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Fisher DW, Dunn JT, Keszycki R, Rodriguez G, Bennett DA, Wilson RS, Dong H. Unique transcriptional signatures correlate with behavioral and psychological symptom domains in Alzheimer's disease. Transl Psychiatry 2024; 14:178. [PMID: 38575567 PMCID: PMC10995139 DOI: 10.1038/s41398-024-02878-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 03/07/2024] [Accepted: 03/14/2024] [Indexed: 04/06/2024] Open
Abstract
Despite the significant burden, cost, and worse prognosis of Alzheimer's disease (AD) with behavioral and psychological symptoms of dementia (BPSD), little is known about the molecular causes of these symptoms. Using antemortem assessments of BPSD in AD, we demonstrate that individual BPSD can be grouped into 4 domain factors in our cohort: affective, apathy, agitation, and psychosis. Then, we performed a transcriptome-wide analysis for each domain utilizing bulk RNA-seq of post-mortem anterior cingulate cortex (ACC) tissues. Though all 4 domains are associated with a predominantly downregulated pattern of hundreds of differentially expressed genes (DEGs), most DEGs are unique to each domain, with only 22 DEGs being common to all BPSD domains, including TIMP1. Weighted gene co-expression network analysis (WGCNA) yielded multiple transcriptional modules that were shared between BPSD domains or unique to each domain, and NetDecoder was used to analyze context-dependent information flow through the biological network. For the agitation domain, we found that all DEGs and a highly associated transcriptional module were functionally enriched for ECM-related genes including TIMP1, TAGLN, and FLNA. Another unique transcriptional module also associated with the agitation domain was enriched with genes involved in post-synaptic signaling, including DRD1, PDE1B, CAMK4, and GABRA4. By comparing context-dependent changes in DEGs between cases and control networks, ESR1 and PARK2 were implicated as two high-impact genes associated with agitation that mediated significant information flow through the biological network. Overall, our work establishes unique targets for future study of the biological mechanisms of BPSD and resultant drug development.
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Affiliation(s)
- Daniel W Fisher
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, 98195, USA
| | - Jeffrey T Dunn
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Rachel Keszycki
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, 98195, USA
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Guadalupe Rodriguez
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Rush University Medical Center, Chicago, IL, 60611, USA
| | - Robert S Wilson
- Rush Alzheimer's Disease Center, Rush University Medical Center, Rush University Medical Center, Chicago, IL, 60611, USA
| | - Hongxin Dong
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA.
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Taranrød LB, Kirkevold Ø, Pedersen I, Eriksen S. The transition of care from farm-based daycare for people with dementia: The perspective of next of kin. Int J Qual Stud Health Well-being 2023; 18:2228047. [PMID: 38016039 PMCID: PMC10291912 DOI: 10.1080/17482631.2023.2228047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 06/18/2023] [Indexed: 11/30/2023] Open
Abstract
PURPOSE The aim of the present study was to explore the next of kin's experiences with the transition for people with dementia from a farm-based daycare (FDC) to another service in the municipality. METHODS The study has a qualitative, descriptive design. Eight semi-structured interviews with next of kin were conducted. The data were analysed in accordance with content analysis. RESULTS Through the analysis three main categories were developed: (1) Bearing the burden, (2) Being in transition, and (3) Feeling supported. The transition period was highly stressful for next of kin due to the exacerbation of their relatives' dementia symptoms. The next of kin focussed on optimizing the everyday lives of their relatives with dementia, even at the expense of their own well-being. Most participants experienced support from FDC, healthcare services and their informal network. CONCLUSIONS The study contributes important insights into the next of kin's experiences. Good quality service, close dialog, information, and support between the different part in the transition process, can be useful for the further development of services with good quality and to reduce the negative effects of care on next of kin.
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Affiliation(s)
- Liv Bjerknes Taranrød
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Øyvind Kirkevold
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Centre for Age Related Functional Decline and Diseases (AFS) at Innlandet Hospital Trust, Hamar, Norway
- Department of Health Sciences in Gjøvik, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway
| | - Ingeborg Pedersen
- Department of Public Health Science, Ås, Norway, Norwegian University of Life Sciences, Ås, Norway
| | - Siren Eriksen
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Bachelor of Nursing, Lovisenberg Diaconal University College, Oslo, Norway
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Radcliffe KG, Halim M, Ritchie CS, Maus M, Harrison KL. Care Setting Transitions for People With Dementia: Qualitative Perspectives of Current and Former Care Partners. Am J Hosp Palliat Care 2023; 40:1310-1316. [PMID: 36730920 PMCID: PMC10394111 DOI: 10.1177/10499091231155601] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Care partners (CP) of people with dementia (PWD) report that decisions about care setting are aided by the support of healthcare providers. However, providers are often underprepared to offer adequate counseling. This qualitative study aimed to identify what support from providers will assist CPs in making decisions related to care setting throughout the dementia journey. We conducted semi-structured interviews with current CPs of PWD and former CPs of decedents. We utilized the constant comparative method to identify themes regarding preferences around care setting as the PWD progressed from diagnosis to end-of-life. Participants were 31 CPs, including 16 current and 15 former CPs. CPs had a mean age of 67 and were primarily white (n = 23/31), female (n = 21/31), and spouses (n = 24/31). Theme 1: Current CPs discussed overwhelming uncertainty pertaining to care setting, expressing "I don't know when I need to plan on more care," and a desire to understand "what stage we are at." Theme 2: Later in the disease, former CPs wanted guidance from healthcare providers on institutional placement ("I sure would've loved some help finding better places") or support to stay in the home ("a doctor had to come to the house"). CPs want early, specific guidance from healthcare providers related to transitions between home and long-term care. Early in the disease course, counseling geared toward prognosis and expected disease course helps CPs make plans. Later, caregivers want help identifying locations or institutionalization or finding home care resources.
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Affiliation(s)
- Kate G Radcliffe
- UC Berkeley-UCSF Joint Medical Program, University of California at Berkeley, Berkeley, CA, USA
- School of Medicine, University of California at San Francisco, San Francisco, CA, USA
| | - Madina Halim
- Division of Geriatrics, Department of Medicine, University of California at San Francisco, San Francisco, CA, USA
| | - Christine S Ritchie
- Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Marlon Maus
- School of Public Health, University of California at Berkeley, Berkeley, CA, USA
| | - Krista L Harrison
- Division of Geriatrics, Department of Medicine, University of California at San Francisco, San Francisco, CA, USA
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
- Global Brain Health Institute, University of California, San Francisco, CA, USA
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Guthrie DM, Williams N, O'Rourke HM, Orange JB, Phillips N, Pichora-Fuller MK, Savundranayagam MY, Sutradhar R. Development and validation of risk of CPS decline (RCD): a new prediction tool for worsening cognitive performance among home care clients in Canada. BMC Geriatr 2023; 23:792. [PMID: 38041046 PMCID: PMC10693097 DOI: 10.1186/s12877-023-04463-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 11/06/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND To develop and validate a prediction tool, or nomogram, for the risk of a decline in cognitive performance based on the interRAI Cognitive Performance Scale (CPS). METHODS Retrospective, population-based, cohort study using Canadian Resident Assessment Instrument for Home Care (RAI-HC) data, collected between 2010 and 2018. Eligible home care clients, aged 18+, with at least two assessments were selected randomly for model derivation (75%) and validation (25%). All clients had a CPS score of zero (intact) or one (borderline intact) on intake into the home care program, out of a possible score of six. All individuals had to remain as home care recipients for the six months observation window in order to be included in the analysis. The primary outcome was any degree of worsening (i.e., increase) on the CPS score within six months. Using the derivation cohort, we developed a multivariable logistic regression model to predict the risk of a deterioration in the CPS score. Model performance was assessed on the validation cohort using discrimination and calibration plots. RESULTS We identified 39,292 eligible home care clients, with a median age of 79.0 years, 62.3% were female, 38.8% were married and 38.6% lived alone. On average, 30.3% experienced a worsening on the CPS score within the six-month window (i.e., a change from 0 or 1 to 2, 3, 4, 5, or 6). The final model had good discrimination (c-statistic of 0.65), with excellent calibration. CONCLUSIONS The model accurately predicted the risk of deterioration on the CPS score over six months among home care clients. This type of predictive model may provide useful information to support decisions for home care clinicians who use interRAI data internationally.
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Affiliation(s)
- Dawn M Guthrie
- Department of Kinesiology & Physical Education, Wilfrid Laurier University, Waterloo, ON, Canada
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Nicole Williams
- Department of Kinesiology & Physical Education, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Hannah M O'Rourke
- College of Health Sciences, Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Joseph B Orange
- School of Communication Sciences and Disorders, Western University, London, ON, Canada
| | - Natalie Phillips
- Department of Psychology, Centre for Research in Human Development, Concordia University, Montreal, QC, Canada
| | | | | | - Rinku Sutradhar
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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Hoang MT, Kåreholt I, Schön P, von Koch L, Xu H, Tan EC, Johnell K, Eriksdotter M, Garcia-Ptacek S. The Impact of Educational Attainment and Income on Long-Term Care for Persons with Alzheimer's Disease and Other Dementias: A Swedish Nationwide Study. J Alzheimers Dis 2023; 96:789-800. [PMID: 37840486 PMCID: PMC10657673 DOI: 10.3233/jad-230388] [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] [Accepted: 09/06/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Long-term care improves independence and quality of life of persons with dementia (PWD). The influence of socioeconomic status on access to long-term care was understudied. OBJECTIVE To explore the socioeconomic disparity in long-term care for PWD. METHODS This registry-based study included 14,786 PWD, registered in the Swedish registry for cognitive and dementia disorders (2014-2016). Education and income, two traditional socioeconomic indicators, were the main exposure. Outcomes were any kind of long-term care, specific types of long-term care (home care, institutional care), and the monthly average hours of home care. The association between outcomes and socioeconomic status was examined with zero-inflated negative binomial regression and binary logistic regression. RESULTS PWD with compulsory education had lower likelihood of receiving any kind of long-term care (OR 0.80, 95% CI 0.68-0.93), or home care (OR 0.83, 95% CI 0.70-0.97), compared to individuals with university degrees. Their monthly average hours of home care were 0.70 times (95% CI 0.59-0.82) lower than those of persons with university degrees. There was no significant association between education and the receipt of institutional care. Stratifying on persons with Alzheimer's disease showed significant association between lower education and any kind of long-term care, and between income and the hours of home care. CONCLUSIONS Socioeconomic inequalities in long-term care existed in this study population. Lower-educated PWD were less likely to acquire general long-term care, home care and had lower hours of home care, compared to their higher-educated counterparts. Income was not significantly associated with the receipt of long-term care.
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Affiliation(s)
- Minh Tuan Hoang
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Ingemar Kåreholt
- Institute of Gerontology, School of Health Welfare, Aging Research Network – Jönköping (ARN-J), Jönköping University, Jönköping, Sweden
| | - Pär Schön
- Department of Social Work, Stockholm University, Stockholm, Sweden
| | - Lena von Koch
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Hong Xu
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Edwin C.K Tan
- The University of Sydney, Faculty of Medicine and Health, School of Pharmacy, New South Wales, Australia
| | - Kristina Johnell
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Maria Eriksdotter
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Aging Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Sara Garcia-Ptacek
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Aging Theme, Karolinska University Hospital, Stockholm, Sweden
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Burton JK, Ciminata G, Lynch E, Shenkin SD, Geue C, Quinn TJ. Understanding Pathways into Care homes using Data (UnPiCD study): a retrospective cohort study using national linked health and social care data. Age Ageing 2022; 51:6964930. [PMID: 36580557 PMCID: PMC9799248 DOI: 10.1093/ageing/afac304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Pathways into care are poorly understood but important life events for individuals and their families. UK policy is to avoid moving-in to care homes from acute hospital settings. This assumes that moves from secondary care represent a system failure. However, those moving to care homes from community and hospital settings may be fundamentally different groups, each requiring differing care approaches. OBJECTIVE To characterise individuals who move-in to a care home from hospital and compare with those moving-in from the community. DESIGN AND SETTING A retrospective cohort study using cross-sectoral data linkage of care home data. METHODS We included adults moving-in to care homes between 1/4/13 and 31/3/16, recorded in the Scottish Care Home Census. Care home data were linked to general and psychiatric hospital admissions, community prescribing and mortality records to ascertain comorbidities, significant diagnoses, hospital resource use, polypharmacy and frailty. Multivariate logistic regression identified predictors of moving-in from hospital compared to from community. RESULTS We included 23,892 individuals moving-in to a care home, 13,564 (56.8%) from hospital and 10,328 (43.2%) from the community. High frailty risk adjusted Odds Ratio (aOR) 5.11 (95% Confidence Interval (CI): 4.60-5.68), hospital discharge with diagnosis of fracture aOR 3.91 (95%CI: 3.41-4.47) or stroke aOR 8.42 (95%CI: 6.90-10.29) were associated with moving-in from hospital. Discharge from in-patient psychiatry was also a highly significant predictor aOR 19.12 (95%CI: 16.26-22.48). CONCLUSIONS Individuals moving-in to care homes directly from hospital are clinically distinct from those from the community. Linkage of cross-sectoral data can allow exploration of pathways into care at scale.
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Affiliation(s)
- Jennifer Kirsty Burton
- Address correspondence to: Jennifer Kirsty Burton, School of Cardiovascular & Metabolic Health, Room 2.42 Level 2, New Lister Building, University of Glasgow, Glasgow Royal Infirmary, Alexandra Parade, Glasgow, G31 2ER, UK. Tel: +44 141 956 0517.
| | - Giorgio Ciminata
- Health Economics and Health Technology Assessment, School of Health & Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Ellen Lynch
- Social Care Analytical Unit, Health and Social Care Analysis, Scottish Government, Edinburgh, Scotland
| | - Susan D Shenkin
- Ageing and Health Research Group and Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, Scotland
| | - Claudia Geue
- Health Economics and Health Technology Assessment, School of Health & Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Terence J Quinn
- Academic Geriatric Medicine, School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, Scotland
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Dreyer J, Bergmann JM, Köhler K, Hochgraeber I, Pinkert C, Roes M, Thyrian JR, Wiegelmann H, Holle B. Differences and commonalities of home-based care arrangements for persons living with dementia in Germany - a theory-driven development of types using multiple correspondence analysis and hierarchical cluster analysis. BMC Geriatr 2022; 22:723. [PMID: 36050645 PMCID: PMC9438141 DOI: 10.1186/s12877-022-03310-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Most persons with dementia live at home and want to stay there as long as possible. In most cases, informal carers such as spouses or children care for them. Together with other family members and professional carers, they form care arrangements to address the complex needs of persons with dementia. One major aim of informal carers is to keep the care arrangement stable. The middle-range theory of 'stability of home-based care arrangements for people living with dementia' (SoCA-Dem theory) offers a theory to understand what constitutes and influences the stability of home-based care arrangements. Based on this theory, the aim of this study was to (1) uncover the underlying structures of differences and commonalities of home-based care arrangements for persons living with dementia, (2) construct types of these care arrangements, and (3) compare these types with regard to their stability. METHOD This is a secondary analysis of data from a convenience sample of n = 320 care arrangements for persons with dementia obtained in the observational DemNet-D study. Data were analysed using multiple correspondence analysis and hierarchical cluster analysis. Sociodemographic data and variables related to the structure of the care arrangement (D-IVA), burden of the informal carer (BICS-D), dementia severity (FAST), and quality of life of the person with dementia (QOL-AD) were included. RESULTS The multiple correspondence analysis identified 27 axes that explained the entire variance between all care arrangements. The two axes 'dementia and care trajectory' and 'structure of the dyadic relationship' best distinguished care arrangements from each other and together explained 27.10% of the variance. The subsequent cluster analysis identified four types of care arrangements. Two types included spouse-centred care arrangements, and two types included child-centred care arrangements at different phases of the dementia and care trajectory. The types differ with regard to their stability. CONCLUSION The results highlight the heterogeneity and commonality of care arrangements for persons living with dementia. They contribute to a better understanding of informal dementia home care. Furthermore, the results can guide the development of tailored support for persons living with dementia and their caring families.
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Affiliation(s)
- Jan Dreyer
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), site Witten, Witten, Germany.
| | | | - Kerstin Köhler
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), site Witten, Witten, Germany
| | - Iris Hochgraeber
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), site Witten, Witten, Germany
| | - Christiane Pinkert
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), site Witten, Witten, Germany
| | - Martina Roes
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), site Witten, Witten, Germany
| | - Jochen René Thyrian
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), site Rostock/Greifswald, Greifswald, Germany
| | - Henrik Wiegelmann
- Institute for Public Health and Nursing Research, Health Sciences Bremen, University of Bremen, Bremen, Germany
| | - Bernhard Holle
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), site Witten, Witten, Germany
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Lee KH, Lee JY, Kim B. Information and communication technology for physical activity in persons living with dementia: A systematic review with implications for evidence-based practice. Worldviews Evid Based Nurs 2022; 19:275-281. [PMID: 35635249 DOI: 10.1111/wvn.12591] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/30/2022] [Accepted: 04/03/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Persons living with dementia often encounter many difficulties in their community due to functional limitations. Information and Communication Technology (ICT) could be useful to monitor changes in their physical function. However, there is a lack of systematic reviews about using ICT for physical activity. AIM This review aimed to synthesize the literature regarding the use of ICT to monitor the physical activity of persons living with dementia. METHODS A systematic search was conducted in five electronic databases using search terms derived from the Patient, Intervention, Comparison, Outcome (PICO) framework. We included articles published in English from 2011 to 2021. Quality of the included studies was evaluated by two independent authors using the Mixed Methods Appraisal Tool (MMAT). RESULTS Thirty-three quantitative studies were included for review. Included studies showed fairly good quality in the MMAT evaluation. Wearable devices were mainly employed (88%). The ICTs were used to objectively measure physical activity, activity status, gait, and circadian rhythm. ICTs have been utilized for four purposes: (1) comparing physical activity within the dementia subgroups or with the normal group, (2) exploring the relationship with other variables, 3) examining the experimental study's outcomes, and (4) checking the sensors' feasibility. The results demonstrated that ICT devices were feasible to use in persons living with dementia in the community, helpful for monitoring the physical activity of persons living with dementia, and useful for improving physical activity when properly incorporated in care planning. LINKING EVIDENCE TO ACTION ICTs can help gather objective data regarding the type, intensity, and level of physical activity in persons living with dementia without time constraints. Also, ICTs use in persons living with dementia in the community was acceptable. We suggest future studies to activate and use ICTs in dementia research.
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Affiliation(s)
- Kyung Hee Lee
- Yonsei University College of Nursing and Mo-Im Kim Nursing Research Institute, Seoul, South Korea
| | - Ji Yeon Lee
- Yonsei University College of Nursing and Mo-Im Kim Nursing Research Institute, Seoul, South Korea
| | - Bora Kim
- Yonsei University College of Nursing and the Brain Korea 21 FOUR Project, Seoul, South Korea
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Lee K, Chung J, Meyer KN, Dionne-Odom JN. Unmet needs and health-related quality of life of dementia family caregivers transitioning from home to long-term care: A scoping review. Geriatr Nurs 2021; 43:254-264. [PMID: 34953331 DOI: 10.1016/j.gerinurse.2021.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/05/2021] [Accepted: 12/07/2021] [Indexed: 01/07/2023]
Abstract
This scoping review is to identify experiences, unmet needs, and health-related quality of life (HRQoL) of family caregivers transitioning their care recipients with dementia into long-term care (LTC). The methodological framework of Arksey and O'Malley guided the review. Themes from nineteen selected studies were organized around three categories. First, caregiver experiences during LTC placement featured challenges around placement decision-making and distress and changes in relationships and responsibilities. Second, unmet needs of caregivers were desired emotional support and information about transitions. Finally, caregivers' HRQoL varies around transition. Family caregivers experience unique challenges and can have unmet needs during the LTC placement of their care recipients with dementia. Findings suggest the need for interventions that teach skills, care planning, assistance with conflict resolution, communication training, and guidance finding services and resources.
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Affiliation(s)
- Kyungmi Lee
- School of Nursing, The University of Alabama at Birmingham, Alabama, United States.
| | - Jane Chung
- School of Nursing, Virginia Commonwealth University, Virginia, United States
| | - Kylie Nicole Meyer
- School of Nursing, University of Texas Health Center San Antonio, Texas, United States
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Köhler K, Dreyer J, Hochgraeber I, von Kutzleben M, Pinkert C, Roes M, Holle B. Towards a middle-range theory of 'Stability of home-based care arrangements for people living with dementia' (SoCA-Dem): findings from a meta-study on mixed research. BMJ Open 2021; 11:e042515. [PMID: 33853798 PMCID: PMC8054086 DOI: 10.1136/bmjopen-2020-042515] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Most people with dementia and their informal carers live at home and strive to create a stable care situation for as long as possible. This preference of dyads is consistent with the global policy of ageing in place. Therefore, we aimed to develop a middle-range theory of stability guided by two research questions: How is stability of home-based care arrangements for people living with dementia constituted? What are the essential factors influencing stability? METHODS Within the 'Stability of home-based care arrangements for people living with dementia' project (SoCA project) at the German Center for Neurodegenerative Diseases (DZNE), we conducted a meta-study on mixed research. The analytical steps of meta-data analysis, meta-method and meta-theory are merged in an integrative synthesis. Eligible publications were identified through systematic database searches (MEDLINE, CINAHL and PsycINFO; last searched on 3 January 2017), backward/forward citation tracking and snowballing. All publications were screened against predefined inclusion criteria and evaluated through a quality appraisal. The analytical approach was thematic synthesis. RESULTS 99 publications were included. The middle-range theory conceptualises stability as a complex phenomenon comprising three components including eight concepts that are dynamically inter-related. The conceptual model visualises: (1) the trajectory of the dementia care arrangement, which involves a cyclic process of change and balancing over time; (2) the characteristics of the care arrangement, including needs, the carer role, the dyadic relationship and resources; and (3) the context, which is determined by society and culture and the respective healthcare system. The relevance of each concept in relation to stability changes over time. The forming of each concept is actively shaped by the informal carer. DISCUSSION This middle-range theory provides a thorough understanding of the stability of home-based care arrangements for people living with dementia and can be used to guide future research and practice. OTHER This meta-study was funded by the DZNE and registered in PROSPERO (registration number CRD42016041727).
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Affiliation(s)
- Kerstin Köhler
- German Centre for Neurodegenerative Diseases (DZNE), Witten, Germany
- Faculty of Health, Department of Nursing Science, Witten/Herdecke University (UW/H), Witten, Germany
| | - Jan Dreyer
- German Centre for Neurodegenerative Diseases (DZNE), Witten, Germany
- Faculty of Health, Department of Nursing Science, Witten/Herdecke University (UW/H), Witten, Germany
| | - Iris Hochgraeber
- German Centre for Neurodegenerative Diseases (DZNE), Witten, Germany
- Faculty of Health, Department of Nursing Science, Witten/Herdecke University (UW/H), Witten, Germany
| | - Milena von Kutzleben
- Department of Health Services Research, School of Medicine and Health Sciences, University of Oldenburg, Oldenburg, Germany
| | - Christiane Pinkert
- German Centre for Neurodegenerative Diseases (DZNE), Witten, Germany
- Faculty of Health, Department of Nursing Science, Witten/Herdecke University (UW/H), Witten, Germany
| | - Martina Roes
- German Centre for Neurodegenerative Diseases (DZNE), Witten, Germany
- Faculty of Health, Department of Nursing Science, Witten/Herdecke University (UW/H), Witten, Germany
| | - Bernhard Holle
- German Centre for Neurodegenerative Diseases (DZNE), Witten, Germany
- Faculty of Health, Department of Nursing Science, Witten/Herdecke University (UW/H), Witten, Germany
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11
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Giebel C, Hollinghurst J, Akbari A, Schnier C, Wilkinson T, North L, Gabbay M, Rodgers S. Socio-economic predictors of time to care home admission in people living with dementia in Wales: A routine data linkage study. Int J Geriatr Psychiatry 2021; 36:511-520. [PMID: 33045103 PMCID: PMC7984448 DOI: 10.1002/gps.5446] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 10/02/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Limited research has shown that people with dementia (PwD) from lower socio-economic backgrounds can face difficulties in accessing the right care at the right time. This study examined whether socio-economic status (SES) and rural versus urban living location are associated with the time between diagnosis and care home admission in PwD living in Wales, UK. METHODS/DESIGN This study linked routine health data and an e-cohort of PwD who have been admitted into a care home between 2000 and 2018 living in Wales. Survival analysis explored the effects of SES, living location, living situation, and frailty on the time between diagnosis and care home admission. RESULTS In 34,514 PwD, the average time between diagnosis and care home admission was 1.5 (±1.4) years. Cox regression analysis showed that increased age, living alone, frailty, and living in less disadvantaged neighbourhoods were associated with faster rate to care home admission. Living in rural regions predicted a slower rate until care home admission. CONCLUSIONS This is one of the first studies to show a link between socio-economic factors on time to care home admission in dementia. Future research needs to address variations in care needs between PwD from different socio-economic and geographical backgrounds.
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Affiliation(s)
- Clarissa Giebel
- Institute of Population Health SciencesUniversity of LiverpoolLiverpoolUK,NIHR ARC NWCLiverpoolUK
| | - Joe Hollinghurst
- Health Data Research UK (HDR‐UK)Data Science BuildingSwansea UniversitySwanseaUK
| | - Ashley Akbari
- Health Data Research UK (HDR‐UK)Data Science BuildingSwansea UniversitySwanseaUK,Administrative Data Research WalesSwansea UniversitySwanseaUK,Dementia PlatformLondonUK
| | - Christian Schnier
- Dementia PlatformLondonUK,Usher InstituteUniversity of EdinburghEdinburghUK
| | - Tim Wilkinson
- Dementia PlatformLondonUK,Usher InstituteUniversity of EdinburghEdinburghUK,Centre for Clinical Brain SciencesUniversity of EdinburghEdinburghUK
| | - Laura North
- Health Data Research UK (HDR‐UK)Data Science BuildingSwansea UniversitySwanseaUK,Dementia PlatformLondonUK
| | - Mark Gabbay
- Institute of Population Health SciencesUniversity of LiverpoolLiverpoolUK,NIHR ARC NWCLiverpoolUK
| | - Sarah Rodgers
- Institute of Population Health SciencesUniversity of LiverpoolLiverpoolUK,NIHR ARC NWCLiverpoolUK
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McGrath T, Blundell B, Morrisby C. The 'tipping point': Exploring the factors associated with entry into residential care for people with dementia in Western Australia. DEMENTIA 2021; 20:2494-2508. [PMID: 33745334 DOI: 10.1177/14713012211001265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND People with dementia usually prefer to live in the community. Research is needed to identify the 'tipping point' for residential care entry and to highlight how people with dementia can be supported to remain at home as long as possible. Few previous studies have examined caregivers' perceptions and explanations for the reasons people with dementia need to enter residential care in Australia. AIM To explore the factors contributing to people with dementia entering residential care in Perth, Western Australia, from the perspectives of informal carers and care staff. METHOD This phenomenological study used purposive sampling to recruit informal and formal caregivers of people with dementia. Semi-structured in-depth interviews were conducted with 13 family carers and 11 home care staff. Data were thematically analysed to identify individual, carer and contextual factors that impact on residential care entry. FINDINGS The majority of participants identified a combination of factors as the 'tipping point' to residential care entry; a few also identified the cause as a sudden event or specific issue. Factors identified included deterioration related to worsening cognition, changed behaviours and a decline in the performance of activities of daily living; co-occurring health conditions; safety concerns; carer no longer able to meet care needs; impact of providing support becoming too much for the informal carer; lack of family or social support and needing assistance from services that were unavailable or inaccessible. Factors assisting people with dementia to remain living at home longer were family and social support, formal services and dog ownership. CONCLUSION This study identified individual, carer and contextual factors that contribute to people with dementia entering residential care in Australia. The 'tipping point' was recognised as when the needs of a person with dementia outweigh the capacity of their informal and formal carers, services and supports to care for them.
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Affiliation(s)
- Thomas McGrath
- School of Allied Health, 1649Curtin University, Perth, Australia
| | - Barbara Blundell
- School of Allied Health, 1649Curtin University, Perth, Australia
| | - Claire Morrisby
- School of Allied Health, 1649Curtin University, Perth, Australia
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13
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Zafeiridi E, McMichael AJ, Passmore AP, McGuinness B. Factors influencing transition to care homes for people with dementia in Northern Ireland. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2021; 7:e12120. [PMID: 33748397 PMCID: PMC7968123 DOI: 10.1002/trc2.12120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 10/12/2020] [Accepted: 11/04/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The increasing number of people with dementia (PwD) is a significant health and financial challenge for countries. PwD often transition to a care home. This study explored factors predicting transition to care homes for PwD and the place and causes of death. METHODS Data about dementia medication, care home transitions, demographic characteristics, deaths, and hospital admissions were extracted from national databases from 2010 to 2016. RESULTS PwD (n = 25,418) were identified through prescriptions of dementia medication, from which 11,930 transitioned to care homes. A logistic regression showed that increased age, female sex, living in less deprived and urban areas, and hospital admissions predicted this transition. PwD who transition to care homes are more likely to die there. The most common cause of death was dementia. DISCUSSION Certain demographic characteristics are significant predictors for care home transitions and they should be considered in the development of early community-based care services to delay transitions. In the last decades, dementia has been reported more frequently in death certificates.
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Affiliation(s)
- Evi Zafeiridi
- Centre for Public HealthQueen's University BelfastBelfastUK
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14
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Ohno S, Chen Y, Sakamaki H, Matsumaru N, Yoshino M, Tsukamoto K. Burden of caring for Alzheimer's disease or dementia patients in Japan, the US, and EU: results from the National Health and Wellness Survey: a cross-sectional survey. J Med Econ 2021; 24:266-278. [PMID: 33538195 DOI: 10.1080/13696998.2021.1880801] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AIMS The growing prevalence of Alzheimer's disease (AD) worldwide has sparked the implementation of national policies to support the growing burden among caregivers of AD/dementia patients. This study aims to quantify and compare the burden of AD/dementia caregivers and evaluate how different living arrangements might impact health outcomes among caregivers in Japan, five European countries (5EU), and the United States (US). MATERIALS AND METHODS This is a cross-sectional study based on existing data from the 2018 National Health and Wellness Survey. Health outcome measures included health-related quality of life (HRQoL), health state utilities, work productivity and activity impairment (WPAI), and measurement of depression and anxiety amongst AD/dementia caregivers and non-caregivers. Pairwise comparisons between AD/dementia caregivers in Japan, 5EU, and the US were conducted. Multivariate analysis was used to compare across groups within each region, with adjustment for potential confounding effects. RESULTS A higher proportion of caregivers of AD/dementia patients in Japan were 65 years or older as compared to 5EU and US. On the contrary, female caregivers were significantly higher in the US than Japan and 5EU. The HRQoL and health state utilities index scores amongst AD/dementia caregivers were highest in Japan and lowest in the US. Caregivers in Japan incurred the lowest WPAI among the three regions. The proportion of AD/dementia patients reportedly living in an institution was highest in Japan as compared to the US and EU. Notably, US caregivers whose patients lived in an institution experienced significantly less caregiving burden as compared to caregivers whose patients lived in the community. CONCLUSIONS The caregiving burden among AD/dementia caregivers was substantial across the three regions, with similarities and differences between the West and Japan. The lower caregiving burden in Japan was potentially associated with national policies supporting long-term healthcare and institutionalized nursing care facilities for AD/dementia patients.
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Affiliation(s)
- Shinya Ohno
- Global Regulatory Science, Gifu Pharmaceutical University, Gifu, Japan
- Chugai Pharmaceutical Co., Ltd., Tokyo, Japan
| | - Yirong Chen
- Health Division, Kantar Health Inc., Singapore, Singapore
| | - Hiroyuki Sakamaki
- Graduate School of Health Innovation, Kanagawa University of Human Services, Kawasaki, Japan
| | - Naoki Matsumaru
- Global Regulatory Science, Gifu Pharmaceutical University, Gifu, Japan
| | | | - Katsura Tsukamoto
- Global Regulatory Science, Gifu Pharmaceutical University, Gifu, Japan
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15
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Jeon YH, Krein L, Simpson JM, Szanton SL, Clemson L, Naismith SL, Low LF, Mowszowski L, Gonski P, Norman R, Gitlin LN, Brodaty H. Feasibility and potential effects of interdisciplinary home-based reablement program (I-HARP) for people with cognitive and functional decline: a pilot trial. Aging Ment Health 2020; 24:1916-1925. [PMID: 31345051 DOI: 10.1080/13607863.2019.1642298] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives: To test feasibility and potential effects of the interdisciplinary Home-bAsed Reablement Program (I-HARP) that integrates evidence-based strategies and cognitive rehabilitation techniques into a dementia-specific, bio-behavioural-environmental intervention.Methods: A parallel-group randomised controlled pilot trial was conducted in Sydney, Australia, targeting community-dwelling people with amnestic mild cognitive impairment or mild/moderate stages of dementia and their carer (n = 18 dyads). I-HARP comprised: up to 12 home visits by registered nurse, occupational therapist, and psychologist, tailored to the individual client's needs; <A$1000 for home modification/assistive devices; and individual carer support, all provided over four months. Additional allied health services were recommended when necessary. Clients' daily activities, mobility, mood, caregiver burden, and quality of life were assessed at baseline, four months and 12 months. Semi-structured interviews were conducted with I-HARP participants post intervention.Results: Of 51 dyads who expressed interest in participation, 25 were eligible, with 76% consent rate (19/25 eligible dyads consented), and high adherence to the program (all nine intervention group participants completed and complied). Challenges included: need for better carer and allied health support, with more targeted recruitment points to speed up the process. The I-HARP group showed favourable effects across most outcomes at short-term (4 months) and longer-term (12 months) assessments. However, wide Confidence Intervals (CIs) point to the degree of uncertainty around interpretation of these results.Conclusion: The delivery of I-HARP, a dementia-specific reablement program and the trial design concerning randomisation, screening and consent procedures, were deemed feasible, acceptable and appropriate for the target population group. Building on the success and lessons from the pilot, a larger trial is currently underway.
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Affiliation(s)
- Yun-Hee Jeon
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, Australia
| | - Luisa Krein
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, Australia
| | - Judy M Simpson
- Sydney School of Public Health, The University of Sydney, Sydney, Australia.,ARC Centre of Excellence in Population Ageing Research, The University of Sydney, Sydney, Australia
| | | | - Lindy Clemson
- Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Sharon L Naismith
- Healthy Brain Ageing Program, Brain and Mind Centre, Charles Perkins Centre and School of Psychology, Faculty of Science, The University of Sydney, Sydney, Australia
| | - Lee-Fay Low
- Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Loren Mowszowski
- Healthy Brain Ageing Program, Brain and Mind Centre and School of Psychology, Faculty of Science, The University of Sydney, Sydney, Australia
| | - Peter Gonski
- Division of Aged and Extended Care (Southcare), Sutherland Hospital, South Eastern Sydney Local Health District, Sutherland, Australia
| | | | - Laura N Gitlin
- College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
| | - Henry Brodaty
- School of Psychiatry, UNSW Sydney, CHeBA (Centre for Healthy Brain Ageing) and Dementia Centre for Research Collaboration, Australia
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Experiences of caregiving and quality of healthcare among caregivers of patients with complex chronic processes: A qualitative study. Appl Nurs Res 2020; 56:151344. [PMID: 32907769 DOI: 10.1016/j.apnr.2020.151344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 07/12/2020] [Accepted: 08/22/2020] [Indexed: 11/20/2022]
Abstract
Aim To explore the perceptions of main caregivers regarding caring for chronic complex patients in two different regions of Spain. BACKGROUND Spain is a country with an ageing population and a high number of people with chronic diseases. It is well known that the role of the caregiver is important to ensure quality of life and appropriate care. METHODS Qualitative design using focus groups. Five focus groups, from two different regions, were conducted with 22 caregivers of people with chronic complex diseases to explore their personal experience, examine the quality of care received by the patient and their family and to develop strategies for the improvement of the quality of health care. The focus groups were audio and video recorded. The transcriptions of the focus group sessions were exported to qualitative software analysis MAXQDA 2018.2. The qualitative content analysis was based on different analytical cycles. RESULTS In general terms, caregivers would refer to accepting the care of their family members, but they highlight many negative aspects such as tiredness, lack of help and overload of care. They indicated general satisfaction with the health system but indicated that help was insufficient and that strategies to better address the situations of the complex chronic patient should be improved. The main categories observed were: Conclusions. Complex chronic illnesses are increasingly common at present, generating important consequences on the lives of patients and that of their caregivers. The design of any health strategy for facing the dilemma of chronic illnesses, must necessarily include the vision of the caregivers.
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Giebel C, Zwakhalen S, Louise Sutcliffe C, Verbeek H. Exploring the abilities of performing complex daily activities in dementia: the effects of supervision on remaining independent. Aging Ment Health 2020; 24:1288-1294. [PMID: 30990082 DOI: 10.1080/13607863.2019.1603283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: The aim of this study was to explore the remaining abilities of people with dementia (PwD) in performing daily activities.Method: Informal carers of community-residing PwD were recruited across England via mail out and carer support groups. Carers completed the revised Interview for Deteriorations in Daily Living Activities in Dementia 2 to rate the PwD's initiative and performance of daily activities. Six complex instrumental activities of daily living (IADLs) were selected: shopping, preparing a hot drink, using the telephone, preparing a cold meal, house work, and engaging in social activities, all of which were broken down into three sub-tasks. Data were analysed using Chi-square tests and linear regression analysis, assessing the contributions of hours of IADL care, hours of supervision, and dementia stage for each activity.Results: 581 carers of people with mild, moderate, and severe dementia completed the questionnaire. The ability to perform individual activities deteriorated from mild to moderate to severe dementia, with PwD remaining the most able to perform subtasks of preparing a hot drink and a cold meal. Subtask performance varied across activities, with some better maintained than others across severity stages. Linear regression models showed that hours of supervising PwD explained a greater proportion of the variance of each IADL than IADL care hours.Conclusion: PwD should be supervised to continue engaging in activities, thereby avoiding performing everything for the PwD. Findings can have implications for PwD living in nursing homes, and future research should explore the remaining IADL abilities of nursing home residents.
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Affiliation(s)
- Clarissa Giebel
- Institute of Population Health Sciences, University of Liverpool, Liverpool, United Kingdom of Great Britain and Northern Ireland.,NIHR CLAHRC NWC, Liverpool, United Kingdom of Great Britain and, Northern Ireland
| | - Sandra Zwakhalen
- CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands
| | - Caroline Louise Sutcliffe
- Personal Social Services Research Unit, University of Manchester, Manchester, United Kingdom of Great Britain and Northern Ireland
| | - Hilde Verbeek
- CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands
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18
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Stiefler S, Seibert K, Domhoff D, Görres S, Wolf-Ostermann K, Peschke D. [Influencing factors for nursing home admission in case of pre-existing need of care - a systematic review]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2020; 153-154:60-75. [PMID: 32540308 DOI: 10.1016/j.zefq.2020.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 05/02/2020] [Accepted: 05/03/2020] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Knowledge about predictors of nursing home placement is highly relevant. If they are known, targeted interventions such as counselling can help prevent or delay relocation to a nursing home. Above all, preventive and structural measures can target influenceable predictors. The aim of the review was to map predictors of nursing home admission and thus the permanent stay in inpatient long-term care for the target group of people with a pre-existing need for care. METHODS A systematic literature search in the databases The Cochrane Library, PubMed, CINAHL, GeroLit and CareLit® was conducted in September 2017. Longitudinal studies with quantitative analyses were included. The methodological quality was assessed using the Newcastle-Ottawa Scale. RESULTS 45 cohort studies were included. 21 studies examined study populations with need for care, in 24 studies the care status was unclear. A variety of predictors of nursing home admission with at least one-and-a-half times higher risk for both study populations could be identified, including higher age, dementia, underweight, higher age of caregiver, psychiatric symptoms, smoking status, ethnicity, challenging behaviour in people with dementia, higher number of hospitalizations and lower level of life satisfaction. DISCUSSION All the predictors identified are relevant to people in need of care. No predictors for the study population with need of care could be identified that are particularly important in contrast to persons with an unclear care status. However, the quality of studies among people with care and support needs is limited compared to studies targeting people with unclear care status. CONCLUSIONS Many factors seem to predict the admission to a nursing facility. For the first time, these factors are listed in this systematic review for the target group of people in need of care. Interventions or preventive measures based on known influenceable predictors can help prevent or delay nursing home admission.
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Affiliation(s)
- Susanne Stiefler
- Universität Bremen, Institut für Public Health und Pflegeforschung, Bremen, Deutschland.
| | - Kathrin Seibert
- Universität Bremen, Institut für Public Health und Pflegeforschung, Bremen, Deutschland
| | - Dominik Domhoff
- Universität Bremen, Institut für Public Health und Pflegeforschung, Bremen, Deutschland
| | - Stefan Görres
- Universität Bremen, Institut für Public Health und Pflegeforschung, Bremen, Deutschland
| | - Karin Wolf-Ostermann
- Universität Bremen, Institut für Public Health und Pflegeforschung, Bremen, Deutschland
| | - Dirk Peschke
- Universität Bremen, Institut für Public Health und Pflegeforschung, Bremen, Deutschland; Hochschule für Gesundheit Bochum, Department für Angewandte Gesundheitswissenschaften, Bochum, Deutschland
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Varik M, Medar M, Saks K. Informal caregivers' experiences of caring for persons with dementia in Estonia: A narrative study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:448-455. [PMID: 31637794 DOI: 10.1111/hsc.12877] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 09/10/2019] [Accepted: 09/24/2019] [Indexed: 06/10/2023]
Abstract
This paper presents the results of a qualitative study aimed at exploring the experiences and needs of informal caregivers of persons with dementia and identifying caregiver expectations for support. The research was based on phenomenological and social constructionist approaches; it also took experience-centred and culturally oriented approaches to narratives. It was conducted in Estonia in 2017 by means of unstructured in-depth interviews with 16 informal caregivers who had relatives with dementia. The narrative approach used in this study proved to be an appropriate and valuable method to understand the situations of the caregivers of the people with dementia, in identifying their needs and expectations, and in developing social understanding for caregivers. The results are divided under four thematic headings: awareness of dementia; process of caregiving and different caregiving roles; influence of caregiving on personal life; and expectations of empowerment. We found that it is necessary to raise public awareness of dementia and develop person-centred support services for the people living with dementia.
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Affiliation(s)
- Merle Varik
- School of Governance, Law and Society, Tallinn University, Tallinn, Estonia
- Tartu Health Care College, Tartu, Estonia
| | - Marju Medar
- School of Governance, Law and Society, Tallinn University, Tallinn, Estonia
| | - Kai Saks
- University of Tartu, Tartu, Estonia
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20
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Giebel C, Harvey D, Akpan A, Chamberlain P. Reducing hospital admissions in older care home residents: a 4-year evaluation of the care home innovation Programme (CHIP). BMC Health Serv Res 2020; 20:94. [PMID: 32028940 PMCID: PMC7006107 DOI: 10.1186/s12913-020-4945-9] [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] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 01/29/2020] [Indexed: 11/23/2022] Open
Abstract
Background Older care home residents frequently attend emergency departments with a high conversion to admissions. For this purpose, a novel Care Home Innovation Programme (CHIP) was introduced with the aim of reducing potentially avoidable hospital admissions by 30%. The aim of this study is to evaluate the implementation of this innovative service in practice. Methods A total of 32 care homes with 1314 beds in South Sefton, Merseyside were invited to sign up to CHIP which was launched in April 2015 and continued in its entirety until June 2018. As part of the CHIP, care home matrons were introduced, new protocols were developed to address common presentations, a 24-h 7–day a week televideo system installed across all homes, and a quarterly training collaborative brought care homes together to learn and share good practices together. Data on emergency calls and calls resulting in conveyances were recorded over a four-year period, and analysed using frequency analysis. Results In comparison to the 12 months prior to launch, over a four-year period, implementation of the CHIP resulted in a 15% reduction of emergency calls, and in a 19% reduction of conveyances to hospital. Conclusions The South Sefton CHIP demonstrated itself an effective programme in reducing conveyances and consequently, hospital admissions of care home residents. This model will be superseded by the enhanced health in care homes being promoted by the NHS Long Term Care Plan.
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Affiliation(s)
- Clarissa Giebel
- Institute of Population Health Sciences, University of Liverpool, Waterhouse Building B Block, Brownlow Street, Liverpool, L69 3GL, England. .,NIHR ARC NWC, Liverpool, England.
| | - Debbie Harvey
- South Sefton Clinical Commissioning Group, Liverpool, England
| | - Asangaedem Akpan
- NIHR ARC NWC, Liverpool, England.,Liverpool University Hospitals NHS FT, Liverpool, England.,Institute of Ageing & Chronic Disease, University of Liverpool, Liverpool, England
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21
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Williams N, Phillips NA, Wittich W, Campos JL, Mick P, Orange JB, Pichora-Fuller MK, Savundranayagam MY, Guthrie DM. Hearing and Cognitive Impairments Increase the Risk of Long-term Care Admissions. Innov Aging 2020; 4:igz053. [PMID: 31911955 PMCID: PMC6938463 DOI: 10.1093/geroni/igz053] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Indexed: 11/13/2022] Open
Abstract
Background and Objectives The objective of the study was to understand how sensory impairments, alone or in combination with cognitive impairment (CI), relate to long-term care (LTC) admissions. Research Design and Methods This retrospective cohort study used existing information from two interRAI assessments; the Resident Assessment Instrument for Home Care (RAI-HC) and the Minimum Data Set 2.0 (MDS 2.0), which were linked at the individual level for 371,696 unique individuals aged 65+ years. The exposure variables of interest included hearing impairment (HI), vision impairment (VI) and dual sensory impairment (DSI) ascertained at participants' most recent RAI-HC assessment. The main outcome was admission to LTC. Survival analysis, using Cox proportional hazards regression models and Kaplan-Meier curves, was used to identify risk factors associated with LTC admissions. Observations were censored if they remained in home care, died or were discharged somewhere other than to LTC. Results In this sample, 12.7% of clients were admitted to LTC, with a mean time to admission of 49.6 months (SE = 0.20). The main risk factor for LTC admission was a diagnosis of Alzheimer's dementia (HR = 1.87; CI: 1.83, 1.90). A significant interaction between HI and CI was found, whereby individuals with HI but no CI had a slightly faster time to admission (40.5 months; HR = 1.14) versus clients with both HI and CI (44.9 months; HR = 2.11). Discussion and Implications Although CI increases the risk of LTC admission, HI is also important, making it is imperative to continue to screen for sensory issues among older home care clients.
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Affiliation(s)
- Nicole Williams
- Department of Kinesiology and Physical Education, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Natalie A Phillips
- Department of Psychology/Centre for Research in Human Development, Concordia University, Montreal, Quebec, Canada
| | - Walter Wittich
- School of Optometry, Université de Montréal, Québec, Canada.,CRIR/Lethbridge-Layton-Mackay Rehabilitation Centre of West-Central Montreal Health, Quebec, Canada.,CRIR/Institut Nazareth et Louis-Braille du CISSS de la Montérégie-Centre, Longueuil, Montréal, Québec, Canada
| | - Jennifer L Campos
- KITE, Toronto Rehabilitation Institute, University Health Network, Ontario, Canada.,Department of Psychology, University of Toronto, Ontario, Canada
| | - Paul Mick
- Department of Surgery, Faculty of Medicine, University of British Columbia, Kelowna, Canada.,Department of Surgery, Faculty of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Joseph B Orange
- School of Communication Sciences and Disorders, and Canadian Centre for Activity and Aging, Western University, London, Ontario, Canada
| | | | | | - Dawn M Guthrie
- Department of Kinesiology and Physical Education, Wilfrid Laurier University, Waterloo, Ontario, Canada.,Department of Health Sciences, Wilfrid Laurier University, Waterloo, Ontario, Canada
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Evelyn Malone H, Coyne I. Decision-tables for choosing commonly applied inferential statistical tests in comparative and correlation studies. Nurse Res 2019; 27:29-35. [PMID: 31621211 DOI: 10.7748/nr.2019.e1636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Nurse researchers are increasingly using a wide variety of inferential statistical tests. However, novice researchers might find choosing tests for their studies difficult, as a result of this variety. AIM To present structured decision-tables to help choose which statistical tests to use in comparative and correlation studies. DISCUSSION The wide spectrum of statistical techniques the authors identified in nursing research helped them to construct overview tables that researchers could use as a simple tool to help choose appropriate statistical tests for their studies. CONCLUSION The decision-tables provided in this paper are unique in that they are composed of commonly applied statistical techniques identified in nursing studies and structured to simplify the pathway to statistical test decision-making for a broad spectrum of study designs. IMPLICATIONS FOR PRACTICE Novice nurse researchers can use the decision-tables presented in this paper as a starting point to explore with research colleagues or supervisors the appropriate choice of statistical techniques.
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Affiliation(s)
- Helen Evelyn Malone
- University of Dublin Trinity College, School of Nursing and Midwifery, Dublin, Republic of Ireland
| | - Imelda Coyne
- University of Dublin Trinity College, Dublin, Republic of Ireland
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Konerding U, Bowen T, Forte P, Karampli E, Malmström T, Pavi E, Torkki P, Graessel E. Do Caregiver Characteristics Affect Caregiver Burden Differently in Different Countries? Am J Alzheimers Dis Other Demen 2019; 34:148-152. [PMID: 30595033 PMCID: PMC10852493 DOI: 10.1177/1533317518822047] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
The relationships between caregiver burden as measured with the Burden Scale for Family Caregivers-short form and 6 characteristics of caregivers caring for patients with dementia were investigated for caregivers from England (n = 36), Finland (n = 42), and Greece (n = 46) using survey data. In all 3 countries, caregiver burden increases with physical problems of the caregiver, emotional problems of the caregiver, and weekly hours of care. Hence, in all 3 countries, special support for informal care is required when these characteristics are at high levels. When the caregiver is a spouse or long-term partner of the person with dementia, lives in the same house as this person, or spends fewer than 20 h/wk for other duties than care, this is associated with less caregiver burden in England but with more caregiver burden in Greece. Accordingly, special support is required for Greek caregivers with these characteristics, but the opposite is true for English caregivers.
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Affiliation(s)
- Uwe Konerding
- Department of Psychology and Psychotherapy, Witten/Herdecke University, Witten, Germany
- Trimberg Research Academy, University of Bamberg, Bamberg, Germany
| | | | | | - Eleftheria Karampli
- Department of Health Economics, National School of Public Health, Athens, Greece
| | - Tomi Malmström
- Department of Industrial Engineering and Management, Aalto University, Espoo, Finland
| | - Elpida Pavi
- Department of Health Economics, National School of Public Health, Athens, Greece
| | - Paulus Torkki
- Department of Industrial Engineering and Management, Aalto University, Espoo, Finland
| | - Elmar Graessel
- Department of Psychiatry and Psychotherapy, Centre of Health Services Research in Medicine, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
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Matsuoka T, Manabe T, Akatsu H, Hashizume Y, Yamamoto S, Ogawa N, Kanesaka T, Taniguchi C, Yamamoto T, Mizukami K. Factors influencing hospital admission among patients with autopsy-confirmed dementia. Psychogeriatrics 2019; 19:255-263. [PMID: 30675966 DOI: 10.1111/psyg.12393] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 10/07/2018] [Accepted: 11/21/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND The symptoms of geriatric syndromes and the behavioural and psychological symptoms of dementia (BPSD), in addition to clinical conditions, are associated with hospital admission among dementia patients. However, the principal factors that necessitate hospital admission among dementia patients have not been fully elucidated. METHODS We retrospectively reviewed the data in the medical and autopsy reports of patients who had been treated at a hospital in Toyohashi, Japan. Each patient had been hospitalized sometime between 2012 and 2016 and underwent a brain autopsy. Dementia and the subtypes of dementia were diagnosed neuropathologically. Information about patients' general backgrounds, clinical conditions at the time of admission, and the geriatric syndrome symptoms and BPSD before admission was collected; comparisons were then made between patients with and without dementia and among those with the different major subtypes of dementia. Then, the factors relating to hospital admission of dementia patients were comprehensively evaluated by using principle component analysis. RESULTS Of the 128 eligible patients, 100 (78.1%) had dementia. In the comparison of patients with and without dementia, patients without dementia were younger at both admission (P = 0.034) and death (P = 0.003). Among the patients with dementia with Lewy bodies, delusions had a significantly high prevalence (P = 0.014). Principal component analysis identified nine components (disinhibition, irritability/lability, agitation/aggression, anxiety, delusions, sleep/night-time behaviour disorders, hallucinations, aberrant motor behaviour, and speech impairment) as the principal factors related to hospital admission among dementia patients. Thus, BPSD were identified as principal factors. CONCLUSIONS Compared to other factors, BPSD are more likely to cause dementia patients to be admitted to hospital. The present results indicate that measures should be taken to ameliorate the difficulties associated with caring for patients with BPSD at home.
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Affiliation(s)
- Tamami Matsuoka
- Department of Social Health and Stress Management, University of Tsukuba, Graduate School of Comprehensive Human Science, Tsukuba, Japan
| | - Toshie Manabe
- Department of Social Health and Stress Management, University of Tsukuba, Graduate School of Comprehensive Human Science, Tsukuba, Japan.,Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan.,Department of Community-based Medicine, Nagoya City University Graduate School of Medicine, Nagoya, Japan
| | - Hiroyasu Akatsu
- Department of Community-based Medicine, Nagoya City University Graduate School of Medicine, Nagoya, Japan.,Fukushimura Hospital, Toyohashi, Japan
| | | | | | | | | | | | | | - Katsuyoshi Mizukami
- Department of Social Health and Stress Management, University of Tsukuba, Graduate School of Comprehensive Human Science, Tsukuba, Japan.,Faculty of Health and Sport Sciences, University of Tsukuba, Tokyo, Japan
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25
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Understanding the dining experience of individuals with dysphagia living in care facilities: A grounded theory analysis. Int J Nurs Stud 2019; 92:144-153. [DOI: 10.1016/j.ijnurstu.2019.01.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 01/17/2019] [Accepted: 01/30/2019] [Indexed: 12/16/2022]
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26
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Stolz E, Mayerl H, Rásky É, Freidl W. Individual and country-level determinants of nursing home admission in the last year of life in Europe. PLoS One 2019; 14:e0213787. [PMID: 30870521 PMCID: PMC6417724 DOI: 10.1371/journal.pone.0213787] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 02/28/2019] [Indexed: 12/04/2022] Open
Abstract
Background Previous research has focussed on individual-level determinants of nursing home admission (NHA), although substantial variation in the prevalence of NHA between European countries suggests a substantial impact of country of residence. The aim of this analysis was to assess individual-level determinants and the role of country of residence and specifically a country`s public institutional long-term care infrastructure on proxy-reported NHA in the last year of life. Methods We analysed data from 7,018 deceased respondents (65+) of the Survey of Health, Ageing and Retirement in Europe (2004–2015, 16 countries) using Bayesian hierarchical logistic regression analysis in order to model proxy-reported NHA. Results In total, 14% of the general older population utilised nursing home care in the last year of life but there was substantial variation across countries (range = 2–30%). On the individual-level, need factors such as functional and cognitive impairment were the strongest predictors of NHA. In total, 18% of the variance of NHA was located at the country-level; public expenditure on institutional care strongly affected the chance of NHA in the last year of life. Conclusion On the individual-level, the strong impact of need factors indicated equitable access to NHA, whereas differences in public spending for institutional care indicated inequitable access across European countries.
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Affiliation(s)
- Erwin Stolz
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Graz, Austria
- * E-mail:
| | - Hannes Mayerl
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Graz, Austria
| | - Éva Rásky
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Graz, Austria
| | - Wolfgang Freidl
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Graz, Austria
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27
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Rhynas SJ, Garrido AG, Burton JK, Logan G, MacArthur J. New care home admission following hospitalisation: How do older people, families and professionals make decisions about discharge destination? A case study narrative analysis. Int J Older People Nurs 2018; 13:e12192. [PMID: 29573561 DOI: 10.1111/opn.12192] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 02/01/2018] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To gain an in-depth understanding of the decision-making processes involved in the discharge of older people admitted to hospital from home and discharged to a care home, as described in the case records. BACKGROUND The decision for an older person to move into a care home is significant and life-changing. The discharge planning literature for older people highlights the integral role of nurses in supporting and facilitating effective discharge. However, little research has been undertaken to explore the experiences of those discharged from hospital to a care home or the processes involved in decision-making. METHOD A purposive sample of 10 cases was selected from a cohort of 100 individuals admitted to hospital from home and discharged to a care home. Cases were selected to highlight important personal, relational and structural factors thought to affect the decision-making process. Narrative case studies were created and were thematically analysed to explore the perspectives of each stakeholder group and the conceptualisations of risk which influenced decision-making. RESULTS Care home discharge decision-making is a complex process involving stakeholders with a range of expertise, experience and perspectives. Decisions take time and considerable involvement of families and the multidisciplinary team. There were significant deficits in documentation which limit the understanding of the process and the patient's voice is often absent from case records. The experiences of older people, families and multidisciplinary team members making care home decisions in the hospital setting require further exploration to identify and define best practice. IMPLICATIONS FOR PRACTICE Nurses have a critical role in the involvement of older people making discharge decisions in hospital, improved documentation of the patient's voice is essential. Health and social care systems must allow older people time to make significant decisions about their living arrangements, adapting to changing medical and social needs.
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Affiliation(s)
| | | | - Jennifer K Burton
- Alzheimer Scotland Dementia Research Centre, & Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
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28
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Backhouse T, Camino J, Mioshi E. What Do We Know About Behavioral Crises in Dementia? A Systematic Review. J Alzheimers Dis 2018; 62:99-113. [DOI: 10.3233/jad-170679] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Tamara Backhouse
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Julieta Camino
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Eneida Mioshi
- School of Health Sciences, University of East Anglia, Norwich, UK
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29
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Konerding U, Bowen T, Forte P, Karampli E, Malmström T, Pavi E, Torkki P, Graessel E. Investigating burden of informal caregivers in England, Finland and Greece: an analysis with the short form of the Burden Scale for Family Caregivers (BSFC-s). Aging Ment Health 2018; 22:280-287. [PMID: 27754704 DOI: 10.1080/13607863.2016.1239064] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The burden of informal caregivers might show itself in different ways in different cultures. Understanding these differences is important for developing culture-specific measures aimed at alleviating caregiver burden. Hitherto, no findings regarding such cultural differences between different European countries were available. In this paper, differences between English, Finnish and Greek informal caregivers of people with dementia are investigated. METHODS A secondary analysis was performed with data from 36 English, 42 Finnish and 46 Greek caregivers obtained with the short form of the Burden Scale for Family Caregivers (BSFC-s). The probabilities of endorsing the BSFC-s items were investigated by computing a logit model with items and countries as categorical factors. Statistically significant deviation of data from this model was taken as evidence for country-specific response patterns. RESULTS The two-factorial logit model explains the responses to the items quite well (McFadden's pseudo-R-square: 0.77). There are, however, also statistically significant deviations (p < 0.05). English caregivers have a stronger tendency to endorse items addressing impairments in individual well-being; Finnish caregivers have a stronger tendency to endorse items addressing the conflict between the demands resulting from care and demands resulting from the remaining social life and Greek caregivers have a stronger tendency to endorse items addressing impairments in physical health. CONCLUSION Caregiver burden shows itself differently in English, Finnish and Greek caregivers. Accordingly, measures for alleviating caregiver burden in these three countries should address different aspects of the caregivers' lives.
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Affiliation(s)
- Uwe Konerding
- a Trimberg Research Academy , University of Bamberg , Bamberg , Germany
| | - Tom Bowen
- b The Balance of Care Group , London , UK
| | - Paul Forte
- b The Balance of Care Group , London , UK
| | - Eleftheria Karampli
- c Department of Health Economics , National School of Public Health , Athens , Greece
| | - Tomi Malmström
- d Department of Industrial Engineering and Management , Aalto University , Espoo , Finland
| | - Elpida Pavi
- c Department of Health Economics , National School of Public Health , Athens , Greece
| | - Paulus Torkki
- d Department of Industrial Engineering and Management , Aalto University , Espoo , Finland
| | - Elmar Graessel
- e Centre of Health Services Research in Medicine, Department of Psychiatry and Psychotherapy , Friedrich-Alexander-University Erlangen-Nürnberg , Erlangen , Germany
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30
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Tucker S, Brand C, Sutcliffe C, Challis D, Saks K, Verbeek H, Cabrera E, Karlsson S, Leino-Kilpi H, Stephan A, Soto ME. What Makes Institutional Long-Term Care the Most Appropriate Setting for People With Dementia? Exploring the Influence of Client Characteristics, Decision-Maker Attributes, and Country in 8 European Nations. J Am Med Dir Assoc 2017; 17:465.e9-465.e15. [PMID: 27107162 DOI: 10.1016/j.jamda.2016.02.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 02/22/2016] [Accepted: 02/22/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To explore the extent to which client characteristics, decision-maker attributes, and country influence judgments of institutional long-term care (ILTC) appropriateness for people with dementia. DESIGN, SETTING, AND PARTICIPANTS A total of 161 experts in dementia care from 8 European countries reviewed a series of 14 vignettes representing people with dementia on the cusp of ILTC admission and indicated the most appropriate setting in which to support each case in a simple discrete choice exercise: own home, very sheltered housing, residential home, or nursing home. At least 16 experts participated in each country (Estonia, Finland, France, Germany, the Netherlands, Spain, Sweden, and the United Kingdom). MEASUREMENTS Descriptive statistics were used to characterize the experts and their placement preferences. Logistic regression modeling was used to explore the extent to which the sociodemographic and clinical characteristics of people with dementia, and the profession, workplace, and country of decision-makers were associated with ILTC recommendation. RESULTS Client characteristics, decision-maker attributes, and country all seemed to play a part in influencing professionals' perceptions of the appropriateness of ILTC for people with dementia. Expert decision-makers were more likely to recommend ILTC for individuals who required help with mobility or had multiple care needs, and appeared to give more weight to carers' than clients' wishes. Community-based social workers were less likely than other professional groups to favor ILTC placement. Experts in Finland, Germany, and the United Kingdom were less likely to recommend ILTC than experts in France, the Netherlands, and Estonia; experts in Sweden and Spain took an intermediate position. CONCLUSION This study provides new understanding of the factors that shape professionals' perceptions of ILTC appropriateness and highlights the need to construct multifaceted models of institutionalization when planning services for people with dementia. It also has several important clinical implications (including flagging interventions that could decrease the need for ILTC), and provides a basis for enhancing professionals' decision-making capabilities (including the greater involvement of clients themselves).
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Affiliation(s)
- Sue Tucker
- Personal Social Services Research Unit, University of Manchester, Manchester, United Kingdom.
| | - Christian Brand
- Personal Social Services Research Unit, University of Manchester, Manchester, United Kingdom
| | - Caroline Sutcliffe
- Personal Social Services Research Unit, University of Manchester, Manchester, United Kingdom
| | - David Challis
- Personal Social Services Research Unit, University of Manchester, Manchester, United Kingdom
| | - Kai Saks
- Department of Internal Medicine, University of Tartu, Tartu, Estonia
| | - Hilde Verbeek
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Esther Cabrera
- School of Health Sciences TecnoCampus, University Pompeu Fabra, Barcelona, Spain
| | | | - Helena Leino-Kilpi
- Department of Nursing Science, University of Turku, and Turku University Hospital, Turku, Finland
| | - Astrid Stephan
- Faculty of Health, School of Nursing Science, University of Witten/Herdecke, Witten, Germany
| | - Maria E Soto
- Geriatrics Department, Gerontôpole, Toulouse University Hospital, INSERM UMR 1027, Toulouse, France
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31
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Burton JK, Ferguson EEC, Barugh AJ, Walesby KE, MacLullich AMJ, Shenkin SD, Quinn TJ. Predicting Discharge to Institutional Long-Term Care After Stroke: A Systematic Review and Metaanalysis. J Am Geriatr Soc 2017; 66:161-169. [PMID: 28991368 PMCID: PMC5813141 DOI: 10.1111/jgs.15101] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND/OBJECTIVES Stroke is a leading cause of disability worldwide, and a significant proportion of stroke survivors require long-term institutional care. Understanding who cannot be discharged home is important for health and social care planning. Our aim was to establish predictive factors for discharge to institutional care after hospitalization for stroke. DESIGN We registered and conducted a systematic review and meta-analysis (PROSPERO: CRD42015023497) of observational studies. We searched MEDLINE, EMBASE, and CINAHL Plus to February 2017. Quantitative synthesis was performed where data allowed. SETTING Acute and rehabilitation hospitals. PARTICIPANTS Adults hospitalized for stroke who were newly admitted directly to long-term institutional care at the time of hospital discharge. MEASUREMENTS Factors associated with new institutionalization. RESULTS From 10,420 records, we included 18 studies (n = 32,139 participants). The studies were heterogeneous and conducted in Europe, North America, and East Asia. Eight studies were at high risk of selection bias. The proportion of those surviving to discharge who were newly discharged to long-term care varied from 7% to 39% (median 17%, interquartile range 12%), and the model of care received in the long-term care setting was not defined. Older age and greater stroke severity had a consistently positive association with the need for long-term care admission. Individuals who had a severe stroke were 26 times as likely to be admitted to long-term care than those who had a minor stroke. Individuals aged 65 and older had a risk of stroke that was three times as great as that of younger individuals. Potentially modifiable factors were rarely examined. CONCLUSION Age and stroke severity are important predictors of institutional long-term care admission directly from the hospital after an acute stroke. Potentially modifiable factors should be the target of future research. Stroke outcome studies should report discharge destination, defining the model of care provided in the long-term care setting.
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Affiliation(s)
- Jennifer K Burton
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, United Kingdom.,Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, United Kingdom
| | - Eilidh E C Ferguson
- Department of Medicine for the Elderly, Royal Infirmary of Edinburgh, National Health Service Lothian, Edinburgh, United Kingdom
| | - Amanda J Barugh
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, United Kingdom.,Department of Medicine for the Elderly, Royal Infirmary of Edinburgh, National Health Service Lothian, Edinburgh, United Kingdom
| | - Katherine E Walesby
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, United Kingdom.,Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, United Kingdom
| | - Alasdair M J MacLullich
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, United Kingdom.,Geriatric Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Susan D Shenkin
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, United Kingdom.,Geriatric Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Terry J Quinn
- Institute of Cardiovascular and Medical Science, University of Glasgow, Glasgow, United Kingdom
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"We don't have the infrastructure to support them at home": How health system inadequacies impact on long-term care admissions of people with dementia. Health Policy 2017; 121:1280-1287. [PMID: 29031934 DOI: 10.1016/j.healthpol.2017.09.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 09/18/2017] [Accepted: 09/27/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The influence of healthcare system factors on long-term care admissions has received relatively little attention. We address this by examining how inadequacies in the healthcare system impact on long-term care admissions of people with dementia. This is done in the context of the Irish healthcare system. METHODS Thirty-eight qualitative in-depth interviews with healthcare professionals and family carers were conducted. Interviews focused on participants' perceptions of the main factors which influence admission to long-term care. Interviews were analysed thematically. RESULTS The findings suggest that long-term care admissions of people with dementia may be affected by inadequacies in the healthcare system in three ways. Firstly, participants regarded the economic crisis in Ireland to have exacerbated the under-resourcing of community care services. These services were also reported to be inequitable. Consequently, the effectiveness of community care was seen to be limited. Secondly, such limits in community care appear to increase acute hospital admissions. Finally, admission of people with dementia to acute hospitals was believed to accelerate the journey towards long-term care. CONCLUSIONS Inadequacies in the healthcare system are reported to have a substantial impact on the threshold for long-term care admissions. The findings indicate that we cannot fully understand the factors that predict long-term care admission of people with dementia without accounting for healthcare system factors on the continuation of homecare.
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33
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Harrison JK, Walesby KE, Hamilton L, Armstrong C, Starr JM, Reynish EL, MacLullich AMJ, Quinn TJ, Shenkin SD. Predicting discharge to institutional long-term care following acute hospitalisation: a systematic review and meta-analysis. Age Ageing 2017; 46:547-558. [PMID: 28444124 PMCID: PMC5860007 DOI: 10.1093/ageing/afx047] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 03/21/2017] [Indexed: 01/29/2023] Open
Abstract
Background moving into long-term institutional care is a significant life event for any individual. Predictors of institutional care admission from community-dwellers and people with dementia have been described, but those from the acute hospital setting have not been systematically reviewed. Our aim was to establish predictive factors for discharge to institutional care following acute hospitalisation. Methods we registered and conducted a systematic review (PROSPERO: CRD42015023497). We searched MEDLINE; EMBASE and CINAHL Plus in September 2015. We included observational studies of patients admitted directly to long-term institutional care following acute hospitalisation where factors associated with institutionalisation were reported. Results from 9,176 records, we included 23 studies (n = 354,985 participants). Studies were heterogeneous, with the proportions discharged to a care home 3–77% (median 15%). Eleven studies (n = 12,642), of moderate to low quality, were included in the quantitative synthesis. The need for institutional long-term care was associated with age (pooled odds ratio (OR) 1.02, 95% confidence intervals (CI): 1.00–1.04), female sex (pooled OR 1.41, 95% CI: 1.03–1.92), dementia (pooled OR 2.14, 95% CI: 1.24–3.70) and functional dependency (pooled OR 2.06, 95% CI: 1.58–2.69). Conclusions discharge to long-term institutional care following acute hospitalisation is common, but current data do not allow prediction of who will make this transition. Potentially important predictors evaluated in community cohorts have not been examined in hospitalised cohorts. Understanding these predictors could help identify individuals at risk early in their admission, and support them in this transition or potentially intervene to reduce their risk.
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Affiliation(s)
- Jennifer Kirsty Harrison
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - Katherine E Walesby
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - Lorna Hamilton
- Department of Medicine for the Elderly, NHS Lothian, Edinburgh, UK
| | | | - John M Starr
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
- Department of Medicine for the Elderly, NHS Lothian, Edinburgh, UK
| | - Emma L Reynish
- Department of Medicine for the Elderly, NHS Lothian, Edinburgh, UK
- School of Applied Social Science, University of Stirling, Stirling, UK
| | - Alasdair M J MacLullich
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
- Department of Medicine for the Elderly, NHS Lothian, Edinburgh, UK
- Geriatric Medicine, University of Edinburgh, Edinburgh, UK
| | - Terry J Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Susan D Shenkin
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
- Department of Medicine for the Elderly, NHS Lothian, Edinburgh, UK
- Geriatric Medicine, University of Edinburgh, Edinburgh, UK
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34
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Facilitating aging in place: A qualitative study of practical problems preventing people with dementia from living at home. Geriatr Nurs 2017. [PMID: 28624128 DOI: 10.1016/j.gerinurse.2017.05.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Although the majority of people with dementia wish to age in place, they are particularly susceptible to nursing home admission. Nurses can play an important role in detecting practical problems people with dementia and their informal caregivers are facing and in advising them on various ways to manage these problems at home. Six focus group interviews (n = 43) with formal and informal caregivers and experts in the field of assistive technology were conducted to gain insight into the most important practical problems preventing people with dementia from living at home. Problems within three domains were consistently described as most important: informal caregiver/social network-related problems (e.g. high load of care responsibility), safety-related problems (e.g. fall risk, wandering), and decreased self-reliance (e.g. problems regarding self-care, lack of day structure). To facilitate aging in place and/or to delay institutionalization, nurses in community-based dementia care should focus on assessing problems within those three domains and offer potential solutions.
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35
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Harrison JK, Garrido AG, Rhynas SJ, Logan G, MacLullich AMJ, MacArthur J, Shenkin S. New institutionalisation following acute hospital admission: a retrospective cohort study. Age Ageing 2017; 46:238-244. [PMID: 27744305 PMCID: PMC5860512 DOI: 10.1093/ageing/afw188] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 10/04/2016] [Indexed: 11/13/2022] Open
Abstract
Background institutionalisation following acute hospital admission is common and yet poorly described, with policy documents advising against this transition. Objective to characterise the individuals admitted to a care home on discharge from an acute hospital admission and to describe their assessment. Design and setting a retrospective cohort study of people admitted to a single large Scottish teaching hospital. Subjects 100 individuals admitted to the acute hospital from home and discharged to a care home. Methods a single researcher extracted data from ward-based case notes. Results people discharged to care homes were predominantly female (62%), widowed (52%) older adults (mean 83.6 years) who lived alone (67%). About 95% had a diagnosed cognitive disorder or evidence of cognitive impairment. One-third of cases of delirium were unrecognised. Hospital stays were long (median 78.5 days; range 14-231 days) and transfers between settings were common. Family request, dementia, mobility, falls risk and behavioural concerns were the commonest reasons for the decision to admit to a care home. About 55% were in the acute hospital when the decision for a care home was made and 44% of that group were discharged directly from the acute hospital. Conclusions care home admission from hospital is common and yet there are no established standards to support best practice. Decisions should involve the whole multidisciplinary team in partnership with patients and families. Documentation of assessment in the case notes is variable. We advocate the development of interdisciplinary standards to support the assessment of this vulnerable and complex group of patients.
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Affiliation(s)
- Jennifer Kirsty Harrison
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
- Address correspondence to: J. K. Harrison. Tel: 0131 242 6371; Fax: 0131 242 6370. E-mail:
| | | | - Sarah J. Rhynas
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
- Nursing Studies, University of Edinburgh, Edinburgh, UK
| | | | - Alasdair M. J. MacLullich
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
- Department of Clinical and Surgical Sciences, Geriatric Medicine, University of Edinburgh, Edinburgh, UK
| | - Juliet MacArthur
- Nursing Studies, University of Edinburgh, Edinburgh, UK
- Corporate Nursing, NHS Lothian, Edinburgh, UK
| | - Susan Shenkin
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
- Department of Clinical and Surgical Sciences, Geriatric Medicine, University of Edinburgh, Edinburgh, UK
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Abstract
BACKGROUND Up to half of people with dementia in high income countries live in nursing homes and more than two-thirds of care home residents have dementia. Fewer than half of these residents report good quality of life and most older people are anxious about the prospect of moving into a nursing home. Robust evidence is needed as to the causes of admission to nursing homes, particularly where these risk factors are modifiable. METHODS We conducted a systematic literature search to identify controlled comparison studies in which the primary outcome was admission to nursing home of older adults with dementia. Identified studies were assessed for validity and 26 (17 cohort and 9 case-control) were included. Qualitative and quantitative analyses were conducted, including meta-analysis of 15 studies. RESULTS Poorer cognition and behavioral and psychological symptoms of dementia (BPSD) were consistently associated with an increased risk of nursing home admission and most of our meta-analyses demonstrated impairments in activities of daily living as a significant risk. The effects of community support services were unclear, with both high and low levels of service use leading to nursing home placement. There was an association between caregiver burden and risk of institutionalization, but findings with regard to caregiver depression varied, as did physical health associations, with some studies showing an increased risk of nursing home placement following hip fracture, reduced mobility, and multiple comorbidities. CONCLUSION We recommend focusing on cognitive enhancement strategies, assessment and management of BPSD, and carer education and support to delay nursing home placement.
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Rustad EC, Seiger Cronfalk B, Furnes B, Dysvik E. Next of kin's experiences of information and responsibility during their older relatives’ care transitions from hospital to municipal health care. J Clin Nurs 2016; 26:964-974. [DOI: 10.1111/jocn.13511] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Else Cathrine Rustad
- Department of Health Studies; Faculty of Social Sciences; University of Stavanger; Stavanger Norway
- Faculty of Health and Caring sciences; Stord Haugesund University College; Stord Norway
- Department of Clinical Medicine; Helse Fonna Local Health Authority; Haugesund Norway
| | - Berit Seiger Cronfalk
- Palliative Research Center; Ersta Sklöndal University College; Stockholm Sweden
- Faculty of Health and Caring Sciences; Stord Haugesund University College; Haugesund Norway
- Department of Oncology-Pathology; Karolinska Institute; Stockholm Sweden
| | - Bodil Furnes
- Department of Health Studies; Faculty of Social Sciences; University of Stavanger; Stavanger Norway
| | - Elin Dysvik
- Department of Health Studies; Faculty of Social Sciences; University of Stavanger; Stavanger Norway
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Harrison JK, Noel-Storr AH, Demeyere N, Reynish EL, Quinn TJ. Outcomes measures in a decade of dementia and mild cognitive impairment trials. Alzheimers Res Ther 2016; 8:48. [PMID: 27866472 PMCID: PMC5116815 DOI: 10.1186/s13195-016-0216-8] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 10/14/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND In a research study, to give a comprehensive evaluation of the impact of interventions, the outcome measures should reflect the lived experience of the condition. In dementia studies, this necessitates the use of outcome measures which capture the range of disease effects, not limited to cognitive functioning. In particular, assessing the functional impact of cognitive impairment is recommended by regulatory authorities, but there is no consensus on the optimal approach for outcome assessment in dementia research. Our aim was to describe the outcome measures used in dementia and mild cognitive impairment (MCI) intervention studies, with particular interest in those evaluating patient-centred outcomes of functional performance and quality of life. METHODS We performed a focused review of the literature with multiple embedded checks of internal and external validity. We used the Cochrane Dementia and Cognitive Improvement Group's register of dementia studies, ALOIS. ALOIS was searched to obtain records of all registered dementia and MCI intervention studies over a 10-year period (2004-2014). We included both published and unpublished materials. Outcomes were categorised as cognitive, functional, quality of life, mood, behaviour, global/disease severity and institutionalisation. RESULTS From an initial return of 3271 records, we included a total of 805 records, including 676 dementia trial records and 129 MCI trial records. Of these, 78 % (630) originated from peer-reviewed publications and 60 % (487) reported results of pharmacological interventions. Cognitive outcomes were reported in 70 % (563), in contrast with 29 % (237) reporting measures of functional performance and only 13 % (102) reporting quality of life measures. We identified significant heterogeneity in the tools used to capture these outcomes, with frequent use of non-standardised tests. CONCLUSIONS This focus on cognitive performance questions the extent to which intervention studies for dementia are evaluating outcome measures which are relevant to individual patients and their carers. The heterogeneity in measures, use of bespoke tools and poor descriptions of test strategy all support the need for a more standardised approach to the conduct and reporting of outcomes assessments.
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Affiliation(s)
- Jennifer Kirsty Harrison
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, c/o Room S1642, Geriatric Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SB UK
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - Anna H. Noel-Storr
- Cochrane Dementia and Cognitive Improvement Group, University of Oxford, Oxford, UK
| | - Nele Demeyere
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Emma L. Reynish
- School of Applied Social Sciences, University of Stirling, Stirling, UK
| | - Terry J. Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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Kirk E, Burrows L, Kent B, Abbott R, Warren A. Facilitators and barriers to remaining at home for people with dementia who live alone: a protocol for a systematic review of qualitative evidence. ACTA ACUST UNITED AC 2016; 14:20-9. [PMID: 27532306 DOI: 10.11124/jbisrir-2016-2550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
REVIEW QUESTION/OBJECTIVE This qualitative review aims to gain an increased understanding of the factors that support (facilitators) and challenge (barriers) people who have dementia and live alone in being able to remain living in their own homes. The review will contribute to the development of a complex intervention, inform clinical practice and influence policy development for this population.Overarching review question: what are the barriers to, and facilitators for, people with a dementia who live alone being able to remain in their own homes? SUB-QUESTIONS 1. What are the factors that support and/or challenge a person with dementia who lives alone?2. What are the barriers to, and facilitators for, people with a dementia who live alone being able to remain in their own homes from the perspective of people who have dementia and live alone?3. What are the barriers to, and facilitators for, people with dementia who live alone being able to remain in their own homes from the perspective of people who interact closely with this population, including family, and health and social care workers?
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Affiliation(s)
- Emma Kirk
- 1School of Nursing and Midwifery, Plymouth University, United Kingdom 2University of Exeter Medical School, University of Exeter, United Kingdom 3School of Health Professions, Plymouth University, United Kingdom 4Center for Health and Social Care Innovation (Plymouth University): an Affiliate Center of the Joanna Briggs Institute 5Collaboration for Leadership in Applied Health Research and Care, South West Peninsula (PenCLARHC), The National Institute for Health Research (NIHR), United Kingdom
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Alders P, Comijs HC, Deeg DJH. Changes in admission to long-term care institutions in the Netherlands: comparing two cohorts over the period 1996-1999 and 2006-2009. Eur J Ageing 2016; 14:123-131. [PMID: 28579933 PMCID: PMC5435789 DOI: 10.1007/s10433-016-0393-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Using data from two cohorts, we examine to what extent a decline in institutional care in the Netherlands is associated with changes in the need for care and/or societal factors. We compared older adults, aged 65–89, who were admitted to a long-term care (LTC) institution in the period 1996–1999 and 2006–2009. Using the Andersen model, we tested per block of predisposing, enabling and need factors, which factors were significant predictors of admission to institutional care. With a Blinder–Oaxaca decomposition regression, we decomposed the difference in admission to an LTC institution between the period 1996–1999 and 2006–2009 into a part that is due to differences in health needs and other factors such as effect of policy, social values, and technology. Between 1996 and 2006, the percentage of co-residing partners and income increased and the average level of loneliness decreased significantly. The prevalence of disability, chronic diseases, however, increased. Whereas the care by partners declined, the formal care by professionals increased. Although the observed decline in the admission rate to institutional care was relatively small across the 10 years (from 5.3 % in 1996–1999 to 4.5 % in 2006–2009, a 15 % decrease), the probability of admission in 2006–2009 was relatively much lower when accounting for changes in the health and social conditions of the participants: the probability was 1.7–2.1 % point lower for adults in the period 2006–2009 compared to 1996–1999, a 32–40 % decrease. Our results show that the decline in the admission rate to LTC institutions is not the result of changes in need. The decline is suggested to be the combined effect of changes in policy, technological advances and changes in social norms.
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Affiliation(s)
- Peter Alders
- Institute of Health Policy and Management, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands
| | - Hannie C Comijs
- Department of Psychiatry, EMGO Institute for Health and Care Research, VU University Medical Center and GGZ inGeest, Amsterdam, The Netherlands
| | - Dorly J H Deeg
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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Olsen C, Pedersen I, Bergland A, Enders-Slegers MJ, Jøranson N, Calogiuri G, Ihlebæk C. Differences in quality of life in home-dwelling persons and nursing home residents with dementia - a cross-sectional study. BMC Geriatr 2016; 16:137. [PMID: 27400744 PMCID: PMC4939817 DOI: 10.1186/s12877-016-0312-4] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 07/06/2016] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Dementia often eventually leads to dependency on others and finally to residential care. However, in Norway about half of the dementia population lives at home, due to individual and political wishes. There is scarce and inconclusive knowledge of how living in a nursing home differs from living at home for persons with dementia (PWDs) with regard to their quality of life (QoL). The first aim of the study was therefore to compare QoL, cognitive and physical functions, social contacts, sleep patterns, physical activity levels, exposure to light, and medication of PWDs in nursing homes and home-dwelling PWDs, and whether living in nursing homes was associated with a lower QoL than living at home for PWDs. A second aim was to examine if possible differences between residencies in QoL were consistent over time. METHODS The cross-sectional study was based on baseline data from two RCT studies of PWDs. A total of 15 nursing homes with adapted units for PWDs and 23 adapted day care centres for home-dwelling PWDs recruited 78 and 115 participants respectively. Trained nurses scored sociodemographic data, level of dementia (on the Clinical Dementia Rating scale), amount of medication, and QoL (QUALID). Sleep patterns, physical activity levels, and light exposure were measured by actigraphy. A multiple regression analysis was used to test the association between residency and QoL. The association between residency and change in QoL over time was investigated by linear regression analysis of a subsample with follow-up data. RESULTS Home-dwelling PWDs showed significantly higher QoL than PWDs in nursing homes. This difference was maintained even after stratifying on the severity of dementia. Home-dwelling PWDs with moderate dementia showed significantly less use of walking aids, more social contact, higher levels of activity and exposure to daylight, and less use of psychotropic medications. The regression model explained 28 % of the variance in QoL in persons with moderate dementia. However, only residency contributed significantly in the model. Residency also significantly predicted negative change over time in QoL. CONCLUSION The study indicated that living at home as long as possible is not only desirable for economic or health political reasons but also is associated with higher QoL for persons with moderate dementia. More studies are needed to investigate how QoL could be increased for PWDs in nursing homes.
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Affiliation(s)
- Christine Olsen
- Department of Landscape Architecture and Spatial Planning, Section for Public Health Science, Norwegian University of Life Sciences, PO Box 5003, NO-1432, Ås, Norway.
| | - Ingeborg Pedersen
- Department of Landscape Architecture and Spatial Planning, Section for Public Health Science, Norwegian University of Life Sciences, PO Box 5003, NO-1432, Ås, Norway
| | - Astrid Bergland
- Faculty of Health Sciences, Oslo and Akershus University College, Oslo, Norway
| | | | - Nina Jøranson
- Department of Landscape Architecture and Spatial Planning, Section for Public Health Science, Norwegian University of Life Sciences, PO Box 5003, NO-1432, Ås, Norway
| | - Giovanna Calogiuri
- Department of Dental Care and Public Health, Hedmark University College, Elverum, Norway
| | - Camilla Ihlebæk
- Department of Landscape Architecture and Spatial Planning, Section for Public Health Science, Norwegian University of Life Sciences, PO Box 5003, NO-1432, Ås, Norway
- Faculty of Health and Social Work Studies, Østfold University College, Fredrikstad, Norway
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Perry L. Dementia care in European countries - findings from the RightTimePlaceCare study. J Adv Nurs 2015; 71:1336-7. [PMID: 25904303 DOI: 10.1111/jan.12671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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