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Nguyen TX, Nguyen AHP, Nguyen HTT, Nguyen TTH, Nguyen HL, Goldberg RJ, Thillainadesan J, Naganathan V, Vu HTT, Tran LV, Nguyen AT. Health-Related Quality of Life among Older Adults with Dementia Living in Vietnamese Nursing Homes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:135. [PMID: 38397626 PMCID: PMC10888023 DOI: 10.3390/ijerph21020135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/18/2024] [Accepted: 01/21/2024] [Indexed: 02/25/2024]
Abstract
Better understanding of the quality of life among nursing home residents with dementia is important for developing interventions. The objectives of this cross-sectional study were to examine factors associated with poor health-related quality of life in older people with dementia living in nursing homes in Hanoi, Vietnam. In-person interviews were conducted with 140 adults who were 60 years and older with dementia, and information about their quality of life was obtained using the Quality of Life in Alzheimer's Disease (QOL-AD) scale. The sociodemographic and clinical factors associated with poor health-related quality of life (lowest quartile) were assessed through the results of physical tests, interviews with nursing home staff, and review of medical records. The average age of the study sample was 78.3 years, 65% were women, and their average QOL-AD total score was 27.3 (SD = 4.4). Malnutrition, total dependence in activities of daily living, and urinary incontinence were associated with poor quality of life after controlling for multiple potentially confounding factors. Our findings show that Vietnamese nursing home residents with dementia have a moderate total quality of life score, and interventions based on comprehensive geriatric assessment remain needed to modify risk factors related to poor health-related quality of life.
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Affiliation(s)
- Thanh Xuan Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi 100000, Vietnam; (H.T.T.N.); (T.T.H.N.); (H.T.T.V.); (A.T.N.)
- National Geriatric Hospital, Hanoi 100000, Vietnam;
| | - Anh Huynh Phuong Nguyen
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam;
| | - Huong Thi Thu Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi 100000, Vietnam; (H.T.T.N.); (T.T.H.N.); (H.T.T.V.); (A.T.N.)
- National Geriatric Hospital, Hanoi 100000, Vietnam;
| | - Thu Thi Hoai Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi 100000, Vietnam; (H.T.T.N.); (T.T.H.N.); (H.T.T.V.); (A.T.N.)
- National Geriatric Hospital, Hanoi 100000, Vietnam;
| | - Hoa Lan Nguyen
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA 01655, USA; (H.L.N.); (R.J.G.)
| | - Robert Joel Goldberg
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA 01655, USA; (H.L.N.); (R.J.G.)
| | - Janani Thillainadesan
- Department of Geriatric Medicine, Centre for Education and Research on Ageing (CERA), Concord Hospital, Sydney, NSW 2139, Australia; (J.T.); (V.N.)
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Vasi Naganathan
- Department of Geriatric Medicine, Centre for Education and Research on Ageing (CERA), Concord Hospital, Sydney, NSW 2139, Australia; (J.T.); (V.N.)
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Huyen Thi Thanh Vu
- Department of Geriatrics, Hanoi Medical University, Hanoi 100000, Vietnam; (H.T.T.N.); (T.T.H.N.); (H.T.T.V.); (A.T.N.)
- National Geriatric Hospital, Hanoi 100000, Vietnam;
| | - Luc Viet Tran
- National Geriatric Hospital, Hanoi 100000, Vietnam;
- Neurology Department, Hanoi Medical University, Hanoi 100000, Vietnam
| | - Anh Trung Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi 100000, Vietnam; (H.T.T.N.); (T.T.H.N.); (H.T.T.V.); (A.T.N.)
- National Geriatric Hospital, Hanoi 100000, Vietnam;
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Sya'diyah H, Nursalam N, Mahmudah M, Efendy F. Structural Model of Family Caregiver for Elderly with Dementia. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2023; 28:730-734. [PMID: 38205406 PMCID: PMC10775866 DOI: 10.4103/ijnmr.ijnmr_249_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 06/03/2023] [Accepted: 07/03/2023] [Indexed: 01/12/2024]
Abstract
Background The number of older people with dementia was continuously increasing globally. Unfortunately, many of them had received inappropriate medical treatment to overcome the dementia they suffered. This current research aimed to analyze the factors that affected family-based caregiver empowerment. Materials and Methods An analytic observational method with a cross-sectional approach was applied. The population was all families with dementia elderly in East Java, Indonesia, in 2021, who met the inclusion and exclusion criteria. The sample size was determined to be 100 respondents. Results The results showed that the factors (i.e., elderly factors, family factors, health service factors, family's filial value, family assessment, and the need for care) had significant effects directly or indirectly on the family's ability to do home care. Conclusions Factors that influenced directly (i.e., elderly factors, family factors, family assessment, and care needs) and indirectly (i.e., health service factors) were essential in constructing a structural model of family care for the elderly with dementia.
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Affiliation(s)
| | | | | | - Ferry Efendy
- Faculty of Nursing, Universitas Airlangga, Indonesia
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Harrison SL, Dyer SM, Laver KE, Milte RK, Fleming R, Crotty M. Physical environmental designs in residential care to improve quality of life of older people. Cochrane Database Syst Rev 2022; 3:CD012892. [PMID: 35253911 PMCID: PMC8900466 DOI: 10.1002/14651858.cd012892.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND The demand for residential aged care is increasing due to the ageing population. Optimising the design or adapting the physical environment of residential aged care facilities has the potential to influence quality of life, mood and function. OBJECTIVES To assess the effects of changes to the physical environment, which include alternative models of residential aged care such as a 'home-like' model of care (where residents live in small living units) on quality of life, behaviour, mood and depression and function in older people living in residential aged care. SEARCH METHODS CENTRAL, MEDLINE, Embase, six other databases and two trial registries were searched on 11 February 2021. Reference lists and grey literature sources were also searched. SELECTION CRITERIA Non-randomised trials, repeated measures or interrupted time series studies and controlled before-after studies with a comparison group were included. Interventions which had modified the physical design of a care home or built a care home with an alternative model of residential aged care (including design alterations) in order to enhance the environment to promote independence and well-being were included. Studies which examined quality of life or outcomes related to quality of life were included. Two reviewers independently assessed the abstracts identified in the search and the full texts of all retrieved studies. DATA COLLECTION AND ANALYSIS Two reviewers independently extracted data, assessed the risk of bias in each included study and evaluated the certainty of evidence according to GRADE criteria. Where possible, data were represented in forest plots and pooled. MAIN RESULTS Twenty studies were included with 77,265 participants, although one large study included the majority of participants (n = 74,449). The main comparison was home-like models of care incorporating changes to the scale of the building which limit the capacity of the living units to smaller numbers of residents and encourage the participation of residents with domestic activities and a person-centred care approach, compared to traditional designs which may include larger-scale buildings with a larger number of residents, hospital-like features such as nurses' stations, traditional hierarchical organisational structures and design which prioritises safety. Six controlled before-after studies compared the home-like model and the traditional environment (75,074 participants), but one controlled before-after study included 74,449 of the participants (estimated on weighting). It is uncertain whether home-like models improve health-related quality of life, behaviour, mood and depression, function or serious adverse effects compared to traditional designs because the certainty of the evidence is very low. The certainty of the evidence was downgraded from low-certainty to very low-certainty for all outcomes due to very serious concerns due to risk of bias, and also serious concerns due to imprecision for outcomes with more than 400 participants. One controlled before-after study examined the effect of home-like models on quality of life. The author stated "No statistically significant differences were observed between the intervention and control groups." Three studies reported on global behaviour (N = 257). One study found little or no difference in global behaviour change at six months using the Neuropsychiatric Inventory where lower scores indicate fewer behavioural symptoms (mean difference (MD) -0.04 (95% confidence interval (CI) -0.13 to 0.04, n = 164)), and two additional studies (N = 93) examined global behaviour, but these were unsuitable for determining a summary effect estimate. Two controlled before-after studies examined the effect of home-like models of care compared to traditional design on depression. After 18 months, one study (n = 242) reported an increase in the rate of depressive symptoms (rate ratio 1.15 (95% CI 1.02 to 1.29)), but the effect of home-like models of care on the probability of no depressive symptoms was uncertain (odds ratio 0.36 (95% CI 0.12 to 1.07)). One study (n = 164) reported little or no difference in depressive symptoms at six months using the Revised Memory and Behaviour Problems Checklist where lower scores indicate fewer depressive symptoms (MD 0.01 (95% CI -0.12 to 0.14)). Four controlled before-after studies examined function. One study (n = 242) reported little or no difference in function over 18 months using the Activities of Daily Living long-form scale where lower scores indicate better function (MD -0.09 (95% CI -0.46 to 0.28)), and one study (n = 164) reported better function scores at six months using the Interview for the Deterioration of Daily Living activities in Dementia where lower scores indicate better function (MD -4.37 (95% CI -7.06 to -1.69)). Two additional studies measured function but could not be included in the quantitative analysis. One study examined serious adverse effects (physical restraints), and reported a slight reduction in the important outcome of physical restraint use in a home-like model of care compared to a traditional design (MD between the home-like model of care and traditional design -0.3% (95% CI -0.5% to -0.1%), estimate weighted n = 74,449 participants at enrolment). The remaining studies examined smaller design interventions including refurbishment without changes to the scale of the building, special care units for people with dementia, group living corridors compared to a non-corridor design, lighting interventions, dining area redesign and a garden vignette. AUTHORS' CONCLUSIONS There is currently insufficient evidence on which to draw conclusions about the impact of physical environment design changes for older people living in residential aged care. Outcomes directly associated with the design of the built environment in a supported setting are difficult to isolate from other influences such as health changes of the residents, changes to care practices over time or different staff providing care across shifts. Cluster-randomised trials may be feasible for studies of refurbishment or specific design components within residential aged care. Studies which use a non-randomised design or cluster-randomised trials should consider approaches to reduce risk of bias to improve the certainty of evidence.
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Affiliation(s)
- Stephanie L Harrison
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, Australia
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, Australia
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK
| | - Suzanne M Dyer
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Kate E Laver
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Rachel K Milte
- Caring futures institute, Flinders University, Adelaide, Australia
| | - Richard Fleming
- School of Science Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Maria Crotty
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, Australia
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Rutten JER, Backhaus R, Tan F, Prins M, van der Roest H, Heijkants C, Hamers JPH, Verbeek H. Work environment and person-centred dementia care in nursing homes-A cross-sectional study. J Nurs Manag 2021; 29:2314-2322. [PMID: 34053141 PMCID: PMC8597031 DOI: 10.1111/jonm.13386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2021] [Indexed: 12/05/2022]
Abstract
Aim This study aims to explore the relationship between work environment, job characteristics and person‐centred care for people with dementia in nursing homes. Background Person‐centred care approaches have become a dominant indicator for good quality of care in nursing homes. Little is known about the relationship between work environment, job characteristics and person‐centred care in nursing homes. Method(s) Cross‐sectional data from the LAD study were used. Direct care staff (n = 552) of nursing homes (n = 49) filled an online questionnaire about work environment characteristics and person‐centred care. To examine relationships, multilevel linear regression analyses were conducted. Results Associations were found between a higher transformational leadership style, less social support from a leader, a higher unity in philosophy of care, higher levels of work satisfaction, more development opportunities, better experienced teamwork and staff‐reported person‐centred care. Conclusion(s) In a complex nursing home environment, person‐centred care is influenced by organisational and work characteristics, shared values and interpersonal relationships. Implications for Nursing Leaders may consider facilitating collaboration and creating unity between care staff, clients and family members in order to provide person‐centred care. Therefore, a transformational leadership style, educational programmes and coaching for leaders are recommended.
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Affiliation(s)
- Johanna E R Rutten
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.,Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Ramona Backhaus
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.,Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Frans Tan
- Department of Methodology and Statistics, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Marleen Prins
- Department on Aging, Netherlands Institute of Mental Health and Addiction (Trimbos-institute), Utrecht, The Netherlands
| | - Henriette van der Roest
- Department on Aging, Netherlands Institute of Mental Health and Addiction (Trimbos-institute), Utrecht, The Netherlands
| | - Ceciel Heijkants
- Department on Aging, Netherlands Institute of Mental Health and Addiction (Trimbos-institute), Utrecht, The Netherlands
| | - Jan P H Hamers
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.,Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Hilde Verbeek
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.,Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
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Prins M, Willemse BM, Heijkants CH, Pot AM. Nursing home care for people with dementia: Update of the design of the Living Arrangements for people with Dementia (LAD)-study. J Adv Nurs 2019; 75:3792-3804. [PMID: 31566778 PMCID: PMC6900200 DOI: 10.1111/jan.14199] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 09/10/2019] [Indexed: 11/29/2022]
Abstract
AIM The aim of the current study is to describe the extended design of the Living Arrangements for people with Dementia (LAD)-study. BACKGROUND The demand for long-term care in care homes increases with the growing number of people with dementia. However, quality of care in care homes needs improvement. It is important to monitor quality of care in care homes for the purposes of conducting scientific research, providing input for policy, and promoting practice improvement. DESIGN The Living Arrangements for people with Dementia -study monitors changes in - quality of - care in care homes since 2008. With its extended design, the Living Arrangements for people with Dementia -study now also focuses on additional topics that are considered to improve quality of care: implementation of person-centred care, involvement of family carers and volunteers and reducing psychotropic drugs and physical restraints using a multidisciplinary approach. METHODS The data collection of the Living Arrangements for people with Dementia -study entails an interview with the manager and questionnaires are completed by care staff, family carers, volunteers, and multidisciplinary team members. This study is partly funded by the Dutch Ministry of Health, Welfare and Sports, grant number 323,088 and partly funded by the participating care homes. DISCUSSION Results of the Living Arrangements for people with Dementia -study will shed more light on variables related to quality of care in care homes for people with dementia. IMPACT Based on the obtained information, appropriate efforts to improve quality of care can be discussed and implemented. Furthermore, the results of this study guide policy making, because it expands knowledge about the effects of changing policies and exposes topics that need further attention. TRIAL REGISTRATION Not applicable. This article does not report the results of a healthcare intervention on human participants.
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Affiliation(s)
- Marleen Prins
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.,Department of Clinical, Neuro & Developmental Psychology, Section Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Bernadette M Willemse
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Ceciel H Heijkants
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Anne Margriet Pot
- Department of Clinical, Neuro & Developmental Psychology, Section Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Optentia, North-West University, Johannesburg, South Africa.,School of Psychology, University of Queensland, Brisbane, Qld., Australia
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