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Chen HL, Li C, Wang J, Fei Y, Min M, Zhao Y, Shan EF, Yin YH, Liu CY, Li XW. Non-Pharmacological Interventions for Feeding and Eating Disorders in Persons with Dementia: Systematic Review and Evidence Summary. J Alzheimers Dis 2023; 94:67-88. [PMID: 37212096 DOI: 10.3233/jad-221032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND Feeding and eating disorders related to cognitive and psycho-behavioral symptoms are strongly associated with health status in persons with dementia (PWD). Non-pharmacological interventions have been the priority selection to address this significant issue. However, the direct targets of non-pharmacological interventions are unclear and there is no consistent evidence of recommendations on the intervention of different dementia stages and the settings of intervention practice. OBJECTIVE To provide caregivers with a set of self-help non-pharmacological interventions for feeding and eating disorders in PWD. METHODS Based on the process of evidence summary, a systematic literature search was performed on dementia websites and seven databases. Two researchers screened the studies independently and appraise the quality. The evidence was graded by Joanna Briggs Institute Grades of Recommendation. RESULTS Twenty-eight articles were included. Twenty-three non-pharmacological intervention recommendations were categorized into six themes containing oral nutritional supplementation, assistance with eating and drinking, person-centered mealtime care, environmental modification, education or training, and multi-component intervention. These interventions corresponded to three direct targets including improving engagement, making up for loss ability, and increasing food intake directly. They were applied to different stages of dementia and most interventions were targeted at PWD in long-term care institutions. CONCLUSION This article summarized the direct targets and the specific implementation of recommendations at different stages of dementia to provide caregivers with self-help non-pharmacological interventions. The practice of recommendations was more applicable to institutionalized PWD. When applied to PWD at home, caregivers need to identify the specific feeding and eating conditions at different stages and adopted the interventions in conjunction with the wishes of the PWD and professional advice.
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Affiliation(s)
- Hong-Li Chen
- School of Nursing, Nanjing Medical University, Nanjing, PR China
| | - Cheng Li
- School of Nursing, Nanjing Medical University, Nanjing, PR China
| | - Jing Wang
- School of Nursing, Nanjing Medical University, Nanjing, PR China
| | - Yang Fei
- School of Nursing, Nanjing Medical University, Nanjing, PR China
| | - Min Min
- Landsea Long-term Care Facility, Nanjing, PR China
| | - Yue Zhao
- School of Nursing, Nanjing Medical University, Nanjing, PR China
| | - En-Fang Shan
- School of Nursing, Nanjing Medical University, Nanjing, PR China
| | - Yue-Heng Yin
- School of Nursing, Nanjing Medical University, Nanjing, PR China
| | - Chong-Yuan Liu
- Center of Clinical Reproductive Medicine, The NMU First Affiliated Hospital, Nanjing Medical University, Nanjing, PR China
| | - Xian-Wen Li
- School of Nursing, Nanjing Medical University, Nanjing, PR China
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Esquer Rochin MA, Gutierrez-Garcia JO, Rosales JH, Rodriguez LF. Design and evaluation of a dashboard to support the comprehension of the progression of patients with dementia in day centers. Int J Med Inform 2021; 156:104617. [PMID: 34710725 DOI: 10.1016/j.ijmedinf.2021.104617] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 09/17/2021] [Accepted: 10/09/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND OBJECTIVE In day centers, people with dementia are assigned to specific groups to receive care according to the progression of the disease. This article presents the design and evaluation of a dashboard aimed at facilitating the comprehension of the progression of people with dementia to support decision-making of healthcare professionals (HCPs) when determining patient-group assignment. MATERIALS AND METHOD A participatory design methodology was followed to build the dashboard. The grounded theory methodology was utilized to identify requirements. A total of 8 HCPs participated in the design and evaluation of a low-fidelity prototype. The perceived usefulness and perceived ease of use of the high-fidelity prototype was evaluated by 15 HCPs (from several day centers) and 38 psychology students utilizing a questionnaire based on the technology acceptance model. RESULTS HCPs perceived the dashboard as extremely likely to be useful (Mdn=6.5 out of 7) and quite likely to be usable (Mdn=6 out of 7). Psychology students perceived the dashboard as quite likely to be useful and usable (both with Mdn=6). CONCLUSIONS Making use of a participatory design helped foster in HCPs a sense of ownership of the dashboard, thus facilitating its acceptance. The creation of low-fidelity and high-fidelity prototypes led to identifying valuable, timely, and specific feedback at different stages of the development process as well as to establishing a set of lessons learned for the development of dashboards in the healthcare domain.
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Huddles and their effectiveness at the frontlines of clinical care: a scoping review. J Gen Intern Med 2021; 36:2772-2783. [PMID: 33559062 PMCID: PMC8390736 DOI: 10.1007/s11606-021-06632-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/17/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Brief, stand-up meetings known as huddles may improve clinical care, but knowledge about huddle implementation and effectiveness at the frontlines is fragmented and setting specific. This work provides a comprehensive overview of huddles used in diverse health care settings, examines the empirical support for huddle effectiveness, and identifies knowledge gaps and opportunities for future research. METHODS A scoping review was completed by searching the databases PubMed, EBSCOhost, ProQuest, and OvidSP for studies published in English from inception to May 31, 2019. Eligible studies described huddles that (1) took place in a clinical or medical setting providing health care patient services, (2) included frontline staff members, (3) were used to improve care quality, and (4) were studied empirically. Two reviewers independently screened abstracts and full texts; seven reviewers independently abstracted data from full texts. RESULTS Of 2,185 identified studies, 158 met inclusion criteria. The majority (67.7%) of studies described huddles used to improve team communication, collaboration, and/or coordination. Huddles positively impacted team process outcomes in 67.7% of studies, including improvements in efficiency, process-based functioning, and communication across clinical roles (64.4%); situational awareness and staff perceptions of safety and safety climate (44.6%); and staff satisfaction and engagement (29.7%). Almost half of studies (44.3%) reported huddles positively impacting clinical care outcomes such as patients receiving timely and/or evidence-based assessments and care (31.4%); decreased medical errors and adverse drug events (24.3%); and decreased rates of other negative outcomes (20.0%). DISCUSSION Huddles involving frontline staff are an increasingly prevalent practice across diverse health care settings. Huddles are generally interdisciplinary and aimed at improving team communication, collaboration, and/or coordination. Data from the scoping review point to the effectiveness of huddles at improving work and team process outcomes and indicate the positive impact of huddles can extend beyond processes to include improvements in clinical outcomes. STUDY REGISTRATION This scoping review was registered with the Open Science Framework on 18 January 2019 ( https://osf.io/bdj2x/ ).
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Manis DR, Rahim A, Poss JW, Bielska IA, Bronskill SE, Tarride JÉ, Abelson J, Costa AP. Do assisted living facilities that offer a dementia care program differ from those that do not? A population-level cross-sectional study in Ontario, Canada. BMC Geriatr 2021; 21:463. [PMID: 34399694 PMCID: PMC8365888 DOI: 10.1186/s12877-021-02400-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/24/2021] [Indexed: 02/23/2023] Open
Abstract
Background Many residents of assisted living facilities live with dementia, but little is known about the characteristics of assisted living facilities that provide specialized care for older adults who live with dementia. In this study, we identify the characteristics of assisted living facilities that offer a dementia care program, compared to those that do not offer such a program. Methods We conducted a population-level cross-sectional study on all licensed assisted living facilities in Ontario, Canada in 2018 (n = 738). Facility-level characteristics (e.g., resident and suite capacities, etc.) and the provision of the other 12 provincially regulated care services (e.g., pharmacist and medical services, skin and wound care, etc.) attributed to assisted living facilities were examined. Multivariable Poisson regression with robust standard errors was used to model the characteristics of assisted living facilities associated with the provision of a dementia care program. Results There were 123 assisted living facilities that offered a dementia care program (16.7% versus 83.3% no dementia care). Nearly half of these facilities had a resident capacity exceeding 140 older adults (44.7% versus 21.6% no dementia care) and more than 115 suites (46.3% versus 20.8% no dementia care). All assisted living facilities that offered a dementia care program also offered nursing services, meals, assistance with bathing and hygiene, and administered medications. After adjustment for facility characteristics and other provincially regulated care services, the prevalence of a dementia care program was nearly three times greater in assisted living facilities that offered assistance with feeding (Prevalence Ratio [PR] 2.91, 95% Confidence Interval [CI] 1.98 to 4.29), and almost twice as great among assisted living facilities that offered medical services (PR 1.78, 95% CI 1.00 to 3.17), compared to those that did not. Conclusions A dementia care program was more prevalent in assisted living facilities that housed many older adults, had many suites, and offered at least five of the other 12 regulated care services. Our findings deepen the understanding of specialized care for dementia in assisted living facilities. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02400-w.
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Affiliation(s)
- Derek R Manis
- Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main St W, CRL-201, Hamilton, ON, L8S 4K1, Canada. .,Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, CRL-201, Hamilton, ON, L8S 4K1, Canada. .,ICES, Toronto, Ontario, Canada.
| | | | - Jeffrey W Poss
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Iwona A Bielska
- Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main St W, CRL-201, Hamilton, ON, L8S 4K1, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, CRL-201, Hamilton, ON, L8S 4K1, Canada
| | - Susan E Bronskill
- ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada.,Women's College Research Institute, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Jean-Éric Tarride
- Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main St W, CRL-201, Hamilton, ON, L8S 4K1, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, CRL-201, Hamilton, ON, L8S 4K1, Canada
| | - Julia Abelson
- Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main St W, CRL-201, Hamilton, ON, L8S 4K1, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, CRL-201, Hamilton, ON, L8S 4K1, Canada
| | - Andrew P Costa
- Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main St W, CRL-201, Hamilton, ON, L8S 4K1, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, CRL-201, Hamilton, ON, L8S 4K1, Canada.,ICES, Toronto, Ontario, Canada.,Centre for Integrated Care, St. Joseph's Health System, Hamilton, Ontario, Canada.,Schlegel Research Institute for Aging, Waterloo, Ontario, Canada.,Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Association Between Dementia Care Programs in Assisted Living Facilities and Transitions to Nursing Homes in Ontario, Canada: A Population-Based Cohort Study. J Am Med Dir Assoc 2021; 22:2115-2120.e6. [PMID: 34352202 DOI: 10.1016/j.jamda.2021.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/25/2021] [Accepted: 07/08/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE We investigate whether older adults who were newly diagnosed with dementia (severity unspecified) and resided in an assisted living facility that offered a dementia care program had a lower rate of transition to a nursing home, compared to those who resided in an assisted living facility without such a program. DESIGN Population-based retrospective cohort study. SETTING AND PARTICIPANTS Linked, person-level health system administrative data on older adults who were newly diagnosed with dementia and resided in an assisted living facility in Ontario, Canada, from 2014 to 2019 (n = 977). METHODS Access to a dementia care program in an assisted living facility (n = 57) was examined. Multivariable Cox proportional hazards regression with robust standard errors clustered on the assisted living facility was used to model the time to transition to a nursing home from the new dementia diagnosis. RESULTS There were 11.8 transitions to a nursing home per 100 person-years among older adults who resided in an assisted living facility with a dementia care program, compared with 20.5 transitions to a nursing home per 100 person-years among older adults who resided in an assisted living facility without a dementia care program. After adjustment for relevant characteristics at baseline, older adults who resided in an assisted living facility with a dementia care program had a 40% lower rate of transition to a nursing home (hazard ratio 0.60, 95% confidence interval 0.44, 0.81), compared with those in an assisted living facility without such a program at any point during the follow-up period. CONCLUSIONS AND IMPLICATIONS The rate of transition to a nursing home was significantly lower among older adults who resided in an assisted living facility that offered a dementia care program. These findings support the expansion of dementia care programs in assisted living facilities.
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