1
|
Sun LL, Zheng L, Chen LL, Wang ZD, Li Q, Liu L. Experiences of formal caregivers of elderly inpatients with physical disabilities in China: a qualitative study. BMC Nurs 2024; 23:392. [PMID: 38849821 PMCID: PMC11157724 DOI: 10.1186/s12912-024-02019-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 05/16/2024] [Indexed: 06/09/2024] Open
Abstract
AIM To explore the views and experiences of formal caregivers caring for older inpatients with physical disabilities. METHODS It was a qualitative phenomenological study. Using purposive sampling, twelve formal caregivers were chosen in a tertiary comprehensive hospital in Hangzhou, China. Semi-structured, face-to-face interviews were conducted, guided by open-ended questions that focused on gaining rich insights into participants' views and experiences. Coding reliability thematic analysis was used to guide data analysis and categorize, based on Lazarus and Folkman's theory of transactional coping. RESULTS Four themes emerged from the data analysis: (1) Caregiving Threats. (2) motivations. (3) Responsibility Management. (4) Fear. CONCLUSION Despite facing significant pressure at work, formal caregivers of elderly inpatients with physical disabilities possess the drive and various coping strategies to excel in their role. Identifying caregivers' experiences of care can be helpful in improving resilience to stress and maintaining stability in formal caregivers.
Collapse
Affiliation(s)
- Li-Li Sun
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310000, China.
| | - Li Zheng
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310000, China
| | - Liu-Liu Chen
- School of Health, Zhuhai College of Science and Technology, Zhuhai, 519000, China
| | - Zhao-di Wang
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310000, China
| | - Qian Li
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310000, China
| | - Li Liu
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310000, China
| |
Collapse
|
2
|
Lowers J, Datcher I, Kavalieratos D, Hepburn K, Perkins MM. Proactive Care-Seeking Strategies Among Adults Aging Solo With Early Dementia: A Qualitative Study. J Gerontol B Psychol Sci Soc Sci 2024; 79:gbae020. [PMID: 38375541 PMCID: PMC11128765 DOI: 10.1093/geronb/gbae020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Indexed: 02/21/2024] Open
Abstract
OBJECTIVES People living with dementia need increasing care over time, but 1 in 3 adults with cognitive impairment lives alone. The goal of this study was to explore the self-identified strengths and resources for future care needs of adults aging solo with early dementia. METHODS Semistructured interviews with 15 adults not living with a partner and with no children in the same state, who self-identified as having early dementia or mild cognitive impairment; hybrid inductive/deductive reflexive thematic analysis using a successful aging framework. RESULTS Participants placed a high value on maintaining independence and expressed concerns about preserving selfhood and becoming a burden to others. These values influenced how participants appraised financial and social resources available to address future care needs and strategies to preempt or respond to needs such as transportation, help with finances, or activities of daily living. DISCUSSION Adults without close family are heterogeneous and have variable resources available to address care needs associated with dementia progression. Common values of retaining independence and minimizing burden to others may be helpful in motivating adults aging solo to undertake planning and help-seeking early.
Collapse
Affiliation(s)
- Jane Lowers
- Department of Family and Preventive Medicine, Emory University, Atlanta, Georgia, USA
| | - Ivree Datcher
- School of Public Health, University of Alabama-Birmingham, Birmingham, Alabama, USA
| | - Dio Kavalieratos
- Department of Family and Preventive Medicine, Emory University, Atlanta, Georgia, USA
| | - Ken Hepburn
- Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Molly M Perkins
- Department of Geriatrics, Emory University, Atlanta, Georgia, USA
| |
Collapse
|
3
|
Quach ED, Franzosa E, Zhao S, Ni P, Hartmann CW, Moo LR. Home and Community-Based Service Use Varies by Health Care Team and Comorbidity Level of Veterans with Dementia. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2024; 67:242-257. [PMID: 37584150 DOI: 10.1080/01634372.2023.2246520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 08/07/2023] [Indexed: 08/17/2023]
Abstract
Home and community-based services (HCBSs) such as home care and adult day centers are vital to supporting adults with dementia in community settings. We investigated whether HCBS use (use of both home care and adult day, use of one service, and use of neither service) varied between adults receiving care from three types of health-care teams with case management from social workers and nurses, and by comorbidity level, using 2019 data of 143,281 patients with dementia in the Veterans Health Administration. We compared HCBS use by patients' type of case-managed team (Home-Based Primary Care, geriatrics-based primary care, and dementia-focused specialty care) to patients in none of these teams, stratified by patients' non-dementia comorbidities (<4 or ≥4). Each type of health-care team was associated with both home care and adult day services, at each level of comorbidity. Home-Based Primary Care was most consistently associated with other forms of HCBS use, followed by Dementia Clinics and geriatrics-based primary care, for patients with ≥4 non-dementia comorbidities. Our findings suggest that case management in primary and specialty care settings is a contributor to the use of critical community supports by patients with the most complex needs.
Collapse
Affiliation(s)
- Emma D Quach
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System (152), Bedford, Massachusetts, USA
- New England Geriatric Research Education and Clinical Center, VA Bedford Healthcare System, Bedford, Massachusetts, USA
- Department of Gerontology, McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Emily Franzosa
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Geriatrics Research, Education, and Clinical Center, James J. Peters VA Medical Center, Bronx, New York, USA
| | - Shibei Zhao
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA
| | - Pengsheng Ni
- Health Law, Policy & Management, Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Christine W Hartmann
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA
- Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Lauren R Moo
- New England Geriatric Research Education and Clinical Center, Bedford, Massachusetts, USA
- Harvard Medical School, Neurology, Boston, Massachusetts, USA
| |
Collapse
|
4
|
Reckrey JM, Kleijwegt H, Morrison RS, Nothelle S, Kelley AS, Ornstein KA. Paid Care for People with Functional Impairment and Serious Illness: Results from the Health and Retirement Study. J Gen Intern Med 2023; 38:3355-3361. [PMID: 37349637 PMCID: PMC10681964 DOI: 10.1007/s11606-023-08262-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 06/02/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Paid caregivers (e.g., home health aides) care for individuals living at home with functional impairment and serious illnesses (health conditions with high risk of mortality that impact function and quality of life). OBJECTIVE To characterize those who receive paid care and identify factors associated with receipt of paid care in the context of serious illness and socioeconomic status. DESIGN Retrospective cohort study. PARTICIPANTS Community-dwelling participants ≥ 65 years enrolled in the Health and Retirement Study (HRS) between 1998 and 2018 with new-onset functional impairment (e.g., bathing, dressing) and linked fee-for-service Medicare claims (n = 2521). MAIN MEASURES Dementia was identified using HRS responses and non-dementia serious illness (e.g., advanced cancer, end-stage renal disease) was identified using Medicare claims. Paid care support was identified using HRS survey report of paid help with functional tasks. KEY RESULTS While about 27% of the sample received paid care, those with both dementia and non-dementia serious illnesses in addition to functional impairment received the most paid care (41.7% received ≥ 40 h of paid care per week). In multivariable models, those with Medicaid were more likely to receive any paid care (p < 0.001), but those in the highest income quartile received more hours of paid care (p = 0.05) when paid care was present. Those with non-dementia serious illness were more likely to receive any paid care (p < 0.001), but those with dementia received more hours of care (p < 0.001) when paid care was present. CONCLUSIONS Paid caregivers play a significant role in meeting the care needs of those with functional impairment and serious illness and high paid care hours are common among those with dementia in particular. Future work should explore how paid caregivers can collaborate with families and healthcare teams to improve the health and well-being of the seriously ill throughout the income spectrum.
Collapse
Affiliation(s)
| | | | | | | | - Amy S Kelley
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Katherine A Ornstein
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Center for Equity in Aging, Johns Hopkins University School of Nursing, Baltimore, MD, USA
| |
Collapse
|
5
|
Boon JT, Herr K, Schirle L, Dietrich MS, Maxwell CA. Caregiving self-efficacy and pain assessment by family caregivers of people living with dementia. Geriatr Nurs 2023; 53:146-152. [PMID: 37540909 PMCID: PMC10530151 DOI: 10.1016/j.gerinurse.2023.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 08/06/2023]
Abstract
Like other older adults, people living with dementia (PLWD) experience pain, and the task of pain assessment often falls to family caregivers. In this study, we surveyed family caregivers of PLWD to determine the frequency with which they use different elements of pain assessment. We also determined correlations of family caregivers' characteristics (caregiving self-efficacy, relationship duration and type, mood, education level, and health literacy) with their use of the elements of pain assessment. Participants reported frequent use of many pain assessment elements. Statistically significant correlations were found between caregiving self-efficacy for obtaining respite and asking others about noticed behavior change (rho=.0.41, p=.007); and for responding to disruptive patient behaviors for multiple pain assessment elements including observing pain behaviors (rho=0.49, p<.001), asking others about noticed behavior change (rho=0.54, p<.001) and rechecking (rho=0.56, p<.001). Continued efforts are needed to describe pain assessments by family caregivers of PLWD.
Collapse
Affiliation(s)
- Jeffrey T Boon
- Vanderbilt University School of Nursing, 461 21st Avenue South, Nashville, TN 37240, USA; Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA.
| | - Keela Herr
- University of Iowa College of Nursing, 50 Newton Road, Iowa City, IA 52242-1121, USA
| | - Lori Schirle
- Vanderbilt University School of Nursing, 461 21st Avenue South, Nashville, TN 37240, USA; Vanderbilt University School of Medicine, 2209 Garland Avenue, Nashville, TN 37240, USA
| | - Mary S Dietrich
- Vanderbilt University School of Nursing, 461 21st Avenue South, Nashville, TN 37240, USA; Vanderbilt University School of Medicine, 2209 Garland Avenue, Nashville, TN 37240, USA
| | - Cathy A Maxwell
- Vanderbilt University School of Nursing, 461 21st Avenue South, Nashville, TN 37240, USA
| |
Collapse
|
6
|
Boon JT, Herr K, Schirle L, Dietrich MS, Maxwell CA. People Living With Dementia: Dementia Characteristics and Family Caregiver Pain Assessment. J Gerontol Nurs 2023; 49:17-23. [PMID: 37379047 DOI: 10.3928/00989134-20230615-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
People living with dementia (PLWD) experience pain like other older adults, but with changes due to dementia, they rely more on family caregivers for pain assessment. Many different elements contribute to a pain assessment. Changes in characteristics of PLWD may be associated with changes in the use of these different pain assessment elements. The current study reports associations between PLWD's agitation, cognitive function, and dementia severity and the frequency with which family caregivers use pain assessment elements. In a sample of family caregivers (N = 48), statistically significant associations were found between worsening cognitive function and greater use of rechecking for pain after intervention (rho = 0.36, p = 0.013), and between lower cognitive scores on a subscale of dementia severity and asking others if they have noticed a behavior change in the PLWD (rho = 0.30, p = 0.044). Limited statistically significant associations suggest that, overall, family caregivers of PLWD do not use pain assessment elements more frequently with changes in characteristics of PLWD. [Journal of Gerontological Nursing, 49(7), 17-23.].
Collapse
|
7
|
Kovaleva MA, Kleinpell R, Dietrich MS, Jones AC, Boon JT, Duggan MC, Dennis BM, Lauderdale J, Maxwell CA. Caregivers’ experience with Tele-Savvy Caregiver Program post-hospitalization. Geriatr Nurs 2023; 51:156-166. [PMID: 36990041 DOI: 10.1016/j.gerinurse.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 02/27/2023] [Accepted: 03/01/2023] [Indexed: 03/30/2023]
Abstract
Despite the frequent hospitalizations and readmissions of persons living with dementia (PLWD), no telehealth transitional care interventions focus on PLWDs' unpaid caregivers. Tele-Savvy Caregiver Program is a 43-day evidence-based online psychoeducational intervention for PLWDs' caregivers. The aim of this formative evaluation was to explore caregivers' acceptability of and experience with their participation in Tele-Savvy after their PLWDs' hospital discharge. Additionally, we gathered caregivers' feedback on the recommended features of a transitional care intervention, suitable for caregivers' schedule and needs post-discharge. Fifteen caregivers completed the interviews. Data were analyzed via conventional content analysis. Four categories were identified: (1) Tele-Savvy improved participants' understanding of dementia and caregiving; (2) hospitalization started a "new level of normal"; (3) PLWDs' health concerns; and (4) transitional care intervention development. Participation in Tele-Savvy was acceptable for most caregivers. Participants' feedback provides content and structural guidance for the development of a new transitional care intervention for PLWDs' caregivers.
Collapse
Affiliation(s)
- Mariya A Kovaleva
- College of Nursing - Omaha Division, University of Nebraska Medical Center, 985330 Nebraska Medical Center, Omaha, NE 68198-5330, USA.
| | - Ruth Kleinpell
- Vanderbilt University School of Nursing, 461 21st Ave S, Nashville, TN 37240, USA
| | - Mary S Dietrich
- Vanderbilt University School of Nursing, 461 21st Ave S, Nashville, TN 37240, USA; Department of Biostatistics, Vanderbilt University School of Medicine, 1161 21st Ave S, #D3300, Nashville, TN 37232, USA
| | - Abigail C Jones
- Vanderbilt University School of Nursing, 461 21st Ave S, Nashville, TN 37240, USA; Yale University School of Nursing, 400 West Campus Drive, Orange, CT 06477, USA
| | - Jeffrey T Boon
- Vanderbilt University School of Nursing, 461 21st Ave S, Nashville, TN 37240, USA; Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN 37232, USA
| | - Maria C Duggan
- Division of Geriatric Medicine, Vanderbilt University School of Medicine, 1161 21st Ave S, #D3300, Nashville, TN 37232, USA; Geriatric Research Education and Clinical Center, Department of Veterans Affairs, Tennessee Valley Healthcare System, 1310 24th Ave South, Nashville, TN 37212-2637, USA
| | - Bradley M Dennis
- Division of Acute Care Surgery, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN 37232, USA
| | - Jana Lauderdale
- Vanderbilt University School of Nursing, 461 21st Ave S, Nashville, TN 37240, USA
| | - Cathy A Maxwell
- Vanderbilt University School of Nursing, 461 21st Ave S, Nashville, TN 37240, USA
| |
Collapse
|
8
|
Fabius CD, Millar R, Geil E, Stockwell I, Diehl C, Johnston D, Gallo JJ, Wolff JL. The Role of Dementia and Residential Service Agency Characteristics in the Care Experiences of Maryland Medicaid Home and Community-Based Service Participants and Family and Unpaid Caregivers. J Appl Gerontol 2023; 42:627-638. [PMID: 36200297 PMCID: PMC9991935 DOI: 10.1177/07334648221128286] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2022] Open
Abstract
In Maryland, residential service agencies deliver Medicaid Home and Community-Based Services (HCBS) to older adults with disabilities through direct care workers (e.g., personal care aides). Leveraging survey data from residential service agency administrators, linked to interRAI Home Care assessments for 1144 participants, we describe agency characteristics, and participant and family caregiver experiences by participant dementia status. Most (61.7%) participants experienced low social engagement, and roughly 10.0% experienced a hospitalization or emergency room visit within 90 days. Few (14.4%) participants were served by agencies requiring dementia-specific direct care worker training, and most were served by agencies offering supplemental services, or in which direct care workers helped with health information technology (81.2% and 72.8%, respectively). Few caregivers reported negative care experiences. Participants with dementia and those served by agencies with training and support more often reported negative care experiences. Findings lay the foundation for future longitudinal and embedded interventions within Medicaid HCBS.
Collapse
Affiliation(s)
- Chanee D Fabius
- 25802Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Erick Geil
- 51575The Hilltop Institute, Baltimore, MD, USA
| | | | | | | | - Joseph J Gallo
- 25802Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jennifer L Wolff
- 25802Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
9
|
Reckrey JM, Perez S, Watman D, Ornstein KA, Russell D, Franzosa E. The Need for Stability in Paid Dementia Care: Family Caregiver Perspectives. J Appl Gerontol 2023; 42:607-616. [PMID: 35512123 PMCID: PMC9636070 DOI: 10.1177/07334648221097692] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Paid caregivers (e.g., home health aides, home care workers) provide essential care to people with dementia living at home; this study explored family caregiver perspectives on the role and impact of paid caregivers in home-based dementia care. We conducted semi-structured interviews with family caregivers (n = 15) of people with advanced dementia who received long-term paid care at home in New York between October 2020 and December 2020. We found that given the vulnerability resulting from advanced dementia, family caregivers prioritized finding the "right" paid caregivers and valued continuity in the individual providing care. The stable paid care that resulted improved outcomes for both the person with advanced dementia (e.g., eating better) and their family (e.g., ability to work). Those advocating for high quality, person-centered dementia care should partner with policymakers and home care agencies to promote the stability of well-matched paid caregivers for people with advanced dementia living at home.
Collapse
Affiliation(s)
| | - Sasha Perez
- 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Deborah Watman
- 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | - Emily Franzosa
- 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA.,20071James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
| |
Collapse
|
10
|
Roche-Dean M, Baik S, Moon H, Coe NB, Oh A, Zahodne LB. Paid Care Services and Transitioning out of the Community Among Black and White Older Adults With Dementia. J Gerontol B Psychol Sci Soc Sci 2023; 78:S91-S100. [PMID: 36075074 PMCID: PMC10010476 DOI: 10.1093/geronb/gbac117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Paid care provided in the home includes important support services for older adults with dementia such as cleaning and personal care assistance. By reducing unmet needs, these services could delay the transition to residential long-term care, but access may differ across racial groups. This study examined the relationship between paid care and transitioning out of the community among Black and White older adults with dementia. METHODS Using data from 303 participants (29.4% Black) with probable dementia in the 2011 National Health and Aging Trends Study, competing risk hazards models estimated the association between receiving paid care at baseline and the probability of transitioning out of the community over 8 years (through 2019). Covariate selection was guided by the Andersen model of health care utilization. RESULTS Paid care was associated with lower risk of transitioning out of the community (subhazard ratios [SHR] = 0.70, 95% CI [0.50, 0.98]). This effect was similar after controlling for predisposing factors and most prominent after controlling for enabling and need for services factors (SHR = 0.65, 95% CI [0.44, 0.95]). There was no racial difference in the use of paid care despite evidence of greater care needs in Blacks. Furthermore, Black participants were less likely to transition out of the community than Whites. DISCUSSION Paid care services may help delay transitions out of the community. Future research should seek to explain racial differences in access to and/or preferences for home-based, community-based, and residential care.
Collapse
Affiliation(s)
- Maria Roche-Dean
- Bronson School of Nursing, Western Michigan University, 1903 West Michigan Avenue, Kalamazoo, MI 49008-5345, USA
| | - Sol Baik
- University of Virginia Weldon Cooper Center for Public Service, University of Virginia, 2400 Old Ivy Rd, Charlottesville, VA 22903, USA
| | - Heehyul Moon
- Kent School of Social Work and Family Science, University of Louisville, 2217 S. 3rd st., Louisville, KY 40292, USA
| | - Norma B Coe
- Department of Medical Ethics and Health Policy, University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA 19104, USA
| | - Anna Oh
- San Francisco VA Health Care System, 4150 Clement Street, San Francisco, CA 94121, USA
- Department of Social and Behavioral Sciences, University of California San Francisco, 490 Illinois St., Floor 12 San Francisco, CA 94143, USA
| | - Laura B Zahodne
- Department of Psychology, University of Michigan, 530 Church Street, Ann Arbor, MI 48109, USA
| |
Collapse
|
11
|
Federman AD, Brody A, Ritchie CS, Egorova N, Arora A, Lubetsky S, Goswami R, Peralta M, Reckrey JM, Boockvar K, Shah S, Ornstein KA, Leff B, DeCherrie L, Siu AL. Outcomes of home-based primary care for homebound older adults: A randomized clinical trial. J Am Geriatr Soc 2023; 71:443-454. [PMID: 36054295 PMCID: PMC9939556 DOI: 10.1111/jgs.17999] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 07/13/2022] [Accepted: 07/24/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Homebound older adults are medically complex and often have difficulty accessing outpatient medical care. Home-based primary care (HBPC) may improve care and outcomes for this population but data from randomized trials of HBPC in the United States are limited. METHODS We conducted a randomized controlled trial of HBPC versus office-based primary care for adults ages ≥65 years who reported ≥1 hospitalization in the prior 12 months and met the Medicare definition of homebound. HBPC was provided by teams consisting of a physician, nurse practitioner, nurse, and social worker. Data were collected at baseline, 6- and 12-months. Outcomes were quality of life, symptoms, satisfaction with care, hospitalizations, and emergency department (ED) visits. Recruitment was terminated early because more deaths were observed for intervention patients. RESULTS The study enrolled 229 patients, 65.4% of planned recruitment. The mean age was 82 (9.0) years and 72.3% had dementia. Of those assigned to HBPC, 34.2% never received it. Intervention patients had greater satisfaction with care than controls (2.26, 95% CI 1.46-3.06, p < 0.0001; effect size 0.74) and lower hospitalization rates (-17.9%, 95% CI -31.0% to -1.0%; p = 0.001; number needed to treat 6, 95% CI 3-100). There were no significant differences in quality of life (1.25, 95% CI -0.39-2.89, p = 0.13), symptom burden (-1.92, 95% CI -5.22-1.37, p = 0.25) or ED visits (1.2%, 95% CI -10.5%-12.4%; p = 0.87). There were 24 (21.1%) deaths among intervention patients and 12 (10.7%) among controls (p < 0.0001). CONCLUSION HBPC was associated with greater satisfaction with care and lower hospitalization rates but also more deaths compared to office-based primary care. Additional research is needed to understand the nature of the higher death rate for HBPC patients, as well as to determine the effects of HBPC on quality of life and symptom burden given the trial's early termination.
Collapse
Affiliation(s)
- Alex D. Federman
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Abraham Brody
- Hartford Institute for Geriatric Nursing, NYU Rory Meyers College of Nursing, New York, NY, USA
- Division of Geriatric Medicine and Palliative Care, NYU Grossman School of Medicine, New York, NY, USA
| | - Christine S. Ritchie
- The Mongan Institute and Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Natalia Egorova
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Arushi Arora
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sara Lubetsky
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ruchir Goswami
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Maria Peralta
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jenny M. Reckrey
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kenneth Boockvar
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- James J Peters Veterans Affairs Medical Center, Bronx, New York, USA
- The New Jewish Home, New York, NY, USA
| | - Shivani Shah
- Visiting Nurse Service of New York, New York, NY, USA
| | - Katherine A. Ornstein
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bruce Leff
- Center for Transformative Geriatric Research, Division of Geriatric Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Linda DeCherrie
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Albert L. Siu
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- James J Peters Veterans Affairs Medical Center, Bronx, New York, USA
| |
Collapse
|
12
|
Cao YJ, Wang Y, Mullahy J, Burns M, Liu Y, Smith M. The Relative Importance of Hospital Discharge and Patient Composition in Changing Post-Acute Care Utilization and Outcomes Among Medicare Beneficiaries. Health Serv Insights 2023; 16:11786329231166522. [PMID: 37077324 PMCID: PMC10108411 DOI: 10.1177/11786329231166522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 03/13/2023] [Indexed: 04/21/2023] Open
Abstract
Background The COVID-19 pandemic changed care delivery. But the mechanisms of changes were less understood. Objectives Examine the extent to which the volume and pattern of hospital discharge and patient composition contributed to the changes in post-acute care (PAC) utilization and outcomes during the pandemic. Research design Retrospective cohort study. Medicare claims data on hospital discharges in a large healthcare system from March 2018 to December 2020. Subjects Medicare fee-for-service beneficiaries, 65 years or older, hospitalized for non-COVID diagnoses. Measures Hospital discharges to Home Health Agencies (HHA), Skilled Nursing Facilities (SNF), and Inpatient Rehabilitation Facilities (IRF) versus home. Thirty- and ninety-day mortality and readmission rates. Outcomes were compared before and during the pandemic with and without adjustment for patient characteristics and/or interactions with the pandemic onset. Results During the pandemic, hospital discharges declined by 27%. Patients were more likely to be discharged to HHA (+4.6%, 95% CI [3.2%, 6.0%]) and less likely to be discharged to either SNF (-3.9%, CI [-5.2%, -2.7%]) or to home (-2.8% CI [-4.4%, -1.3%]). Thirty- and ninety-day mortality rates were significantly higher by 2% to 3% points post-pandemic. Readmission were not significantly different. Up to 15% of the changes in discharge patterns and 5% in mortality rates were attributable to patient characteristics. Conclusions Shift in discharge locations were the main driver of changes in PAC utilization during the pandemic. Changes in patient characteristics explained only a small portion of changes in discharge patterns and were mainly channeled through general impacts rather than differentiated responses to the pandemic.
Collapse
Affiliation(s)
- Ying Jessica Cao
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Yang Wang
- Robert M. La Follette School of Public Affairs, University of Wisconsin-Madison, Madison, WI, USA
| | - John Mullahy
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Marguerite Burns
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Yao Liu
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Maureen Smith
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, USA
- Department of Family Medicine and Community Health, University of Wisconsin-Madison, Madison, WI, USA
- Health Innovation Program, University of Wisconsin-Madison, Madison, WI, USA
| |
Collapse
|
13
|
Fabius CD, Okoye SM, Mulcahy J, Burgdorf JG, Wolff JL. Associations Between Use of Paid Help and Care Experiences Among Medicare-Medicaid Enrolled Older Adults With and Without Dementia. J Gerontol B Psychol Sci Soc Sci 2022; 77:e216-e225. [PMID: 35554530 PMCID: PMC9799184 DOI: 10.1093/geronb/gbac072] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Community-living older Medicare and Medicaid enrollees ("dual-enrollees") have high care needs and commonly receive paid and unpaid long-term services and supports (LTSS) to help with routine activities. Little is known about whether receiving paid help or individuals' state and neighborhood environmental context ("LTSS environment") relates to dual-enrollees' care experiences. METHODS We examine a sample of n = 979 community-dwelling dual-enrollees with disabilities from 2011 to 2015 National Health and Aging Trends Study, linked to measures of neighborhood disadvantage and state Medicaid home and community-based services (HCBS) generosity. Logistic regression models stratified by dementia status assess associations between paid help and: (a) adverse consequences due to unmet care needs, and (b) participation restrictions in valued activities, among dual-enrollees with and without dementia, adjusting for individual and LTSS environmental characteristics. RESULTS Use of paid help was greater for those with (versus without) dementia (46.9% vs. 37.8%). Neighborhood disadvantage was associated with greater use of paid help among dual-enrollees living with dementia. High state Medicaid HCBS generosity was associated with the use of paid help, regardless of dementia status. Dual-enrollees with dementia receiving paid help had higher odds of experiencing adverse consequences due to unmet need (adjusted odds ratio = 2.05; 95% confidence interval 1.16-3.61; p = .02)-no significant associations were observed for participation restrictions. Use of paid help and LTSS environment were not significantly associated with care experiences for dual-enrollees without dementia. DISCUSSION Findings highlight the complexities of caring for dual-enrollees, particularly those with dementia, and emphasize the need to strengthen the delivery of paid care with considerations for the LTSS environment.
Collapse
Affiliation(s)
- Chanee D Fabius
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - John Mulcahy
- University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Julia G Burgdorf
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Visting Nurse Service of New York, New York, New York, USA
| | - Jennifer L Wolff
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| |
Collapse
|
14
|
Harrison KL, Garrett SB, Halim M, Sideman AB, Allison TA, Dohan D, Naasan G, Miller BL, Smith AK, Ritchie CS. “I Didn’t Sign Up for This”: Perspectives from Persons Living with Dementia and Care Partners on Challenges, Supports, and Opportunities to Add Geriatric Neuropalliative Care to Dementia Specialty Care. J Alzheimers Dis 2022; 90:1301-1320. [DOI: 10.3233/jad-220536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: In the United States, dementia specialty centers affiliated with centers of excellence for research hold promise as locations to develop innovative, holistic care in care systems otherwise siloed by discipline or payer. Objective: We conducted foundational research to inform development of patient-and family-centered palliative care interventions for dementia specialty centers. Methods: We interviewed persons living with dementia (PLWD), current, and former care partners (CP) recruited from a specialty dementia clinic and purposively selected for variation across disease syndrome and stage. A framework method of thematic analysis included coding, analytic matrices, and pattern mapping. Results: 40 participants included 9 PLWD, 16 current CPs, and 15 former CPs of decedents; 48% impacted by Alzheimer’s disease dementia. While help from family, support groups and adult day centers, paid caregiving, and sensitive clinical care were invaluable to PLWD, CPs, or both, these supports were insufficient to navigate the extensive challenges. Disease-oriented sources of distress included symptoms, functional impairment and falls, uncertainty and loss, and inaccessible care. Social and relational challenges included constrained personal and professional opportunities. The obligation and toll of giving or receiving caregiving were challenging. Clinical care challenges for PLWD and/or CPs included care fragmentation, insufficient guidance to inform planning and need for expert interdisciplinary clinical care at home. Conclusion: Findings highlight the breadth and gravity of gaps, which surpass the disciplinary focus of either behavioral neurology or palliative care alone. Results can inform the development of novel interventions to add principles of geriatrics and neuropalliative care to dementia care.
Collapse
Affiliation(s)
- Krista L. Harrison
- Division of Geriatrics, University of California, San Francisco, San Francisco, CA, USA
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
- Global Brain Health Institute, University of California, San Francisco, CA, USA
| | - Sarah B. Garrett
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
| | - Madina Halim
- Division of Geriatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Alissa Bernstein Sideman
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
- Global Brain Health Institute, University of California, San Francisco, CA, USA
- Department of Humanities and Social Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Theresa A. Allison
- Division of Geriatrics, University of California, San Francisco, San Francisco, CA, USA
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
- Department of Family & Community Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Daniel Dohan
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
- Department of Humanities and Social Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Georges Naasan
- The Barbara and Maurice Deane Center for Wellness and Cognitive Health, Department of Neurology, Mount Sinai Hospitals, Icahn School of Medicine, New York, NY, USA
| | - Bruce L. Miller
- Global Brain Health Institute, University of California, San Francisco, CA, USA
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | - Alexander K. Smith
- Division of Geriatrics, University of California, San Francisco, San Francisco, CA, USA
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Christine S. Ritchie
- Division of Geriatrics, University of California, San Francisco, San Francisco, CA, USA
- The Mongan Institute and the Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, MA, USA
| |
Collapse
|
15
|
Reckrey JM, Leff B, Kumar RG, Yee C, Garrido MM, Ornstein KA. Home, but Not Homebound: A Prospective Analysis of Persons Living With Dementia. J Am Med Dir Assoc 2022; 23:1648-1652.e1. [PMID: 35063398 PMCID: PMC9294063 DOI: 10.1016/j.jamda.2021.12.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 11/29/2021] [Accepted: 12/07/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Homebound persons living with dementia may have increased difficulty accessing needed care in the community. This study identifies factors associated with becoming homebound among a national sample of Medicare beneficiaries with newly identified dementia. DESIGN Prospective cohort analysis. SETTING AND PARTICIPANTS We used the National Health and Aging Trends Study (NHATS) 2011-2018 to identify community-dwelling older adults at the time of a new dementia diagnosis (n = 939). Dementia status was determined based on cognitive testing and self and proxy reporting. METHODS We compared characteristics of homebound (ie, those who never or rarely left home) and non-homebound participants at the time of dementia identification. Among non-homebound participants, we used a Fine-Gray subdistribution hazard model to identify factors associated with becoming homebound over follow-up (median follow-up 4 years), accounting for competing risks of death and moving to a nursing home. RESULTS 20% of individuals with newly identified dementia were homebound and this group was more functionally impaired, medically complex, and socioeconomically disadvantaged as compared to the non-homebound. Over time, depression [subhazard ratio (SHR) 2.19, 95% CI 1.36, 3.54], living in an assisted living facility (SHR 2.60, 95% CI 1.35, 4.97), and Hispanic ethnicity (SHR 1.91, 95% CI 1.05, 3.47) were associated with becoming homebound. CONCLUSIONS AND IMPLICATIONS Most adults are not homebound at the time of dementia diagnosis. Identifying and addressing modifiable factors like depression may slow progression to homebound status and enable persons living with dementia to access needed care in the community. In order to accommodate diverse individual and family preferences for long-term care, robust systems of home-based clinical and long-term care are necessary for those who do become homebound.
Collapse
Affiliation(s)
| | - Bruce Leff
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Raj G Kumar
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Cynthia Yee
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Melissa M Garrido
- Boston University School of Public Health, Boston, MA, USA; Boston VA Healthcare System, Boston, MA, USA
| | | |
Collapse
|
16
|
Aldridge MD. The Missing Piece of the Puzzle: High-Quality, Nonhospice, Community-Based Care for Persons with Dementia. J Palliat Med 2022; 25:1324-1325. [PMID: 36066951 DOI: 10.1089/jpm.2022.0362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Melissa D Aldridge
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Geriatric Research Education and Clinical Center, James J. Peters VA Medical Center, Bronx, New York, USA
| |
Collapse
|
17
|
Hogan L, Boron JB, Masters J, MacArthur K, Manley N. Characteristics of dementia family caregivers who use paid professional in-home respite care. Home Health Care Serv Q 2022; 41:310-329. [DOI: 10.1080/01621424.2022.2098083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Lakelyn Hogan
- Department of Gerontology, University of Nebraska, Omaha, Nebraska, USA
| | | | - Julie Masters
- Department of Gerontology, University of Nebraska, Lincoln, Nebraska, USA
| | - Kelly MacArthur
- Department of Sociology & Anthropology, University of Nebraska, Omaha, Nebraska, USA
| | - Natalie Manley
- Division of Geriatrics, University of Nebraska Medical Center, Omaha, Nebraska, USA
| |
Collapse
|
18
|
Mueller A, Thao L, Condon O, Liebzeit D, Fields B. A Systematic Review of the Needs of Dementia Caregivers Across Care Settings. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2022. [DOI: 10.1177/10848223211056928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The U.S. population of older adults living with dementia is projected to double by 2060. They rely on over 16 million family and unpaid caregivers to provide for their increasingly complex needs and care transitions. Caregivers frequently feel underprepared and without adequate support or access to resources. This systematic review seeks to identify the needs of family and unpaid caregivers of older adults living with dementia across various care settings in the U.S. A systematic search was conducted to identify articles pertaining to the needs of caregivers of older adults living with dementia. The data extraction tool was developed using aspects from the Care Transitions Framework and the Family Caregiver Alliance. Data were organized based on 3 domains of caregiver needs and the care setting(s) of the older adults living with dementia and their caregivers. A total of 31 articles were eligible for inclusion. The majority met the MMAT screening criteria, but more than half only met 2 or less of the 5 quality criteria. Caregivers’ needs were identified in the care settings of home/community-residing, assisted living, long-term care, skilled nursing, and memory care. Most articles either did not specify a care setting or included more than 1 and did not report the findings separately. Caregivers in each care setting, except memory care, identified needs in all 3 of the following domains: (1) social support—formal and informal, (2) confidence, competence, and strengths in the caregiving role, and (3) values and preferences.
Collapse
|
19
|
Su Z, Bentley BL, McDonnell D, Ahmad J, He J, Shi F, Takeuchi K, Cheshmehzangi A, da Veiga CP. 6G and Artificial Intelligence Technologies for Dementia Care: Literature Review and Practical Analysis. J Med Internet Res 2022; 24:e30503. [PMID: 35475733 PMCID: PMC9096635 DOI: 10.2196/30503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 11/23/2021] [Accepted: 01/31/2022] [Indexed: 01/20/2023] Open
Abstract
Background The dementia epidemic is progressing fast. As the world’s older population keeps skyrocketing, the traditional incompetent, time-consuming, and laborious interventions are becoming increasingly insufficient to address dementia patients’ health care needs. This is particularly true amid COVID-19. Instead, efficient, cost-effective, and technology-based strategies, such as sixth-generation communication solutions (6G) and artificial intelligence (AI)-empowered health solutions, might be the key to successfully managing the dementia epidemic until a cure becomes available. However, while 6G and AI technologies hold great promise, no research has examined how 6G and AI applications can effectively and efficiently address dementia patients’ health care needs and improve their quality of life. Objective This study aims to investigate ways in which 6G and AI technologies could elevate dementia care to address this study gap. Methods A literature review was conducted in databases such as PubMed, Scopus, and PsycINFO. The search focused on three themes: dementia, 6G, and AI technologies. The initial search was conducted on April 25, 2021, complemented by relevant articles identified via a follow-up search on November 11, 2021, and Google Scholar alerts. Results The findings of the study were analyzed in terms of the interplay between people with dementia’s unique health challenges and the promising capabilities of health technologies, with in-depth and comprehensive analyses of advanced technology-based solutions that could address key dementia care needs, ranging from impairments in memory (eg, Egocentric Live 4D Perception), speech (eg, Project Relate), motor (eg, Avatar Robot Café), cognitive (eg, Affectiva), to social interactions (eg, social robots). Conclusions To live is to grow old. Yet dementia is neither a proper way to live nor a natural aging process. By identifying advanced health solutions powered by 6G and AI opportunities, our study sheds light on the imperative of leveraging the potential of advanced technologies to elevate dementia patients’ will to live, enrich their daily activities, and help them engage in societies across shapes and forms.
Collapse
Affiliation(s)
- Zhaohui Su
- School of Public Health, Southeast University, Nanjing, China
| | - Barry L Bentley
- Cardiff School of Technologies, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Dean McDonnell
- Department of Humanities, Institute of Technology Carlow, Carlow, Ireland
| | - Junaid Ahmad
- Prime Institute of Public Health, Peshawar Medical College, Peshawar, Pakistan
| | - Jiguang He
- Centre for Wireless Communications, University of Oulu, Oulu, Finland
| | - Feng Shi
- Department of Research and Development, Shanghai United Imaging Intelligence, Shanghai, China
| | - Kazuaki Takeuchi
- Ory Laboratory Inc, Tokyo, Japan.,Kanagawa Institute of Technology, Kanagawa, Japan
| | - Ali Cheshmehzangi
- Department of Architecture and Built Environment, University of Nottingham Ningbo China, Ningbo, China.,Network for Education and Research on Peace and Sustainability, Hiroshima University, Hiroshima, Japan
| | | |
Collapse
|
20
|
Juckett LA, Hariharan G, Dodonova DC, Klaus J, Rowe M, Burak E, Mason B, Bunck L. Implementing a Community-Based Initiative to Improve Nutritional Intake among Home-Delivered Meal Recipients. Nutrients 2022; 14:nu14050944. [PMID: 35267919 PMCID: PMC8912420 DOI: 10.3390/nu14050944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 11/27/2022] Open
Abstract
Home-delivered meal (HDM) recipients are a highly vulnerable group of older adults at risk for malnutrition and subsequent health decline. To help HDM recipients increase their nutritional intake, HDM agencies may provide expanded meal options that allow older adults to have greater autonomy over their meal selection; however, the extent to which recipients are able to select nutritious meals that are responsive to their health complexities is unknown. This study examined the nutritional content of meals selected by HDM recipients enrolled in an expanded menu plan through a large HDM agency. Data were drawn from a retrospective chart review of 130 HDM recipients who had the option of selecting their own HDM meals and frequency of meal delivery. Findings indicate that older adults who selected their own meals chose meals that were significantly lower in protein, potassium, fat, and calories. The lack of these nutrients suggests that older adults enrolled in expanded menu plans should be referred to registered dietitian nutritionists who can provide skilled guidance in meal selection. To address this need, we also describe and provide preliminary data representing a referral program designed to connect HDM recipients to dietetic services with the goal of optimizing older adult nutrition and health-related outcomes.
Collapse
Affiliation(s)
- Lisa A. Juckett
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH 43210-2205, USA
- Correspondence: ; Tel.: +1-614-366-7543
| | - Govind Hariharan
- Coles College of Business, Kennesaw State University, Kennesaw, GA 30144-0405, USA; (G.H.); (D.C.D.)
| | - Dimitri Camargo Dodonova
- Coles College of Business, Kennesaw State University, Kennesaw, GA 30144-0405, USA; (G.H.); (D.C.D.)
| | - Jared Klaus
- Lifecare Alliance, Columbus, OH 43223-1809, USA; (J.K.); (M.R.); (E.B.); (B.M.); (L.B.)
| | - Melinda Rowe
- Lifecare Alliance, Columbus, OH 43223-1809, USA; (J.K.); (M.R.); (E.B.); (B.M.); (L.B.)
| | - Elana Burak
- Lifecare Alliance, Columbus, OH 43223-1809, USA; (J.K.); (M.R.); (E.B.); (B.M.); (L.B.)
| | - Benetta Mason
- Lifecare Alliance, Columbus, OH 43223-1809, USA; (J.K.); (M.R.); (E.B.); (B.M.); (L.B.)
| | - Leah Bunck
- Lifecare Alliance, Columbus, OH 43223-1809, USA; (J.K.); (M.R.); (E.B.); (B.M.); (L.B.)
| |
Collapse
|
21
|
Falzarano FB, Cimarolli V, Boerner K, Siedlecki KL, Horowitz A. Use of Home Care Services Reduces Care-Related Strain in Long-Distance Caregivers. THE GERONTOLOGIST 2022; 62:252-261. [PMID: 34166493 PMCID: PMC8827323 DOI: 10.1093/geront/gnab088] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Prior work examining the role of older adult home care service use in alleviating strain in family caregivers has resulted in contradictory findings. However, prior research has been entirely limited to caregivers who live within close geographical proximity to their care recipients. Long-distance caregivers are a unique caregiving subgroup that has remained understudied. Guided by the stress process model, this study examined if the association between primary caregiving stressors (the care recipient's functional and cognitive status) and secondary stressors (perceived role strains related to work and to other family responsibilities) in long-distance caregivers was mediated by the care recipient's utilization of home care services. RESEARCH DESIGN AND METHODS The sample included 166 long-distance caregivers in the United States who provide and manage care to a community-dwelling care recipient living 2 or more hours away. Participants reported on their care recipient's cognitive and functional status, perceived interference of caregiving with work and other family responsibilities, and the care recipient's use of home care services. RESULTS Path analyses show that home care use by the care recipient fully mediated the association between care recipients' functional impairment and caregiver strains (work and family). Furthermore, home care use partially mediated the effects of care recipients' cognitive impairment on caregiver strains. DISCUSSION AND IMPLICATIONS Results indicate that the care recipient's home care service utilization may serve as a protective factor against care-related strain in long-distance caregivers. These findings can be used to inform intervention efforts focused on a family-centered care approach that can be specifically tailored to long-distance caregivers.
Collapse
Affiliation(s)
- Francesca B Falzarano
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Verena Cimarolli
- LeadingAge LTSS Center @UMass Boston, Washington, District of Columbia, USA
| | - Kathrin Boerner
- Department of Gerontology, University of Massachusetts Boston, USA
| | | | - Amy Horowitz
- Graduate School of Social Service, Fordham University, New York, New York, USA
| |
Collapse
|
22
|
"I Am the Home Care Agency": The Dementia Family Caregiver Experience Managing Paid Care in the Home. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031311. [PMID: 35162335 PMCID: PMC8834786 DOI: 10.3390/ijerph19031311] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/14/2022] [Accepted: 01/21/2022] [Indexed: 02/01/2023]
Abstract
As the locus of long-term care in the United States shifts from institutions to the community, paid caregivers (i.e., home health aides, personal care attendants) are providing more hands-on care to persons with dementia living at home. Yet, little is known about how family caregivers engage with paid caregivers. We conducted in-depth, semi-structured interviews (n = 15) with family caregivers, of persons living at home with severe dementia, and enriched our findings with data from a second cohort of family caregivers of persons with dementia (n = 9). Whether paid caregivers were hired privately or employed via a Medicaid-funded agency, family caregivers reported that they needed to manage paid caregivers in the home. Core management tasks were day-to-day monitoring and relationship building with family caregivers; training paid caregivers and coordinating care with homecare agencies was also described. In order to support family caregivers of individuals with dementia at home, it is important consider their preferences and skills in order to effectively manage paid caregivers. Support of efforts to build a high-quality paid caregiving workforce has the potential to improve not only care delivered to persons with dementia, but the experiences of their family caregivers.
Collapse
|
23
|
Reckrey JM, Li L, Zhan S, Wolff J, Yee C, Ornstein KA. Caring Together: Trajectories of Paid and Family Caregiving Support to Those Living in the Community With Dementia. J Gerontol B Psychol Sci Soc Sci 2022; 77:S11-S20. [PMID: 35034123 PMCID: PMC9122661 DOI: 10.1093/geronb/gbac006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES Paid caregivers (e.g., home health aides) often work with family caregivers to support persons living with dementia at home. We identify (a) unique trajectories of paid and family caregiving support among persons living with dementia with high care needs and (b) factors associated with these trajectories. METHODS We used group-based multiple trajectory modeling to identify distinct trajectories of paid and family caregiving hours among National Health and Aging Trends Study respondents with dementia who died or moved to a nursing home (n = 334, mean follow-up 5.5 years). We examined differences between trajectory groups and identified factors associated with group membership using generalized estimating equation modeling. RESULTS A 3-group model best fit our data: (a) "low/stable care" (61.3% of respondents) with stable, low/no paid care and moderate family care, (b) "increasing paid care" with increasing, moderate paid and family care, and (c) "high family care" with increasing, high family care and stable, low paid care. While both the "increasing paid care" and "high family care" groups were more functionally impaired than the "low/stable care" group, the "high family care" group was also more likely to be non-White and experience multiple medical comorbidities, depression, and social isolation. DISCUSSION Study findings highlight the importance of considering unique arrangements in dementia care. Receipt of paid care was not only determined by patient care needs. Creating equitable access to paid care may be a particularly important way to support both persons living with dementia and their family caregivers as care needs grow.
Collapse
Affiliation(s)
- Jennifer M Reckrey
- Address correspondence to: Jennifer M. Reckrey, MD, Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1216, New York, NY 10029, USA. E-mail:
| | - Lihua Li
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York, USA,Department of Population Health Sciences and Policy, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Serena Zhan
- Department of Population Health Sciences and Policy, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Jennifer Wolff
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Cynthia Yee
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Katherine A Ornstein
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York, USA,Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| |
Collapse
|
24
|
Davis-Ajami ML, Lu ZK, Wu J. Exploring the home healthcare workforce in Alzheimer's disease and related dementias: Utilization and cost outcomes in US community dwelling older adults. Arch Gerontol Geriatr 2022; 98:104536. [DOI: 10.1016/j.archger.2021.104536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/01/2021] [Accepted: 09/20/2021] [Indexed: 11/29/2022]
|
25
|
Fabius CD, Parker LJ, Thorpe RJ. The Influence of Race and Gender on Receiving Assistance with Daily Activities among Older Americans. Innov Aging 2021; 6:igab060. [PMID: 35233471 PMCID: PMC8874838 DOI: 10.1093/geroni/igab060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Indexed: 11/29/2022] Open
Abstract
Background and Objectives Nearly 8.2 million community-dwelling, older Medicare beneficiaries receive support from long-term services and supports (LTSS) with routine daily activities. Prior work demonstrates disability-related disparities; however, it is unclear whether these patterns persist among LTSS recipients and across specific sets of activities. We examine race and gender differences in receiving help with self-care (e.g., eating), mobility (e.g., getting around the house), and household (e.g., shopping) activities in a nationally representative sample of community-dwelling Medicare beneficiaries receiving LTSS. Research Design and Methods Cross-sectional analysis of 1,808 White and Black older adults receiving assistance with routine daily activities in the 2015 National Health and Aging Trends Study. Bivariate statistics were used to describe the sample and provide comparisons of characteristics by race and gender. Logistic regression models examined race and gender differences in receiving assistance with self-care, mobility, and household activities after adjusting for sociodemographic and health characteristics. Results Race and gender differences were observed across all sociodemographic and health characteristics, as well as for all forms of assistance. Relative to White men, Black men had lower odds of receiving help with self-care activities. White and black women had higher odds and Black men had lower odds of getting help with mobility activities than White men. Black men and White and Black women all had higher odds of receiving assistance with household tasks compared to White men. Discussion and Implications Our findings indicate that, despite prior evidence of disability-related disparities, the receipt of help with self-care, mobility, and household activities varies by race and gender. Findings reveal several target areas for future research. Future work should examine the role of cultural and social preferences for care, as well as the appropriateness of help, as evidenced by health service use and changes in quality of life.
Collapse
Affiliation(s)
- Chanee D Fabius
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Lauren J Parker
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Roland J Thorpe
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| |
Collapse
|
26
|
Reckrey JM, Boerner K, Franzosa E, Bollens-Lund E, Ornstein KA. Paid Caregivers in the Community-Based Dementia Care Team: Do Family Caregivers Benefit? Clin Ther 2021; 43:930-941. [PMID: 33972126 DOI: 10.1016/j.clinthera.2021.03.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/18/2021] [Accepted: 03/30/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Older adults with dementia often rely on both paid caregivers (ie, home health aides, personal care attendants, other direct care workers) and family caregivers (ie, spouses, children, other unpaid individuals) to remain in the community. This study conceptualizes paid caregivers as part of the collaborative dementia care team and examines the association between receipt of paid care and primary family caregiver experience. METHODS Using data from 3 waves (2011, 2015, and 2017) of the National Health and Aging Trends Study linked to the National Study of Caregiving, community-dwelling Medicare beneficiaries aged ≥67 years with advanced dementia (n = 338 observations) were identified. Primary family caregiver experiences were compared among those with zero, part-time (<40 hours/week), and full-time (≥40 hours/week) paid care, and multivariable models were used to evaluate the associations between full-time paid care and family caregiver strain (eg, being overwhelmed due to caregiving) and activity restriction (eg, being unable to work for pay due to caregiving). FINDINGS About one half of the community-dwelling older adults with advanced dementia received paid care: 30% had part-time paid care and 18% had full-time paid care. The experiences of family caregivers of those receiving part-time and no paid care were not significantly different. After adjusting for family caregiver and care recipient characteristics, receipt of full-time paid care was associated with a nearly 70% reduced odds of having activity restrictions due to caregiving (odds ratio, 0.31; P = 0.01) and a reduction in mean caregiver strain score (-0.73; P = 0.04). There was no statistically significantly association between the odds of high caregiver strain (score ≥5) and receipt of paid care (odds ratio, 0.65; P = 0.33). IMPLICATIONS The provision of paid care for individuals with dementia in the community may benefit family caregivers. Future work should acknowledge the important ways that paid caregivers contribute to outcomes for all members of the collaborative dementia care team.
Collapse
Affiliation(s)
- Jennifer M Reckrey
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Kathrin Boerner
- Department of Gerontology, McCormack Graduate School of Policy and Global Studies, University of Massachusetts, Boston, MA
| | - Emily Franzosa
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai and Geriatrics Research, Education, and Clinical Center, James J. Peters VA Medical Center, New York, NY
| | - Evan Bollens-Lund
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Katherine A Ornstein
- Department of Geriatrics and Palliative Medicine and Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY
| |
Collapse
|
27
|
Werner P, Tur-Sinai A, AboJabel H. Examining Dementia Family Caregivers' Forgone Care for General Practitioners and Medical Specialists during a COVID-19 Lockdown. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3688. [PMID: 33916152 PMCID: PMC8036927 DOI: 10.3390/ijerph18073688] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 12/16/2022]
Abstract
The present study aimed to assess dementia caregivers' reports of the prevalence and correlates of forgone care regarding visits to a general practitioner (GP) and to a specialist during the COVID-19 lockdown in Israel, using Andersen's Behavioral Model of Healthcare Utilization. A cross-sectional study using an online survey was conducted with 73 Israeli family caregivers of persons with dementia residing in the community (81% Jews, 86% female, mean age = 54). Overall, one out of two participants reported having to delay seeking needed help from a GP or a specialist for themselves, as well as for their relatives with dementia, during the COVID-19 lockdown period. Among the predisposing factor, education was associated with caregivers' reports regarding forgone care for themselves as well as for their loved ones. Living with the care-receiver and income level were the enabling factors associated with forgone care for caregivers. Finally, feelings of burden were associated with caregivers' forgone care and feelings of loneliness and perceptions of the care-receiver's cognitive functioning were associated with care-receivers' forgone care. Our findings show that it is essential that this population receive appropriate practical and emotional support at times of distress and crisis to enable them to continue with their caregiving role.
Collapse
Affiliation(s)
- Perla Werner
- Department of Community Mental Health, University of Haifa, Mt. Carmel, Haifa 3498838, Israel;
| | - Aviad Tur-Sinai
- Department of Health Systems Management, The Max Stern Yezreel Valley College, Yezreel Valley 1930600, Israel;
- School of Nursing, University of Rochester Medical Center, Rochester, NY 14627-0446, USA
| | - Hanan AboJabel
- Department of Community Mental Health, University of Haifa, Mt. Carmel, Haifa 3498838, Israel;
| |
Collapse
|
28
|
Chen C, Thunell J, Zissimopoulos J. Changes in physical and mental health of Black, Hispanic, and White caregivers and non-caregivers associated with onset of spousal dementia. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2020; 6:e12082. [PMID: 33163612 PMCID: PMC7606182 DOI: 10.1002/trc2.12082] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 08/17/2020] [Indexed: 01/02/2023]
Abstract
INTRODUCTION We aim to determine whether racial/ethnic health disparities are a consequence of caregiving for persons with dementia and/or health status before becoming a caregiver. METHODS Longitudinal data from the Health and Retirement Study (1998-2012) on 7859 Black, Hispanic, and White couples were analyzed for changes in physical and mental health with incident dementia of a spouse. RESULTS Blacks and Hispanics, but not Whites, had poorer health before becoming caregivers for a spouse with dementia, than those who did not become caregivers. Spouse's dementia onset was associated with caregiver's higher odds of depressive disorder, with no racial/ethnic variation. Racial disparities in caregiver's health were attributed to health differences before caregiving, not differential health changes due to caregiving. DISCUSSION Older Blacks and Hispanics with poor health are at increased risk of caregiving for a spouse with dementia. Protecting the health of persons supporting spouses with dementia requires understanding socioeconomic and cultural factors driving care provision.
Collapse
Affiliation(s)
- Cynthia Chen
- Saw Swee Hock School of Public HealthNational University of SingaporeSingapore
| | - Johanna Thunell
- USC Price School of Public PolicySchaeffer Center for Health Policy and EconomicsUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Julie Zissimopoulos
- USC Price School of Public PolicySchaeffer Center for Health Policy and EconomicsUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| |
Collapse
|
29
|
Kumar V, Ankuda CK, Aldridge MD, Husain M, Ornstein KA. Family Caregiving at the End of Life and Hospice Use: A National Study of Medicare Beneficiaries. J Am Geriatr Soc 2020; 68:2288-2296. [PMID: 32602571 PMCID: PMC7718293 DOI: 10.1111/jgs.16648] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 05/11/2020] [Accepted: 05/13/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND/OBJECTIVES Hospice care confers well-documented benefits to patients and their families, but it is underutilized. One potential reason is inadequate family support to make end-of-life decisions and care for older adults on hospice at home. We assessed the association between amount of family support and hospice use among a population of decedents and among specific illness types. DESIGN Prospective cohort study using the National Health and Aging Trends Study waves 2011 to 2017, linked to Medicare claims data. SETTING Contiguous United States. PARTICIPANTS A total of 1,868 NHATS decedents. MEASUREMENTS Outcome variable was 1 day or longer of hospice. Family caregiving intensity was measured by self-reported hours of care per week and number of caregivers. Covariates included probable dementia status and other demographic, clinical, and functional characteristics. RESULTS At the end of life, hours of family caregiving and numbers of helpers vary widely with individuals with dementia receiving the most hours of unpaid care (mean = 64.5 hours per week) and having 2.4 unpaid caregivers on average. In an adjusted analysis, older adults with cancer receiving 40 hours and more of unpaid care/week as compared with fewer than 6 hours per week were twice as likely to receive hospice care at the end of life (odds ratio = 2.0; 95% confidence interval = 1.0-4.1). This association was not seen among those with dementia or among decedents in general. No significant association was found between number of caregivers and hospice use at the end of life. CONCLUSION Older adults at the end of life receive a high number of hours of help at the end of life, many from more than one caregiver, which may shape hospice access. Better understanding of disparities in hospice use can facilitate timely access to care for older adults with a serious illness. J Am Geriatr Soc 68:2288-2296, 2020.
Collapse
Affiliation(s)
| | - Claire K. Ankuda
- Icahn School of Medicine at Mount Sinai
- Brookdale Department of Geriatrics and Palliative Medicine
| | - Melissa D. Aldridge
- Icahn School of Medicine at Mount Sinai
- Brookdale Department of Geriatrics and Palliative Medicine
| | - Mohammed Husain
- Icahn School of Medicine at Mount Sinai
- Brookdale Department of Geriatrics and Palliative Medicine
| | - Katherine A. Ornstein
- Icahn School of Medicine at Mount Sinai
- Brookdale Department of Geriatrics and Palliative Medicine
- Institute for Translational Epidemiology
| |
Collapse
|
30
|
Giebel C, Hanna K, Cannon J, Eley R, Tetlow H, Gaughan A, Komuravelli A, Shenton J, Rogers C, Butchard S, Callaghan S, Limbert S, Rajagopal M, Ward K, Shaw L, Whittington R, Hughes M, Gabbay M. Decision-making for receiving paid home care for dementia in the time of COVID-19: a qualitative study. BMC Geriatr 2020; 20:333. [PMID: 32900360 PMCID: PMC7478902 DOI: 10.1186/s12877-020-01719-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 08/19/2020] [Indexed: 12/22/2022] Open
Abstract
Background The lockdown imposed in the UK on the 23rd of March and associated public health measures of social distancing are likely to have had a great impact on care provision. The aim of this study was to explore the decision-making processes of continued paid home care support for dementia in the time of COVID-19. Methods Unpaid carers caring for a person living with dementia (PLWD) who were accessing paid home care before COVID-19 and residing in the UK were eligible to take part. Participants were interviewed over the phone and asked about their experiences of using paid home care services before and since COVID-19, and their decision-making processes of accessing paid home care since the outbreak and public health restrictions. Results Fifteen unpaid carers, who were also accessing paid care support for the PLWD before COVID-19, were included in the analysis. Thematic analysis identified three overarching themes: (1) Risk; (2) Making difficult choices and risk management; and (3) Implications for unpaid carers. Many unpaid carers decided to discontinue paid carers entering the home due to the risk of infection, resulting in unpaid carers having to pick up the care hours to support the person living with dementia. Conclusions This is the first study to report on the impact of COVID-19 on paid home care changes in dementia. Findings raise implications for providing better Personal Protective Equipment for paid carers, and to support unpaid carers better in their roles, with the pandemic likely to stay in place for the foreseeable future.
Collapse
Affiliation(s)
- Clarissa Giebel
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK. .,NIHR ARC NWC, Liverpool, UK. .,Waterhouse Building B Block, University of Liverpool, Brownlow Street, Liverpool, L69 3GL, UK.
| | - Kerry Hanna
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | | | - Ruth Eley
- Liverpool Dementia Action Alliance, Liverpool, UK
| | | | | | | | | | | | - Sarah Butchard
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK.,Mersey Care NHS Trust, Liverpool, UK
| | | | | | | | - Kym Ward
- The Brain Charity, Liverpool, UK
| | | | | | - Mishca Hughes
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Mark Gabbay
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK.,NIHR ARC NWC, Liverpool, UK
| |
Collapse
|
31
|
Boon JT, Maxwell CA. Policy Opportunities to Support Family Caregivers Managing Pain in People with Dementia. Pain Manag Nurs 2020; 22:8-10. [PMID: 32690469 DOI: 10.1016/j.pmn.2020.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/14/2020] [Accepted: 06/16/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Jeffrey T Boon
- Vanderbilt University Medical Center, Nashville, TN, USA
| | | |
Collapse
|
32
|
Reckrey JM. COVID-19 Confirms It: Paid Caregivers Are Essential Members of the Healthcare Team. J Am Geriatr Soc 2020; 68:1679-1680. [PMID: 32424889 PMCID: PMC7276871 DOI: 10.1111/jgs.16566] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 05/10/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Jennifer M Reckrey
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| |
Collapse
|