Familial caregivers' experiences with home-visit nursing for persons with dementia who live alone

Nursing students' simulated home-visit learning experiences with dementia -a qualitative research

BACKGROUND

In response to the growing demand for community nursing, practical and dynamic changes in educational methods are essential to nurturing competent nurses. The aim of this study was to explore the learning experiences of nursing students' simulation-based community visits and understand these experiences in detail.

METHODS

This study followed Colizzi's phenomenological research method. Nineteen participants were divided into three teams and participated in focus group interviews. The research question was: "How was your experience with the simulated nursing home visit?"

RESULTS

Four essential themes were identified: "burden of community nursing simulation-based learning," "solving the problems faced by patients with dementia through teamwork," "home-visiting nursing skills learned through physical practice," and "community nursing competency growth."

CONCLUSION

The study results provide a basis for developing a community nursing curriculum with effective evaluation and management of community nursing home-visit education using simulation.

The impact of formal and informal support on emotional stress among non-co-resident caregivers of persons with dementia

OBJECTIVES

The purpose of this study was to examine the prevalence of formal and informal support between non-co-resident and co-resident family caregivers of persons with dementia and to investigate the impact of receiving formal or informal assistance on family caregivers' residential status and their perceived emotional stress.

METHOD

We used secondary data from the 2018 National Survey of Older American Act conducted by the Administration for Community Living. We selected 751 primary family caregivers of persons with dementia and conducted regression analyses to explore our research questions.

RESULTS

Non-co-resident caregivers of persons with dementia were younger, racially and ethnically diverse, employed, and had higher income than co-resident caregivers. They were less likely to utilize formal support, such as caregiver training or education (p = .005) and respite care (p = .019) but more likely to rely on informal support in their social networks (p = .002), compared to co-resident caregivers. Non-co-resident caregivers who had better informal support systems showed less emotional stress than co-resident caregivers (p = .024).

CONCLUSION

Findings from our study suggest the importance of engaging informal networks to alleviate emotional stress of non-co-resident caregivers of persons with dementia. Furthermore, it is critical to help them utilize adequate caregiver training and education as well as respite care before their loved ones experience dramatic functional and health declines.

Psychological Distress in Caregivers for People with Dementia: A Population-Based Analysis of a National Cross-Sectional Study

BACKGROUND

Taking care of patients with dementia is often stressful and exhausting. The burden placed on caregivers (CGs) for care recipients with dementia (CRDs) has been reported to cause psychological distress.

OBJECTIVE

The aim of this study was to evaluate the psychological distress experienced by CGs for CRDs and identify the sociodemographic factors affecting that distress.

METHODS

We utilized the 2013 Comprehensive Survey of the Living Conditions for CRDs and CGs. Linked data from 643 pairs of CRDs and CGs were extracted. Serious psychological distress experienced by CGs was measured by Kessler's Psychological Distress scale (K6) with a cutoff point of 13. Factors predictive of psychological distress were evaluated using multivariable logistic regression analysis with the forward selection method.

RESULTS

Overall, the mean age of the CGs was 63.5±11.6 years, and 5.3%(34/643) experienced serious psychological distress. Male sex of CRDs, knowing how to access consulting services, spending almost all day for nursing care, and having subjective symptoms within a few days of completing the survey were associated with having serious psychological distress, while older age, participating in shopping as part of the nursing activities, and having their own house were related to freedom from serious psychological distress.

CONCLUSION

Clinicians should be aware of the risk factors for psychological distress in CGs and consider providing support to reduce the distress imposed by modifiable factors. Further studies are warranted to examine whether such efforts would improve the mental health of CGs for CRDs.

Association Between Cohabitation Status and Sleep Quality in Families of Persons With Dementia in Korea: A Cross-sectional Study

Objectives

The aim of this study was to identify the association between cohabitation status and sleep quality in family members of people with dementia (PwDs).

Methods

Data of 190 365 participants aged ≥19 years from the 2018 Korea Community Health Survey were analyzed. Participants were categorized according to their cohabitation status with PwDs. Multiple logistic regression and ordinal logistic regression analyses were performed to evaluate the relationship between the cohabitation status of PwDs’ relatives and sleep quality measured using the Pittsburgh Sleep Quality Index (PSQI) and PSQI subscales.

Results

Compared to participants without PwDs in their families, both cohabitation and non-cohabitation with PwDs were associated with poor sleep quality (cohabitation, male: odds ratio [OR],1.28; 95% confidence interval [CI], 1.08 to 1.52; female: OR, 1.40; 95% CI, 1.20 to 1.64; non-cohabitation, male: OR, 1.14; 95% CI, 1.05 to 1.24; female: OR, 1.23; 95% CI, 1.14 to 1.33). In a subgroup analysis, non-cohabiting family members showed the highest odds of experiencing poor sleep quality when the PwD lived alone (male: OR, 1.48; 95% CI, 1.14 to 1.91; female: OR, 1.58; 95% CI, 1.24 to 2.01). Cohabiting male and female participants had higher odds of poor subjective sleep quality and use of sleeping medications than non-cohabiting male and female participants, respectively.

Conclusions

The residence of PwDs and cohabitation status may contribute to poor sleep quality among PwDs’ family members. The circumstances faced by cohabiting and non-cohabiting family members should be considered when evaluating sleep quality in family members of PwDs, and appropriate interventions may be needed to improve sleep quality in both cohabiting and non-cohabiting family members.

Perceptions of loneliness and well-being of psychiatric patients' families

PURPOSE

This study was conducted to determine and explain the relationship between the loneliness perceptions and well-being of family caregivers of psychiatric patients.

DESIGN AND METHODS

This cross-sectional and descriptive study was conducted with the families of 141 individuals with mental illness, who were outpatients  psychiatry clinic of a university hospital.

FINDINGS

There was a statistically significant moderate relationship between loneliness levels and well-being subscales of the psychiatric patients' caregivers (p < 0.001).

PRACTICAL IMPLICATIONS

Mental health nurses should carefully evaluate the perception of loneliness of family caregivers when diagnosing the family and determining needs.

Components of Empowerment Among Family Caregivers of Community-Dwelling People With Dementia in Japan: A Qualitative Research Study

BACKGROUND

Family caregivers of people with dementia (PWDs) experience significant physical, psychological, and social burdens. Empowerment, which refers to the process of gaining power in society through behavioral change, is important to coping successfully with care-related burdens. The high burden of care faced by family caregivers in Japan often makes accepting social support difficult for caregivers of PWDs, resulting in feelings of isolation. Clarifying what components constitute empowering experiences for family caregivers of PWDs is necessary to gain a better understanding of their empowerment experiences and to develop relevant support schemes.

PURPOSE

This study was developed to describe the components of empowerment experienced by family caregivers of community-dwelling PWDs in Japan.

METHODS

This qualitative descriptive study used semistructured in-depth interviews to explore components of empowerment experienced by family caregivers of adults/older adults with dementia. Purposive sampling was used to recruit 20 family caregivers (age range: 50-87 years) from four self-help groups. A qualitative content analysis method was used to analyze the data. The components derived from the interviews were reviewed by three nursing researchers not directly involved in this study who are specialists in qualitative research and geriatric nursing.

RESULTS

Four categories and 12 subcategories were derived to illuminate the components of empowerment among family caregivers of PWDs. Specifically, these categories were as follows: (a) proactive aspects of dementia care that were acquired through the caregiving experience, (b) creating a relationship that respects PWDs, (c) Building relationships based on mutual understanding of one's surroundings, and (d) understanding the social aspects of dementia care.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

The findings of this study provide additional understanding of the components of the empowerment experiences of family caregivers of PWDs in Japan and in other East Asian countries experiencing increasing dementia diagnoses and population aging. In addition, the structural components of empowerment offer a useful perspective for health professionals on assessment and intervention that is framed on the cultural characteristics of East Asia. Ultimately, the results suggest that healthcare professionals should develop intervention programs that are tailored to the needs of caregivers at different levels of empowerment.

Family carers' involvement strategies in response to sub-optimal health services to older adults living with dementia - a qualitative study

BACKGROUND

While dementia policy strategies emphasize the importance of partnerships between families and formal carers to provide tailored care and effectively allocate community resources, family carers often feel left out or excluded. Poor communication has been identified as one reason for the lack of good partnerships. Few studies have investigated how family carers seek to involve themselves when they experience sub-optimal services, and how their strategies may depend on different considerations and personal abilities.

METHODS

Qualitative in-depth interviews were conducted with 23 family carers to explore their experiences with, perspectives on, contributions to, and interactions with healthcare services provided to older adults living with dementia. To capture nuances and variations, a semi-structured interview guide was used. Interviews were audio-recorded and transcribed verbatim. A four-step analysis of the transcripts was conducted, informed by hermeneutic and phenomenological methodology.

RESULTS

Two main involvement strategies were identified: 1) being "the hub in the wheel" and 2) getting the wheel rolling. The first strategy was used to support and complement health services, while the second was used to add momentum and leverage to arguments or processes. The two main strategies were used differently among participants, in part due to differences in personal resources and the ability to utilize these, but also in light of family carers' weighing conflicting concerns and perceived costs and benefits.

CONCLUSIONS

Awareness and acknowledgment of family carers' strategies, personal resources, and considerations may help policymakers and healthcare personnel when they build or maintain good partnerships together with family carers. A better understanding of family carers' own perspectives on carer involvement is a necessary precursor to developing good care partnerships.

The Role of the Family in the Care of Alzheimer Patients

According to the World Health Organisation (WHO 2002), people's life expectancy worldwide is continuously growing, and on the one hand, that is one of the greatest triumphs of humanity to date. But at the same time, it is also one of the most important challenges as the aging of the population raises economic and social requirements in all countries.

Development of a Visiting Nursing Practice Self-Evaluation Scale: Assessment of Skill for Caring for Individuals With Behavioral and Psychological Symptoms of Dementia

Behavioral and psychological symptoms of dementia (BPSD) continue to be a concern for our rapidly progressing aging society. Visiting nurses play an important role in community service for individuals with BPSD. The aim of the current study was to develop a visiting nursing practice self-evaluation scale for nurses who care for individuals with BPSD. The study was conducted in two phases. Semi-structured interviews were arranged to generate a draft scale that was further examined by an expert panel. A national survey was performed using the draft scale and two existing scales. Four factors and 22 items were obtained from exploratory factor analysis: (a) assessment and response factors related to BPSD, (b) interventions for reducing family care burdens, (c) nonpharmacological approaches, and (d) attitudes in trying to understand a patient's intentions. Reliability and validity were verified. The scale is useful for improving visiting nursing services for individuals with dementia. [Research in Gerontological Nursing, 13(1), 49-60.].

Association Between Home Health Services and Facility Admission in Older Adults With and Without Alzheimer's Disease

OBJECTIVES

To evaluate the association between home health (HH) services, including skilled nursing (SN), physical therapy (PT), occupational therapy, social work (SW), and homemaking aide assistance with the hazard of unplanned facility admissions among Medicare patients with and without Alzheimer's disease and related dementias (ADRD).

DESIGN

Analysis of the Outcome and Assessment Information Set and billing records.

SETTING

A not-for-profit HH agency serving multiple counties in New York State.

PARTICIPANTS

Adults ≥65 years old who received HH from January 1, 2017 to December 31, 2017.

MEASURES

Outcome was time from HH start of care to an unplanned facility admission of any type, including the hospital, nursing home, and rehabilitation facility. Independent variables included weekly intensity (visits/week, hours/week) of SN, PT, occupational therapy, SW, and, homemaking aide assistance separately. ADRD was identified by diagnosis (International Classification of Diseases, Tenth Revision codes in billing records) and cognitive impairment assessment (Outcome and Assessment Information Set).

RESULTS

Of the sample (N = 6153), 14.9% had an unplanned facility admission. In multivariable Cox proportional hazard models that adjusted for time-varying effects of HH intensity and covariates, receiving the highest intensity of SN (3.3 visits of 2.78 hours per week) and PT (2.5 visits of 2 hours per week) was related to up to a 54% and 86% decrease, respectively, in the hazard of unplanned facility admission among patients with ADRD (n = 1525), and decreases of 56% and 90%, respectively, among patients without ADRD (n = 4628). Receiving any SW was related to 40% decreased in the hazard of facility admission in patients without ADRD only. Other HH services were not consistently related to the risk of facility admission.

CONCLUSIONS AND IMPLICATIONS

Receiving a higher intensity of SN and PT was associated with reduced hazards of unplanned facility admission among HH patients with and without ADRD. Policies should ensure that patients with ADRD receive a sufficient amount and appropriate mix of HH services.