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Janson P, Hung CW, Willeke K, Frisch D, Berghöfer A, Heuschmann P, Zapf A, Wildner M, Stupp C, Keil T. [How effective are non-pharmacological interventions for family caregivers? A systematic review with meta-analyses]. DAS GESUNDHEITSWESEN 2024. [PMID: 39146966 DOI: 10.1055/a-2340-1560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
INTRODUCTION Informal caregiving is associated with mental disorders and reduced quality of life. The aim of this systematic review was to summarize the results of methodologically high-quality intervention studies on the effectiveness of non-pharmacological interventions on patient-relevant outcomes for family caregivers in Germany. METHOD We searched three large scientific literature databases for intervention studies with a control group and a low or moderate risk of bias on the effectiveness of non-pharmacological interventions for family caregivers in Germany. RESULT Among 4,376 publications reviewed, 10 intervention studies with good methodological quality were identified. These investigated multi-component interventions or cognitive behavioral therapy for family caregivers of people with dementia (8 studies), stroke (1 study) and with general care dependency (1 study). The control groups received information material as a minimal intervention or usual standard care. Meta-analyses showed a statistically significant slight reduction in depressive symptoms 3-6 months after the start of the study as a result of cognitive behavioral therapy (standardized mean difference -0.27; 95% confidence interval -0.44 - -0.10), but this no longer reached statistical significance after 9-12 months (-0.21; -0.51 - 0.09). Multi-component interventions showed no changes in depressive symptoms either after 3-6 or after 9-12 months (-0.18; -0.40 - 0.03 and -0.14; -0.47 - 0.14, respectively). In contrast, the mental component of quality of life of family caregivers improved statistically significantly in the multi-component intervention groups compared to the control groups: slightly after 3-6 months (0.28; 0.01 - 0.56) and moderately after 9-12 months (0.45; 0.09 - 0.82). The interventions had no effect on the physical component of quality of life. CONCLUSION The reduction of depressive symptoms by behavioral therapy interventions for family caregivers appears to be only slight and not sustainable. The mental component of quality of life of people affected may be improved in the longer term by multi-component interventions. Current scientifically examined interventions for informal caregivers do not appear to have a sufficient and sustainable effect. Greater effects could possibly be achieved through more elaborate behavioral approaches, but also structural preventive measures.
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Affiliation(s)
- Patrick Janson
- Landesinstitut Gesundheit I, Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, Erlangen, Germany
- Institut für Klinische Epidemiologie und Biometrie, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
| | - Chu-Wei Hung
- Landesinstitut Gesundheit I, Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, Erlangen, Germany
- Institut für Sozialmedizin, Epidemiologie und Gesundheitsökonomie, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Kristina Willeke
- Landesinstitut Gesundheit I, Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, Erlangen, Germany
- Institut für Klinische Epidemiologie und Biometrie, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
| | - Dieter Frisch
- Landesinstitut Gesundheit I, Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, Erlangen, Germany
- Institut für Klinische Epidemiologie und Biometrie, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
| | - Anne Berghöfer
- Institut für Sozialmedizin, Epidemiologie und Gesundheitsökonomie, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Peter Heuschmann
- Institut für Klinische Epidemiologie und Biometrie, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
- Zentrum für Klinische Studien Würzburg, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Andreas Zapf
- Bayerisches Staatsministerium für Umwelt und Verbraucherschutz, München, Germany
- Pettenkofer School of Public Health, Ludwig-Maximilians-Universität München, München, Germany
| | - Manfred Wildner
- Landesinstitut Gesundheit I, Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, Erlangen, Germany
- Pettenkofer School of Public Health, Ludwig-Maximilians-Universität München, München, Germany
| | - Carolin Stupp
- Landesinstitut Gesundheit I, Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, Erlangen, Germany
- Institut für Klinische Epidemiologie und Biometrie, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
| | - Thomas Keil
- Landesinstitut Gesundheit I, Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, Erlangen, Germany
- Institut für Klinische Epidemiologie und Biometrie, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
- Institut für Sozialmedizin, Epidemiologie und Gesundheitsökonomie, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Rojas-Rozo L, Lee L, Khanassov V, Sivananthan S, Ismail Z, Gauthier S, Vedel I. Latest Canadian Consensus Conference on the Diagnosis and Treatment of Dementia: What's in It for Primary Care? Can J Aging 2024; 43:185-196. [PMID: 37855225 DOI: 10.1017/s0714980823000521] [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] [Indexed: 10/20/2023] Open
Abstract
In 2020, the fifth Canadian Consensus Conference on the Diagnosis and Treatment of Dementia (CCCDTD5) published up-to-date recommendations for the clinical management of persons living with dementia (PLWD) and their caregivers. During the CCCDTD5 meetings, a list of recommendations for dementia care was compiled. With the aid of family physicians and the Canadian Consortium on Neurodegeneration in Aging, we selected the most relevant CCCDTD5 recommendations for primary care and tailored and summarized them in the present manuscript to facilitate their reference and use. These recommendations focus on (a) risk reduction, (b) screening and diagnosis, (c) deprescription of dementia medications, and (d) non-pharmacological interventions. The development of recommendations for the ongoing management of dementia is an iterative process as new evidence on interventions for dementia is published. These recommendations are important in the primary care setting as the entry point for PLWD into the health system.
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Affiliation(s)
- Laura Rojas-Rozo
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Linda Lee
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | | | | | - Zahinoor Ismail
- Departments of Psychiatry, Clinical Neurosciences, and Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Serge Gauthier
- Departments of Neurology and Neurosurgery, and Psychiatry, McGill University, Montreal, QC, Canada
| | - Isabelle Vedel
- Department of Family Medicine, McGill University, Montreal, QC, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
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Mohr W, Rädke A, Afi A, Mühlichen F, Platen M, Scharf A, Michalowsky B, Hoffmann W. Development of a Quantitative Preference Instrument for Person-Centered Dementia Care—Stage 2: Insights from a Formative Qualitative Study to Design and Pretest a Dementia-Friendly Analytic Hierarchy Process Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148554. [PMID: 35886406 PMCID: PMC9321359 DOI: 10.3390/ijerph19148554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/04/2022] [Accepted: 07/11/2022] [Indexed: 02/05/2023]
Abstract
Person-centered care (PCC) requires knowledge about patient preferences. An analytic hierarchy process (AHP) is one approach to quantify, weigh and rank patient preferences suitable for People living with Dementia (PlwD), due to simple pairwise comparisons of individual criteria from a complex decision problem. The objective of the present study was to design and pretest a dementia-friendly AHP survey. Methods: Two expert panels consisting of n = 4 Dementia Care Managers and n = 4 physicians to ensure content-validity, and “thinking-aloud” interviews with n = 11 PlwD and n = 3 family caregivers to ensure the face validity of the AHP survey. Following a semi-structured interview guide, PlwD were asked to assess appropriateness and comprehensibility. Data, field notes and partial interview transcripts were analyzed with a constant comparative approach, and feedback was incorporated continuously until PlwD had no further comments or struggles with survey completion. Consistency ratios (CRs) were calculated with Microsoft® Excel and ExpertChoice Comparion®. Results: Three main categories with sub-categories emerged: (1) Content: clear task introduction, (sub)criteria description, criteria homogeneity, (sub)criteria appropriateness, retest questions and sociodemography for heterogeneity; (2) Format: survey structure, pairwise comparison sequence, survey length, graphical design (incl. AHP scale), survey procedure explanation, survey assistance and response perspective; and (3) Layout: easy wording, short sentences and visual aids. Individual CRs ranged from 0.08 to 0.859, and the consolidated CR was 0.37 (0.038). Conclusions: Our formative qualitative study provides initial data for the design of a dementia-friendly AHP survey. Consideration of our findings may contribute to face and content validity in future quantitative preference research in dementia.
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Affiliation(s)
- Wiebke Mohr
- German Center for Neurodegenerative Diseases e.V. (DZNE), Site Rostock/Greifswald, Ellernholzstrasse 1-2, D-17487 Greifswald, Germany; (A.R.); (A.A.); (F.M.); (M.P.); (A.S.); (B.M.); (W.H.)
- Correspondence: ; Tel.: +49-3834-8685-37
| | - Anika Rädke
- German Center for Neurodegenerative Diseases e.V. (DZNE), Site Rostock/Greifswald, Ellernholzstrasse 1-2, D-17487 Greifswald, Germany; (A.R.); (A.A.); (F.M.); (M.P.); (A.S.); (B.M.); (W.H.)
| | - Adel Afi
- German Center for Neurodegenerative Diseases e.V. (DZNE), Site Rostock/Greifswald, Ellernholzstrasse 1-2, D-17487 Greifswald, Germany; (A.R.); (A.A.); (F.M.); (M.P.); (A.S.); (B.M.); (W.H.)
| | - Franka Mühlichen
- German Center for Neurodegenerative Diseases e.V. (DZNE), Site Rostock/Greifswald, Ellernholzstrasse 1-2, D-17487 Greifswald, Germany; (A.R.); (A.A.); (F.M.); (M.P.); (A.S.); (B.M.); (W.H.)
| | - Moritz Platen
- German Center for Neurodegenerative Diseases e.V. (DZNE), Site Rostock/Greifswald, Ellernholzstrasse 1-2, D-17487 Greifswald, Germany; (A.R.); (A.A.); (F.M.); (M.P.); (A.S.); (B.M.); (W.H.)
| | - Annelie Scharf
- German Center for Neurodegenerative Diseases e.V. (DZNE), Site Rostock/Greifswald, Ellernholzstrasse 1-2, D-17487 Greifswald, Germany; (A.R.); (A.A.); (F.M.); (M.P.); (A.S.); (B.M.); (W.H.)
| | - Bernhard Michalowsky
- German Center for Neurodegenerative Diseases e.V. (DZNE), Site Rostock/Greifswald, Ellernholzstrasse 1-2, D-17487 Greifswald, Germany; (A.R.); (A.A.); (F.M.); (M.P.); (A.S.); (B.M.); (W.H.)
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases e.V. (DZNE), Site Rostock/Greifswald, Ellernholzstrasse 1-2, D-17487 Greifswald, Germany; (A.R.); (A.A.); (F.M.); (M.P.); (A.S.); (B.M.); (W.H.)
- Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, University Medicine Greifswald, Ellernholzstrasse 1-2, D-17487 Greifswald, Germany
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Mougias AA, Christidi F, Kontaxopoulou D, Zervou M, Kostoglou D, Vlami MA, Dimitriou M, Politis A. A Multicomponent Home-Based Intervention for Neuropsychiatric Symptoms in People With Dementia and Caregivers' Burden and Depression: A 6-Month Longitudinal Study. J Geriatr Psychiatry Neurol 2022; 35:535-543. [PMID: 34151638 DOI: 10.1177/08919887211023593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Many people with dementia live in their home and require ongoing care, which is often provided by informal family caregivers. Thus, we examined the effectiveness of a multicomponent home-based intervention by evaluating its impact on a) neuropsychiatric symptoms of people with dementia and b) burden and depression of their caregivers. METHODS During the first 6 months of this prospective single-center study, we applied a home-based multicomponent intervention in 205 dyads of care-recipients and caregivers. In further analyzes, we included only dyads of caregivers and care-recipients with available data both at baseline and 6-month follow-up (N = 144). All assessments were conducted at home and included sociodemographic features, care-recipients' clinical data, cognitive status (Mini-Mental State Examination), activities of daily living (Instrumental Activities of Daily Living; Katz Index of Independence in Activities of Daily Living), neuropsychiatric symptoms (Neuropsychiatric Inventory), and caregivers' burden (Zarit Burden Inventory) and depression (Center for Epidemiological Studies-Depression). RESULTS We found significant decreases in the severity (pFDR = 0.002) and associated distress (pFDR = 0.001) of neuropsychiatric symptoms, as well as caregivers' burden (pFDR = 0.004) and depressive symptoms (pFDR = 0.001). As expected, there was significant deterioration in care-recipients' cognitive status (pFDR = 0.005) and measures of activities of daily living (pFDR < 0.005). CONCLUSION Despite the progressive course of dementia, the home-based multicomponent intervention was effective in decreasing caregivers' burden and depression and minimizing care-recipients' neuropsychiatric symptoms' severity and associated distress after 6 months. Our study highlights the establishment of home-based care units as an advantageous solution, specifically for family members seen to have a "taken-for-granted" role in dementia caring.
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Affiliation(s)
| | - Foteini Christidi
- Greek Psychogeriatric Association "243439Nestor," Athens, Greece
- Department of Medical Physics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Mariyanna Zervou
- Greek Psychogeriatric Association "243439Nestor," Athens, Greece
| | | | - Maria Anna Vlami
- Greek Psychogeriatric Association "243439Nestor," Athens, Greece
| | - Maria Dimitriou
- Greek Psychogeriatric Association "243439Nestor," Athens, Greece
| | - Antonis Politis
- First Department of Psychiatry, Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Development of a Quantitative Instrument to Elicit Patient Preferences for Person-Centered Dementia Care Stage 1: A Formative Qualitative Study to Identify Patient Relevant Criteria for Experimental Design of an Analytic Hierarchy Process. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137629. [PMID: 35805286 PMCID: PMC9266267 DOI: 10.3390/ijerph19137629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 06/15/2022] [Accepted: 06/17/2022] [Indexed: 01/19/2023]
Abstract
Background: Person-centered care (PCC) requires knowledge about patient preferences. This formative qualitative study aimed to identify (sub)criteria of PCC for the design of a quantitative, choice-based instrument to elicit patient preferences for person-centered dementia care. Method: Interviews were conducted with n = 2 dementia care managers, n = 10 People living with Dementia (PlwD), and n = 3 caregivers (CGs), which followed a semi-structured interview guide including a card game with PCC criteria identified from the literature. Criteria cards were shown to explore the PlwD’s conception. PlwD were asked to rank the cards to identify patient-relevant criteria of PCC. Audios were verbatim-transcribed and analyzed with qualitative content analysis. Card game results were coded on a 10-point-scale, and sums and means for criteria were calculated. Results: Six criteria with two sub-criteria emerged from the analysis; social relationships (indirect contact, direct contact), cognitive training (passive, active), organization of care (decentralized structures and no shared decision making, centralized structures and shared decision making), assistance with daily activities (professional, family member), characteristics of care professionals (empathy, education and work experience) and physical activities (alone, group). Dementia-sensitive wording and balance between comprehensibility vs. completeness of the (sub)criteria emerged as additional themes. Conclusions: Our formative study provides initial data about patient-relevant criteria of PCC to design a quantitative patient preference instrument. Future research may want to consider the balance between (sub)criteria comprehensibility vs. completeness.
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Chester H, Beresford R, Clarkson P, Entwistle C, Gillan V, Hughes J, Orrell M, Pitts R, Russell I, Symonds E, Challis D. Implementing the Dementia Early Stage Cognitive Aids New Trial (DESCANT) intervention: mixed-method process evaluation alongside a pragmatic randomised trial. Aging Ment Health 2022; 26:667-678. [PMID: 33438441 DOI: 10.1080/13607863.2020.1870204] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The DESCANT (Dementia Early Stage Cognitive Aids New Trial) intervention provided a personalised care package designed to improve the cognitive abilities, function and well-being of people with early-stage dementia and their carers, by providing a range of memory aids, together with appropriate training and support. This sub-study aimed to assess implementation and identify contextual factors potentially associated with participant outcomes. METHOD A mixed-methods approach was adopted alongside the pragmatic randomised trial. Data were obtained from intervention records and interviews with five dementia support practitioners across seven National Health Service Trusts in England and Wales. A reporting framework was constructed from available literature and data assessed by descriptive statistics and thematic analysis. RESULTS Participation and engagement was high with 126 out of 128 participants completing the intervention with packages tailored to individual participants. Misplacing items and poor orientation to date and time were common areas of need. Memory aids frequently supplied included orientation clocks (91%), whiteboards (60%), calendars (43%) and notebooks (32%), plus bespoke items. Intervention duration and timing were broadly consistent with expectations. Variation reflected participants' needs, circumstances and preferences. Qualitative findings suggested a potentially positive impact on the well-being of people with dementia and their carers. Issues associated with successful roll-out of the intervention are explored in the discussion. CONCLUSION Successful implementation increased confidence in future findings of the randomised trial. Depending on these, DESCANT may prove a scalable intervention with potential to improve the function and quality of life of people with dementia and their carers.
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Affiliation(s)
- Helen Chester
- Institute of Mental Health, School of Medicine, The University of Nottingham, Nottingham, UK
| | - Rebecca Beresford
- Social Care and Society, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Paul Clarkson
- Social Care and Society, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Charlotte Entwistle
- Department of Psychology, Fylde College, Lancaster University, Lancaster, UK
| | - Vincent Gillan
- Social Care and Society, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Jane Hughes
- Institute of Mental Health, School of Medicine, The University of Nottingham, Nottingham, UK
| | - Martin Orrell
- Institute of Mental Health, School of Medicine, The University of Nottingham, Nottingham, UK
| | - Rosa Pitts
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Ian Russell
- Swansea Trials Unit, Medical School, Swansea University, Swansea, Wales
| | - Eileen Symonds
- Institute of Mental Health, School of Medicine, The University of Nottingham, Nottingham, UK
| | - David Challis
- Institute of Mental Health, School of Medicine, The University of Nottingham, Nottingham, UK
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Hirt J, Langer G, Wilde F, Bauernschmidt D, Meyer G, Bieber A. Technology-based counselling in dementia (TeCoDem): study protocol of a mixed-methods systematic review with qualitative comparative analysis and meta-analysis. BMJ Open 2021; 11:e054157. [PMID: 34880025 PMCID: PMC8655568 DOI: 10.1136/bmjopen-2021-054157] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Information technology can enhance timely and individual support for people with dementia and informal carers. There is some evidence that people with dementia and informal carers would benefit from technology-based counselling. However, it remains unclear which features of those interventions relate to beneficial outcomes and which aspects are necessary for a successful implementation. Therefore, the primary objectives are: (1) to identify conditions of successful implementation of technology-based counselling interventions in dementia and (2) to investigate the effectiveness of those interventions. METHODS AND ANALYSIS We will conduct a mixed-methods systematic review. The first primary objective requires evidence from various study designs addressing aspects on effective and non-effective implementation of technology-based counselling. This could be telephone-based, web-based or mobile-based interventions for people with dementia and informal carers. For the second primary objective, randomised controlled trials (RCTs) dealing with any outcomes will be included. Year of publication and language will not be restricted. We will search CINAHL, Cochrane Library, MEDLINE, PsycINFO and Web of Science up to April 2021. Additionally, we will perform web searching and citation tracking. To achieve the first primary objective, a Qualitative Comparative Analysis (QCA) will be conducted. The QCA enables us to identify necessary or sufficient components for a successful implementation. To reach the second primary objective, a meta-analysis will be performed with respect to potential clinical and statistical heterogeneity of RCTs. The revised Risk of Bias tool 2.0 will be used to check the risk of bias in RCTs. For all other study designs, the Mixed Method Appraisal Tool will be used. ETHICS AND DISSEMINATION Ethics approval is not required for this review. We will disseminate our findings through scientific and non-scientific journal articles and conference presentations as well as formats directed to the public and decision-makers in healthcare. PROSPERO REGISTRATION NUMBER CRD42021245473.
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Affiliation(s)
- Julian Hirt
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
- Center for Dementia Care, Institute of Applied Nursing Sciences, Department of Health, Eastern Switzerland University of Applied Sciences, St Gallen, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Gero Langer
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Fabian Wilde
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Dorothee Bauernschmidt
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Gabriele Meyer
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Anja Bieber
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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Mohr W, Rädke A, Afi A, Edvardsson D, Mühlichen F, Platen M, Roes M, Michalowsky B, Hoffmann W. Key Intervention Categories to Provide Person-Centered Dementia Care: A Systematic Review of Person-Centered Interventions. J Alzheimers Dis 2021; 84:343-366. [PMID: 34542075 PMCID: PMC8609709 DOI: 10.3233/jad-210647] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Person-centered care (PCC) is an important concept in many countries’ national guidelines and dementia plans. Key intervention categories, i.e., a taxonomy of person-centered (PC)-interventions, to provide person-centered dementia care, are difficult to identify from literature. Objective: This systematic review aimed to identify and categorize published PC-interventions into key intervention categories to guide the provision of person-centered dementia care. Methods: Conduct of this systematic review followed Cochrane guidelines. A search of the dimensions ‘Dementia’, ‘Person-Centered Care’, and ‘Intervention’ combined was performed in PubMed, EMBASE, and Web of Science. Study selection was based on 2-stage screening against eligibility criteria, limited to controlled study designs. Information about interventions and outcomes was extracted into an “Effects Table”. The identified PC-interventions were categorized in intervention categories to provide person-centered dementia care. Results: Searches identified 1,806 records. 19 studies were included. These covered a range of psychosocial interventions, oftentimes multi-component interventions, which followed heterogeneous approaches. Studies were conducted in long-term care/hospital settings. Nine key intervention categories were identified: social contact, physical activities, cognitive training, sensory enhancement, daily living assistance, life history oriented emotional support, training and support for professional caregivers, environmental adjustments, and care organization. Conclusion: Our findings provide a current overview of published PC-interventions in dementia, which followed heterogeneous approaches under the PCC-concept. The heterogeneity made it challenging to identify a well-defined concept of PCC and common key intervention categories. An effectiveness-evaluation of “PC” - including “relationship-centered”-interventions may be valuable, to assess whether an explicit focus on relationships around PCC-interventions yields an added benefit. PROSPERO-ID: CRD42021225084.
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Affiliation(s)
- Wiebke Mohr
- German Center for Neurodegenerative Diseases e.V. (DZNE), Site Rostock/Greifswald, Greifswald, Germany
| | - Anika Rädke
- German Center for Neurodegenerative Diseases e.V. (DZNE), Site Rostock/Greifswald, Greifswald, Germany
| | - Adel Afi
- German Center for Neurodegenerative Diseases e.V. (DZNE), Site Rostock/Greifswald, Greifswald, Germany
| | - David Edvardsson
- Department of Nursing, Umeaa University, Umeaa, Sweden.,School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
| | - Franka Mühlichen
- German Center for Neurodegenerative Diseases e.V. (DZNE), Site Rostock/Greifswald, Greifswald, Germany
| | - Moritz Platen
- German Center for Neurodegenerative Diseases e.V. (DZNE), Site Rostock/Greifswald, Greifswald, Germany
| | - Martina Roes
- German Center for Neurodegenerative Diseases e.V. (DZNE), Site Witten, Witten, Germany
| | - Bernhard Michalowsky
- German Center for Neurodegenerative Diseases e.V. (DZNE), Site Rostock/Greifswald, Greifswald, Germany
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases e.V. (DZNE), Site Rostock/Greifswald, Greifswald, Germany.,Institute for Community Medicine, University Medicine Greifswald (UMG), Greifswald, Germany
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Ellis U, Kitchin V, Vis-Dunbar M. Identification and Reporting of Patient and Public Partner Authorship on Knowledge Syntheses: Rapid Review. J Particip Med 2021; 13:e27141. [PMID: 34110293 PMCID: PMC8235296 DOI: 10.2196/27141] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 04/12/2021] [Accepted: 05/11/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Patient and public involvement (PPI) in health research is an area of growing interest. Several studies have examined the use and impact of PPI in knowledge syntheses (systematic, scoping, and related reviews); however, few studies have focused specifically on the patient or public coauthorship of such reviews. OBJECTIVE This study seeks to identify published systematic and scoping reviews coauthored by patient or public partners and examine the characteristics of these coauthored reviews, such as which journals publish them, geographic location of research teams, and terms used to describe patient or public partner authors in affiliations, abstracts, or article text. METHODS We searched CAB Direct, CINAHL, Cochrane Database of Systematic Reviews (Ovid), Embase (Ovid), MEDLINE (Ovid), and PsycInfo from 2011 to May 2019, with a supplementary search of several PPI-focused databases. We refined the Ovid MEDLINE search by examining frequently used words and phrases in relevant search results and searched Ovid MEDLINE using the modified search strategy in June 2020. RESULTS We screened 13,998 results and found 37 studies that met our inclusion criteria. In line with other PPI research, we found that a wide range of terms were used for patient and public authors in author affiliations. In some cases, partners were easy to identify with titles such as patient, caregiver or consumer representative, patient partner, expert by experience, citizen researcher, or public contributor. In 11% (n=4) of studies, they were identified as members of a panel or advisory council. In 27% (n=10) of articles, it was either impossible or difficult to tell whether an author was a partner solely from the affiliation, and confirmation was found elsewhere in the article. We also investigated where in the reviews the partner coauthors' roles were described, and when possible, what their specific roles were. Often, there was little or no information about which review tasks the partner coauthors contributed to. Furthermore, only 14% (5/37) of reviews mentioned patient or public involvement as authors in the abstract; involvement was often only indicated in the author affiliation field or in the review text (most often in the methods or contributions section). CONCLUSIONS Our findings add to the evidence that searching for coproduced research is difficult because of the diversity of terms used to describe patient and public partners, and the lack of consistent, detailed reporting about PPI. For better discoverability, we recommend ensuring that patient and public authorships are indicated in commonly searched database fields. When patient and public-authored research is easier to find, its impact will be easier to measure.
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Affiliation(s)
- Ursula Ellis
- Woodward Library, University of British Columbia, Vancouver, BC, Canada
| | - Vanessa Kitchin
- Woodward Library, University of British Columbia, Vancouver, BC, Canada
| | - Mathew Vis-Dunbar
- University of British Columbia Okanagan Library, Kelowna, BC, Canada
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10
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Clarkson P, Challis D, Hughes J, Roe B, Davies L, Russell I, Orrell M, Poland F, Jolley D, Kapur N, Robinson C, Chester H, Davies S, Sutcliffe C, Peconi J, Pitts R, Fegan G, Islam S, Gillan V, Entwistle C, Beresford R, Abendstern M, Giebel C, Ahmed S, Jasper R, Usman A, Malik B, Hayhurst K. Components, impacts and costs of dementia home support: a research programme including the DESCANT RCT. PROGRAMME GRANTS FOR APPLIED RESEARCH 2021. [DOI: 10.3310/pgfar09060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background
Over half of people with dementia live at home. We know little about what home support could be clinically effective or cost-effective in enabling them to live well.
Objectives
We aimed to (1) review evidence for components of home support, identify their presence in the literature and in services in England, and develop an appropriate economic model; (2) develop and test a practical memory support package in early-stage dementia, test the clinical effectiveness and cost-effectiveness of routine home support in later-stage dementia and design a toolkit based on this evidence; and (3) elicit the preferences of staff, carers and people with dementia for home support inputs and packages, and evaluate the cost-effectiveness of these approaches in early- and later-stage dementia.
Design
We undertook (1) an evidence synthesis, national surveys on the NHS and social care and an economic review; (2) a multicentre pragmatic randomised trial [Dementia Early Stage Cognitive Aids New Trial (DESCANT)] to estimate the clinical effectiveness and cost-effectiveness of providing memory aids and guidance to people with early-stage dementia (the DESCANT intervention), alongside process evaluation and qualitative analysis, an observational study of existing care packages in later-stage dementia along with qualitative analysis, and toolkit development to summarise this evidence; and (3) consultation with experts, staff and carers to explore the balance between informal and paid home support using case vignettes, discrete choice experiments to explore the preferences of people with dementia and carers between home support packages in early- and later-stage dementia, and cost–utility analysis building on trial and observational study.
Setting
The national surveys described Community Mental Health Teams, memory clinics and social care services across England. Recruitment to the trial was through memory services in nine NHS trusts in England and one health board in Wales. Recruitment to the observational study was through social services in 17 local authorities in England. Recruitment for the vignette and preference studies was through memory services, community centres and carers’ organisations.
Participants
People aged > 50 years with dementia within 1 year of first attendance at a memory clinic were eligible for the trial. People aged > 60 years with later-stage dementia within 3 months of a review of care needs were eligible for the observational study. We recruited staff, carers and people with dementia for the vignette and preference studies. All participants had to give written informed consent.
Main outcome measures
The trial and observational study used the Bristol Activities of Daily Living Scale as the primary outcome and also measured quality of life, capability, cognition, general psychological health and carers’ sense of competence.
Methods
Owing to the heterogeneity of interventions, methods and outcome measures, our evidence and economic reviews both used narrative synthesis. The main source of economic studies was the NHS Economic Evaluation Database. We analysed the trial and observational study by linear mixed models. We analysed the trial by ‘treatment allocated’ and used propensity scores to minimise confounding in the observational study.
Results
Our reviews and surveys identified several home support approaches of potential benefit. In early-stage dementia, the DESCANT trial had 468 randomised participants (234 intervention participants and 234 control participants), with 347 participants analysed. We found no significant effect at the primary end point of 6 months of the DESCANT intervention on any of several participant outcome measures. The primary outcome was the Bristol Activities of Daily Living Scale, for which scores range from 0 to 60, with higher scores showing greater dependence. After adjustment for differences at baseline, the mean difference was 0.38, slightly but not significantly favouring the comparator group receiving treatment as usual. The 95% confidence interval ran from –0.89 to 1.65 (p = 0.56). There was no evidence that more intensive care packages in later-stage dementia were more effective than basic care. However, formal home care appeared to help keep people at home. Staff recommended informal care that cost 88% of formal care, but for informal carers this ratio was only 62%. People with dementia preferred social and recreational activities, and carers preferred respite care and regular home care. The DESCANT intervention is probably not cost-effective in early-stage dementia, and intensive care packages are probably not cost-effective in later-stage dementia. From the perspective of the third sector, intermediate intensity packages were cheaper but less effective. Certain elements may be driving these results, notably reduced use of carers’ groups.
Limitations
Our chosen outcome measures may not reflect subtle outcomes valued by people with dementia.
Conclusions
Several approaches preferred by people with dementia and their carers have potential. However, memory aids aiming to affect daily living activities in early-stage dementia or intensive packages compared with basic care in later-stage dementia were not clinically effective or cost-effective.
Future work
Further work needs to identify what people with dementia and their carers prefer and develop more sensitive outcome measures.
Study registration
Current Controlled Trials ISRCTN12591717. The evidence synthesis is registered as PROSPERO CRD42014008890.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 9, No. 6. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Paul Clarkson
- Social Care and Society, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - David Challis
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Jane Hughes
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Brenda Roe
- Evidence-based Practice Research Centre, Edge Hill University, Ormskirk, UK
| | - Linda Davies
- Health Economics Research Team, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Ian Russell
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Martin Orrell
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Fiona Poland
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - David Jolley
- Social Care and Society, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Narinder Kapur
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Catherine Robinson
- Social Care and Society, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Helen Chester
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Sue Davies
- Social Care and Society, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Caroline Sutcliffe
- Social Care and Society, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Julie Peconi
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Rosa Pitts
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Greg Fegan
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Saiful Islam
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Vincent Gillan
- Social Care and Society, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Charlotte Entwistle
- Social Care and Society, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Rebecca Beresford
- Social Care and Society, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Michele Abendstern
- Social Care and Society, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Clarissa Giebel
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
| | - Saima Ahmed
- Social Care and Society, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Rowan Jasper
- Social Policy Research Unit, University of York, York, UK
| | - Adeela Usman
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Baber Malik
- Social Care and Society, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Karen Hayhurst
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
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11
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Tuomikoski AM, Parisod H, Lotvonen S, Välimäki T. Experiences of people with progressive memory disorders receiving non-pharmacological interventions: a qualitative systematic review protocol. JBI Evid Synth 2021; 18:2404-2408. [PMID: 32813434 DOI: 10.11124/jbisrir-d-19-00314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE This systematic review aims to identify, critically appraise, and synthesize the best available literature on the experiences of people with progressive memory disorders who are involved in non-pharmacological interventions. INTRODUCTION Some non-pharmacological interventions have been demonstrated to have a significant effect in reducing functional decline in people with progressive memory disorders. Additionally, there is evidence that people with progressive memory disorders have a need for activities tailored to their abilities and interests. INCLUSION CRITERIA This review will consider studies that describe the experiences of people with progressive memory disorders with non-pharmacological interventions. No limitations regarding care facilities will be made. METHODS The databases to be searched will include PubMed, CINAHL, Medic, Scopus and PsycARTICLES, as well as MedNar for unpublished studies. Studies published in English, Finnish and Swedish will be considered for inclusion in this review, which will use a three-step search strategy. The papers selected for retrieval will be assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments and findings will be pooled using meta-aggregation.
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Affiliation(s)
- Anna-Maria Tuomikoski
- Oulu University of Applied Sciences, Oulu, Finland.,Finnish Centre for Evidence-Based Health Care: A JBI Centre of Excellence, Helsinki, Finland.,University of Oulu, Department of Nursing Science and Health Management, Oulu, Finland
| | - Heidi Parisod
- Finnish Centre for Evidence-Based Health Care: A JBI Centre of Excellence, Helsinki, Finland.,Nursing Research Foundation, Helsinki, Finland
| | - Sinikka Lotvonen
- University of Oulu, Department of Nursing Science and Health Management, Oulu, Finland
| | - Tarja Välimäki
- Finnish Centre for Evidence-Based Health Care: A JBI Centre of Excellence, Helsinki, Finland.,University of Eastern Finland, Department of Nursing Science, Kuopio, Finland
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12
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Vedel I, Sheets D, McAiney C, Clare L, Brodaty H, Mann J, Anderson N, Liu‐Ambrose T, Rojas‐Rozo L, Loftus L, Gauthier S, Sivananthan S. CCCDTD5: Individual and community-based psychosocial and other non-pharmacological interventions to support persons living with dementia and their caregivers. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2020; 6:e12086. [PMID: 33209973 PMCID: PMC7657138 DOI: 10.1002/trc2.12086] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 08/25/2020] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Current pharmacological therapies for dementia have limited efficacy. Thus it is important to provide recommendations on individual and community-based psychosocial and non-pharmacological interventions for persons living with dementia (PLWDs) and their caregivers. METHODS Phase 1: A systematic review for developing recommendations on psychosocial and non-pharmacological interventions at the individual and community level for PLWDs and their caregivers. Phase 2: Rating of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines. Phase 3: Delphi process (>50 dementia experts) for approving recommendations by the 5th Canadian Consensus Conference on the Diagnosis and Treatment of Dementia (CCCDTD5). RESULTS The CCCDTD5 approved the following recommendations: Exercise (1B) and group cognitive stimulation for PLWDs (2B), psychosocial and psychoeducational interventions for caregivers (2C), development of dementia friendly organization and communities (2C), and case management for PLWDs (2B). DISCUSSION The CCCDTD5 provides for the first time, evidence-based recommendations on psychosocial and non-pharmacological interventions for PLWDs and their caregivers that can inform evidence-based policies for PLWDs in Canada.
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Affiliation(s)
| | - Debra Sheets
- School of NursingUniversity of VictoriaVictoriaBritish ColumbiaCanada
| | - Carrie McAiney
- University of Waterloo and Schlegel‐UW Research Institute for AgingWaterlooOntarioCanada
| | - Linda Clare
- College of Medicine and HealthUniversity of ExeterExeterUK
| | | | - James Mann
- Alzheimer AdvocateVancouverBritish ColumbiaCanada
| | - Nicole Anderson
- Rotman Research Institute, Baycrest, and University of TorontoTorontoOntarioCanada
| | - Teresa Liu‐Ambrose
- Djavad Mowafaghian Centre for Brain Health Center for Hip Health and MobilityUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | | | - Lynn Loftus
- Alzheimer AdvocateP.E.I.VancouverBritish ColumbiaCanada
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13
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Bressan V, Visintini C, Palese A. What do family caregivers of people with dementia need? A mixed-method systematic review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:1942-1960. [PMID: 32542963 DOI: 10.1111/hsc.13048] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 05/10/2020] [Accepted: 05/13/2020] [Indexed: 06/11/2023]
Abstract
Caring for people with dementia is a major challenge for relatives and society worldwide. Understanding the family caregivers' needs is crucial to promote their care-giving role during the disease trajectory. The aim of this mixed-method systematic review was to identify and synthetise the existing literature on the needs of family caregivers of people with dementia at home. PubMed, CINAHL, Cochrane Database of Systematic Reviews and PsycINFO databases were systematically explored to find quantitative, qualitative and mixed-method studies published between 2009 and 2019. A total of 1,196 citations were retrieved and 34 studies were included in the review. The variety of interrelated needs emerged from studies has been summarised in four themes: (a) Being supported, (b) Receiving accessible and personalised information, (c) Being trained and educated to care for their beloved with dementia and (d) Finding a balance. Care-giving for individuals with dementia is an ever-changing process characterised by continuous adjustments to their needs. The majority of a family caregivers' needs are oriented towards receiving support, help in offering daily care and finding a balance between the care-giving role and their own personal needs. For family caregivers, receiving information is a priority to improve their knowledge and to develop coping abilities, care skills and strategies aimed at promoting a balance between care assistance duties and their own needs. They also need social, psychological and emotional support and access to flexible, tailored and timely formal care. Further studies are recommended to detect changes in family caregivers' needs throughout the disease progression in order to tailor formal care offered by social and healthcare services.
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14
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Abstract
Family members are the primary source of support for older adults with chronic illness and disability. Thousands of published empirical studies and dozens of reviews have documented the psychological and physical health effects of caregiving, identified caregivers at risk for adverse outcomes, and evaluated a wide range of intervention strategies to support caregivers. Caregiving as chronic stress exposure is the conceptual driver for much of this research. We review and synthesize the literature on the impact of caregiving and intervention strategies for supporting caregivers. The impact of caregiving is highly variable, driven largely by the intensity of care provided and the suffering of the care recipient. The intervention literature is littered with many failures and some successes. Successful interventions address both the pragmatics of care and the emotional toll of caregiving. We conclude with both research and policy recommendations that address a national agenda for caregiving.
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Affiliation(s)
- Richard Schulz
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA; .,University Center for Social and Urban Research, University of Pittsburgh, Pittsburgh, Pennsylvania 15260, USA
| | - Scott R Beach
- University Center for Social and Urban Research, University of Pittsburgh, Pittsburgh, Pennsylvania 15260, USA
| | - Sara J Czaja
- Center on Aging and Behavioral Research, Weill Cornell Medicine, Cornell University, New York, NY 10065, USA
| | - Lynn M Martire
- College of Health and Human Development, Pennsylvania State University, University Park, Pennsylvania 16802, USA
| | - Joan K Monin
- School of Public Health, Yale University, New Haven, Connecticut 06520, USA
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15
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Ismail Z, Black SE, Camicioli R, Chertkow H, Herrmann N, Laforce R, Montero‐Odasso M, Rockwood K, Rosa‐Neto P, Seitz D, Sivananthan S, Smith EE, Soucy J, Vedel I, Gauthier S. Recommendations of the 5th Canadian Consensus Conference on the diagnosis and treatment of dementia. Alzheimers Dement 2020; 16:1182-1195. [PMID: 32725777 PMCID: PMC7984031 DOI: 10.1002/alz.12105] [Citation(s) in RCA: 124] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/03/2020] [Accepted: 04/09/2020] [Indexed: 12/13/2022]
Abstract
Since 1989, four Canadian Consensus Conferences on the Diagnosis and Treatment of Dementia (CCCDTD) have provided evidence-based dementia guidelines for Canadian clinicians and researchers. We present the results of the 5th CCCDTD, which convened in October 2019, to address topics chosen by the steering committee to reflect advances in the field, and build on previous guidelines. Topics included: (1) utility of the National Institute on Aging research framework for clinical Alzheimer's disease (AD) diagnosis; (2) updating diagnostic criteria for vascular cognitive impairment, and its management; (3) dementia case finding and detection; (4) neuroimaging and fluid biomarkers in diagnosis; (5) use of non-cognitive markers of dementia for better dementia detection; (6) risk reduction/prevention; (7) psychosocial and non-pharmacological interventions; and (8) deprescription of medications used to treat dementia. We hope the guidelines are useful for clinicians, researchers, policy makers, and the lay public, to inform a current and evidence-based approach to dementia.
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Affiliation(s)
- Zahinoor Ismail
- Department of PsychiatryHotchkiss Brain Institute and O'Brien Institute for Public HealthUniversity of CalgaryCalgaryAlbertaCanada
| | - Sandra E. Black
- Department of Medicine (Neurology) Sunnybrook Health Sciences CentreUniversity of TorontoTorontoOntarioCanada
| | - Richard Camicioli
- Neuroscience and Mental Health InstituteUniversity of AlbertaEdmontonAlbertaCanada
| | - Howard Chertkow
- University of TorontoBaycrest Health SciencesTorontoOntarioCanada
| | | | - Robert Laforce
- Clinique Interdisciplinaire de MémoireDépartement des Sciences NeurologiquesCHU de Québec, and Faculté de MédecineUniversité LavalLavalQuébecCanada
| | - Manuel Montero‐Odasso
- Departments of Medicine, and Epidemiology and BiostatisticsUniversity of Western OntarioLondonOntarioCanada
- Gait and Brain Lab, Parkwood InstituteLondonOntarioCanada
| | | | - Pedro Rosa‐Neto
- Neurosurgery and PsychiatryMcGill Centre for Studies in AgingMontrealQuebecCanada
| | - Dallas Seitz
- Hotchkiss Brain InstituteUniversity of CalgaryCalgaryAlbertaCanada
| | | | - Eric E. Smith
- Hotchkiss Brain InstituteUniversity of CalgaryCalgaryAlbertaCanada
| | - Jean‐Paul Soucy
- McConnell Brain Imaging CentreMontreal Neurological InstituteMcGill UniversityPERFORM CentreConcordia UniversityMontrealQuebecCanada
| | - Isabelle Vedel
- Department of Family MedicineMcGill UniversityMontrealQuebecCanada
| | - Serge Gauthier
- Alzheimer Disease Research UnitMcGill Center for Studies in AgingMontrealQuebecCanada
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16
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Cheng ST, Zhang F. A comprehensive meta-review of systematic reviews and meta-analyses on nonpharmacological interventions for informal dementia caregivers. BMC Geriatr 2020; 20:137. [PMID: 32293325 PMCID: PMC7158025 DOI: 10.1186/s12877-020-01547-2] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 04/02/2020] [Indexed: 01/01/2023] Open
Abstract
Background Many reviews with conflicting findings on dementia caregiver interventions have been published. A meta-review was conducted to synthesize the findings of systematic reviews and meta-analyses. Methods MEDLINE, PsycINFO, CINAHL and Cochrane Library were searched to identify reviews published during 2006–2018. Results Sixty reviews covering > 500 intervention studies were selected and appraised with Assessment of Multiple Systematic Reviews (AMSTAR) II. The great majority of studies were of low quality according to AMSTAR II, but quality factors appeared unrelated to the conclusions obtained. Depression was most modifiable, with effects found across a spectrum of interventions (psychoeducation, counseling/psychotherapy, occupational therapy, mindfulness-based interventions, multicomponent interventions, etc.). Evidence of intervention effect was also found for quality of life (psychoeducation), mastery (psychoeducation, occupational therapy and multicomponent interventions) and communication skills (communication training). Null or weak results were found for anxiety, social support and burden. Support groups and respite were generally ineffective. There was no evidence that dyadic programs were better than caregiver-only programs, or that programs delivered individually or in groups would differ in their impacts. The evidence also does not support multicomponent interventions to have broader impacts than single-component programs. Methodological issues in the existing reviews (e.g., selective use of studies to serve different research purposes and inconsistent classification of interventions) were noted and taken into account when interpreting findings. Conclusions This meta-review clarified variations in review methodology and identified a few potent groups of intervention (most notably psychoeducation, psychotherapy, occupational therapy, and multicomponent interventions), although no intervention type had broad effects on caregiver outcomes. We note that improvements are needed in the reporting of intervention studies and in making the classification of interventions more transparent and consistent. We further recommend fewer and larger-scale reviews and more attention to positive outcomes in order to better inform the field. Developing interventions with broader impacts and packaging them to meet caregivers’ changing needs in the course of dementia should be a priority for researchers and practitioners.
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Affiliation(s)
- Sheung-Tak Cheng
- Department of Health and Physical Education, The Education University of Hong Kong, 10 Lo Ping Road, Tai Po, N.T, Hong Kong. .,Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norwich, UK.
| | - Fan Zhang
- Department of Health and Physical Education, The Education University of Hong Kong, 10 Lo Ping Road, Tai Po, N.T, Hong Kong
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17
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Schulz R. The Future of Caregiver Efficacy Research: Commentary on "Long-Term Outcomes of the Benefit-Finding Group Intervention for Alzheimer Family Caregivers". Am J Geriatr Psychiatry 2019; 27:995-997. [PMID: 31031074 DOI: 10.1016/j.jagp.2019.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 04/05/2019] [Indexed: 11/16/2022]
Affiliation(s)
- Richard Schulz
- Department of Psychiatry, University of Pittsburgh, Pittsburgh.
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18
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Abendstern M, Davies K, Chester H, Clarkson P, Hughes J, Sutcliffe C, Poland F, Challis D. Applying a new concept of embedding qualitative research: an example from a quantitative study of carers of people in later stage dementia. BMC Geriatr 2019; 19:227. [PMID: 31438867 PMCID: PMC6704652 DOI: 10.1186/s12877-019-1240-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 07/31/2019] [Indexed: 01/09/2023] Open
Abstract
Background Qualitative methods are increasingly included in larger studies to provide a richer understanding of people’s experience. This paper explores the potential of using a novel approach to embedded qualitative design as part of an observational study examining the effectiveness of home support for people in later stage dementia in England. The method involved collecting and analysing unsolicited conversational comments made by participants as they completed standardised measures. An evaluation of the method is presented using the voices of participants to illustrate its potential. Methods The conversations of 17 carers recruited to an observational study were audio recorded to gather commentary made while completing a structured interview. Data were interrogated using thematic analysis to investigate the feasibility of conducting an embedded qualitative study, the potential richness of the material and participants’ reactions to formal questioning and participating in research. Results The findings revealed that qualitative data were available from this approach. Analysis generated three themes from carers: conflicting carer emotions; the importance of maintaining normality and agency within day-to-day life; and tensions between these desires and making use of formal services. Important issues for carers were revealed establishing the benefit of using the method. The advantages of exploiting unsolicited conversation included enhancing understanding of people’s lived experience, reducing participant burden in research and easing the process of data collection. In addition, it provided an opportunity to evaluate individuals’ experience of the research process. Conclusions The findings demonstrate how unsolicited comments during structured interviews may appear incidental but can reveal important aspects of living with dementia. The method also emphasised methodological challenges for research in dementia, including the influence and impact of the research context. Further research is required to evaluate the method with other groups including people with dementia themselves. Electronic supplementary material The online version of this article (10.1186/s12877-019-1240-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michele Abendstern
- Personal Social Services Research Unit, University of Manchester, Manchester, UK.
| | - Karen Davies
- Personal Social Services Research Unit, University of Manchester, Manchester, UK
| | - Helen Chester
- School of Biological Sciences, University of Manchester, Manchester, UK
| | - Paul Clarkson
- Personal Social Services Research Unit, University of Manchester, Manchester, UK
| | - Jane Hughes
- Formerly Personal Social Services Research Unit, University of Manchester, Manchester, UK
| | - Caroline Sutcliffe
- Personal Social Services Research Unit, University of Manchester, Manchester, UK
| | - Fiona Poland
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - David Challis
- Institute of Mental Health, University of Nottingham, Nottingham, UK
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19
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Giebel CM, Worden A, Challis D, Jolley D, Bhui KS, Lambat A, Kampanellou E, Purandare N. Age, memory loss and perceptions of dementia in South Asian ethnic minorities. Aging Ment Health 2019; 23:173-182. [PMID: 29206481 DOI: 10.1080/13607863.2017.1408772] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND South Asian older adults are represented less frequently in mainstream mental health services or those for people with dementia. This study aimed to explore in detail the perceptions of dementia (symptoms, causes, consequences, treatments) held by South Asians and to discern how these understandings vary by age and by the self-recognition of memory problems, as these influence help-seeking behaviour. METHODS Participants were allocated to three groups: younger adults; older adults; and older adults with subjective memory problems. They completed the semi-structured Barts Explanatory Model Inventory for Dementia schedule, whilst older adults also completed measures of cognition (MMSE), and depression (GDS). Interviews were conducted in English, Gujarati or Urdu. RESULTS Groups were similar in identifying unusual forgetting and confusion as the most frequent symptoms; stress and age as the most frequent causes; and talking to your GP/nurse, taking medication, and talking to family and friends as the most frequent treatments. Younger adults more often knew about risk factors and reported practical consequences more than older adults. Older adults with subjective memory problems were more likely to describe sleep related problems or symptoms commonly associated with depression. They more often cited as causes of dementia lack of sleep, side effects of medication and medical reasons, and mentioned religion as a means to cope. CONCLUSIONS Findings highlight variability in perceptions of dementia across the South Asian Community and identify specific areas where dementia awareness could be raised in South Asian sub-groups to improve timely diagnosis, treatment outcomes and service access.
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Affiliation(s)
- Clarissa M Giebel
- a Division of Neuroscience and Experimental Psychology , The University of Manchester , Manchester , UK.,b Personal Social Services Research Unit , The University of Manchester , Manchester , UK
| | - Angela Worden
- b Personal Social Services Research Unit , The University of Manchester , Manchester , UK
| | - David Challis
- b Personal Social Services Research Unit , The University of Manchester , Manchester , UK
| | - David Jolley
- b Personal Social Services Research Unit , The University of Manchester , Manchester , UK
| | - Kamaldeep Singh Bhui
- c Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London , London , UK
| | | | - Eleni Kampanellou
- b Personal Social Services Research Unit , The University of Manchester , Manchester , UK
| | - Nitin Purandare
- a Division of Neuroscience and Experimental Psychology , The University of Manchester , Manchester , UK
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Kampanellou E, Chester H, Davies L, Davies S, Giebel C, Hughes J, Challis D, Clarkson P. Carer preferences for home support services in later stage dementia. Aging Ment Health 2019; 23:60-68. [PMID: 29090948 DOI: 10.1080/13607863.2017.1394441] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To examine the relative importance of different home support attributes from the perspective of carers of people with later-stage dementia. METHOD Preferences from 100 carers, recruited through carers' organisations, were assessed with a Discrete Choice Experiment (DCE) survey, administered online and by paper questionnaire. Attributes were informed by an evidence synthesis and lay consultations. A conditional logit model was used to estimate preference weights for the attributes within a home support 'package'. RESULTS The most preferred attributes were 'respite care, available regularly to fit your needs' (coefficient 1.29, p = < 0.001) and 'home care provided regularly for as long as needed' (coefficient 0.93, p = < 0.001). Cost had a significant effect with lower cost packages preferred. Findings were similar regardless of the method of administration, with respite care considered to be the most important attribute for all carers. Carers reported that completing the DCE had been a positive experience; however, feedback was mixed overall. CONCLUSIONS These carer preferences concur with emerging evidence on home support interventions for dementia. Respite care, home care and training on managing difficulties provided at home are important components. Carers' preferences revealed the daily challenges of caring for individuals with later stage dementia and the need for tailored and specialised home support.
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Affiliation(s)
- Eleni Kampanellou
- a Personal Social Services Research Unit, Division of Population Health, Health Services Research and Primary Care , University of Manchester , Manchester , UK
| | - Helen Chester
- a Personal Social Services Research Unit, Division of Population Health, Health Services Research and Primary Care , University of Manchester , Manchester , UK
| | - Linda Davies
- b Centre For Health Economics, Division of Population Health, Health Services Research and Primary Care , University of Manchester , Manchester , UK
| | - Sue Davies
- a Personal Social Services Research Unit, Division of Population Health, Health Services Research and Primary Care , University of Manchester , Manchester , UK
| | - Clarissa Giebel
- a Personal Social Services Research Unit, Division of Population Health, Health Services Research and Primary Care , University of Manchester , Manchester , UK
| | - Jane Hughes
- a Personal Social Services Research Unit, Division of Population Health, Health Services Research and Primary Care , University of Manchester , Manchester , UK
| | - David Challis
- a Personal Social Services Research Unit, Division of Population Health, Health Services Research and Primary Care , University of Manchester , Manchester , UK
| | - Paul Clarkson
- a Personal Social Services Research Unit, Division of Population Health, Health Services Research and Primary Care , University of Manchester , Manchester , UK
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Ahmed S, Hughes J, Davies S, Stewart K, Orrell M, Clarkson P, Challis D. Specialist services in early diagnosis and support for older people with dementia in England: Staff roles and service mix. Int J Geriatr Psychiatry 2018; 33:1280-1285. [PMID: 29932255 DOI: 10.1002/gps.4925] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 05/08/2018] [Indexed: 11/05/2022]
Abstract
OBJECTIVES This study investigated staff roles and tasks in Community Mental Health Teams (CMHT) and memory clinics, which are provided within a framework determined by local Clinical Commissioning Groups. METHODS A cross-sectional survey design was used to collect data in England in 2015. Teams were identified by mental health providers (n = 68) and invited to complete a questionnaire. RESULTS Fifty-one NHS Trusts responded to the request. The response rate varied. Data were obtained for all Clinical Commissioning Groups areas in 3 of the 9 regions in England, but only half in one of them. CMHTs were significantly more likely to have larger staff groups. Compared with memory clinics they were also more likely to have staff that were not professionally qualified. The occupational therapist role showed a strong association with the provision of all services in CMHTs. Both CMHTs and memory clinics provided information and advice about dementia. CMHTs provided more services associated with the support of a person with dementia at home. CONCLUSION Variations in the staff mix in CMHTs and memory clinics reflected their different functions. There was limited evidence in both of profession specific interventions relating to the provision of support, information, therapy and education, associated with either diagnosis or long-term support. The potential for a single service to undertake both diagnostic and long-term support and the associated costs and benefits are areas for future research.
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Affiliation(s)
- Saima Ahmed
- Personal Social Services Research Unit (PSSRU), The University of Manchester, Manchester, UK
| | - Jane Hughes
- Personal Social Services Research Unit (PSSRU), The University of Manchester, Manchester, UK
| | - Sue Davies
- Personal Social Services Research Unit (PSSRU), The University of Manchester, Manchester, UK
| | - Karen Stewart
- Personal Social Services Research Unit (PSSRU), The University of Manchester, Manchester, UK
| | - Martin Orrell
- The University of Nottingham, Institute of Mental Health, Nottingham, UK
| | - Paul Clarkson
- Personal Social Services Research Unit (PSSRU), The University of Manchester, Manchester, UK
| | - David Challis
- Personal Social Services Research Unit (PSSRU), The University of Manchester, Manchester, UK
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Clarkson P, Hughes J, Roe B, Giebel CM, Jolley D, Poland F, Abendstern M, Chester H, Challis D. Systematic review: Effective home support in dementia care, components and impacts - Stage 2, effectiveness of home support interventions. J Adv Nurs 2017; 74:507-527. [DOI: 10.1111/jan.13460] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2017] [Indexed: 01/20/2023]
Affiliation(s)
- Paul Clarkson
- Personal Social Services Research Unit; Division of Population Health; Health Services Research and Primary Care; School of Health Sciences; Faculty of Biology, Medicine and Health; University of Manchester; Manchester Academic Health Science Centre; Manchester UK
| | - Jane Hughes
- Personal Social Services Research Unit; Division of Population Health; Health Services Research and Primary Care; School of Health Sciences; Faculty of Biology, Medicine and Health; University of Manchester; Manchester Academic Health Science Centre; Manchester UK
| | - Brenda Roe
- Faculty of Health & Social Care; Evidence-based Practice Research Centre; Edge Hill University; Ormskirk UK
| | - Clarissa M. Giebel
- Personal Social Services Research Unit; Division of Population Health; Health Services Research and Primary Care; School of Health Sciences; Faculty of Biology, Medicine and Health; University of Manchester; Manchester Academic Health Science Centre; Manchester UK
| | - David Jolley
- Personal Social Services Research Unit; Division of Population Health; Health Services Research and Primary Care; School of Health Sciences; Faculty of Biology, Medicine and Health; University of Manchester; Manchester Academic Health Science Centre; Manchester UK
| | - Fiona Poland
- School of Health Sciences; University of East Anglia; Norwich UK
| | - Michele Abendstern
- Personal Social Services Research Unit; Division of Population Health; Health Services Research and Primary Care; School of Health Sciences; Faculty of Biology, Medicine and Health; University of Manchester; Manchester Academic Health Science Centre; Manchester UK
| | - Helen Chester
- Personal Social Services Research Unit; Division of Population Health; Health Services Research and Primary Care; School of Health Sciences; Faculty of Biology, Medicine and Health; University of Manchester; Manchester Academic Health Science Centre; Manchester UK
| | - David Challis
- Personal Social Services Research Unit; Division of Population Health; Health Services Research and Primary Care; School of Health Sciences; Faculty of Biology, Medicine and Health; University of Manchester; Manchester Academic Health Science Centre; Manchester UK
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Clarkson P, Hughes J, Xie C, Larbey M, Roe B, Giebel CM, Jolley D, Challis D. Overview of systematic reviews: Effective home support in dementia care, components and impacts-Stage 1, psychosocial interventions for dementia. J Adv Nurs 2017. [DOI: 10.1111/jan.13362] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Paul Clarkson
- Personal Social Services Research Unit; Division of Population Health; Health Services Research and Primary Care; School of Health Sciences; Faculty of Biology; Medicine and Health; University of Manchester; Manchester Academic Health Science Centre; Manchester UK
| | - Jane Hughes
- Personal Social Services Research Unit; Division of Population Health; Health Services Research and Primary Care; School of Health Sciences; Faculty of Biology; Medicine and Health; University of Manchester; Manchester Academic Health Science Centre; Manchester UK
| | - Chengqiu Xie
- Personal Social Services Research Unit; Division of Population Health; Health Services Research and Primary Care; School of Health Sciences; Faculty of Biology; Medicine and Health; University of Manchester; Manchester Academic Health Science Centre; Manchester UK
| | - Matthew Larbey
- Personal Social Services Research Unit; Division of Population Health; Health Services Research and Primary Care; School of Health Sciences; Faculty of Biology; Medicine and Health; University of Manchester; Manchester Academic Health Science Centre; Manchester UK
| | - Brenda Roe
- Personal Social Services Research Unit; Division of Population Health; Health Services Research and Primary Care; School of Health Sciences; Faculty of Biology; Medicine and Health; University of Manchester; Manchester Academic Health Science Centre; Manchester UK
- Evidence-based Practice Research Centre; Faculty of Health & Social Care; Edge Hill University; Ormskirk UK
| | - Clarissa M. Giebel
- Personal Social Services Research Unit; Division of Population Health; Health Services Research and Primary Care; School of Health Sciences; Faculty of Biology; Medicine and Health; University of Manchester; Manchester Academic Health Science Centre; Manchester UK
- School of Health Sciences; University of East Anglia; Norwich UK
| | - David Jolley
- Personal Social Services Research Unit; Division of Population Health; Health Services Research and Primary Care; School of Health Sciences; Faculty of Biology; Medicine and Health; University of Manchester; Manchester Academic Health Science Centre; Manchester UK
| | - David Challis
- Personal Social Services Research Unit; Division of Population Health; Health Services Research and Primary Care; School of Health Sciences; Faculty of Biology; Medicine and Health; University of Manchester; Manchester Academic Health Science Centre; Manchester UK
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Evaluating the effectiveness of different approaches to home support for people in later stage dementia: a protocol for an observational study. Int Psychogeriatr 2017; 29:1213-1221. [PMID: 28266281 DOI: 10.1017/s1041610217000291] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Dementia is a major health problem with a growing number of people affected by the condition, both directly and indirectly through caring for someone with dementia. Many live at home but little is known about the range and intensity of the support they receive. Previous studies have mainly reported on discrete services within a single geographical area. This paper presents a protocol for study of different services across several sites in England. The aim is to explore the presence, effects, and cost-effectiveness of approaches to home support for people in later stage dementia and their carers. METHODS This is a prospective observational study employing mixed methods. At least 300 participants (people with dementia and their carers) from geographical areas with demonstrably different ranges of services available for people with dementia will be selected. Within each area, participants will be recruited from a range of services. Participants will be interviewed on two occasions and data will be collected on their characteristics and circumstances, quality of life, carer health and burden, and informal and formal support for the person with dementia. The structured interviews will also collect qualitative data to explore the perceptions of older people and carers. CONCLUSIONS This national study will explore the components of appropriate and effective home support for people with late stage dementia and their carers. It aims to inform commissioners and service providers across health and social care.
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