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Puustinen J, Kangasniemi M, Pasanen M, Turjamaa R. Recognising older people's individual resources and home‐care‐specific tasks in home care in Finland: A document analysis of care and service plans. Scand J Caring Sci 2022; 37:507-523. [PMID: 36464860 DOI: 10.1111/scs.13135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 10/27/2022] [Accepted: 11/06/2022] [Indexed: 12/07/2022]
Abstract
BACKGROUND AND RATIONALE Comprehensive care and service planning in home care is tailored to older people's individual needs and resources in order to support them living at home. However, little is known about how these individual resources and home-care-specific tasks are recognised in older people's care and service plans. AIMS To describe the content of care and service plans in older people's home care with special attention to their individual resources and home-care-specific tasks. DESIGN This was a document-based cross-sectional study with mixed-methods analysis, carried out in Eastern Finland during Spring 2018. METHODS A document analysis using the deductive Finnish Care Classification (FinCC), and an inductively developed framework of older people's care and service plans (n = 71). The data were analysed with descriptive statistical methods. RESULTS Altogether, 1718 notes were relevant to the FinCC main categories: 707 (41%) focused on older people's needs and 1011 (59%) on nursing interventions. We identified 1104 notes based on the 26 inductively developed main categories: the majority (n = 628, 57%) focused on individual resources and the remainder (n = 476, 43%) on home-care-specific tasks. Increasing age resulted in fewer notes on safety and sensory functions. There were fewer notes on resources related to sleeping and wakefulness after longer care and service periods. An increased number of home visits resulted in more documentation on tasks related to pharmaceutical issues, including repeat prescriptions. DISCUSSION Individual resources for older people were documented, to some extent, in their care and service plans. It is necessary to review these alongside home-care-specific tasks that support older people's independence and safety at home. CONCLUSION Individual resources need to be recognised in order to enable home-care professionals to provide tailored, high-quality home care services. Home-care-specific tasks should be supported by documentation with updated, sensitive home care classifications.
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Affiliation(s)
- Jonna Puustinen
- Department of Nursing Science, Faculty of Medicine University of Turku Turku Finland
| | - Mari Kangasniemi
- Department of Nursing Science, Faculty of Medicine University of Turku Turku Finland
| | - Miko Pasanen
- Department of Nursing Science, Faculty of Medicine University of Turku Turku Finland
| | - Riitta Turjamaa
- Unit of Continuous Learning Savonia University of Applied Sciences Kuopio Finland
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Li Y, Li X, Li R, Chen N, Yang K. PROTOCOL: Home-based care for people with dementia: A systematic review. CAMPBELL SYSTEMATIC REVIEWS 2022; 18:e1285. [PMID: 36908844 PMCID: PMC9629276 DOI: 10.1002/cl2.1285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
The abstract section should read: This is the protocol for a Campbell systematic review. The objectives are as follows: (1) Which formal HBC services for people with dementia have been tested in an RCT? (2) How effective are the different formal HBC services in improving the physical and mental health outcomes of people with dementia? (3) What is the cost and patient's health service usage of different formal HBC services?
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Affiliation(s)
- Yanfei Li
- Evidence‐Based Medicine Center, School of Basic Medical SciencesLanzhou UniversityLanzhouChina
| | - Xiuxia Li
- Evidence‐Based Social Sciences Research Center/Health Technology Assessment Center, School of Public HealthLanzhou UniversityLanzhouChina
| | - Rui Li
- Evidence‐Based Social Sciences Research Center/Health Technology Assessment Center, School of Public HealthLanzhou UniversityLanzhouChina
| | - Nan Chen
- Research and Education DepartmentShanxi Provincial Rehabilitation HospitalXi'anChina
| | - Kehu Yang
- Evidence‐Based Medicine Center, School of Basic Medical SciencesLanzhou UniversityLanzhouChina
- Evidence‐Based Social Sciences Research Center/Health Technology Assessment Center, School of Public HealthLanzhou UniversityLanzhouChina
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Dibao-Dina C, Oger C, Foley T, Torzsa P, Lazic V, Kreitmayer Peštiae S, Adler L, Kareli A, Mallen C, Heaster C, Dumitra G, Kurpas D, Viegas R, Giezendanner S, Tkachenko V, De Lepeleire J, Falanga R, Missiou A, Jennings A, Petrazzuoli F. Intermediate care in caring for dementia, the point of view of general practitioners: A key informant survey across Europe. Front Med (Lausanne) 2022; 9:1016462. [PMID: 36341273 PMCID: PMC9627031 DOI: 10.3389/fmed.2022.1016462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 09/27/2022] [Indexed: 12/03/2022] Open
Abstract
Background Intermediate care is often defined as healthcare occurring somewhere between traditional primary (community) and secondary (hospital) care settings. High quality intermediate care is important in dementia, may prevent caregiver burnout and also lead to optimal care for people with dementia. However, very little is known about the point of intermediate care for persons with dementia in Europe. Research questions What intermediate care services exist and how are they utilized in the care of people with dementia in Europe? Objective This study aims at describing the point of view of General Practitioners on intermediate care services for people with dementia across Europe. Methods Key informant survey was sent to GPs via a self-developed questionnaire with space for open ended comments. 16 European countries participated to this cross-sectional mixed method study. Given the volunteer nature of the study, no minimum sample size requirements were applied to participation. Convenience sampling technique was used to address variations due to regional variations and regulations within the same country. Descriptive analyses of all intermediate care facilities groups by countries were performed. Qualitative analyses approach was used for the optional-free text to exemplify and/or complete the reasons contained in the closed response categories. Results The questionnaire was sent to 16 European countries. 583 questionnaires were analyzed. The responding physicians were 48 (± 11) years old on average and they had been in practice for an average of 18 (+ /11) years. The types of intermediate care considered were integrated at-home services, respite and relief services, day care centers and nursing homes. Their availability was considered very inhomogeneous by the majority of respondents. The main benefits of intermediate care cited were better medical care for the patient (78%), better quality of life for the caregiver (67%), prevention of the caregiver burden (73%) and a break for the caregiver (59%). The reported difficulties were: accessing these facilities due to limited financial support (76%) and cumbersome administrative procedures (67%). Many other facets of our findings were captured in the qualitative themes that emerged. Conclusion Intermediate care in Europe is diverse and heterogeneous. Major concerns of GPs are about the cost issues and the cumbersome administrative procedures to access them.
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Affiliation(s)
| | - Caroline Oger
- Department of General Practice, University of Tours, Tours, France
| | - Tony Foley
- Department of General Practice, University College Cork, Cork, Ireland
| | - Péter Torzsa
- Department of Family Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | | | - Sanda Kreitmayer Peštiae
- JZNU Dom Zdravlja “Dr. Mustafa Šehoviæ”, Department of General/Family Medicine, Tuzla, Bosnia and Herzegovina
| | - Limor Adler
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ana Kareli
- Georgian Family Medicine Association, Tbilisi State Medical University, Tbilisi, Georgia
| | - Christian Mallen
- Primary, Community and Social Care, Keele University, Keele, United Kingdom
| | - Cindy Heaster
- Department of Family Medicine, Faculty of Medicine, Riga Stradiņš University, Riga, Latvia
| | - Gindrovel Dumitra
- Romanian National Society of Family Medicine, Bucharest, Romania
- Department of Family Medicine, University of Medicine and Pharmacy, Craiova, Romania
| | - Donata Kurpas
- Department of Family Medicine, Wrocław Medical University, Wrocław, Poland
| | - Rita Viegas
- Department of Family Medicine, NOVA Medical School, Lisbon, Portugal
| | | | - Victoria Tkachenko
- Department of Family Medicine, Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine
| | - Jan De Lepeleire
- Department of Public Health and Primary Care, General Practice, University of Leuven, Leuven, Belgium
| | - Rosario Falanga
- Department of Primary Care, Azienda Sanitaria Friuli Occidentale, Pordenone, Italy
| | - Aristea Missiou
- Research Unit for General Medicine and Primary Health Care, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Aisling Jennings
- Department of General Practice, University College Cork, Cork, Ireland
| | - Ferdinando Petrazzuoli
- Department of Clinical Sciences, Center for Primary Health Care Research, Lund University, Malmö, Sweden
- *Correspondence: Ferdinando Petrazzuoli, ;
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Britton A, Zimmermann M. Informal dementia care: The carer's lived experience at the divides between policy and practice. DEMENTIA 2022; 21:2117-2127. [PMID: 35838118 PMCID: PMC9483676 DOI: 10.1177/14713012221112234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Support for informal dementia care at a local community level is not working for most carers today. Carers looking after a person with dementia have long lamented the absence of an empowered named support and an effectively actioned care plan. Drawing on literary writing and social research, we argue in this article that these challenges have existed since dementia emerged as a major condition in the West during the 1980s. Based on this historical context, we ask: Why has this issue persisted over the last four decades? How have healthcare politics and policy initiatives responded to these requests? And what can we learn from this for the current, COVID-19 exacerbated crisis of care? This article focuses on the English context, to discuss these ongoing challenges in the light of a series of policy papers, and to ask what is hampering the implementation of such policy initiatives. In England, local authorities are responsible for dementia support. This article focuses on the situation in a county in the Midlands where one of us (AB) has been lobbying local government for over a decade. The discussion contextualises the lived experience of dementia care within the situation exacerbated by the COVID-19 pandemic, ensuing politics of crises and persistent emphasis on cure over care. We find that the absence on two points centrally challenges care: a joined-up approach between health and social care and adequate information on available care support services, accessible through an empowered named contact. To enhance the lived experience of dementia care, consistent provision of individual named support and professional care support, as and when required, should become essential to local implementation of the care policy.
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Affiliation(s)
- Anthony Britton
- Founder Trustee, The Pam Britton Trust for Dementia, Leamington Spa, UK
| | - Martina Zimmermann
- UKRI Future Leaders Fellow and Lecturer, Health Humanities and Health Sciences, Department of English, 4616King's College London, London, UK
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Sm-Rahman A, Hydén LC, Kelfve S. People Living with a Dementia Diagnosis with No Eldercare at all: Who Are They? J Aging Soc Policy 2022; 34:876-893. [PMID: 35957610 DOI: 10.1080/08959420.2022.2111165] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Dementia is a non-curable disease that progressively affects people's ability to handle their everyday life. Still, previous Swedish research found that many people living with dementia (PlwD) do not use any eldercare. In this study, we investigated the association between not using eldercare services and key social background factors: years with dementia, hospital care, and country of birth for PlwD. We identified all people aged 65+ diagnosed with dementia between January 2006 and March 2015 (n = 43,372) using secondary data analysis of information taken from multiple Swedish nationwide registers. Results showed that not using eldercare was more common among younger age groups and men. The likelihood of having no eldercare was three times higher for those cohabiting; notably, almost a fifth of the PlwD who had the diagnosis for four years or more did not have eldercare at all. Finally, people born outside Europe used eldercare less than persons born in Sweden. Since the public dementia policy in Sweden is basically geared toward PlwD in a later stage and primarily in residential care, there has been almost no policy development around the needs and rights of PlwD in their homes. This study provides a ground for reconsidering dementia policy regardless of the ethnic and cultural backgrounds of PlwD.
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Affiliation(s)
- Atiqur Sm-Rahman
- Department of Culture and Society (IKOS), Division Ageing and Social Change (ASC), Linkoping University, Norrköping, Sweden
| | - Lars-Christer Hydén
- Department of Culture and Society (IKOS), Division Ageing and Social Change (ASC), Linkoping University, Norrköping, Sweden.,Center for Dementia Research (CEDER), Linkoping University, Norrköping, Sweden
| | - Susanne Kelfve
- Department of Culture and Society (IKOS), Division Social Work (SOCARB), Linkoping University, Norrköping, Sweden.,Department of Neurobiology, Care Sciences and Society, Aging Research Center, Karolinska Institutet & Stockholm University, Solna, Sweden
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Li Y, Leng F, Xiong Q, Zhou J, Du A, Zhu F, Kou X, Sun W, Chen L, Wang H, Xie H, Gao F, Jin H, Sun Y. Factors Associated With Alzheimer's Disease Patients' Caregiving Status and Family Caregiving Burden in China. Front Aging Neurosci 2022; 14:865933. [PMID: 35370609 PMCID: PMC8970011 DOI: 10.3389/fnagi.2022.865933] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 02/21/2022] [Indexed: 02/02/2023] Open
Abstract
Background The increasing prevalence of Alzheimer's disease (AD) has emerged as a major challenge worldwide. China as the most populous country in the globe is amid rapid aging of its population, highlighting the need for appropriate social and medical policies to meet the challenge. The current multicenter cross-sectional observational study aims to provide understanding of the current status of caring given to AD patients in China and investigate the factors that influence the family burden as well as the choice of care given to AD patients. Methods A total of 1,675 patients with probable AD from 30 provincial regions of mainland China were enrolled in the current study from August 2019 to December 2019. We analyzed the caregiving status and its relationship with family burden and various socio-economical and medical factors. Results In the current study, 90.87% of the AD patients enrolled adopted family care. The choice of caregiving method was influenced by factors including age (>80 years old, OR 0.648; 95% CI, 0.427-0.983), overall family burden (high, OR 0.574; 95% CI, 0.0.373-0.884), patients' income (OR 0.511; 95% CI, 0.330-0.789) and self-care ability (OR 0.329; 95% CI, 0.183-0.588). Conclusion Family care is the primary method of care for AD patients in China and the institutional care system for AD patients is still underprepared in China.
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Affiliation(s)
- Yuxian Li
- Department of Neurology, Peking University First Hospital, Peking University, Beijing, China
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Fangda Leng
- Department of Neurology, Peking University First Hospital, Peking University, Beijing, China
| | - Qi Xiong
- Health Service Department of the Guard Bureau of the Joint Staff Department, Beijing, China
| | - Jiong Zhou
- Department of Neurology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang, China
| | - Ailian Du
- Department of Neurology, Shanghai Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Feiqi Zhu
- Department of Neurology, Shenzhen Luohu People’s Hospital, Shenzhen, China
| | - Xiaowen Kou
- Health Times, The People’s Daily, Beijing, China
| | - Wei Sun
- Department of Neurology, Peking University First Hospital, Peking University, Beijing, China
| | - Luzeng Chen
- Department of Ultrasonography, Peking University First Hospital, Peking University, Beijing, China
| | - Huali Wang
- Department of Psychiatry, Peking University Sixth Hospital, Peking University, Beijing, China
| | - Hengge Xie
- Department of Neurology, Second Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Feng Gao
- Health Service Department of the Guard Bureau of the Joint Staff Department, Beijing, China
| | - Haiqiang Jin
- Department of Neurology, Peking University First Hospital, Peking University, Beijing, China
| | - Yongan Sun
- Department of Neurology, Peking University First Hospital, Peking University, Beijing, China
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Arias-Casais N, Amuthavalli Thiyagarajan J, Rodrigues Perracini M, Park E, Van den Block L, Sumi Y, Sadana R, Banerjee A, Han ZA. What long-term care interventions have been published between 2010 and 2020? Results of a WHO scoping review identifying long-term care interventions for older people around the world. BMJ Open 2022; 12:e054492. [PMID: 35105637 PMCID: PMC8808408 DOI: 10.1136/bmjopen-2021-054492] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 12/20/2021] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE The global population is rapidly ageing. To tackle the increasing prevalence of older adults' chronic conditions, loss of intrinsic capacity and functional ability, long-term care interventions are required. The study aim was to identify long-term care interventions reported in scientific literature from 2010 to 2020 and categorise them in relation to WHO's public health framework of healthy ageing. DESIGN Scoping review conducted on PubMed, CINHAL, Cochrane and Google Advanced targeting studies reporting on long-term care interventions for older and frail adults. An internal validated Excel matrix was used for charting.Setting nursing homes, assisted care homes, long-term care facilities, home, residential houses for the elderly and at the community. INCLUSION CRITERIA Studies published in peer-reviewed journals between 1 January 2010 to 1 February 2020 on implemented interventions with outcome measures provided in the settings mentioned above for subjects older than 60 years old in English, Spanish, German, Portuguese or French. RESULTS 305 studies were included. Fifty clustered interventions were identified and organised into four WHO Healthy Ageing domains and 20 subdomains. All interventions delved from high-income settings; no interventions from low-resource settings were identified. The most frequently reported interventions were multimodal exercise (n=68 reports, person-centred assessment and care plan development (n=22), case management for continuum care (n=16), multicomponent interventions (n=15), psychoeducational interventions for caregivers (n=13) and interventions mitigating cognitive decline (n=13). CONCLUSION The identified interventions are diverse overarching multiple settings and areas seeking to prevent, treat and improve loss of functional ability and intrinsic capacity. Interventions from low-resource settings were not identified.
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Affiliation(s)
- Natalia Arias-Casais
- ATLANTES Global Observatory for Palliative Care, University of Navarra, Pamplona, Spain
| | | | | | - Eunok Park
- College of Nursing, Jeju National University, Jeju, Republic of Korea
| | - Lieve Van den Block
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussels, Belgium
- End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Yuka Sumi
- Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Ritu Sadana
- Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Anshu Banerjee
- Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Zee-A Han
- Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
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Ydstebø AE. Hjemmeboende personer med demens: Hva påvirker deres livskvalitet og bruk av helse- og omsorgsressurser? TIDSSKRIFT FOR OMSORGSFORSKNING 2022. [DOI: 10.18261/issn.2387-5984-2021-01-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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9
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Krutter S, Schaffler‐Schaden D, Eßl‐Maurer R, Seymer A, Osterbrink J, Flamm M. Home care nursing for persons with dementia from a family caregivers' point of view: Predictors of utilisation in a rural setting in Austria. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:389-399. [PMID: 33963625 PMCID: PMC9290922 DOI: 10.1111/hsc.13412] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 03/18/2021] [Accepted: 04/04/2021] [Indexed: 06/12/2023]
Abstract
The service utilisation of persons with dementia (PwD) and their caregivers is subject to lively debate. The reasons for non-utilisation are manifold and heterogeneous. Conceptual models and explanatory frameworks may help identify predictors of the usage of health services. Literature examining the utilisation of home care services for PwD is scarce. This study explored predictors of home care nursing utilisation of PwD and their informal caregivers in a rural setting, according to the Andersen Behavioural Model of Health Care Use. A mixed-methods study was conducted in a rural area of Austria. In using non-random multistage sampling, anonymous questionnaires were distributed to collect data on family caregivers of PwD. Data were analysed using sequential binary logistic regression to characterise home care service users. To reflect the complexity of the Andersen model, a regression tree model was used. In total, 107 family caregivers completed the survey. Predisposing factors for home care nursing utilisation were higher age of the caregiver, female gender of PwD and kinship of the PwD and caregiver. Disruptive behaviour and independence in activities of daily living of PwD were associated with need factors for service use. According to the Andersen model, the predisposing and need factors contributed most to the explanation of home care nursing utilisation. The enabling factors employment, education and income tend to predict service use. Our findings indicate that higher age of the family caregiver and female gender of PwD are the main predictors for utilisation of home care nursing in a rural setting. To improve utilisation, the advantages of professional care services should be promoted, and the awareness about the variety of services available should be increased. To ensure a better understanding of the barriers to accessing home care, PwD should more often be included in healthcare service research.
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Affiliation(s)
- Simon Krutter
- Institute for Nursing Science and PracticeParacelsus Medical UniversitySalzburgAustria
| | - Dagmar Schaffler‐Schaden
- Institute of General Practice, Family Medicine and Preventive MedicineParacelsus Medical UniversitySalzburgAustria
| | - Roland Eßl‐Maurer
- Institute for Nursing Science and PracticeParacelsus Medical UniversitySalzburgAustria
| | | | - Juergen Osterbrink
- Institute for Nursing Science and PracticeParacelsus Medical UniversitySalzburgAustria
| | - Maria Flamm
- Institute of General Practice, Family Medicine and Preventive MedicineParacelsus Medical UniversitySalzburgAustria
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Tokovska M, Nour MM, Sørensen A, Småland Goth U. Informal caregivers and psychosocial support: Analysis of European Dementia Policy documents. J Public Health Res 2021; 11. [PMID: 34579521 PMCID: PMC8874860 DOI: 10.4081/jphr.2021.2416] [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: 05/24/2021] [Accepted: 08/13/2021] [Indexed: 11/23/2022] Open
Abstract
Various countries in Europe have different strategies for promoting care solutions for dementia challenges. The different approaches of Austria, Belgium, Czechia, Denmark, Finland, Germany, Gibraltar, Ireland, Israel, Malta, Nederland, Norway, Sweden and the United Kingdom (Scotland and Wales) were investigated. Dementia has a significant social, psychological and economic impact on the individual, family and society. As the disease progresses dementia sufferers become increasingly dependent. As many dementia sufferers are at home during the initial stages, the physical, emotional, and social demands of the dementia sufferers are often covered by informal caregivers. This study, therefore, aims to investigate the integration of psychosocial interventions for comprehensive care pertaining to informal caregivers of people with dementia in Europe. Furthermore, the study will highlight how implementation of technologies might enable psychosocial support of informal caregivers. The data is based on 15 national dementia strategies from various European countries. Data was based on preexisting coding systems with the predefined keywords and analyzed by qualitative content analysis by four of the authors. Our results show that psychosocial support is provided in various modalities and that informal caregivers need to be supported by a psychosocial approach. Due to this need the national dementia strategies should include measures to reduce the emotional burden of informal caregivers. Psychosocial support provided to informal caregivers in a comprehensive and systematic way is likely to enable informal caregivers to handle the emotional, cognitive, and behavioral consequences of the disease and its treatment, while helping to maintain their work-life balance. Significance for public health This study has important public health impacts on informal caregivers in a European context. The study reveals that the European countries of Alzheimer Europe - especially policymakers, social and healthcare providers and non-government organizations - should update or prepare the necessary national dementia strategies, promote benchlearning, improve international collaboration and systematically manage those who provide psychosocial support.
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Affiliation(s)
| | - Magde Mohamed Nour
- School of Health Science, Kristiania University College, Oslo; Department of Information Science and Media Studies, University of Bergen, Bergen.
| | - Anette Sørensen
- School of Health Science, Kristiania University College, Oslo.
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Puustinen J, Kangasniemi M, Turjamaa R. Are comprehensive and individually designed care and service plans for older people's home care a vision or a reality in Finland? HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:e144-e152. [PMID: 33326161 DOI: 10.1111/hsc.13255] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 09/10/2020] [Accepted: 11/08/2020] [Indexed: 06/12/2023]
Abstract
The global population is ageing and many older people want to continue to live in their own homes, supported by home-care services. The basis for comprehensive care is real-time care and service plans, but more knowledge is needed about these plans to ensure that older people benefit from individual and comprehensive home care. Our aim was to describe the contents of older home-care clients' care and service plans by using the Finnish Care Classification (FinCC), version 3.0, which includes the Finnish classification of nursing diagnoses (FiCND) and the Finnish classification of nursing interventions (FiCNI). The data were collected during spring 2018 from 71 anonymised care and service plans provided by 47 registered and practical nurses who worked for one government-funded home-care organisation in an urban region of Finland. We analysed the data using descriptive statistical methods. The documentation focused on daily activities, but was based on a narrow view of individual needs and comprehensive care planning. In addition, we found a statistically significant association between documented clients' needs (FiCND) and nursing interventions (FiCNI) in secretions, fluid balance, respiration and skin integrity. The client's age, gender, how long they had been receiving home care and the number of home visits they received each week were all associated with certain documented needs and interventions. Our findings provide new knowledge about inconsistent documentation related to clients' needs and nursing interventions. Collaboration between technical and home-care professionals is needed to develop and test specific content in the FinCC related to home care. The contents should also take into account the views of older people on how they want their care and services needs to be planned and delivered so that they can lead independent and fulfilling lives.
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Affiliation(s)
- Jonna Puustinen
- Karelia University of Applied Sciences, Social Services and Health Care, Joensuu, Finland
| | - Mari Kangasniemi
- Department of Nursing Science, Faculty of Medicine, University Researcher, University of Turku, Turku, Finland
| | - Riitta Turjamaa
- Savonia University of Applied Sciences, School of Health Care, Kuopio, Finland
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, University of Turku, Kuopio, Finland
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Sm-Rahman A, Hydén LC, Kelfve S. Eldercare services for people with and without a dementia diagnosis: an analysis of Swedish registry data. BMC Health Serv Res 2021; 21:893. [PMID: 34461894 PMCID: PMC8404279 DOI: 10.1186/s12913-021-06891-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 08/13/2021] [Indexed: 11/15/2022] Open
Abstract
Background The growing number of people living with dementia (PlwD) implies an increase in the demand for eldercare services in Sweden like in many other countries. Few studies have analyzed the use of eldercare services for PlwD. The aim of the present study is to investigate the association between demographic factors (age, sex, cohabiting status) and the use of municipal eldercare services (including both home care and residential care) for older adults with dementia compared to older adults without dementia in Sweden. Methods This study used several nationwide Swedish registers targeting all individuals aged 65 and above living in Sweden in 2014 and still alive 31st of March 2015 (n = 2,004,409). The primary outcomes variables were different types of eldercare service, and all participants were clustered based on age, sex, cohabiting status, and dementia diagnosis. In addition to descriptive statistics, we performed multivariate logistic regression models for binary outcomes and linear regression models for continuous outcomes. Results Results showed that (1) older age is a significantly strong predictor for the use of eldercare services, although PlwD start using eldercare at an earlier age compared with people without dementia; (2) women tend to receive more eldercare services than men, especially in older age, although men with dementia who live alone are more likely than women living alone to receive eldercare; (3) having a dementia diagnosis is a strong predictor for receiving eldercare. However, it was also found that a substantial proportion of men and women with dementia did not receive any eldercare services. Conclusions We found that people with a dementia diagnosis use more as well as start to use eldercare services at an earlier age than people without dementia. However, further research is needed to investigate why a substantial part of people with a dementia diagnosis does not have any eldercare at all and what the policy implications of this might be.
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Affiliation(s)
- Atiqur Sm-Rahman
- Department of Culture and Society (IKOS), Division Ageing and Social Change (ASC), Linkoping University, Kåkenhus, Rum 5516, 601 74, Norrköping, Sweden.
| | - Lars-Christer Hydén
- Department of Culture and Society (IKOS), Division Ageing and Social Change (ASC), Linkoping University, Kåkenhus, Rum 5516, 601 74, Norrköping, Sweden.,Center for Dementia Research (CEDER), Linkoping University, Linköping, Sweden
| | - Susanne Kelfve
- Department of Culture and Society (IKOS), Division Social Work (SOCARB), Linkoping University, Linköping, Sweden.,Department of Neurobiology, Care Sciences and Society, Aging Research Center, Karolinska Institutet & Stockholm University, Solna, Sweden
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13
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Hedman R, Sandman PO, Edvardsson D. Enacting person-centred care in home care services for people with dementia. J Clin Nurs 2021; 31:1519-1530. [PMID: 34396618 DOI: 10.1111/jocn.16004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/09/2021] [Accepted: 07/27/2021] [Indexed: 01/12/2023]
Abstract
AIMS AND OBJECTIVES To develop the theoretical understanding of the process of providing person-centred home care for people with dementia. BACKGROUND People with dementia are increasingly cared for at home by family members and home care staff. Care of people with dementia should be person-centred; however, little is known about how home care staff understand and enact person-centred care in their daily work. DESIGN Grounded theory. METHODS Home care staff (n = 29) were recruited from home care services specialised in providing care for people with dementia. Group interviews were conducted, and a tentative theoretical model for providing person-centred home care to people with dementia was outlined. Nine of the participants were then individually interviewed to further develop the model. The analysis was conducted parallel to the data collection, and hypotheses concerning the evolving theoretical model were continuously tested in the following interviews. The COREQ checklist for qualitative studies was used in reporting the study. RESULTS Person-centred home care of people with dementia was conceptualised as a series of processes: Getting ready, getting in, giving care, getting out and finalising the story, each with subprocesses. Theatre metaphors were used to describe how the care was provided. A core process, Enacting and re-enacting familiarity, was at centre in all processes. CONCLUSIONS In the person-centred care of people with dementia, familiarity had to be established and continuously fostered. When familiarity was in place, the care recipient and the home care staff acted as a team to perform the care. The theoretical works of Goffman were used to interpret the results. RELEVANCE TO CLINICAL PRACTICE The study provides a model for person-centred care of people with dementia at home that deepens the understanding of its processes, prerequisites and outcomes. The model can inform education and administration of home care for people with dementia.
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Affiliation(s)
- Ragnhild Hedman
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden.,Department of Nursing Science, Sophiahemmet University, Stockholm, Sweden
| | - Per-Olof Sandman
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Department of Nursing, Umeå University, Umeå, Sweden
| | - David Edvardsson
- Department of Nursing, Umeå University, Umeå, Sweden.,School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
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14
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Gudnadottir M, Ceci C, Kirkevold M, Björnsdóttir K. Community-based dementia care re-defined: Lessons from Iceland. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:1091-1099. [PMID: 32885543 DOI: 10.1111/hsc.13143] [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: 12/12/2019] [Revised: 06/26/2020] [Accepted: 07/27/2020] [Indexed: 06/11/2023]
Abstract
Studies of families caring for persons with dementia living at home often reflect feelings of being forgotten and abandoned by the authorities to shoulder the responsibility for care-giving. This has increased interest in how formal services can better support these families. This article analyses how health and social care professionals envision the needs of families of persons with dementia living in the community. It also describes the contributions of the formal care system to these families. The study design was qualitative. It involved interviews with professionals (N = 20), field observations from the settings where they worked, and public documents addressing care-giving for people with dementia. Data were analysed using the framework method. The findings reflected how those providing services to persons experiencing cognitive changes mainly understood the services as specialised. They focused on the diagnosis and treatment of the individual with dementia. They considered other aspects of care, such as attending to practical issues of daily life, to be a private matter, for which the family was responsible. In later stages of dementia, specialised day programs become available, offering rehabilitation to motivate positive daily living-for both the person experiencing dementia and family-centred supporters. Professionals in the field described primary care, community-based healthcare and home care services as poorly equipped to support these families. Participants acknowledged that families were often under a lot of stress and might need more support earlier in the illness. However, they saw themselves as powerless. Towards the end of the data collection, services were being re-designed to emphasise the role of primary care. In light of its holistic and family-centred approach, primary care may be well placed to integrate relational understanding of living with dementia and specialised knowledge of dementia treatment.
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Affiliation(s)
| | - Christine Ceci
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Marit Kirkevold
- Institute of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
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15
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Hoel KA, Rokstad AMM, Feiring IH, Lichtwarck B, Selbaek G, Bergh S. Staff's perspectives on the organization of homecare services to people with dementia-A qualitative study. Nurs Open 2021; 8:1797-1804. [PMID: 33626244 PMCID: PMC8186689 DOI: 10.1002/nop2.822] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 12/11/2020] [Accepted: 01/29/2021] [Indexed: 11/17/2022] Open
Abstract
Aims The aim of the study was to explore the experiences of homecare staff about the impact of the organization of homecare services for people with dementia. Design This study has a qualitative, exploratory design based on a phenomenological‐hermeneutic approach, using individual in‐depth interviews with homecare staff to collect data. Methods A convenience sample of 14 homecare staff from five municipalities participated in the study. Main topics introduced: (a) how homecare services for people with dementia are organized and (b) challenges in respondents' everyday practice of caring for people with dementia. Interviews were conducted from October to December 2017. Results Three main themes were identified from the interviews. (a) Complexity and need for individualized facilitated homecare services; homecare services were described as complex in regard to both the patient and the service. The complexity of the service made it challenging to tailor the service to the individual patient. (b) The importance of trust and relationships; establishing trust in the relationship between the patient and the staff resulted in better‐quality care. This was crucial for identifying the patient's need for help. (c) Organizational challenges; homecare services could be vulnerable to changes in the organization. Practical tasks and following the daily scheduled task list were often prioritized at the expense of an individually tailored service.
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Affiliation(s)
- Kari-Anne Hoel
- The Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Brumunddal, Norway
| | - Anne Marie Mork Rokstad
- The Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tonsberg, Norway.,Faculty of Health and Social Sciences, Molde University College, Molde, Norway
| | - Ingvild Hjorth Feiring
- The Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Brumunddal, Norway
| | - Bjørn Lichtwarck
- The Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Brumunddal, Norway
| | - Geir Selbaek
- The Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tonsberg, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Sverre Bergh
- The Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Brumunddal, Norway.,The Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tonsberg, Norway
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16
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Teahan Á, Carney P, Cahill S, O'Shea E. Establishing priorities for psychosocial supports and services among family carers of people with dementia in Ireland. DEMENTIA 2021; 20:2109-2132. [PMID: 33423536 DOI: 10.1177/1471301220984907] [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] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Many family carers, particularly those caring for people with dementia, report significant personal and social challenges associated with caring. The aim of this article is to identify the range of challenges experienced by family carers of people with dementia and to ascertain their preferences for various supports and services that address those challenges. METHOD Three modified nominal group technique (NGT) focus groups were conducted with family carers of people with dementia. The NGT groups were conducted with 17 participants in two stages, focusing separately on personal and social domains. Family carers identified challenges and individually ranked preferences for both existing and new services and supports. Data analysis consisted of qualitative content analysis and summative scoring of individual rankings. FINDINGS Family carers identified the following personal-level challenges: needing a break, social isolation and relationship changes. Family carers' combined preferences for personal-level supports and services to overcome these challenges were day care, family care support groups, short-term respite, long-break respite and social activities. Social challenges referenced by family carers included finances, rights and entitlements and stigma and awareness. Preferences for supports and services to address these social challenges were non-means-tested carer's allowance, legal recognition, carer's support grant, monthly wage and community awareness programmes. CONCLUSION Participants ranked day care and non-means-tested carer's allowance as their top priorities under personal and social headings. Increased government investment in these two areas would not only help to maintain family carers' contributions to community-based care in dementia but would also facilitate social inclusion, social connectedness and economic sustainability.
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Affiliation(s)
- Áine Teahan
- Centre for Economic and Social Research on Dementia (CESRD), 8799NUI Galway, Galway, Ireland
| | - Patricia Carney
- Department of Public Health Midlands, 8004Health Service Executive, Tullamore, Ireland
| | - Suzanne Cahill
- Centre for Economic and Social Research on Dementia (CESRD), 8799NUI Galway, Galway, Ireland
| | - Eamon O'Shea
- Centre for Economic and Social Research on Dementia (CESRD), 8799NUI Galway, Galway, Ireland
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17
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Olsen M, Udo C, Boström AM, Hammar LM. Important aspects of home care service: An interview study of persons with dementia. DEMENTIA 2020; 20:1649-1663. [DOI: 10.1177/1471301220964393] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background and Aim Because of the policy of ‘ageing in place’ and a decreasing number of beds in residential settings, more persons with dementia live at home with support from home care services. However, previous studies have revealed more unmet needs and a lower quality of life in this group than in other groups. Because few qualitative studies are performed in which persons with dementia have the opportunity to tell their own stories and describe what they find important, this study aimed to interview persons with dementia and describe their views on the important aspects of receiving home care service. Methods The study used a qualitative approach, and 14 persons with dementia participated in the interviews. The interviews were analysed using qualitative content analysis. Findings The findings revealed one overarching theme. The importance of being supported as a unique and capable human, that is the persons with dementia stated that despite their dementia diagnoses, it was important to be seen as a person with capabilities, although in need of support. This theme was built on three subthemes: being seen as a person, being informed and involved, and being part of a relationship. Conclusions Our study showed that persons with dementia are able to express, formulate and reflect on their needs and preferences about their daily care as well as what is important to them when receiving home care service. Therefore, their point of view should be taken into consideration when planning, providing and evaluating care.
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Affiliation(s)
- Marie Olsen
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden; Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute and Stockholm University, Stockholm, Sweden
| | - Camilla Udo
- School of Education, Health and Social Studies, Dalarna University, Sweden; Center for Clinical Research, Dalarna, Sweden; Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | - Anne-Marie Boström
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute, Sweden; Theme Ageing, Karolinska University Hospital, Huddinge, Sweden; Stockholms Sjukhem, R&D Unit, Stockholm, Sweden
| | - Lena Marmstål Hammar
- School of Health, Care, and Social Welfare, Mälardalen University, Sweden; School of Education, Health and Social Studies, Dalarna University, Sweden; Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute, Sweden
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18
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Khemai C, Janssen DJA, Schols JMGA, Naus L, Kemper S, Jole I, Bolt SR, Meijers JMM. Nurses' needs when collaborating with other healthcare professionals in palliative dementia care. Nurse Educ Pract 2020; 48:102866. [PMID: 32950940 DOI: 10.1016/j.nepr.2020.102866] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 07/10/2020] [Accepted: 08/20/2020] [Indexed: 11/26/2022]
Abstract
Adequate interprofessional collaboration is essential to provide high quality palliative dementia care across different settings. Within interprofessional collaboration, nurses are the frontline healthcare professionals (HCPs), who interact closely with people with dementia, their loved ones, and other HCPs. A survey was conducted to explore the needs of nurses regarding interprofessional collaboration in home care (HC) organisations, nursing homes (NHs) and during NH admissions. The survey identified the perceived quality of and preferred needs regarding interprofessional collaboration. In total, 384 participants (53.9% home care nurses) completed the survey. The most frequently reported collaboration needs in HC organisations and NH were optimal communication content e.g. information transfer and short communication lines (being able to easily contact other disciplines), and coordination e.g. one contact person, and clear task division and responsibilities). During NH admissions, it was important to create transparency about agreements concerning end-of-life wishes, optimize nurse-to-nurse handover during NH admissions (through performing visits prior to admissions, and receiving practical information on how to guide relatives), and improve coordination (e.g. one contact person). In conclusion, the key collaboration needs were organising central coordination, establishing optimal communication, and creating transparency on end-of-life care agreements.
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Affiliation(s)
- C Khemai
- Department of Health Services Research, CAPHRI (Care and Public Health Research Institute), Faculty of Health Medicine and Life Sciences, Maastricht University, Duboisdomein 30, 6229, GT, Maastricht, the Netherlands.
| | - D J A Janssen
- Department of Health Services Research, CAPHRI (Care and Public Health Research Institute), Faculty of Health Medicine and Life Sciences, Maastricht University, Duboisdomein 30, 6229, GT, Maastricht, the Netherlands; Department of Research and Development, CIRO, Hornerheide 1, 6085, NM Horn, the Netherlands
| | - J M G A Schols
- Department of Health Services Research, CAPHRI (Care and Public Health Research Institute), Faculty of Health Medicine and Life Sciences, Maastricht University, Duboisdomein 30, 6229, GT, Maastricht, the Netherlands
| | - L Naus
- Department of Health Services Research, CAPHRI (Care and Public Health Research Institute), Faculty of Health Medicine and Life Sciences, Maastricht University, Duboisdomein 30, 6229, GT, Maastricht, the Netherlands
| | - S Kemper
- Department of Health Services Research, CAPHRI (Care and Public Health Research Institute), Faculty of Health Medicine and Life Sciences, Maastricht University, Duboisdomein 30, 6229, GT, Maastricht, the Netherlands
| | - I Jole
- Department of Health Services Research, CAPHRI (Care and Public Health Research Institute), Faculty of Health Medicine and Life Sciences, Maastricht University, Duboisdomein 30, 6229, GT, Maastricht, the Netherlands
| | - S R Bolt
- Department of Health Services Research, CAPHRI (Care and Public Health Research Institute), Faculty of Health Medicine and Life Sciences, Maastricht University, Duboisdomein 30, 6229, GT, Maastricht, the Netherlands
| | - J M M Meijers
- Department of Health Services Research, CAPHRI (Care and Public Health Research Institute), Faculty of Health Medicine and Life Sciences, Maastricht University, Duboisdomein 30, 6229, GT, Maastricht, the Netherlands; Zuyderland Care, Zuyderland Medical Center, Dr. H. van der Hoffplein 1, 6162, BG Sittard-Geleen, the Netherlands
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19
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Hammar LM, Alam M, Olsen M, Swall A, Boström AM. Being Treated With Respect and Dignity?-Perceptions of Home Care Service Among Persons With Dementia. J Am Med Dir Assoc 2020; 22:656-662. [PMID: 32839126 DOI: 10.1016/j.jamda.2020.07.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 06/30/2020] [Accepted: 07/01/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Studies on the quality of home care services (HCS) offered to persons with dementia (PwDs) reveal the prevalence of unmet needs and dissatisfaction related to encounters and a lack of relationships with staff. The objective of this study was to enhance knowledge of the perceptions of PwDs regarding their treatment with dignity and respect in HCS over time. DESIGN A mixed longitudinal cohort study was designed to study trends in the period between 2016 and 2018 and compare the results between PwDs (cases) and persons without dementia (controls) living at home with HCS. SETTING AND PARTICIPANTS Persons aged 65 years and older with HCS in Sweden. METHODS Data from an existing yearly HCS survey by the Swedish National Board of Health and Welfare (NBHW) was used. The focus was on questions concerning dignity and respect. NBHW data sets on diagnoses, medications, HCS hours, and demographic information were also used. We applied GEE logistic and cumulative logit regression models to estimate effects and trends of interest after controlling for the effects of age, gender, self-rated health, and number of HCS hours. RESULTS Over the study period, 271,915 (PwDs = 8.1%) respondents completed the survey. The results showed that PwDs were significantly less likely (3%-10% lower odds and cumulative odds) than controls to indicate that they were satisfied in response to questions related to dignity and respect. Both groups experienced a decrease in satisfaction from 2016 to 2018. Females, individuals with poor self-rated health, and individuals granted more HCS hours were found to be more dissatisfied. CONCLUSIONS AND IMPLICATIONS The HCS organization needs to shift from a task-oriented system to a person-centered approach, where dignity and respect are of the utmost importance. The HCS organizations need to be developed to focus on competence in person-centered care, and leadership to support staff.
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Affiliation(s)
- Lena Marmstål Hammar
- School of Health, Care, and Social Welfare, Mälardalen University, Västerås, Sweden; School of Education, Health and Social Studies, Dalarna University, Falun, Sweden; Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.
| | - Moudud Alam
- School of Technology and Business Studies/Statistics, Dalarna University, Falun, Sweden
| | - Marie Olsen
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden; Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Anna Swall
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Anne-Marie Boström
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden; Theme Ageing, Karolinska University Hospital, Huddinge, Sweden; Stockholms Sjukhem, R&D Unit, Stockholm, Sweden
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20
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Ydstebø AE, Benth JŠ, Bergh S, Selbæk G, Vossius C. Informal and formal care among persons with dementia immediately before nursing home admission. BMC Geriatr 2020; 20:296. [PMID: 32811440 PMCID: PMC7436969 DOI: 10.1186/s12877-020-01703-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 08/12/2020] [Indexed: 11/14/2022] Open
Abstract
Background Dementia is a care intensive disease, especially in the later stages, implying in many cases a substantial carer burden. This study assesses the use of formal and informal care resources among persons with dementia during the last month before nursing home admission. It also describes main providers of informal care and assesses the extent of informal care rendered by the extended social network. Methods In this cross-sectional study, we collected data about persons with dementia that were newly admitted to a nursing home in Norway. Information about the amount of formal and informal care during the last 4 weeks preceding nursing home admission was collected from the primary caregivers. Clinical data were collected by examining the patients, while sociodemographic data was collected from the patients’ files. Results A total of 395 persons with dementia were included. The amount of informal care provided by the family caregiver was 141.9 h per month SD = 227.4. Co-resident patients received five times more informal care than non-co-residents. Informal care from the extended social network was provided to 212 patients (53.7%) with a mean of 5.6 (SD = 11.2) hours per month and represented 3.8% of the total informal care rendered to the patients. Formal care was provided to 52.7% of the patients with a mean of 18.0 (SD = 50.1) hours per month. Co-residency was significantly associated with more informal care, and the associations varied with respect to age, relation to the caregiver, and the caregiver’s working situation. Good/excellent general health was associated with less formal care. Conclusion Persons with dementia on the verge of admission to a nursing home are mainly supported by the family caregiver, and the use of informal care is particularly high among co-residents. In order to delay nursing home admission, future research should explore the unrealized care potential in extended social networks, as well as the potential for increasing the number of recipients of formal care services.
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Affiliation(s)
- Arnt Egil Ydstebø
- Centre for Age-related Medicine, Stavanger University Hospital, Stavanger, Norway. .,Centre for Development of Institutional and Home Care Services Rogaland, Stavanger, Norway. .,Research centre for Age-related Functional decline and Disease, Innlandet Hospital Trust, Postboks 68, N-2312, Ottestad, Norway.
| | - Jurate Šaltytė Benth
- Research centre for Age-related Functional decline and Disease, Innlandet Hospital Trust, Postboks 68, N-2312, Ottestad, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Health Services Research Unit, Akershus University Hospital, Akershus, Norway
| | - Sverre Bergh
- Research centre for Age-related Functional decline and Disease, Innlandet Hospital Trust, Postboks 68, N-2312, Ottestad, Norway.,Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - Geir Selbæk
- Research centre for Age-related Functional decline and Disease, Innlandet Hospital Trust, Postboks 68, N-2312, Ottestad, Norway.,Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Corinna Vossius
- Centre for Age-related Medicine, Stavanger University Hospital, Stavanger, Norway.,Centre for Development of Institutional and Home Care Services Rogaland, Stavanger, Norway
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21
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Fallahpour M, Borell L, Sandberg L, Boström AM. Dementia Care Education Targeting Job Strain and Organizational Climate Among Dementia Care Specialists in Swedish Home Care Services. J Multidiscip Healthc 2020; 13:85-97. [PMID: 32158218 PMCID: PMC6986249 DOI: 10.2147/jmdh.s214378] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 11/14/2019] [Indexed: 12/02/2022] Open
Abstract
Introduction An increasing number of older persons live at home with various limitations, such as dementia, requiring well-educated and trained home care staff to meet their complex care needs. Dementia care specialists working in home care service have reported high levels of job strain in comparison with home care staff in general. Aim This pilot study aims to evaluate the effects of a dementia care education model targeting self-reported job strain and organizational climate, among dementia care specialists in home care service. Methods A quasi-experimental, one-group pretest–posttest design was applied, with 12 months’ follow-up. Participants were dementia care specialists who worked in home care service (n=34 baseline; n=30 follow-up). The data were collected using the Strain in Dementia Care Scale and Creative Climate Questionnaires, administered pre- and post-intervention. The intervention applied an educational model based on previous research in dementia care and a person-centered approach. Results The educational model was implemented in the context of home care services. Of 34 participants at baseline, only 21 responded to the questionnaires, due to a drop off of 13 participants and recruitment of 9 new participants (follow-up=30). A significantly reduced perceived job strain among the participants was detected, indicating perceiving less difficulty in “Balancing competing needs” when caring for the older persons. No significant difference was found in the self-reported creative organizational climate between the two occasions. Conclusion The educational model could be integrated into dementia home care and it seemed to reduce job strain among dementia care specialists. Future studies are needed to evaluate the effects of the intervention using a stronger study design and a larger sample.
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Affiliation(s)
- Mandana Fallahpour
- Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, Stockholm, Sweden.,Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden
| | - Lena Borell
- Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, Stockholm, Sweden
| | - Linda Sandberg
- Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, Stockholm, Sweden
| | - Anne-Marie Boström
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet Stockholm, Solna, Sweden.,Theme Aging, Karolinska University Hospital, Stockholm, Sweden.,Department of Nursing, Western Norway University of Applied Science, Haugesund, Norway
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Varik M, Medar M, Saks K. Informal caregivers' experiences of caring for persons with dementia in Estonia: A narrative study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:448-455. [PMID: 31637794 DOI: 10.1111/hsc.12877] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 09/10/2019] [Accepted: 09/24/2019] [Indexed: 06/10/2023]
Abstract
This paper presents the results of a qualitative study aimed at exploring the experiences and needs of informal caregivers of persons with dementia and identifying caregiver expectations for support. The research was based on phenomenological and social constructionist approaches; it also took experience-centred and culturally oriented approaches to narratives. It was conducted in Estonia in 2017 by means of unstructured in-depth interviews with 16 informal caregivers who had relatives with dementia. The narrative approach used in this study proved to be an appropriate and valuable method to understand the situations of the caregivers of the people with dementia, in identifying their needs and expectations, and in developing social understanding for caregivers. The results are divided under four thematic headings: awareness of dementia; process of caregiving and different caregiving roles; influence of caregiving on personal life; and expectations of empowerment. We found that it is necessary to raise public awareness of dementia and develop person-centred support services for the people living with dementia.
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Affiliation(s)
- Merle Varik
- School of Governance, Law and Society, Tallinn University, Tallinn, Estonia
- Tartu Health Care College, Tartu, Estonia
| | - Marju Medar
- School of Governance, Law and Society, Tallinn University, Tallinn, Estonia
| | - Kai Saks
- University of Tartu, Tartu, Estonia
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Frias CE, Garcia-Pascual M, Montoro M, Ribas N, Risco E, Zabalegui A. Effectiveness of a psychoeducational intervention for caregivers of People With Dementia with regard to burden, anxiety and depression: A systematic review. J Adv Nurs 2020; 76:787-802. [PMID: 31808211 DOI: 10.1111/jan.14286] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 11/07/2019] [Accepted: 11/27/2019] [Indexed: 11/28/2022]
Abstract
AIM To assess the effectiveness of psychoeducational interventions with respect to burden, anxiety and depression in family caregivers of People With Dementia living at home. BACKGROUND In dementia, the family assumes the role of main caregiver, maintaining the patient in a good state of health. Nevertheless, burden, anxiety and depression may have negative repercussions in caregivers. Therefore, professional supports through psychoeducational programmes are recommended as interventions for improving caregivers' health. DESIGN A quantitative systematic review. DATA SOURCES Electronic searches were performed in CINAHL/AMED/CENTRAL/Web of Science/LILACS/PUBMED from January 2005-August 2018. REVIEW METHODS The review was conducted using the JADAD scale to assess bias risk and the quality of the randomized controlled trials (RCTs) and the CONSORT instrument to assess study quality report. The extracted data were reviewed by independent reviewer pairs. The review was reported using PRISMA. RESULTS A total of 18 RCTs met inclusion criteria. Seven were classified as Technology-based Interventions and 11 as Group-based Interventions. CONCLUSION Psychoeducational interventions for caregivers allow them to increase their knowledge of the illness, develop problem-solving skills and facilitate social support. Technology-based Interventions significantly affect burden while Group-based Interventions affect anxiety, depression, insomnia and burden and quality of life and self-efficacy. IMPACT Research findings can be used to classify caregivers in future interventions according to illness stage to obtain more precise results.
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Affiliation(s)
| | | | | | - Nuria Ribas
- Hospital Clinic of Barcelona, Barcelona, Spain
| | - Ester Risco
- Hospital Clinic of Barcelona, Barcelona, Spain
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Sawyer JM, Sallnow L, Kupeli N, Stone P, Sampson EL. Social networks, social capital and end-of-life care for people with dementia: a realist review. BMJ Open 2019; 9:e030703. [PMID: 31822539 PMCID: PMC6924787 DOI: 10.1136/bmjopen-2019-030703] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES (1) To develop an understanding of how social capital may be conceptualised within the context of end-of-life care and how it can influence outcomes for people with dementia and their families with specific reference to the context and mechanisms that explain observed outcomes. (2) To produce guidance for healthcare systems and researchers to better structure and design a public health approach to end-of-life care for people with dementia. DESIGN A realist review. DATA SOURCES MEDLINE, EMBASE, CINAHL and grey literature. ANALYSIS We conceptualised social capital as a complex intervention and, in order to understand how change is generated, used realist evaluation methods to create different configurations of context, mechanism and outcomes. We conducted an iterative search focusing on social capital, social networks and end-of-life care in dementia. All study designs and outcomes were screened and analysed to elicit explanations for a range of outcomes identified. Explanations were consolidated into an overarching programme theory that drew on substantive theory from the social sciences and a public health approach to palliative care. RESULTS We identified 118 articles from 16 countries ranging from 1992 to 2018. A total of 40 context-mechanism-outcome configurations help explain how social capital may influence end-of-life care for people with dementia. Such influence was identified within five key areas. These included: (1) socially orientating a person with dementia following diagnosis; (2) transitions in the physical environment of care; (3) how the caregiving experience is viewed by those directly involved with it; (4) transition of a person with dementia into the fourth age; (5) the decision making processes underpinning such processes. CONCLUSION This review contributes to the dispassionate understanding of how complex systems such as community and social capital might be viewed as a tool to improve end-of-life care for people with dementia. PROSPERO REGISTRATION NUMBER CRD42018084524.
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Affiliation(s)
- Joseph M Sawyer
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Libby Sallnow
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
- Camden, Islington ELiPSe and UCLH & HCA Palliative Care Service, London, UK
| | - Nuriye Kupeli
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Patrick Stone
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Elizabeth L Sampson
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
- Barnet Enfield and Haringey Mental Health Trust Liaison Psychiatry Team, North Middlesex University Hospital, London, UK
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Sanerma P, Paavilainen E, Åstedt-Kurki P. Home care services for older persons. The views of older persons and family members: A realistic evaluation. Int J Older People Nurs 2019; 15:e12281. [PMID: 31621204 DOI: 10.1111/opn.12281] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 08/24/2019] [Accepted: 09/16/2019] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES The aim of the present study was to evaluate client-centred care in older persons' home care services from the perspective of older persons and family members. The following research questions were addressed: How do home care older persons and family members perceive client-centered care in their home care services? What kind of social mechanisms are realized when home care services are implemented? BACKGROUND Several older persons are dependent on home care services for their continued living at home. The fundamental value and best practice of home care is the client-centred care in services. METHOD The research method was realistic evaluation. Six families with six older person clients of home care and seven family members were interviewed. In the present study, the interview contained three themes (1) content and services of the home care, (2) activities and practices of the home care and (3) development of client centredness in home care. Research data were analysed with deductive content analysis. RESULTS Home care service should be based on analysis of older person's individual life situation. Social mechanisms such as interaction, participation, trust and adaptation are realised in implementation of home care services. The most significant outcomes of client-centred service were timely availability of services, safe care relationship and continuity of care, ability to influence on own services and appropriate price of services. Significant factors in quality of service were unhurriedness, kindness and competence of professionals. IMPLICATION FOR PRACTICE Social mechanisms, such as participation, trust, adaptation and interaction, should be taken in account in care relationship in home care. Client centredness and methods for evaluating it should be defined in practical work. Client-centeredness competence should also be included in all stages of professional education of home care.
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Affiliation(s)
- Päivi Sanerma
- Faculty of Social Sciences, Nursing Science, University of Tampere, Tampere, Finland
| | - Eija Paavilainen
- Faculty of Social Sciences, Nursing Science, University of Tampere, Tampere, Finland
| | - Päivi Åstedt-Kurki
- Faculty of Social Sciences, Nursing Science, University of Tampere, Tampere, Finland
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Hammar LM, Williams CL, Meranius MS, McKee K. Being 'alone' striving for belonging and adaption in a new reality - The experiences of spouse carers of persons with dementia. DEMENTIA 2019; 20:273-290. [PMID: 31583888 DOI: 10.1177/1471301219879343] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND AIM Spouse carers of a person with dementia report feeling lonely and trapped in their role, lacking support and having no time to take care of their own health. In Sweden, the support available for family carers is not specialised to meet the needs of spouse carers of people with dementia. The aim of the study described in this paper was to explore spouse carers' experiences of caring for a partner with dementia, their everyday life as a couple and their support needs. METHODS Nine spouse carers of a partner with dementia living at home were recruited through a memory clinic and a dementia organisation. Semi-structured interviews were conducted with the participants, focusing on their experiences of providing care, their support needs in relation to their caring situation, their personal well-being and their marital relationship. The interviews were transcribed and underwent qualitative content analysis. RESULTS The analysis resulted in one overall theme Being 'alone' striving for belonging and adaption in a new reality, synthesized from four sub-themes: (1) Being in an unknown country; (2) Longing for a place for me and us; (3) Being a carer first and a person second; and (4) Being alone in a relationship. CONCLUSIONS The training of care professionals regarding the unique needs of spouse carers of people with dementia needs improvement, with education, in particular, focusing on their need to be considered as a person separate from being a carer and on the significance of the couple's relationship for their mutual well-being.
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Affiliation(s)
- Lena Marmstål Hammar
- School of Education, Health, and Social Studies, Dalarna University, Sweden; Department of Neurobiology, Care Sciences and Society, Karolinska Insitute, Sweden; School of Health, Care, and Social Welfare, Mälardalen University, Sweden
| | | | | | - Kevin McKee
- School of Education, Health, and Social Studies, Dalarna University, Sweden
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Turjamaa R, Pehkonen A, Kangasniemi M. How smart homes are used to support older people: An integrative review. Int J Older People Nurs 2019; 14:e12260. [DOI: 10.1111/opn.12260] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/29/2019] [Accepted: 06/12/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Riitta Turjamaa
- School of Health Care Kuopio Savonia University of Applied Sciences Kuopio Finland
- Department of Nursing Science, Faculty of Health Sciences University of Eastern Finland Kuopio Finland
| | - Aki Pehkonen
- Department of Nursing Science, Faculty of Health Sciences University of Eastern Finland Kuopio Finland
| | - Mari Kangasniemi
- Department of Nursing Science, Faculty of Medicine University of Turku Turku Finland
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Support Needs and Expectations of People Living with Dementia and Their Informal Carers in Everyday Life: A European Study. SOCIAL SCIENCES 2019. [DOI: 10.3390/socsci8070203] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
The aim of this study was to describe the needs and expectations of support within everyday life among community-dwelling people living well with an early stage dementia and their informal carers. The study employed a qualitative design. Data were collected in 2018, via four focus group interviews with, in total, 17 people with dementia and 21 informal carers, transcribed and analyzed with manifest content analysis. Needs and expectations of support among persons with dementia were expressed as the importance of “Participation in my own care,” “Attitude of the informal carers,” and “Trusting relationships with informal carers.” Informal carers’ needs and expectations of support were expressed as the importance of “Formal care and services,” “Getting out of a carer mindset,” and “Family context.” The findings from this study highlighted that persons with dementia were well aware of their cognitive impairments and tried to maintain their independence, with both formal and informal care to help remain “being themselves.” Health professionals should acknowledge persons with dementia and informal carers’ well-being, and acknowledge the importance of their needs together with an understanding of the importance of continuity of frontline carers to building trusting relationships.
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Yeh IL, Samsi K, Vandrevala T, Manthorpe J. Constituents of effective support for homecare workers providing care to people with dementia at end of life. Int J Geriatr Psychiatry 2019; 34:352-359. [PMID: 30430628 DOI: 10.1002/gps.5027] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 11/03/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The aim of this study was to enhance understanding about homecare workers providing care to people with dementia at end of life by exploring homecare workers' perceptions of challenges and the support they needed and sometimes received. METHODS Qualitative semi-structured interviews were conducted with 29 homecare workers and 13 homecare managers in England. Framework analysis was used to analyse the data. FINDINGS Four overarching challenges were identified: working with clients with dementia, including clients' sometimes unpredictable responses, communication difficulties, and mood changes; caring for the dying; conflict with family members; and working alone, which often left homecare workers at risk of exhaustion, fatigue, and a sense of isolation. When their work entailed high levels of emotion, such as a client's death or getting embroiled in a client's family conflict, they felt emotionally drained, under-prepared, and overwhelmed. Supportive elements include receiving encouragement and learning from experienced peers and their feelings being acknowledged by managers at their employing homecare agency. Some workers were offered time off or encouraged to attend the client's funeral as a means of supporting the process of bereavement. CONCLUSIONS Peer and manager support are essential and effective in coping with work pressures. There is a need to develop models of effective support to alleviate staff's practical, emotional, and interpersonal pressures. However, due to the isolating nature of homecare work, managers may not recognise early signs of their staff finding stress unmanageable and miss the opportunity to mitigate these negative effects.
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Affiliation(s)
| | - Kritika Samsi
- Social Care Workforce Research Unit, King's College London, London, UK
| | | | - Jill Manthorpe
- Social Care Workforce Research Unit, King's College London, London, UK
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Sandberg L, Nilsson I, Rosenberg L, Borell L, Boström AM. Home care services for older clients with and without cognitive impairment in Sweden. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:139-150. [PMID: 30062814 DOI: 10.1111/hsc.12631] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 06/24/2018] [Accepted: 07/02/2018] [Indexed: 06/08/2023]
Abstract
Little is known about the types of home care services granted to older clients in Sweden. The objectives of this study were to: (a) identify and describe the range of granted home care services and service hours; (b) compare services granted for clients with and without documented cognitive impairment; and (c) examine associations between the range of granted home care services and factors related to cognitive impairment and demographical characteristics. The study design was descriptive and cross-sectional. The data, included records of granted home care services for clients age 65+ with (n = 43) and without (n = 88) cognitive impairment documented by the local municipality assessors, collected from one agency in Sweden during a 2-month period in 2015. Data analyses resulted in an overview of the range of home care services divided into two categories: personal care and service. In the personal care category, the median was 3 for types of services (range 0-12), and shower (n = 69; 52.7%) was the most common service. In the service category, the median was 5 for types of services (range 0-10), and cleaning the household (n = 103; 78.6%) was the most common service. The median for service hours was 27 hr per month (range 2.5-127.5). Logistic regression models revealed that cognitive impairment was associated with a higher number of services in the personal care category and a higher number of hours per month. Living alone was associated with a higher number of services in the service category. In conclusion, a wide range of home care services were provided for clients who have complex needs in daily life. Home care services were granted to clients with cognitive impairment and to a greater extent with clients who were living alone.
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Affiliation(s)
- Linda Sandberg
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Occupational Therapy, Karolinska Institutet, Huddinge, Sweden
| | - Ingeborg Nilsson
- Department of Community Medicine and Rehabilitation, Occupational therapy, Umeå University, Vårdvetarhuset, Umeå, Sweden
- Faculty of Health, Care and Nursing, Norwegian University of Science and Technology, Gjøvik, Norway
| | - Lena Rosenberg
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Occupational Therapy, Karolinska Institutet, Huddinge, Sweden
| | - Lena Borell
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Occupational Therapy, Karolinska Institutet, Huddinge, Sweden
| | - Anne-Marie Boström
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Nursing, Karolinska Institutet, Huddinge, Sweden
- Theme Aging, Karolinska University Hospital, Stockholm, Sweden
- Western Norway University of Applied Sciences, Haugesund, Norway
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Chiatti C, Rodríguez Gatta D, Malmgren Fänge A, Scandali VM, Masera F, Lethin C. Utilization of Formal and Informal Care by Community-Living People with Dementia: A Comparative Study between Sweden and Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15122679. [PMID: 30487417 PMCID: PMC6313614 DOI: 10.3390/ijerph15122679] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 11/21/2018] [Accepted: 11/22/2018] [Indexed: 01/19/2023]
Abstract
Background: Dementia is a public health priority with a dramatic social and economic impact on people with dementia (PwD), their caregivers and societies. The aim of this study was to contribute to the knowledge on how utilization of formal and informal care varies between Sweden and Italy. Methods: Data were retrieved from two trials: TECH@HOME (Sweden) and UP-TECH (Italy). The sample consisted of 89 Swedish and 317 Italian dyads (PwD and caregivers). Using bivariate analysis, we compared demographic characteristics and informal resource utilization. Multiple linear regression was performed to analyze factors associated with time spent on care by the informal caregivers. Results: Swedish participants utilized more frequently health care and social services. Informal caregivers in Italy spent more time in caregiving than the Swedish ones (6.3 and 3.7 h per day, respectively). Factors associated with an increased time were country of origin, PwD level of dependency, living situation, use of formal care services and occupation. Conclusions: Care and service utilization significantly varies between Sweden and Italy. The level of formal care support received by the caregivers has a significant impact on time spent on informal care. Knowledge on the factors triggering formal care resources utilization by PwD and their caregivers might further support care services planning and delivery across different countries.
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Affiliation(s)
- Carlos Chiatti
- Department of Health Sciences, Faculty of medicine, Lund University, Box 157, SE-221 00 Lund, Sweden.
| | - Danae Rodríguez Gatta
- Department of Health Sciences, Faculty of medicine, Lund University, Box 157, SE-221 00 Lund, Sweden.
| | - Agneta Malmgren Fänge
- Department of Health Sciences, Faculty of medicine, Lund University, Box 157, SE-221 00 Lund, Sweden.
| | | | - Filippo Masera
- Department of Health Care Planning, Regional Health Agency of Marche Region, 60015 Ancona, Italy.
| | - Connie Lethin
- Department of Health Sciences, Faculty of medicine, Lund University, Box 157, SE-221 00 Lund, Sweden.
- Department of Clinical Sciences, Clinical Memory Research Unit, Faculty of Medicine, Lund University, SE-214 28 Malmö, Sweden.
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Lethin C, Giertz L, Vingare EL, Hallberg IR. Dementia care and service systems - a mapping system tested in nine Swedish municipalities. BMC Health Serv Res 2018; 18:778. [PMID: 30326900 PMCID: PMC6192069 DOI: 10.1186/s12913-018-3592-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 10/01/2018] [Indexed: 12/17/2022] Open
Abstract
Background In dementia care, it is crucial that the chain of care is adapted to the needs of people with dementia and their informal caregivers throughout the course of the disease. Assessing the existing dementia care system with regard to facilities, availability and utilization may provide useful information for ensuring that the professional dementia care and service system meets the needs of patients and their families from disease onset to end of life. Methods The aim of this study was to further develop and test a mapping system, and adapt it to a local context. In addition, the aim was to assess availability and utilization of care activities as well as professional providers’ educational level in nine municipalities under the categories of Screening, the diagnostic procedures, and treatment; Outpatient care facilities; Institutional care and Palliative care. This cross-sectional study was conducted in April through May 2015. Data was derived from the health care and social service systems in nine rural and urban municipalities in two counties in Sweden. The mapping system covered seven categories with altogether 56 types of health care and social service activities. Results The mapping system was found to be reliable with minor adaptations to the context mainly in terms of activities. Availability of care activities was common with low utilization regarding Screening, the diagnostic procedures, and treatment; Outpatient care facilities; Institutional care and Palliative care and dementia trained staff was rare. Availability and utilization of care activities and professionals’ educational level was higher concerning screening, the diagnostic procedures and treatment compared with outpatient care facilities, institutional care and palliative care. Conclusions The mapping system enables policy makers and professionals to assess and develop health care and social service systems, to be offered proactively and on equal terms to people with dementia and their informal caregivers throughout the course of the disease. The educational level of professionals providing care and services may reveal where, in the chain of care, dementia-specific education for professionals, needs to be developed.
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Affiliation(s)
- Connie Lethin
- Faculty of Medicine, Department of Health Sciences, Lund University, PO Box 157, 221 00, Lund, Sweden. .,Faculty of Medicine, Department of Clinical Sciences, Clinical Memory Research Unit, Lund, Sweden.
| | - Lottie Giertz
- Department of Social Work, Linnaeus University, Universitetsplatsen 1, 351 95, Växjö, Sweden
| | - Emme-Li Vingare
- Department of Social Work, Linnaeus University, Universitetsplatsen 1, 351 95, Växjö, Sweden
| | - Ingalill Rahm Hallberg
- Faculty of Medicine, Department of Health Sciences, Lund University, PO Box 157, 221 00, Lund, Sweden
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Hansen A, Hauge S, Hellesø R, Bergland Å. Purchasers' deliberations on psychosocial needs within the process of allocating healthcare services for older home-dwelling persons with dementia: a qualitative study. BMC Health Serv Res 2018; 18:746. [PMID: 30285719 PMCID: PMC6167900 DOI: 10.1186/s12913-018-3550-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 09/20/2018] [Indexed: 12/03/2022] Open
Abstract
Background Meeting psychosocial needs is a significant component of quality dementia care. To enable persons with dementia to live at home for as long as possible, a community healthcare service offering care where physical, social, psychological, cultural and spiritual needs are met, is recommended. A comprehensive allocation process is required to allocate individually tailored healthcare services. However, the allocation process for older home-dwelling persons with dementia, specifically for services to safeguard psychosocial needs, remains largely unexplored. Accordingly, this study aims to explore purchasers’ deliberations on psychosocial needs during the process of allocating healthcare services to older home-dwelling persons with dementia. Methods The study had a descriptive design with a qualitative approach. The primary data source was focus group interviews with purchasers who assess and allocate healthcare services. The interview data were supplemented by a review of administrative decisions made by the purchasers. Data from the focus group interviews were analysed using a descriptive and interpretive approach. Content analysis of the administrative decisions was conducted. Results The purchasers described the allocation process as challenging. The following four themes reflect the complexity of the allocation process: (i) an unfamiliar and unclear concept; (ii) a hierarchy of needs; (iii) an adjusting allocation process; (iv) a challenging documentation of administrative decisions. Conclusions The purchasers viewed a comprehensive allocation process as important. However, a web of different interplaying aspects prevented the purchasers from conducting a comprehensive need-led allocation process. Insufficient assessment or allocation threatens the adequate safeguarding of the psychosocial needs of persons with dementia. Having varied and sufficient services to allocate is of great importance, but is not sufficient. Psychosocial needs must be better incorporated as a significant element throughout the entire allocation process. Electronic supplementary material The online version of this article (10.1186/s12913-018-3550-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anette Hansen
- Department of Nursing Science, University of Oslo, Faculty of Medicine, Postbox 235, 3603, Kongsberg, Norway. .,Department of Nursing and Health Sciences and Centre for Care Research, University of South-Eastern Norway, Postbox 235, 3603, Kongsberg, Norway.
| | - Solveig Hauge
- Department of Nursing and Health Sciences and Centre for Care Research, University of South-Eastern Norway, Postbox 235, 3603, Kongsberg, Norway
| | - Ragnhild Hellesø
- Institute of Health and Society, Department of Nursing Science, University of Oslo, Faculty of Medicine, Postbox 1130 Blindern,, 0318, OSLO, Norway
| | - Ådel Bergland
- Lovisenberg Diaconal University College, Lovisenberggaten 15b, 0456, Oslo, Norway
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Schütz LH, Boronat-Garrido X, Moser FA, Suhr R, Lahmann N. Dementia-specific drug treatment in home care settings: A German multicentre study. J Clin Nurs 2018; 28:862-869. [PMID: 30256473 DOI: 10.1111/jocn.14682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 09/15/2018] [Accepted: 09/19/2018] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES The aim of this study was to identify and analyse factors influencing the use of drugs for dementia treatment in home care settings. BACKGROUND While the number of care-dependent people with dementia is growing, it is not clear whether their medication follows the state of the art, especially in home care settings where over two-thirds of them are cared for in Germany. Although dementia is not curable, it is possible to reduce cognitive, behavioural and psychological symptoms of dementia with the appropriate use of medication. However, there is a lack of information concerning the drug treatment in home care settings. METHODS The study was conducted as a multicentre cross-sectional survey, including 923 participants from 102 home care institutions throughout Germany. Medical diagnosis, medication, consultations with a specialist within the previous 12 weeks of the initial assessment and additional general information were assessed following a standardised study protocol. Data were analysed using univariate and multivariate statistical methods. The manuscript was developed utilising the STROBE checklist for cross-sectional studies. RESULTS In home care, one in seven clients (14.8%) is diagnosed with some form of dementia. 52.6% (n = 72) of them were treated with dementia medication: AchEIs 16.1% (n = 22), memantine 9.5% (n = 13), antidepressants 23.4% (n = 32), antipsychotic medication 9.5% (n = 13), tranquilisers 16.8% (n = 23) and anticonvulsant drugs 6.6% (n = 9). Drug treatment for dementia was significantly associated with the consultation of a neurologist/psychiatrist in the previous 12 weeks. CONCLUSIONS It has been demonstrated that the use of drugs as a component of home care treatment for dementia depends on many factors and therefore varies. RELEVANCE TO CLINICAL PRACTICE It can be assumed that people living with dementia in home care settings are not sufficiently supplied with medication. Their medical care can be improved by establishing interdisciplinary care involving a neurologist/psychiatrist.
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Affiliation(s)
- Leonhard H Schütz
- Charité - Universitätsmedizin Berlin, Clinic for Geriatrics and Geriatric Medicine, Berlin, Germany
| | - Xavier Boronat-Garrido
- Charité - Universitätsmedizin Berlin, Clinic for Geriatrics and Geriatric Medicine, Berlin, Germany
| | - Fabian A Moser
- Charité - Universitätsmedizin Berlin, Clinic for Geriatrics and Geriatric Medicine, Berlin, Germany
| | - Ralf Suhr
- ZQP - Centre for Quality in Care, Berlin, Germany
| | - Nils Lahmann
- Charité - Universitätsmedizin Berlin, Clinic for Geriatrics and Geriatric Medicine, Berlin, Germany
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Stephan A, Bieber A, Hopper L, Joyce R, Irving K, Zanetti O, Portolani E, Kerpershoek L, Verhey F, de Vugt M, Wolfs C, Eriksen S, Røsvik J, Marques MJ, Gonçalves-Pereira M, Sjölund BM, Jelley H, Woods B, Meyer G. Barriers and facilitators to the access to and use of formal dementia care: findings of a focus group study with people with dementia, informal carers and health and social care professionals in eight European countries. BMC Geriatr 2018; 18:131. [PMID: 29866102 PMCID: PMC5987478 DOI: 10.1186/s12877-018-0816-1] [Citation(s) in RCA: 137] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Accepted: 05/14/2018] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND People with dementia and informal carers often access formal care late in the process of dementia. The barriers and facilitators to service use from the perspectives of different stakeholders involved are not well understood. Thus, we aimed to explore the barriers and facilitators of access to and utilisation of formal care from the perspectives of people with dementia, their informal carers and health and social care professionals. METHOD Focus groups with people with dementia, informal carers and professionals were conducted in eight European countries. Recruitment targeted people with dementia, informal carers with experience of formal care and professionals involved in providing (access to) formal care. Qualitative content analysis using open coding was used on a national level. Cross-national synthesis was based on the translated national reports. RESULTS Overall, 55 focus groups with 261 participants were conducted, involving 51 people with dementia, 96 informal carers and 114 professionals. Sixteen categories describing barriers and facilitators were identified, referring to three global themes: Aspects related to 1) individuals involved, 2) the system or 3) overarching aspects. The attitudes and beliefs of people with dementia and their carers may have a major impact, and they often serve as barriers. Formal care was perceived as a threat to the individual independence of people with dementia and was thus avoided as long as possible. A healthcare professional serving as a constant key contact person could be an essential facilitator to overcome these barriers. Contact should be initiated proactively, as early as possible, and a trusting and consistent relationship needs to be established. Beyond that, the findings largely confirm former research and show that barriers to accessing and using formal care still exist across Europe despite a number of national and European initiatives. CONCLUSION Further investigations are needed to elaborate how the concept of a key contact person could be integrated with existing case management approaches and how the independence and autonomy of people with dementia can be strengthened when formal care needs to be accessed and used. These may be meaningful facilitators regarding enhanced access to formal care for people with dementia and their families.
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Affiliation(s)
- Astrid Stephan
- Institute for Health and Nursing Science, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany.
| | - Anja Bieber
- Institute for Health and Nursing Science, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany
| | - Louise Hopper
- School of Nursing and Human Sciences, Dublin City University, Glasnevin, Dublin 9, Ireland
| | - Rachael Joyce
- School of Nursing and Human Sciences, Dublin City University, Glasnevin, Dublin 9, Ireland
| | - Kate Irving
- School of Nursing and Human Sciences, Dublin City University, Glasnevin, Dublin 9, Ireland
| | - Orazio Zanetti
- Alzheimer Unit, IRCCS S. Centro Giovanni di Dio "Fatebenefratelli", Via Pilastroni 4, Brescia (BS), Italy
| | - Elisa Portolani
- Alzheimer Unit, IRCCS S. Centro Giovanni di Dio "Fatebenefratelli", Via Pilastroni 4, Brescia (BS), Italy
| | - Liselot Kerpershoek
- Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands
| | - Frans Verhey
- Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands
| | - Marjolein de Vugt
- Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands
| | - Claire Wolfs
- Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands
| | - Siren Eriksen
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - Janne Røsvik
- Department of Geriatric Medicine, Oslo University Hospital, Aldring og Helse, Oslo, Norway
| | - Maria J Marques
- Chronic Diseases Research Center, Nova Medical School
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo Mártires da Pátria, 130, 1169-056, Lisbon, Portugal
| | - Manuel Gonçalves-Pereira
- Chronic Diseases Research Center, Nova Medical School
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo Mártires da Pátria, 130, 1169-056, Lisbon, Portugal
| | - Britt-Marie Sjölund
- Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, University of Gävle, Gävle, Sweden
| | - Hannah Jelley
- Dementia Services Development Centre Wales, Bangor University, Bangor, LL57 2PZ, UK
| | - Bob Woods
- Dementia Services Development Centre Wales, Bangor University, Bangor, LL57 2PZ, UK
| | - Gabriele Meyer
- Institute for Health and Nursing Science, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany.
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36
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Faes K, Cohen J, Annemans L. Resource Use During the Last 6 Months of Life of Individuals Dying with and of Alzheimer's Disease. J Am Geriatr Soc 2018; 66:879-885. [DOI: 10.1111/jgs.15287] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 12/27/2017] [Accepted: 12/27/2017] [Indexed: 12/19/2022]
Affiliation(s)
- Kristof Faes
- Department of Public HealthInteruniversity Center for Health Economic Research, Ghent UniversityGhent Belgium
- Department of Family Medicine and Chronic CareEnd‐of‐Life Care Research Group, Vrije Universiteit Brussel and Ghent UniversityBrussels Belgium
| | - Joachim Cohen
- Department of Family Medicine and Chronic CareEnd‐of‐Life Care Research Group, Vrije Universiteit Brussel and Ghent UniversityBrussels Belgium
| | - Lieven Annemans
- Department of Public HealthInteruniversity Center for Health Economic Research, Ghent UniversityGhent Belgium
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Odzakovic E, Hydén LC, Festin K, Kullberg A. People diagnosed with dementia in Sweden: What type of home care services and housing are they granted? A cross-sectional study. Scand J Public Health 2018; 47:229-239. [DOI: 10.1177/1403494818755600] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Aims: This study aims to examine what types of home care services and housing are granted to people with a dementia diagnosis and how these types are associated with socio-demographic factors (sex, age, marital status, native or foreign born, and regional area). Methods: A cross-sectional study of all people diagnosed with dementia in three Swedish counties was conducted from the medical records in 2012. Logistic regression analysis was carried out to investigate associations between home care services and housing and socio-demographic variables. Results: In total, 17,405 people had a dementia diagnosis, and the majority were women, aged 80+ years, and unmarried. Some 72% were living in ordinary housing and 28% lived in special housing. Of those who lived in ordinary housing, 50% did not receive any home care service. Not receiving any type of home care services was less common for older people and was also associated with being married and living in rural municipalities. The most common home care services granted were home help and personal care. Special housing was more common for older people, unmarried persons, and those living in rural municipalities. Conclusions: Most people with a dementia diagnosis were living in ordinary housing, and, surprisingly, half of those did not receive any type of home care service. This knowledge is essential for making the living conditions and needs of people living with dementia more visible and to provide good home care services for people with dementia and their families.
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Affiliation(s)
- Elzana Odzakovic
- Division of Nursing Science, Department of Social and Welfare Studies, Faculty of Medicine and Health Sciences, Linköping University, Norrköping, Sweden
| | - Lars-Christer Hydén
- Center for Dementia Research, Department of Social and Welfare Studies, Faculty of Arts and Science, Linköping University, Norrköping, Sweden
- Division of Ageing and Social Change, Department of Social and Welfare Studies, Faculty of Arts and Science, Linköping University, Norrköping, Sweden
| | - Karin Festin
- Division of Community Medicine, Department of Medical and Health Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Agneta Kullberg
- Division of Community Medicine, Department of Medical and Health Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
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38
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Bökberg C, Ahlström G, Karlsson S. Utilisation of formal and informal care and services at home among persons with dementia: a cross-sectional study. Scand J Caring Sci 2017; 32:843-851. [DOI: 10.1111/scs.12515] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 07/18/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Christina Bökberg
- Department of Health Sciences; Faculty of Medicine; Lund University; Lund Sweden
| | - Gerd Ahlström
- Department of Health Sciences; Faculty of Medicine; Lund University; Lund Sweden
| | - Staffan Karlsson
- Department of Health Sciences; Faculty of Medicine; Lund University; Lund Sweden
- School of Health and Welfare; Halmstad University; Halmstad Sweden
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39
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Clarkson P, Hughes J, Xie C, Larbey M, Roe B, Giebel CM, Jolley D, Challis D. Overview of systematic reviews: Effective home support in dementia care, components and impacts-Stage 1, psychosocial interventions for dementia. J Adv Nurs 2017. [DOI: 10.1111/jan.13362] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Paul Clarkson
- Personal Social Services Research Unit; Division of Population Health; Health Services Research and Primary Care; School of Health Sciences; Faculty of Biology; Medicine and Health; University of Manchester; Manchester Academic Health Science Centre; Manchester UK
| | - Jane Hughes
- Personal Social Services Research Unit; Division of Population Health; Health Services Research and Primary Care; School of Health Sciences; Faculty of Biology; Medicine and Health; University of Manchester; Manchester Academic Health Science Centre; Manchester UK
| | - Chengqiu Xie
- Personal Social Services Research Unit; Division of Population Health; Health Services Research and Primary Care; School of Health Sciences; Faculty of Biology; Medicine and Health; University of Manchester; Manchester Academic Health Science Centre; Manchester UK
| | - Matthew Larbey
- Personal Social Services Research Unit; Division of Population Health; Health Services Research and Primary Care; School of Health Sciences; Faculty of Biology; Medicine and Health; University of Manchester; Manchester Academic Health Science Centre; Manchester UK
| | - Brenda Roe
- Personal Social Services Research Unit; Division of Population Health; Health Services Research and Primary Care; School of Health Sciences; Faculty of Biology; Medicine and Health; University of Manchester; Manchester Academic Health Science Centre; Manchester UK
- Evidence-based Practice Research Centre; Faculty of Health & Social Care; Edge Hill University; Ormskirk UK
| | - Clarissa M. Giebel
- Personal Social Services Research Unit; Division of Population Health; Health Services Research and Primary Care; School of Health Sciences; Faculty of Biology; Medicine and Health; University of Manchester; Manchester Academic Health Science Centre; Manchester UK
- School of Health Sciences; University of East Anglia; Norwich UK
| | - David Jolley
- Personal Social Services Research Unit; Division of Population Health; Health Services Research and Primary Care; School of Health Sciences; Faculty of Biology; Medicine and Health; University of Manchester; Manchester Academic Health Science Centre; Manchester UK
| | - David Challis
- Personal Social Services Research Unit; Division of Population Health; Health Services Research and Primary Care; School of Health Sciences; Faculty of Biology; Medicine and Health; University of Manchester; Manchester Academic Health Science Centre; Manchester UK
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40
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Doyle C, Setoya N, Goeman D, Kayama M. The Role of Home Nursing Visits in Supporting People Living with Dementia in Japan and Australia: Cross-National Learnings and Future System Reform. Health Syst Reform 2017; 3:203-213. [DOI: 10.1080/23288604.2017.1342178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Colleen Doyle
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Fitzroy, Victoria, Australia
| | | | - Dianne Goeman
- Royal District Nursing Service, RDNS Institute, St. Kilda, Victoria, Australia
| | - Mami Kayama
- St. Luke's International University, Tokyo, Japan
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41
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Bieber A, Stephan A, Verbeek H, Verhey F, Kerpershoek L, Wolfs C, de Vugt M, Woods RT, Røsvik J, Selbaek G, Sjölund BM, Wimo A, Hopper L, Irving K, Marques MJ, Gonçalves-Pereira M, Portolani E, Zanetti O, Meyer G. Access to community care for people with dementia and their informal carers : Case vignettes for a European comparison of structures and common pathways to formal care. Z Gerontol Geriatr 2017; 51:530-536. [PMID: 28616816 DOI: 10.1007/s00391-017-1266-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 04/12/2017] [Accepted: 05/29/2017] [Indexed: 01/16/2023]
Abstract
BACKGROUND People with dementia and their informal carers often do not receive appropriate professional support or it is not received at the right time. OBJECTIVES Description and comparison of common pathways to formal community dementia care in eight European countries as a part of the transnational Actifcare project. MATERIALS AND METHODS The German team was responsible for creating an individual case scenario as a starting point. The research teams in Ireland, Italy, the Netherlands, Norway, Portugal, Sweden, and the United Kingdom were then asked to describe a common pathway to formal dementia care by writing their own vignette using the provided individual case scenario. RESULTS A transnational qualitative content analysis was used to identify the following categories as being the most important: involved professionals, dementia-specific and team-based approaches, proactive roles, and financial aspects. General practitioners (GPs) are described as being the most important profession supporting the access to formal care in all the involved countries. In some countries other professionals take over responsibility for the access procedure. Dementia-specific approaches are rarely part of standard care; team-based approaches have differing significances in each of the countries. Informal carers are mainly proactive in seeking formal care. The Nordic countries demonstrate how financial support enhances access to the professional system. CONCLUSION Enhanced cooperation between GPs and other professions might optimize access to formal dementia care. Team-based approaches focusing on dementia care should be developed further. Informal carers should be supported and relieved in their role. Financial barriers remain which should be further investigated and reduced.
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Affiliation(s)
- A Bieber
- Medical Faculty, Institute for Health and Nursing Science, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany
| | - A Stephan
- Medical Faculty, Institute for Health and Nursing Science, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany
| | - H Verbeek
- School for Mental Health and Neuroscience, Alzheimer Center Limburg, Department of Psychiatry and Neuropsychology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - F Verhey
- School for Mental Health and Neuroscience, Alzheimer Center Limburg, Department of Psychiatry and Neuropsychology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - L Kerpershoek
- School for Mental Health and Neuroscience, Alzheimer Center Limburg, Department of Psychiatry and Neuropsychology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - C Wolfs
- School for Mental Health and Neuroscience, Alzheimer Center Limburg, Department of Psychiatry and Neuropsychology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - M de Vugt
- School for Mental Health and Neuroscience, Alzheimer Center Limburg, Department of Psychiatry and Neuropsychology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - R T Woods
- Dementia Services Development Centre Wales, Bangor University, Bangor, UK
| | - J Røsvik
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, and Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - G Selbaek
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, and Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - B M Sjölund
- Department of Neurobiology, Care sciences and Society, Karolinska Institut, Stockholm, Sweden.,Department of Health and Caring Services, University of Gävle, Gävle, Sweden
| | - A Wimo
- Department of Neurobiology, Care sciences and Society, Karolinska Institut, Stockholm, Sweden
| | - L Hopper
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
| | - K Irving
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
| | - M J Marques
- CEDOC, Chronic Diseases Research Centre, Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - M Gonçalves-Pereira
- CEDOC, Chronic Diseases Research Centre, Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - E Portolani
- Alzheimer's Research Unit-Memory Clinic, Brescia, Italy
| | - O Zanetti
- Alzheimer's Research Unit-Memory Clinic, Brescia, Italy
| | - G Meyer
- Medical Faculty, Institute for Health and Nursing Science, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany.
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D'Astous V, Abrams R, Vandrevala T, Samsi K, Manthorpe J. Gaps in Understanding the Experiences of Homecare Workers Providing Care for People with Dementia up to the End of Life: A Systematic Review. DEMENTIA 2017; 18:970-989. [PMID: 28358269 DOI: 10.1177/1471301217699354] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This systematic review of the literature explores the perspectives and experiences of homecare workers providing care for people with dementia living at home up to the end of life. A search of major English language databases in 2016 identified 378 studies on the topic, of which 12 met the inclusion criteria. No empirical research was identified that specifically addressed the research question. However, synthesis of the findings from the broader literature revealed three overarching themes: value of job role, emotional labour and poor information and communication. The role of homecare workers supporting a person with dementia up to the end of life remains under-researched, with unmet needs for informational, technical and emotional support reported. The effective components of training and support are yet to be identified.
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Affiliation(s)
| | - Ruth Abrams
- School of School of Social and Behavioural Sciences, Faculty of Arts & Social Sciences, Kingston University, UK
| | - Tushna Vandrevala
- School of School of Social and Behavioural Sciences, Faculty of Arts & Social Sciences, Kingston University, UK
| | - Kritika Samsi
- Social Care Workforce Research Unit, King's College London, UK
| | - Jill Manthorpe
- Social Care Workforce Research Unit, King's College London, UK
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Giebel CM, Davies S, Clarkson P, Sutcliffe C, Challis D. Costs of formal and informal care at home for people with dementia: ‘Expert panel’ opinions from staff and informal carers. DEMENTIA 2016; 18:210-227. [DOI: 10.1177/1471301216665705] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Effective home support in dementia is key in delaying nursing home admission. However, home support is frequently not tailored to the individual needs of people with dementia. Staff allocating home support services may not identify important care needs, which only be recognised by informal carers. The purpose of this study was to explore the balance of informal and formal home support and their associated costs from the perspectives of both informal carers and paid staff. Five case vignettes of people with dementia were designed based on an existing English data set from a European study into transition into long-term care (the RightTimePlaceCare programme), representing 42 per cent of the English sample. In total, 14 informal carers and 14 paid staff were consulted in separate groups, as expert panels, regarding their recommendations for home care services for each vignette. Care recommendations of carers and staff were costed based on nationally available unit costs and compared. Informal carers allocated fewer hours of care than staff. Personal and domestic home care and day care centres were the most frequently recommended formal services by both groups, and some vignettes of people with dementia were recommended for care home admission. The ratio of costs of informal versus formal support was relatively equal for paid staff, yet unbalanced from the perspectives of informal carers with a greater proportion of formal care costs. Recommendations from this study can help shape dementia care to be more tailored to the individual needs of people with dementia and their carers.
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Affiliation(s)
| | - Susan Davies
- Personal Social Services Research Unit, University of Manchester, Manchester, UK
| | - Paul Clarkson
- Personal Social Services Research Unit, University of Manchester, Manchester, UK
| | - Caroline Sutcliffe
- Personal Social Services Research Unit, University of Manchester, Manchester, UK
| | - David Challis
- Personal Social Services Research Unit, University of Manchester, Manchester, UK
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Lethin C, Leino-Kilpi H, Roe B, Soto MM, Saks K, Stephan A, Zwakhalen S, Zabalegui A, Karlsson S. Formal support for informal caregivers to older persons with dementia through the course of the disease: an exploratory, cross-sectional study. BMC Geriatr 2016; 16:32. [PMID: 26832354 PMCID: PMC4734848 DOI: 10.1186/s12877-016-0210-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 01/26/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In European countries, knowledge about availability and utilization of support for informal caregivers caring for older persons (≥65 years) with dementia (PwD) is lacking. To be able to evaluate and develop the dementia support system for informal caregivers to PwD, a survey of European support systems and professionals involved is needed. The aim of this study was to explore support for informal caregivers to PwD in European countries. We investigated the availability and utilization of support in each of the participating countries, and the professional care providers involved, through the dementia disease. METHODS A mapping system was used in 2010-2011 to gather information about estimations of availability, utilization, and professional providers of support to informal caregivers caring for PwD. Data collected was representing each country as a whole. RESULTS There was high availability of counselling, caregiver support, and education from the diagnosis to the intermediate stage, with a decrease in the late to end of life stage. Utilization was low, although there was a small increase in the intermediate stage. Day care and respite care were highly available in the diagnosis to the intermediate stage, with a decrease in the late to end of life stage, but both types of care were utilized by few or no caregivers through any of the disease stages. Professionals specialized in dementia (Bachelor to Master's degree) provided counselling and education, whereas caregiver support for informal caregivers and day care, respite care, and respite care at home were provided by professionals with education ranging from upper secondary schooling to a Master's degree. CONCLUSIONS Counselling, caregiver support, and education were highly available in European countries from diagnosis to the intermediate stage of the dementia disease, decreasing in the late/end of life stages but were rarely utilized. Countries with care systems based on national guidelines for dementia care seem to be more aware of the importance of professionals specialized in dementia care when providing support to informal caregivers. Mapping the systems of support for informal caregivers of PwD is a valuable tool for evaluating existing systems, internationally, nationally and locally for policy making.
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Affiliation(s)
- Connie Lethin
- />Faculty of medicine, Department of Health Sciences, Lund University, Box 157, SE-221 00 Lund, Sweden
| | - Helena Leino-Kilpi
- />Nursing Science, University of Turku, Turku University Hospital, Turku, Finland
| | - Brenda Roe
- />Evidence Based Practice Research Centre, Faculty of Health and Social Care, Edge Hill University, Ormskirk, Lancashire, UK
| | - Maria Martin Soto
- />Alzheimer’s disease Research and Clinical Centre in Toulouse, University Hospital, Toulouse, France
| | - Kai Saks
- />Department of internal medicine, University of Tartu, Tartu, Estonia
| | - Astrid Stephan
- />Faculty of Health, School of Nursing Science, Witten/Herdecke University, Witten, Germany
| | - Sandra Zwakhalen
- />Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
| | | | - Staffan Karlsson
- />Faculty of medicine, Department of Health Sciences, Lund University, Box 157, SE-221 00 Lund, Sweden
| | - on behalf of the RightTimePlaceCare Consortium
- />Faculty of medicine, Department of Health Sciences, Lund University, Box 157, SE-221 00 Lund, Sweden
- />Nursing Science, University of Turku, Turku University Hospital, Turku, Finland
- />Evidence Based Practice Research Centre, Faculty of Health and Social Care, Edge Hill University, Ormskirk, Lancashire, UK
- />Alzheimer’s disease Research and Clinical Centre in Toulouse, University Hospital, Toulouse, France
- />Department of internal medicine, University of Tartu, Tartu, Estonia
- />Faculty of Health, School of Nursing Science, Witten/Herdecke University, Witten, Germany
- />Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
- />Hospital Clinic of Barcelona, Barcelona, Spain
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