging for older patients with cognitive dysfunction (PWCD). Targeted patient-oriented approaches to improve the care for PWCD are needed. The aim of this pilot study was to design and evaluate a program for volunteers to support PWCD in the ED. Volunteers (N = 9) first received a training and during the following six months (N = 90 shifts), they accompanied PWCD (N = 112) during their stay. Results showed that the training increased volunteers' knowledge and expertise, but not shift-related self-efficacy. The most frequent strategies applied were conversations, holding hands and touching, and providing food and drinks. After six months, volunteers reported a great sense of meaningfulness and felt that they were highly appreciated by the patients. ED nurses' sceptical attitudes towards the program decreased. The program is beneficial for PWCD, appears to be meaningful for volunteers and is appreciated by ED nurses.
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Affiliation(s)
- Ulrike A Gisch
- Charité - Universitaetsmedizin Berlin, Department of Psychiatry and Neurosciences, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany; Charité - Universitaetsmedizin Berlin, Department of Emergency Medicine, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany.
| | - Eike Ahlers
- Charité - Universitaetsmedizin Berlin, Department of Psychiatry and Neurosciences, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany; Johanniter-Krankenhaus Treuenbrietzen, Department of Psychiatry and Psychotherapy, Johanniterstraße 1, 14929 Treuenbrietzen, Germany.
| | - Denise Lee
- Charité - Universitaetsmedizin Berlin, Department of Emergency Medicine, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany.
| | - Isabella Heuser-Collier
- Charité - Universitaetsmedizin Berlin, Department of Psychiatry and Neurosciences, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany.
| | - Rajan Somasundaram
- Charité - Universitaetsmedizin Berlin, Department of Emergency Medicine, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany.
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4
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Sharrock J, Happell B, Jeong SYS. The impact of Mental Health Nurse Consultants on the care of general hospital patients experiencing concurrent mental health conditions: An integrative literature review. Int J Ment Health Nurs 2022; 31:772-795. [PMID: 35319133 PMCID: PMC9313616 DOI: 10.1111/inm.12994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 03/09/2022] [Accepted: 03/11/2022] [Indexed: 12/22/2022]
Abstract
Mental Health Nurse Consultants are advanced practice mental health nurses who consult with nurses and other health professionals in a general hospital setting. The aim of this review was to analyse and synthesize the available evidence related to the impact of Mental Health Nurse Consultants on the care of general hospital patients experiencing concurrent mental health conditions. The integrative literature review method was utilized as it allows for the inclusion and integration of quantitative, qualitative, and mixed methods research which produces a synthesized understanding of data to inform practice, policy, and research. The Preferred Reporting Items of Systematic Review and Meta-Analyses guided the search strategy. All published studies examining the impact of clinical consultations provided by Mental Health Nurse Consultants on the mental health care of general hospital patients were included. The 19 selected articles were from North America, Australia, the United Kingdom, and Europe. Fifteen were quantitative, three were qualitative, and one used mixed methods. The findings highlight the role is generally positively received by hospital staff. The results indicate that clinical consultations provided by Mental Health Nurse Consultants (i) may improve patient experiences of mental health conditions, (ii) influence aspects of care delivery, (iii) are valued by staff, particularly nurses, and (iv) increase staff competence and confidence in the provision of mental health care. The review highlighted significant limitations of the available evidence, the need for contemporary discussion and debate of MHNC theory and practice, and further evaluation of the role to inform future service delivery.
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Affiliation(s)
- Julie Sharrock
- School of Nursing and Midwifery, College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Brenda Happell
- School of Nursing and Midwifery, College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Sarah Yeun-Sim Jeong
- School of Nursing and Midwifery, College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
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Calamia M, Kaseda ET, Price JS, De Vito A, Silver CH, Cherry J, VanLandingham H, Khan H, Sparks PJ, Ellison RL. Mentorship in clinical neuropsychology: Survey of current practices, cultural responsiveness, and untapped potential. J Clin Exp Neuropsychol 2022; 44:366-385. [DOI: 10.1080/13803395.2022.2128068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Matthew Calamia
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA
| | - Erin T. Kaseda
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Jenessa S. Price
- Division of Transplant Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Alyssa De Vito
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Cheryl H. Silver
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jared Cherry
- Department of Psychology, Illinois Institute of Technology, Chicago, IL, USA
| | | | - Humza Khan
- Department of Psychology, Illinois Institute of Technology, Chicago, IL, USA
| | - P. Johnelle Sparks
- Department of Demography, University of Texas at San Antonio, San Antonio, TX, USA
| | - Rachael L. Ellison
- Department of Psychology, Illinois Institute of Technology, Chicago, IL, USA
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6
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Kristiansen S, Olsen LS, Beck M. Hospitality in dementia-friendly environments is significant to caregivers during hospitalisation of their loved ones. A qualitative study. J Clin Nurs 2022; 32:2790-2801. [PMID: 35692079 DOI: 10.1111/jocn.16400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 05/07/2022] [Accepted: 05/16/2022] [Indexed: 11/28/2022]
Abstract
AIM AND OBJECTIVES To explore what is meaningful to caregivers in relation to a dementia-friendly environment during hospitalisation of their loved ones with dementia or cognitive impairment. BACKGROUND Implementation of dementia-friendly initiatives and person-centred care approach have shaped the political agenda within Danish society. Patients with dementia or cognitive impairment and their accompanying caregivers are challenged when admitted to hospital. During hospitalisation, caregivers find themselves in a vulnerable state of mind. Thus, the implementation of a dementia-friendly environment and adherence to person-centred care in hospital settings leaves room for improvement. METHODS This study was guided by a qualitative and explorative approach. Data were collected through 17 semi-structured interviews with caregivers at a subacute neurological ward. Thematic analysis was employed to interpret data. The study reports according to the COREQ checklist. RESULTS The following three themes were identified: 1) Being a watchful bystander. 2) Visiting an undefined and foreign environment. 3) Longing for kindness. CONCLUSION Hospitality expressed by staff towards caregivers is significant in allowing caregivers to experience hospital environments as "friendly." Dementia-friendly environments embrace existential aspects that go far beyond physical spaces; hence, experiences of kind acts shape caregivers' sense of safety and comfort during hospitalisation. Hospitality is an essential part of nursing in dementia care because caregivers are contextually vulnerable. Our study sheds new light on the provision of person-centred care to people with dementia and their families in healthcare. RELEVANCE TO CLINICAL PRACTICE Nurses need to be aware that caregivers experience vulnerability and to involve caregivers in the care provided for patients with dementia. We recommend that a permanent contact person be appointed to follow patients throughout their admission period. Furthermore, systematic interventions focusing on phenomena such as hospitality and kindness may serve to form a person-centred clinical culture; an issue that warrants further investigation.
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Affiliation(s)
| | - Lotte Schelde Olsen
- Department of Neurology, Zealand University Hospital, Roskilde, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Malene Beck
- Institute of Health, Department of Nursing Science, Aarhus University, Copenhagen, Denmark.,Research Unit of Progrez, NSR Hospitals, Zealand University, Roskilde, Denmark
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7
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Tay E, Vlaev I, Massaro S. The Behavioral Factors That Influence Person-Centered Social Care: A Literature Review and Conceptual Framework. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:4334. [PMID: 35410016 PMCID: PMC8998779 DOI: 10.3390/ijerph19074334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/28/2022] [Accepted: 04/01/2022] [Indexed: 11/25/2022]
Abstract
The last decade has seen numerous policy reforms to emplace person-centered social care. Consequently, the public has been given more information, choice, and autonomy to decide how best they want to be cared for later in life. Despite this, adults generally fail to plan or prepare effectively for their future care needs. Understanding the behavioral antecedents of person-centered decision-making is thus critical for addressing key gaps in the provision of quality social care. To this end, we conducted a literature review of the psychological and health sciences with the aim of identifying the aspects that influence person-centered decision-making in social care. Using an established theoretical framework, we distilled nine behavioral factors-knowledge, competency, health, goal clarity, time discounting, familiarity, cognitive biases, cognitive overload, and emotion-associated with "Capability," "Opportunity," "Motivation," and "Behavior" that explained person-centered decision-making in social care. These factors exist to different degrees and change as a person ages, gradually impacting their ability to obtain the care they want. We discuss the role of carers and the promise of shared decision-making and conclude by advocating a shift from personal autonomy to one that is shared with carers in the delivery of quality social care.
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Affiliation(s)
- Eugene Tay
- NUS Care Unit, Office of the Senior Deputy President and Provost, National University of Singapore, Singapore 119077, Singapore
| | - Ivo Vlaev
- Department of Behavioural Science, Warwick Business School, University of Warwick, Coventry CV4 7AL, UK;
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8
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Keuning-Plantinga A, Roodbol P, van Munster BC, Finnema EJ. Experiences of informal caregivers of people with dementia with nursing care in acute hospitals: A descriptive mixed-methods study. J Adv Nurs 2021; 77:4887-4899. [PMID: 34532873 PMCID: PMC9292992 DOI: 10.1111/jan.15042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/20/2021] [Accepted: 09/05/2021] [Indexed: 11/30/2022]
Abstract
Aims To explore the experiences of informal caregivers of people with dementia with the hospitalization of their relative concerning patient care, interactions with nurses, caregivers’ situation and the acute hospital environment. Design Mixed‐methods design. Methods The data were collected using an online questionnaire among a panel of caregivers (n = 129), together with a focus group and individual interviews from February to November 2019. The data were triangulated and analysed using a conceptual framework. Results Almost half of the respondents were satisfied with the extent to which nurses considered the patient's dementia. Activities to prevent challenging behaviours and provide person‐centred care were rarely seen by the caregivers. Caregivers experienced strain, intensified by a perceived lack of adequate communication and did not feel like partners in care; they also expressed concern about environmental safety. A key suggestion of caregivers was to create a special department for people with dementia, with specialized nurses. Conclusion Positive experiences of caregivers are reported in relation to how nurses take dementia into account, involvement in care and shared decision making. Adverse experiences are described in relation to disease‐oriented care, ineffective communication and an unfamiliar environment. Caregivers expressed increased involvement when included in decisions and care when care was performed as described by the triangle of care model. Caregivers reported better care when a person‐centred approach was observed. Outcomes can be used in training to help nurses reflect and look for improvements. Impact This study confirms that caregivers perceive that when they are more involved in care, this can contribute to improving the care of patients with dementia. The study is relevant for nurses to reflect on their own experiences and become aware of patients’ caregivers’ perspectives. It also provides insights to improve nurses’ training and for organizations to make the care and environment more dementia‐friendly.
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Affiliation(s)
- Annette Keuning-Plantinga
- NHL Stenden University of Applied Science, Leeuwarden, The Netherlands.,Health Science-Nursing Research, University of Groningen, Groningen, The Netherlands.,University Medical Center Groningen, Groningen, The Netherlands
| | - Petrie Roodbol
- Health Science-Nursing Research, University of Groningen, Groningen, The Netherlands.,University Medical Center Groningen, Groningen, The Netherlands
| | | | - Evelyn J Finnema
- NHL Stenden University of Applied Science, Leeuwarden, The Netherlands.,Health Science-Nursing Research, University of Groningen, Groningen, The Netherlands.,University Medical Center Groningen, Groningen, The Netherlands
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9
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Hoffmann E, Andersen PT, Mogensen CB, Prinds C, Primdahl J. Relatives' negotiation power in relation to older people's acute hospital admission: A qualitative interview study. Scand J Caring Sci 2021; 36:1016-1026. [PMID: 34156115 DOI: 10.1111/scs.13012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 05/30/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Acutely admitted older people are potentially vulnerable and dependent on relatives to negotiate and navigate on their behalf. AIM This study aimed to explore relatives' experiences of their interactions with healthcare professionals during acute hospital admission of older people to derive themes of importance for relatives' negotiations with these professionals. METHOD A qualitative design was applied. Relatives of acutely admitted older people at two emergency departments in Denmark were interviewed (n = 17). The qualitative content analysis was guided by Graneheim and Lundman's concepts. RESULTS The analysis derived four themes: (a) Mandate, (b) Incentive, (c) Capability and (d) Attitude to taking action. These four sources of relatives' negotiation power can be illustrated in the MICA model. CONCLUSION Four themes were identified as important sources of relatives' negotiation power. Since the four sources of power potentially change according to the situation, relatives' negotiation power seems to be context dependent.
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Affiliation(s)
- Eva Hoffmann
- University College South Denmark, Aabenraa, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,OPEN, Open Patient data Explorative, Region of Southern Denmark, Odense, Denmark
| | | | - Christian Backer Mogensen
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Hospital Sønderjylland, University Hospital of Southern Denmark, Aabenraa, Denmark
| | - Christina Prinds
- University College South Denmark, Aabenraa, Denmark.,Research Unit of Obstetrics and Gynecology, University of Southern Denmark, Odense, Denmark
| | - Jette Primdahl
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Hospital Sønderjylland, University Hospital of Southern Denmark, Aabenraa, Denmark.,Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark
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10
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Osuoha P, Masoud SS, Leibas M, Cleveland LM, Reed CC, Piernik-Yoder B, White CL. "Getting to Know Them": Person-Centered Care for Patients With Dementia in Acute Care. J Gerontol Nurs 2021; 47:37-44. [PMID: 34039092 DOI: 10.3928/00989134-20210408-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Older adults with dementia are reported to have twice as many hospital stays as their age-matched counterparts without dementia. Acute care hospitals are generally not equipped to provide best care for persons with dementia. The purpose of the current qualitative study was to gain an understanding of the needs and perspectives of nursing staff and patient care technicians regarding delivering person-centered care (PCC) to patients with dementia. Nine focus groups (N = 49) were conducted. Participants discussed the importance of "getting to know them" as the basis for their care. Several themes emerged that served to support or detract from providing PCC: (a) communication, (b) education, and (c) care environment. Findings from this study support the desire of nurses and patient care technicians to provide PCC, highlight challenges, and indicate needed system-level changes to education, communication, and the care environment to support best practices. [Journal of Gerontological Nursing, 47(5), 37-44.].
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Gwernan-Jones R, Lourida I, Abbott RA, Rogers M, Green C, Ball S, Hemsley A, Cheeseman D, Clare L, Moore D, Burton J, Lawrence S, Rogers M, Hussey C, Coxon G, Llewellyn DJ, Naldrett T, Thompson Coon J. Understanding and improving experiences of care in hospital for people living with dementia, their carers and staff: three systematic reviews. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Being in hospital can be particularly confusing and challenging not only for people living with dementia, but also for their carers and the staff who care for them. Improving the experience of care for people living with dementia in hospital has been recognised as a priority.
Objectives
To understand the experience of care in hospital for people living with dementia, their carers and the staff who care for them and to assess what we know about improving the experience of care.
Review methods
We undertook three systematic reviews: (1) the experience of care in hospital, (2) the experience of interventions to improve care in hospital and (3) the effectiveness and cost-effectiveness of interventions to improve the experience of care. Reviews 1 and 2 sought primary qualitative studies and were analysed using meta-ethnography. Review 3 sought comparative studies and economic evaluations of interventions to improve experience of care. An interweaving approach to overarching synthesis was used to integrate the findings across the reviews.
Data sources
Sixteen electronic databases were searched. Forwards and backwards citation chasing, author contact and grey literature searches were undertaken. Screening of title and abstracts and full texts was performed by two reviewers independently. A quality appraisal of all included studies was undertaken.
Results
Sixty-three studies (reported in 82 papers) were included in review 1, 14 studies (reported in 16 papers) were included in review 2, and 25 studies (reported in 26 papers) were included in review 3. A synthesis of review 1 studies found that when staff were delivering more person-centred care, people living with dementia, carers and staff all experienced this as better care. The line of argument, which represents the conceptual findings as a whole, was that ‘a change of hospital culture is needed before person-centred care can become routine’. From reviews 2 and 3, there was some evidence of improvements in experience of care from activities, staff training, added capacity and inclusion of carers. In consultation with internal and external stakeholders, the findings from the three reviews and overarching synthesis were developed into 12 DEMENTIA CARE pointers for service change: key institutional and environmental practices and processes that could help improve experience of care for people living with dementia in hospital.
Limitations
Few of the studies explored experience from the perspectives of people living with dementia. The measurement of experience of care across the studies was not consistent. Methodological variability and the small number of intervention studies limited the ability to draw conclusions on effectiveness.
Conclusions
The evidence suggests that, to improve the experience of care in hospital for people living with dementia, a transformation of organisational and ward cultures is needed that supports person-centred care and values the status of dementia care. Changes need to cut across hierarchies and training systems to facilitate working patterns and interactions that enable both physical and emotional care of people living with dementia in hospital. Future research needs to identify how such changes can be implemented, and how they can be maintained in the long term. To do this, well-designed controlled studies with improved reporting of methods and intervention details to elevate the quality of available evidence and facilitate comparisons across different interventions are required.
Study registration
This study is registered as PROSPERO CRD42018086013.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 43. See the NIHR Journals Library website for further project information. Additional funding was provided by the NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula.
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Affiliation(s)
- Ruth Gwernan-Jones
- Evidence Synthesis Team, PenCLAHRC, University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Ilianna Lourida
- Evidence Synthesis Team, PenCLAHRC, University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Rebecca A Abbott
- Evidence Synthesis Team, PenCLAHRC, University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Morwenna Rogers
- Evidence Synthesis Team, PenCLAHRC, University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Colin Green
- Health Economics Group, University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Susan Ball
- Health Statistics Group, PenCLAHRC, University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
| | | | | | - Linda Clare
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Darren Moore
- Graduate School of Education, College of Social Sciences and International Studies, University of Exeter, Exeter, UK
| | - Julia Burton
- Alzheimer’s Society Research Network Volunteers, c/o University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Sue Lawrence
- Alzheimer’s Society Research Network Volunteers, c/o University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
| | | | | | | | - David J Llewellyn
- Mental Health Research Group, University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
- The Alan Turing Institute, London, UK
| | | | - Jo Thompson Coon
- Evidence Synthesis Team, PenCLAHRC, University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
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12
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Kroll L, Böhning N, Müßigbrodt H, Stahl M, Halkin P, Liehr B, Grunow C, Kujumdshieva-Böhning B, Freise C, Hopfenmüller W, Friesdorf W, Jockers-Scherübl M, Somasundaram R. Non-contact monitoring of agitation and use of a sheltering device in patients with dementia in emergency departments: a feasibility study. BMC Psychiatry 2020; 20:165. [PMID: 32295567 PMCID: PMC7161155 DOI: 10.1186/s12888-020-02573-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 03/30/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Agitation is common in geriatric patients with cognitive impairment, e.g. in persons with dementia (PWD), who are admitted to an emergency department (ED). It might be a first sign of upcoming delirium and is associated with a higher risk of an unfavorable clinical course. Hence, monitoring of vital signs and enhanced movement as indicators of upcoming agitation is essential in these patients during their stay in the ED. Since PWD rarely tolerate fixed monitoring devices, a novel developed non-contact monitoring system (NCMSys) might represent an appropriate alternative. Aim of this feasibility study was to test the validity of a NCMSys and of the tent-like "Charité Dome" (ChD), aimed to shelter PWD from the busy ED environment. Furthermore, effects of the ChD on wellbeing and agitation of PWD were investigated. METHODS Both devices were attached to patient's bed. Tests on technical validity and safety issues of NCMSys and ChD were performed at the iDoc institute with six healthy volunteers. A feasibility study evaluating the reliability of the NCMSys with and without the ChD was performed in the real-life setting of an ED and on a geriatric-gerontopsychiatric ward. 19 patients were included, ten males and nine females; mean age: 77.4 (55-93) years of which 14 were PWD. PWD inclusion criteria were age ≥ 55 years, a dementia diagnosis and a written consent (by patients or by a custodian). Exclusion criteria were acute life-threatening situations and a missing consent. RESULTS Measurements of heart rate, changes in movement and sound emissions by the NCMSys were valid, whereas patient movements affected respiratory rate measurements. The ChD did not impact patients' vital signs or movements in our study setting. However, 53% of the PWD (7/13) and most of the patients without dementia (4/5) benefited from its use regarding their agitation and overall wellbeing. CONCLUSIONS The results of this feasibility study encourage a future controlled clinical trial in geriatric ED patients, including PWD, to further evaluate if our concept of non-contact measurement of vital signs and movement combined with the "Charité Dome" helps to prevent upcoming agitation in this vulnerable patient group in the ED. TRIAL REGISTRATION ICTRP: "Charité-Dome-Study - DRKS00014737" (retrospectively registered).
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Affiliation(s)
- Lisa Kroll
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Emergency Department Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany
| | - Nikolaus Böhning
- iDoc - Institut für Telemedizin und Gesundheitskommunikation GmbH & Co. KG, Berlin, Germany
| | - Heidi Müßigbrodt
- Oberhavel Kliniken, Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Hennigsdorf, Germany
| | - Maria Stahl
- grid.6734.60000 0001 2292 8254Technical University of Berlin— Institute of Psychology and Ergonomics, Berlin, Germany
| | - Pavel Halkin
- iDoc - Institut für Telemedizin und Gesundheitskommunikation GmbH & Co. KG, Berlin, Germany
| | - Birgit Liehr
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Emergency Department Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany
| | - Christine Grunow
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Emergency Department Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany
| | | | - Christian Freise
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Emergency Department Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany
| | - Werner Hopfenmüller
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Emergency Department Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany
| | - Wolfgang Friesdorf
- HCMB – Institute for Health Care Systems Management Berlin eG, Berlin, Germany
| | - Maria Jockers-Scherübl
- Oberhavel Kliniken, Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Hennigsdorf, Germany
| | - Rajan Somasundaram
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Emergency Department Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany.
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Stuart R, Akther SF, Machin K, Persaud K, Simpson A, Johnson S, Oram S. Carers' experiences of involuntary admission under mental health legislation: systematic review and qualitative meta-synthesis. BJPsych Open 2020; 6:e19. [PMID: 32043435 PMCID: PMC7176830 DOI: 10.1192/bjo.2019.101] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Carers are key providers of care and support to mental health patients and mental health policies consistently mandate carer involvement. Understanding carers' experiences of and views about assessment for involuntary admission and subsequent detention is crucial to efforts to improve policy and practice. AIMS We aimed to synthesise qualitative evidence of carers' experiences of the assessment and detention of their family and friends under mental health legislation. METHOD We searched five bibliographic databases, reference lists and citations. Studies were included if they collected data using qualitative methods and the patients were aged 18 or older; reported on carer experiences of assessment or detention under mental health legislation anywhere in the world; and were published in peer-reviewed journals. We used meta-synthesis. RESULTS The review included 23 papers. Themes were consistent across time and setting and related to the emotional impact of detention; the availability of support for carers; the extent to which carers felt involved in decision-making; relationships with patients and staff during detention; and the quality of care provided to patients. Carers often described conflicting feelings of relief coupled with distress and anxiety about how the patient might cope and respond. Carers also spoke about the need for timely and accessible information, supportive and trusting relationships with mental health professionals, and of involvement as partners in care. CONCLUSIONS Research is needed to explore whether and how health service and other interventions can improve the involvement and support of carers prior to, during and after the detention of family members and friends.
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Affiliation(s)
- Ruth Stuart
- Research Assistant, Health Service & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | | | - Karen Machin
- Visiting Lecturer, School of Health and Social Work, University of Hertfordshire, UK
| | - Karen Persaud
- Honorary Research Associate, NIHR Mental Health Policy Research Unit, Division of Psychiatry, Faculty of Brain Sciences, University College London, UK
| | - Alan Simpson
- Professor of Mental Health Nursing, Health Service & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London; and Director (KCL), NIHR Mental Health Policy Research Unit, UK
| | - Sonia Johnson
- Professor of Social and Community Psychiatry, Division of Psychiatry, Faculty of Brain Sciences, University College London; Director (UCL), NIHR Mental Health Policy Research Unit; and Consultant Clinical Psychiatrist, Camden and Islington NHS Foundation Trust, UK
| | - Sian Oram
- Lecturer and Head of the Section of Women's Mental Health, Health Service & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London; Deputy Director (KCL), NIHR Mental Health Policy Research Unit, UK
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Jensen AM, Pedersen BD, Wilson RL, Bang Olsen R, Hounsgaard L. Nurses’ experiences of delivering acute orthopaedic care to patients with dementia. Int J Older People Nurs 2019; 14:e12271. [DOI: 10.1111/opn.12271] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 04/17/2019] [Accepted: 07/24/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Anders Møller Jensen
- Department of Clinical Research, OPEN, Odense Patient data Explorative Network Odense University Hospital University of Southern Denmark Odense Denmark
- Faculty of Health Sciences, VIA Ageing & Dementia ‐ Center for Research VIA University College Holstebro Denmark
| | - Birthe D. Pedersen
- Department of Clinical Research University of Southern Denmark Odense Denmark
| | - Rhonda L. Wilson
- Department of Clinical Research University of Southern Denmark Odense Denmark
- Faculty of Health, School of Nursing, Midwifery and Public Health University of Canberra Bruce ACT Australia
- Department of Regional Health Research, Faculty of Health Sciences, Center for Psychiatric Nursing and Health Research University of Southern Denmark Odense Denmark
| | - Rolf Bang Olsen
- Department of Clinical Research, OPEN, Odense Patient data Explorative Network Odense University Hospital University of Southern Denmark Odense Denmark
- Faculty of Health Sciences, VIA Ageing & Dementia ‐ Center for Research VIA University College Holstebro Denmark
- Department of Clinical Research University of Southern Denmark Odense Denmark
- Faculty of Health, School of Nursing, Midwifery and Public Health University of Canberra Bruce ACT Australia
- Department of Regional Health Research, Faculty of Health Sciences, Center for Psychiatric Nursing and Health Research University of Southern Denmark Odense Denmark
| | - Lise Hounsgaard
- Department of Clinical Research, OPEN, Odense Patient data Explorative Network Odense University Hospital University of Southern Denmark Odense Denmark
- Department of Clinical Research University of Southern Denmark Odense Denmark
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The acute care experience of older persons with cognitive impairment and their families: A qualitative study. Int J Nurs Stud 2019; 96:44-52. [DOI: 10.1016/j.ijnurstu.2018.11.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 11/21/2018] [Accepted: 11/24/2018] [Indexed: 11/24/2022]
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Reilly JC, Houghton C. The experiences and perceptions of care in acute settings for patients living with dementia: A qualitative evidence synthesis. Int J Nurs Stud 2019; 96:82-90. [PMID: 31345443 DOI: 10.1016/j.ijnurstu.2019.04.018] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 04/29/2019] [Accepted: 04/30/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Increasing numbers of people with dementia are presenting to acute care facilities for management of medical conditions and co-morbidities. They require an individual approach to care due to the confusion and disorientation which may accompany their illness. Current evidence syntheses on this topic explore how staff, family and carers view their care. This review aims to complement previous work in the area by exploring care from the perspective of the patient living with dementia. OBJECTIVES The aim of this qualitative evidence synthesis was to explore the experiences and perceptions of patients living with dementia on the care they receive in acute settings. DESIGN Qualitative evidence synthesis systematically draws the findings from individual studies together to create valid, reliable and meaningful evidence for healthcare policy development. Framework synthesis was utilised and guided by the VIPS framework; Values, Individualised, Perspective, and Social and psychological. The VIPS framework has previously been used for exploring staffs' views of care in the acute setting and provides guidance to caring for people with dementia. REVIEW METHODS Following screening, data were extracted and appraised using Critical Appraisal Skills Programme. Framework synthesis, incorporating thematic synthesis, was conducted and the confidence in findings was assessed using GRADE CERQual. DATA SOURCES Seven qualitative studies that explored care in acute hospitals as experienced or perceived by the person living with dementia. RESULTS The VIPS framework helped to capture views of care. Patients often experienced rushed and task- based approaches, poor communication, and exclusion in some cases. The environments were clearly unsuitable, sometimes exacerbating behaviours of concern, thus leading to unnecessary restraint due to an inability to protect this group. CONCLUSIONS Further research needs to be conducted in testing existing or developing new interventions to improve the physical environment, the systems of care and to provide more person-centred approaches to care. Organisational structures must ensure patients are cared for in a dementia friendly environment by a dementia trained workforce. At local level, involving support workers, eliminating unnecessary care practices, and facilitating individual choices of patients are recommended.
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Affiliation(s)
| | - Catherine Houghton
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland.
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Naef R, Ernst J, Bürgi C, Petry H. Quality of acute care for persons with cognitive impairment and their families: A scoping review. Int J Nurs Stud 2018; 85:80-89. [PMID: 29859348 DOI: 10.1016/j.ijnurstu.2018.05.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 05/14/2018] [Accepted: 05/15/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND An increasing number of older persons with cognitive impairment use inpatient services for co-occurring acute illness. Research has demonstrated that persons with cognitive impairment face more adverse health outcomes during hospitalization than their age counterparts without cognitive impairment. As hospitals tend to be ill equipped to meet the complex care needs of this population, various initiatives underscore the need to better utilize existing evidence to improve quality of care. OBJECTIVES To map the extent of knowledge about quality of acute care in inpatient settings, and to synthesize knowledge on strategies to improve quality care for persons with cognitive impairment and their families. DESIGN A scoping review using Arksey and O'Malley's methodological framework. DATA SOURCES CINAHL and Medline were searched and reference lists of pertinent articles screened to identify publications regarding acute care for persons with cognitive impairment. REVIEW METHODS Two reviewers independently screened and identified publications based on eligibility criteria. Publications were included if they targeted acute care issues relating to persons with cognitive impairment 65 years or older, their family members, or health professionals caring for them, and were published after 2000 in English or German. Publications were read and data were extracted using a predefined template. Thematic analysis was conducted by two reviewers. RESULTS Of the 1445 identified publications, 66 were included. Quality of acute inpatient services pertained to structural (such as staff capacity and knowledge) and process dimensions (such as forming a caring relationship, assessing and intervening). Strategies identified to improve care quality included interventions at the point of care, such as specific tools and specialist roles to improve patient outcomes, as well as educational and training interventions to enable staff to care for this patient group. CONCLUSIONS There is a discrepancy between clearly defined best practice for persons with cognitive impairment utilising inpatient services, and the quality of care actually experienced by patients, family members, and staff. Research reveals a sobering picture of inadequate care and manifold challenges encountered by this patient group, family members and staff alike. Promising strategies to improve care quality target health professionals' knowledge and capacity to work with this group and include specific tools and models of care, such as specialist roles and units. Organisation-wide efforts to ensure quality care for this patient group are needed, as is further research to determine which implementation and intervention strategies achieve the most beneficial outcomes for all involved.
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Affiliation(s)
- Rahel Naef
- Centre of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland.
| | - Jutta Ernst
- Centre of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
| | - Catherine Bürgi
- Division of Abdomen-Metabolism, University Hospital Zurich, Zurich, Switzerland
| | - Heidi Petry
- Centre of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
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18
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Isaac LM, Buggy E, Sharma A, Karberis A, Maddock KM, Weston KM. Enhancing hospital care of patients with cognitive impairment. Int J Health Care Qual Assur 2018; 31:173-186. [DOI: 10.1108/ijhcqa-11-2016-0173] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The patient-centred management of people with cognitive impairment admitted to acute health care facilities can be challenging. The TOP5 intervention utilises carers’ expert biographical and social knowledge of the patient to facilitate personalised care. The purpose of this paper is to explore whether involvement of carers in the TOP5 initiative could improve patient care and healthcare delivery.
Design/methodology/approach
A small-scale longitudinal study was undertaken in two wards of one acute teaching hospital. The wards admitted patients with cognitive impairment, aged 70 years and over, under geriatrician care. Data for patient falls, allocation of one-on-one nurses (“specials”), and length-of-stay (LOS) over 38 months, including baseline, pilot, and establishment phases, were analysed. Surveys of carers and nursing staff were undertaken.
Findings
There was a significant reduction in number of falls and number of patients allocated “specials” over the study period, but no statistically significant reduction in LOS. A downward trend in complaints related to communication issues was identified. All carers (n=43) completing the feedback survey were satisfied or very satisfied that staff supported their role as information provider. Most carers (90 per cent) felt that the initiative had a positive impact and 80 per cent felt that their loved one benefitted. Six months after implementation of the initiative, 80 per cent of nurses agreed or strongly agreed that it was now easier to relate to carers of patients with cognitive impairment. At nine-ten months, this increased to 100 per cent.
Originality/value
Actively engaging carers in management of people with cognitive impairment may improve the patient, staff, and carer journeys, and may improve outcomes for patient care and service delivery.
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Burgstaller M, Mayer H, Schiess C, Saxer S. Experiences and needs of relatives of people with dementia in acute hospitals—A meta‐synthesis of qualitative studies. J Clin Nurs 2018. [DOI: 10.1111/jocn.13934] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Melanie Burgstaller
- Department of Nursing Science University of Vienna Vienna Austria
- Institute for Applied Nursing Sciences IPW‐FHS University of Applied Sciences FHS St.Gallen St. Gallen Switzerland
| | - Hanna Mayer
- Department of Nursing Science University of Vienna Vienna Austria
| | - Cornel Schiess
- Institute for Applied Nursing Sciences IPW‐FHS University of Applied Sciences FHS St.Gallen St. Gallen Switzerland
| | - Susi Saxer
- Institute for Applied Nursing Sciences IPW‐FHS University of Applied Sciences FHS St.Gallen St. Gallen Switzerland
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20
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Beardon S, Patel K, Davies B, Ward H. Informal carers' perspectives on the delivery of acute hospital care for patients with dementia: a systematic review. BMC Geriatr 2018; 18:23. [PMID: 29370769 PMCID: PMC5785800 DOI: 10.1186/s12877-018-0710-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 01/04/2018] [Indexed: 11/17/2022] Open
Abstract
Background Providing high quality acute hospital care for patients with dementia is an increasing challenge as the prevalence of the disease rises. Informal carers of people with dementia are a critical resource for improving inpatient care, due to their insights into patients’ needs and preferences. We summarise informal carers’ perspectives of acute hospital care to inform best practice service delivery. Methods We conducted a systematic search of bibliographic databases and sought relevant grey literature. We used thematic synthesis analysis to assimilate results of the studies and describe components of care that influence perceived quality. Results Twenty papers met the inclusion criteria. Findings identified four overarching components of care that influenced carer experience and their perceptions of care quality: ‘Patient care’, ‘Staff interactions’, ‘Carer’s situation’ and ‘Hospital environment’. Need for improvement was identified in staff training, provision of help with personal care needs, and dignified treatment of patients. Carers need to be informed, involved and supported during hospital admission in order to promote the most positive experience. Conclusion This review identifies common perspectives of informal carers of people with dementia in the acute hospital setting and highlights important areas to address to improve the experience of an admission for both carer and patient.
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Affiliation(s)
- Sarah Beardon
- Patient Experience Research Centre, Imperial College London, Medical School Building, St Mary's Campus, Norfolk Place, London, W2 1PG, UK.
| | - Kiran Patel
- Patient Experience Research Centre, Imperial College London, Medical School Building, St Mary's Campus, Norfolk Place, London, W2 1PG, UK
| | - Bethan Davies
- Patient Experience Research Centre, Imperial College London, Medical School Building, St Mary's Campus, Norfolk Place, London, W2 1PG, UK
| | - Helen Ward
- Patient Experience Research Centre, Imperial College London, Medical School Building, St Mary's Campus, Norfolk Place, London, W2 1PG, UK
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Burton E, Slatyer S, Bronson M, Nichols P, Quested E, Hill A, Maher S, Aoun S, Hill KD, Kuno Y, Toye C. Development and pilot testing of the "focus on the person" form: Supporting care transitions for people with dementia. DEMENTIA 2017; 18:2018-2035. [PMID: 29105505 DOI: 10.1177/1471301217736594] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
When people with dementia are hospitalised, their capacity to communicate with the staff may be limited, compounding risks of distress and other adverse outcomes. Opportunities for carers to share relevant information to inform appropriate person-centred care are also limited. This four-phase mixed methods study aimed to develop an evidence-based family carer–staff communication form, the Focus on the Person form, to address this concern. In Phase I, a literature review plus consultation with clinicians and carers informed form development. In Phase II, the professionally formatted form was piloted by 31 family carers, who were then interviewed about their experiences. These data, combined with data from 30 hospital staff members who participated in Phase III focus groups, led to final, Phase IV, refinements of the form. The form now provides an opportunity for families to inform the person-centred care of people with dementia in hospital, potentially improving outcomes for this vulnerable group.
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Affiliation(s)
- Elissa Burton
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Susan Slatyer
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia; Centre for Nursing Research, Sir Charles Gairdner Hospital, Perth, Australia
| | - Mary Bronson
- Medical Division, Sir Charles Gairdner Hospital, Perth, Australia
| | - Pam Nichols
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia
| | - Eleanor Quested
- School of Psychology and Speech Pathology, Curtin University, Perth, Australia
| | - Andrew Hill
- Medical Division, Sir Charles Gairdner Hospital, Perth, Australia
| | - Sean Maher
- Department of Rehabilitation and Aged Care, Sir Charles Gairdner Hospital, Perth, Australia
| | - Samar Aoun
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia
| | - Keith D Hill
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Yukiko Kuno
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia
| | - Chris Toye
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia; Centre for Nursing Research, Sir Charles Gairdner Hospital, Perth, Australia
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Digby R, Lee S, Williams A. The liminality of the patient with dementia in hospital. J Clin Nurs 2017; 27:e70-e79. [PMID: 28493647 DOI: 10.1111/jocn.13869] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2017] [Indexed: 10/19/2022]
Abstract
AIMS AND OBJECTIVES The aim was to explore the experiences of people with dementia in subacute geriatric rehabilitation hospitals to critically evaluate the care received by such patients. BACKGROUND Globally, the number of people with dementia is growing and is expected to impact progressively more on health systems. People with dementia can become deconditioned and deteriorate in cognitive function while in hospital. The unfamiliar environment and people can cause the person to become disorientated, which then leads to behavioural symptoms which complicate care. DESIGN Critical ethnography. METHODS Methods included observation with field notes and 30 audio-recorded conversational interviews with patients with dementia in an Australian subacute care setting. Data were collected in May-December 2014, transcribed verbatim and analysed using thematic analysis. RESULTS The central theme identified that patients with dementia described a liminal experience and felt like outsiders in the hospital environment. This was supported by the subthemes of not understanding why they were being kept in hospital, feeling lost in the space, bored, anxious about discharge plans and lacking intersubjective relationships. Many felt imprisoned by the locked wards. There was little evidence of nursing care delivered in an empathetic person-centred way. Nurses were busy and engaged with the patients only superficially. CONCLUSIONS People with dementia can have a liminal experience and feel like outsiders in this environment, which does not cater for the specific needs of this patient group. It should be acknowledged that people with dementia require additional resources. A caring nurse-patient relationship is fundamental to the patient experience. Nurses require further support and education about dementia in order to deliver quality care to this patient group. RELEVANCE TO CLINICAL PRACTICE These findings will influence nurse leaders to advocate for improved resources for nurses to provide appropriate care for patients with dementia in subacute geriatric hospitals. The clinical practice of nurses needs to be supported with education, pyschological and material support to improve the therapeutic environment for patients with cognitive impairment resulting from dementia.
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Affiliation(s)
- Robin Digby
- School of Nursing and Midwifery, Monash University, Frankston, Vic., Australia
| | - Susan Lee
- School of Nursing and Midwifery, Monash University, Frankston, Vic., Australia
| | - Allison Williams
- School of Nursing and Midwifery, Monash University, Frankston, Vic., Australia
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Womack JL, Lilja M, Isaksson G. Crossing a Line: A narrative of risk-taking by older women serving as caregivers. J Aging Stud 2017; 41:60-66. [PMID: 28610756 DOI: 10.1016/j.jaging.2017.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 03/27/2017] [Accepted: 04/11/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Caregiving carried out by adults for other adults is increasing around the world as the demographics of many industrialized countries shift toward an older population with escalating care needs toward the end of life. Although much has been written about caregiving, few studies document the experiences of providing care as narrated by the caregivers. AIM To explore the everyday experiences of older adults serving as primary informal caregivers to significant others. METHODS A process of narrative inquiry was used via repeated interviews with three older women caregivers providing care to family members or friends. The data were analyzed using storyboarding techniques and identifying critical turning points, culminating in a poetic transcription of the resulting narrative. RESULTS These caregivers describe a tension that exists across their experiences and communication with authorities on whom they rely for guidance and collaboration. Situations in which this tension pushes the caregivers to act in ways that represent risk to themselves or their care recipients are central to the collective narrative. CONCLUSION AND SIGNIFICANCE The everyday experiences of older adult caregivers include not only familiar care routines, but also advocacy on behalf of care recipients and negotiations with external authorities, resulting at times in unwelcome risk-taking. Their narrative warrants attention due to the lack of power described by caregivers when acting on behalf of their care recipients and the need for those in authority to recognize their dilemma.
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Affiliation(s)
- Jennifer L Womack
- Luleå University of Technology, Luleå, Sweden; The University of North Carolina at Chapel Hill, NC, USA.
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Giacco D, Dirik A, Kaselionyte J, Priebe S. How to make carer involvement in mental health inpatient units happen: a focus group study with patients, carers and clinicians. BMC Psychiatry 2017; 17:101. [PMID: 28320376 PMCID: PMC5359804 DOI: 10.1186/s12888-017-1259-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 03/09/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Carers are family members or friends who support people with a mental health problem without being paid. Carer involvement in mental health treatment has been consistently supported by research evidence and promoted by policies but its implementation rates are poor. Particularly when patients are treated in inpatient units, carers often report being left without information or being excluded from decisions about treatment. In this study we have explored, along with staff perspectives, views of patients and carers who had a recent experience of inpatient mental health care on how to improve the implementation of carer involvement in inpatient care. METHODS Sixteen focus groups were held with carers, patients and clinicians in London, United Kingdom. We included staff working in inpatient units and patients and carers who had experience of inpatient care in the last five years. Data from focus groups were analysed using thematic analysis. RESULTS Eighty six participants in total (31 service users, 22 carers and 33 clinicians) attended the focus groups. Participants identified that generally, carer involvement should happen as soon as possible after admission, although this may be challenging in some cases. Carer involvement should include receiving information, participating in decisions about care and discharge and receiving emotional support by staff. When carers are involved, their personal knowledge of the patient's condition should be utilised. Challenges to carer involvement may include problems with identifying carers during a mental health crisis, obtaining valid patient consent, sharing appropriate information, and contacting and engaging carers. Additionally, it was perceived that all the ward staff need to be actively engaged in order to make carer involvement happen and this cannot be left only to specifically trained clinicians. CONCLUSIONS These findings identify basic components that all family interventions in inpatient units should have. Further studies are needed to explore how and if purposively designed clinical interventions can improve carer involvement in inpatient treatment and, consequently, patient outcomes.
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Affiliation(s)
- Domenico Giacco
- Unit for Social and Community Psychiatry, (WHO Centre for Mental Health Service Development), Queen Mary University of London, E138SP, London, UK. .,Newham Centre for Mental Health, E13 8SP, London, UK.
| | - Aysegul Dirik
- 0000 0001 2171 1133grid.4868.2Unit for Social and Community Psychiatry, (WHO Centre for Mental Health Service Development), Queen Mary University of London, E138SP, London, UK ,0000 0001 2227 3745grid.416554.7Newham Centre for Mental Health, E13 8SP, London, UK
| | - Justina Kaselionyte
- 0000 0001 2171 1133grid.4868.2Unit for Social and Community Psychiatry, (WHO Centre for Mental Health Service Development), Queen Mary University of London, E138SP, London, UK ,0000 0001 2227 3745grid.416554.7Newham Centre for Mental Health, E13 8SP, London, UK
| | - Stefan Priebe
- 0000 0001 2171 1133grid.4868.2Unit for Social and Community Psychiatry, (WHO Centre for Mental Health Service Development), Queen Mary University of London, E138SP, London, UK ,0000 0001 2227 3745grid.416554.7Newham Centre for Mental Health, E13 8SP, London, UK
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Normalization of Neglect: A Grounded Theory of RNs' Experiences as Family Caregivers of Hospitalized Seniors. Can J Aging 2017; 35:215-28. [PMID: 27223578 DOI: 10.1017/s0714980816000179] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Often older people, while maintaining a level of independence, rely on family members to provide care and assistance. Caregivers who are also registered nurses (RNs) may provide a different perspective around the experience when their older relative is admitted to acute care. The aim of our research was to investigate and develop theory regarding nursing care provision as described by RNs, who were family caregivers to older adults, when that older adult was admitted to acute care. Over a six-month period in 2011, RNs meeting this criterion (n = 12) were interviewed individually. We identified two central categories: "Culture of Neglect" and "Vigil by the Bedside". The core category "Normalization of Neglect" was identified as the theory, grounded in the data the participants provided which described a culture of neglect that had normalized poor nursing care. These findings highlight the issue of neglect and abuse, and further investigation is warranted.
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Saletti-Cuesta L, Tutton E, Langstaff D, Willett K. Understanding informal carers' experiences of caring for older people with a hip fracture: a systematic review of qualitative studies. Disabil Rehabil 2016; 40:740-750. [PMID: 27976920 DOI: 10.1080/09638288.2016.1262467] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE This systematic review aimed to reconceptualize experiences from a variety of papers to provide direction for research, policy and practice. METHOD Meta-ethnography was used to inform the review, and 21 studies were included. FINDINGS The analysis identified a core theme of "engaging in care: struggling through", as carers, who wanted to be involved in caring, learnt to live with the intense and stressful impact of caring and changes to their life. The core theme is represented through three themes (1) Helping another to live, (2) Adapting ways of living and (3) Negotiating the unknown. CONCLUSIONS The discussion identified a focus on carers of people suffering from a hip fracture, the willingness of informal carers to engage in caring and the intense experience of adapting to changes in relationships and dependency alongside a steep experiential learning curve. Tensions exist in negotiations with complex health care systems as carers do not feel their expertise is valued and struggle to find and understand information. Implications for Rehabilitation Including relatives/carers in the umbrella of care within a family-centred approach. Involving relatives/carers within shared decision-making about care requirements and rehabilitation goals. Utilizing forms of experiential learning to help the development of relatives/carers skills in relation to their role as carer. Providing opportunities for carers to explore ways of sustaining their own health through self-compassion.
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Affiliation(s)
- Lorena Saletti-Cuesta
- a Culture and Society Research and Study Centre, National Scientific and Technical Research Council. (CIECS-CONICET-UNC), Córdoba , Argentina
| | - Elizabeth Tutton
- b Kadoorie Critical Care Research and Education Centre, Oxford University Hospitals, NHS Foundation Trust , Oxford , UK.,c Royal College of Nursing Research Institute, Warwick Medical School, University of Warwick , Warwick , UK
| | - Debbie Langstaff
- d Trauma Unit , John Radcliffe Hospital, Oxford University Hospital, NHS Foundation Trust , Oxford , UK
| | - Keith Willett
- b Kadoorie Critical Care Research and Education Centre, Oxford University Hospitals, NHS Foundation Trust , Oxford , UK.,e Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science , University of Oxford , Oxford , UK
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Bélanger L, Bourbonnais A, Bernier R, Benoit M. Communication between nurses and family caregivers of hospitalised older persons: a literature review. J Clin Nurs 2016; 26:609-619. [PMID: 27539680 DOI: 10.1111/jocn.13516] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2016] [Indexed: 11/26/2022]
Abstract
AIMS AND OBJECTIVES To review the literature concerning the feelings, thoughts and behaviours of nurses and family caregivers of hospitalised older persons when they communicate with one another. BACKGROUND Communication between nurses and family caregivers of hospitalised older persons is not always optimal. Improving the frequency and quality of this communication might be a way to make the most of available human capital in order to better care for hospitalised older people. DESIGN A literature review was carried out of qualitative, quantitative and mixed-design studies relating to communication between nurses and family caregivers. Findings were analysed thematically. RESULTS Family caregiver thoughts, feelings and behaviours relative to nurse control and authority, nurse recognition of their contribution, information received from and shared with nurses and care satisfaction could influence communication with nurses. Nurse thoughts regarding usefulness of family caregivers as care partners and their lack of availability to meet family caregiver demands could influence communication with family caregivers. CONCLUSIONS The thoughts, feelings and behaviours of family caregivers and nurses that might create positive or negative circular patterns of communication are evidenced. Further research is required to gain a more comprehensive understanding of the phenomenon. RELEVANCE TO CLINICAL PRACTICE Nurses must be trained in how to communicate with family caregivers in order to form a partnership geared to preventing complications in hospitalised older persons. Results could be used to inform policy regarding the care of hospitalised older persons.
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Affiliation(s)
| | - Anne Bourbonnais
- Faculté des sciences infirmières, Université de Montréal, Montréal, QC, Canada
| | | | - Monique Benoit
- Université du Québec en Outaouais, Saint-Jérôme, QC, Canada
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Pluzarić J, Ilakovac V, Železnik D. Comparison of self-esteem and quality of life between residents of old people's home and the elders living at home. OBZORNIK ZDRAVSTVENE NEGE 2016. [DOI: 10.14528/snr.2016.50.3.108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Introduction: Research on self-esteem and quality of life has been so far predominantly focused on younger age groups. The aim of this cross-sectional study was to examine the differences regarding self-esteem and quality of life between the residents of old people's home and the elders living at home. Methods: A questionnaire used in the survey inquired about socio-demographic data and the respondents' activities. It included the respondents' self-esteem assessment, based on the Rosenberg Self-esteem Scale (RSES), the assessment of quality of life, based on the Satisfaction With Life Scale (SWLS) and the assessment of their functional abilities. The purposive sample included 204 respondents. The research was conducted from November 2012 to March 2013. Results: The respondents in both groups expressed equal satisfaction with life (p = 0.846). The respondents who live in their own home demonstrate higher self-esteem than those who live in old people's home (difference in mean scores of the RSES was 3.4; 95 % CI for the difference from 1.0 to 5.8; t-test for independent samples, p = 0.005). Results of the study suggest that the respondents with higher self-esteem are more satisfied with their life (p = 0.537, p < 0.001). Discussion and conclusion: Self-esteem has to be recognised as a factor associated with the quality of life and should therefore be included in the care of the elderly. Timely and adequate interventions may prevent the decline in quality of life, which requires adequate training of health personnel and family members, and the public awareness.
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de Vries K, Drury-Ruddlesden J, Gaul C. 'And so I took up residence': The experiences of family members of people with dementia during admission to an acute hospital unit. DEMENTIA 2016; 18:36-54. [PMID: 27328693 PMCID: PMC6343471 DOI: 10.1177/1471301216656097] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
It is estimated that a quarter of acute hospital beds are in use by older people with dementia at any one time. Little empirical research has been carried out that has specifically examined the day-to-day input of family members into the care of people with dementia during an acute hospital admission. In this article, we present the results of analysis of interviews with 26 family members of people with dementia about their experiences of supporting an admission of a person with dementia to an acute hospital unit in New Zealand. For all family members, the desire to support the person with dementia during their admission was at the forefront and was their primary focus. The theme, ‘And so I took up residence’, exemplifies fully the experiences of all of the family member participants. This study provides evidence that family members are a resource that may be unrecognised, untapped and unsupported in the event of hospitalisation of people with dementia.
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Affiliation(s)
- Kay de Vries
- School of Health Sciences, University of Brighton, UK
| | - Jenny Drury-Ruddlesden
- Graduate School of Nursing, Midwifery & Health, Victoria University of Wellington, New Zealand
| | - Chris Gaul
- Nursing, Nelson Marlborough Institute of Technology, New Zealand
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Tuffrey-Wijne I, Abraham E, Goulding L, Giatras N, Edwards C, Gillard S, Hollins S. Role confusion as a barrier to effective carer involvement for people with intellectual disabilities in acute hospitals: findings from a mixed-method study. J Adv Nurs 2016; 72:2907-2922. [PMID: 27292794 DOI: 10.1111/jan.13041] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2016] [Indexed: 11/28/2022]
Abstract
AIMS To understand issues around carer roles that affect carer involvement for people with intellectual disabilities in acute hospitals. BACKGROUND There is evidence that a lack of effective carer involvement can lead to poorer health outcomes for people with intellectual disabilities, but there is a lack of insight into the reasons for poor carer involvement in acute hospitals. DESIGN Mixed methods in six acute hospital trusts in England (2011-2013). METHODS Electronic hospital staff survey (n = 990), carer questionnaires (n = 88), semi-structured interviews with hospital staff (n = 68) and carers (n = 37). Data were triangulated and analysed using a conceptual framework. RESULTS There was strong support for carer involvement among hospital staff, and most carers indicated that they felt welcomed and supported. However, an investigation of negative experiences showed that there were discrepancies in the perspectives of hospital staff and carers on the scope of 'carer involvement'. An important contributory factor to the effectiveness of carer involvement was the degree to which staff understood the importance of carer expertise (rather than simply carer work) and welcomed it. Carers' contributions to basic nursing care tasks could be taken for granted by hospital staff, sometimes erroneously. CONCLUSION The roles and contributions of carers should be clarified on an individual basis by hospital staff. The authors propose a new model to support this clarification. Further research is needed to assess the suitability of the model for patients with intellectual disabilities and other vulnerable patient groups.
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Affiliation(s)
- Irene Tuffrey-Wijne
- Faculty of Health, Social Care and Education, Kingston University and George's University of London, UK.
| | - Elisabeth Abraham
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
| | - Lucy Goulding
- King's Improvement Science, King's College London, London, UK
| | | | - Christine Edwards
- Institute of Leadership and Management in Health, Kingston University Business School, UK
| | - Steve Gillard
- Social and Community Mental Health, Population Health Research Institute, St George's University of London, UK
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Baillie L, Sills E, Thomas N. Educating a health service workforce about dementia: a qualitative study. QUALITY IN AGEING AND OLDER ADULTS 2016. [DOI: 10.1108/qaoa-11-2015-0051] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– People who are living with dementia are core health service users, but there are ongoing concerns about the quality of their care and the need for improved education of healthcare staff. The purpose of this paper is to report a qualitative study that investigated staff perspectives on an ethnodrama (“Barbara’s Story”) which was used to educate an entire health service workforce and promote a person-centred approach to care.
Design/methodology/approach
– The study used a qualitative, longitudinal design with focus groups held with clinical (nurses, allied health professionals, medical) and non-clinical staff. In Phase 1 there were ten focus groups (n=67 participants) and one individual interview. In Phase 2 there were 16 focus groups (n=77 participants) and three individual interviews.
Findings
– Barbara’s Story raised awareness of dementia, engaged staff emotionally and prompted empathetic responses and improved interactions. The project’s senior leadership, whole organisation and mandatory approach were well-supported, with a perceived impact on organisational culture. The project helped to embed practice developments and initiatives to support person-centred care. Barbara’s Story is now well-integrated into the organisation’s practices, supporting its sustainability in use.
Originality/value
– Whilst there are increasing resources for educating about dementia, there are fewer evaluations, particularly for large-scale educational initiatives, and a lack of focus on long-term effects. The study findings indicate that education about dementia can be delivered to a whole workforce in a sustainable manner, to prompt empathy, raise awareness, support person-centred care and impact on individual behaviour and organisational culture.
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Boltz M, Chippendale T, Resnick B, Galvin JE. Testing family-centered, function-focused care in hospitalized persons with dementia. Neurodegener Dis Manag 2016; 5:203-15. [PMID: 26107319 DOI: 10.2217/nmt.15.10] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
AIM Hospital-acquired disability causes decreased quality of life for patients with dementia and family caregivers, and increased societal costs. MATERIALS & METHODS A comparative, repeated measures study tested the feasibility and preliminary efficacy of the family-centered, function-focused care intervention (Fam-FFC) in dyads of hospitalized, medical patients with dementia and family caregivers (FCGs). RESULTS The intervention group demonstrated better activities of daily living and walking performance, and less severity/duration of delirium and hospital readmissions, but no significant differences in gait/balance. FCGs showed increased preparedness for caregiving and less anxiety but no significant differences in depression, strain and mutuality. CONCLUSION Fam-FFC presents a possible pathway to meeting the Triple Aim of improved patient care, improved patient health and reduced costs for persons with dementia.
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Affiliation(s)
- Marie Boltz
- Boston College, William F Connell School of Nursing, Chestnut Hill, MA 02467, USA
| | - Tracy Chippendale
- Department of Occupational Therapy, Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY 10003, USA
| | - Barbara Resnick
- University of Maryland School of Nursing, Baltimore, MD 21201, USA
| | - James E Galvin
- Charles E Schmidt College of Medicine, Florida Atlantic University, FL, USA
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Morrow EM, Nicholson C. Carer engagement in the hospital care of older people: an integrative literature review. Int J Older People Nurs 2016; 11:298-314. [DOI: 10.1111/opn.12117] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 01/08/2016] [Indexed: 12/13/2022]
Affiliation(s)
| | - Caroline Nicholson
- Florence Nightingale Faculty of Nursing and Midwifery; King's College London; London UK
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Marrujo-Pérez KJ, Berumen-Burciaga LV, Mejía-Mejía Y, Palacios-Ceña D. [The meaning of hospitalization from the perspective of the caregiver: A qualitative study]. ENFERMERIA CLINICA 2016; 26:102-10. [PMID: 26872391 DOI: 10.1016/j.enfcli.2016.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Revised: 12/30/2015] [Accepted: 01/02/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Knowing the meaning of hospitalization for the family caregiver of the hospitalized sick person. METHOD Qualitative study using grounded theory. Participants were included if they met the following criteria: a) being part of the family; b) the sick person was admitted into a hospital in the state of Chihuahua; and c) the hospitalized person was over 18 years old. Sampling was applied by purpose. Data collection was conducted through in-depth interviews with an opening question. Similarly, memos were applied in the process of gathering. The analysis applied was based on grounded theory, with an open, axial and selective coding, identifying the categories and subcategories. During the analysis process the method of constant comparison was applied. RESULTS Eighteen participants were included; 16 of whom were female. The mean age was 48.11 years old. The core category was identified: "the naked soul", formed by the categories; "I deal with the disease" which describes the situations experienced by the caregiver during and after the hospitalization process; "wartime" makes reference to the family problems that develop or worsen during the hospitalization process; and "dancing in the storm" focuses on all the positive changes occurring in the primary caregiver. CONCLUSIONS Hospitalization causes uncertainty in the caregiver. Nurses help facilitate the adaptation of the caregiver at baseline and identify their own strengths.
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Affiliation(s)
| | | | - Yadira Mejía-Mejía
- Facultad de Enfermería y Nutriología, Universidad Autónoma de Chihuahua , Chihuahua, México
| | - Domingo Palacios-Ceña
- Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina Física, Universidad Rey Juan Carlos , Madrid, España.
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Boltz M, Chippendale T, Resnick B, Galvin JE. Anxiety in family caregivers of hospitalized persons with dementia: contributing factors and responses. Alzheimer Dis Assoc Disord 2015; 29:236-41. [PMID: 25635341 PMCID: PMC4714710 DOI: 10.1097/wad.0000000000000072] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Baseline health and functional vulnerabilities increase the risk for complications in persons with dementia and predispose family caregivers (FCGs) to increased stress. METHODS This secondary analysis used a combined quantitative and qualitative approach. Regression analyses examined the contribution of patient and FCG characteristics to FCG anxiety. Interviews with FCGs explored the experiences and responses of FCGs during hospitalization of their family member with dementia. RESULTS Lower patient physical function and higher caregiver strain were associated with higher FCG anxiety. FCGs described the following themes related to the hospitalization: (1) added strain, (2) care-related worries, (3) keeping vigil, (4) need to be heard, and (5) enablers of FCGs. CONCLUSIONS Routine evaluation of caregiver strain and baseline patient function is integral to informing the transitional planning for persons with dementia. The FCG responses suggest that a multifactorial approach (family-centered policies of partnership in care, staff education addressing the specialized needs of patients and family members, and attention to promoting functional recovery) may benefit both hospitalized patients with dementia as well as FCGs and warrants future research.
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Affiliation(s)
- Marie Boltz
- Associate Professor, Boston College, William F. Connell School of Nursing, 140 Commonwealth Avenue, Cushing Hall 203, Chestnut Hill, MA 02467
| | - Tracy Chippendale
- Assistant Professor, New York University, Steinhardt School of Culture, Education, and Human Development, Department of Occupational Therapy, New York, NY 10012, Phone: 212-998-9012
| | - Barbara Resnick
- Professor and Sonya Ziporkin Gershowitz Endowed Chair in Gerontology, University of Maryland School of Nursing, 655 West Lombard Street, Baltimore, MD 21201, Phone: 410-706-5178
| | - James E. Galvin
- Professor of Neurology, Psychiatry, Nursing, Nutrition, and Population Health, Alzheimer Disease Center and Center for Cognitive Neurology, New York University Langone School of Medicine, 145 East 32nd St, 2nd Floor, New York, NY 10016, Phone: 212-263-0770
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Scerri A, Innes A, Scerri C. Discovering what works well: exploring quality dementia care in hospital wards using an appreciative inquiry approach. J Clin Nurs 2015; 24:1916-25. [PMID: 25940022 DOI: 10.1111/jocn.12822] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2015] [Indexed: 11/26/2022]
Abstract
AIMS AND OBJECTIVES To explore the quality dementia care in two geriatric hospital wards using appreciative inquiry with formal care workers and family members of inpatients with dementia. BACKGROUND Care models such as person-centred and relationship-centred care have been developed to explain what 'quality' dementia care should be. However, their usefulness and relevance to clinicians has been questioned. DESIGN Using an exploratory qualitative design within an appreciative inquiry framework, 33 care workers working in a geriatric hospital and 10 family members of patients with dementia were interviewed. METHODS Open-ended questions were asked to encourage care workers to narrate positive care experiences when the care was perceived to be at its best and to identify what made these experiences possible. Interviews were audio-taped and transcribed whilst data were analysed thematically using a qualitative data analysis software to assist in data management. RESULTS Positive care experiences can be understood within five care processes, namely building a relationship between the 'extended' dementia care triad, providing 'quality time' and 'care in time', going the 'extra mile', attending to the psychosocial needs and attending to the physical needs with a 'human touch'. Factors facilitating these positive care experiences included personal attributes of care workers, and organisational, environmental and contextual factors. CONCLUSIONS This study provides an alternative and pragmatic approach to understanding quality dementia care and complements the body of knowledge on factors influencing dementia care practices in hospitals. RELEVANCE TO CLINICAL PRACTICE By understanding the components of quality dementia care and how these can be achieved from different stakeholders, it is possible to develop strategies aimed at improving the care offered to patients with dementia in hospitals.
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Affiliation(s)
- Anthony Scerri
- Department of Nursing, Faculty of Health Sciences, University of Malta, Msida, Malta
| | - Anthea Innes
- School of Health and Social Care, Bournemouth University, Bournemouth, Dorset, UK
| | - Charles Scerri
- Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
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Catlin A, Ford M, Maloney C. Determining Family Needs on an Oncology Hospital Unit Using Interview, Art, and Survey. Clin Nurs Res 2015; 25:209-31. [DOI: 10.1177/1054773815578806] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A movement worldwide, and specifically new to our hospital, is the implementation of Patient- and Family-Centered Care. We were unsure, however, what the needs were of our patients’ families. This triangulated study, on a 28-bed oncology unit, studied family members at the bedside. We asked family members what their needs were in a three-step process (open-ended interview, use of the Draw a Bridge art therapy technique, and the Family Inventory of Needs survey). Nineteen interviews revealed needs for physical comfort, emotional support, cultural sensitivity, recognition of help provided by family members and improved pain management. Art therapy revealed the stress of caregiving and helped to uncover unmet needs for interviewers to explore. The FIN identified that care at home after discharge was a major worry. Knowledge of family members’ needs while a loved one is in the hospital allows for planning and provision of modalities to assist them in their caregiving.
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Affiliation(s)
| | | | - Carrie Maloney
- Kaiser Permanente Rehabilitation Hospital in Vallejo, CA, USA
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Bronson M, Toye C. Providing information for family carers of hospital patients experiencing dementia. DEMENTIA 2014; 14:267-72. [PMID: 25416176 DOI: 10.1177/1471301214560240] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Family carers of people with dementia may take on this role without understanding how it will evolve or how to obtain support. Hospitalisation of the person with dementia can not only compound carers' concerns, but also provides an opportunity for their needs to be addressed. This project involved preparing hospital based nurses, so they could initiate a dialogue with family carers of patients diagnosed with dementia, developing a protocol to guide the nurses as they provided carers with a dementia information booklet, implementing this protocol during a 12-week trial period, and obtaining feedback from the nurses using a questionnaire. At least 21 booklets were distributed; 16 nurses provided feedback. Nurses viewed the practice change positively. Recommendations are to engage ward based champions to embed this strategy into nursing practice, keep the staff informed, and ensure that the booklet is kept in a location visible to the staff.
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Affiliation(s)
- Mary Bronson
- Medical Division, Sir Charles Gairdner Hospital, Western Australia, Australia
| | - Christine Toye
- Centre for Nursing Research, Sir Charles Gairdner Hospital, Western Australia; Faculty of Health Sciences, Curtin University, Western Australia, Australia
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Dewing J, Dijk S. What is the current state of care for older people with dementia in general hospitals? A literature review. DEMENTIA 2014; 15:106-24. [PMID: 24459188 DOI: 10.1177/1471301213520172] [Citation(s) in RCA: 201] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This paper summarises a literature review focusing on the literature directly pertaining to the acute care of older people with dementia in general hospitals from 2007 onwards. Following thematic analysis, one overarching theme emerged: the consequences of being in hospital with seven related subthemes. Significantly, this review highlights that overall there remains mostly negative consequences and outcomes for people with dementia when they go into general hospitals. Although not admitted to hospital directly due to dementia, there are usually negative effects on the dementia condition from hospitalisation. The review suggests this is primarily because there is a tension between prioritisation of acute care for existing co-morbidities and person-centred dementia care. This is complicated by insufficient understanding of what constitutes person-centred care in an acute care context and a lack of the requisite knowledge and skills set in health care practitioners. The review also reveals a worrying lack of evidence for the effectiveness of mental health liaison posts and dementia care specialist posts in nursing. Finally, although specialist posts such as liaison and clinical nurse specialists and specialist units/shared care wards can enhance quality of care and reduce adverse consequences of hospitalisation (they do not significantly) impact on reducing length of stay or the cost of care.
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Affiliation(s)
- Jan Dewing
- East Sussex NHS Trust & Canterbury Christ Church University, UK
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Jurgens FJ, Clissett P, Gladman JRF, Harwood RH. Why are family carers of people with dementia dissatisfied with general hospital care? A qualitative study. BMC Geriatr 2012; 12:57. [PMID: 23006826 PMCID: PMC3509004 DOI: 10.1186/1471-2318-12-57] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 09/21/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Families and other carers report widespread dissatisfaction with general hospital care for confused older people. METHODS We undertook a qualitative interviews study of 35 family carers of 34 confused older patients to ascertain their experiences of care on geriatric and general medical, and orthopaedic wards of a large English hospital. Transcripts were analysed using a grounded theory approach. Themes identified in interviews were categorised, and used to build a model explaining dissatisfaction with care. RESULTS The experience of hospital care was often negative. Key themes were events (illness leading to admission, experiences in the hospital, adverse occurrences including deterioration in health, or perceived poor care); expectations (which were sometimes unrealistic, usually unexplored by staff, and largely unmet from the carers' perspective); and relationships with staff (poor communication and conflict over care). Expectations were influenced by prior experience. A cycle of discontent is proposed. Events (or 'crises') are associated with expectations. When these are unmet, carers become uncertain or suspicious, which leads to a period of 'hyper vigilant monitoring' during which carers seek out evidence of poor care, culminating in challenge, conflict with staff, or withdrawal, itself a crisis. The cycle could be completed early during the admission pathway, and multiple cycles within a single admission were seen. CONCLUSION People with dementia who have family carers should be considered together as a unit. Family carers are often stressed and tired, and need engaging and reassuring. They need to give and receive information about the care of the person with dementia, and offered the opportunity to participate in care whilst in hospital. Understanding the perspective of the family carer, and recognising elements of the 'cycle of discontent', could help ward staff anticipate carer needs, enable relationship building, to pre-empt or avoid dissatisfaction or conflict.
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Affiliation(s)
- Fiona J Jurgens
- Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, NG7 2UH, UK
| | - Philip Clissett
- School of Nursing, University of Nottingham, Nottingham, NG7 2UH, UK
| | - John RF Gladman
- Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, NG7 2UH, UK
- Health Care for Older People, Nottingham University Hospitals NHS Trust, Queens Medical Centre, Nottingham, NG7 2UH, UK
| | - Rowan H Harwood
- Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, NG7 2UH, UK
- Health Care for Older People, Nottingham University Hospitals NHS Trust, Queens Medical Centre, Nottingham, NG7 2UH, UK
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