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Zhao H, Kulbok PA, Williams IC, Manning C, Logan JG, Romo RD. Exploring Experiences of Pain Management Among Family Caregivers of Community-Dwelling Older Adults With Dementia. Am J Hosp Palliat Care 2024; 41:927-933. [PMID: 37880855 DOI: 10.1177/10499091231210290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Pain is often underreported and under-treated in older adults with dementia. The role of family caregivers (FCGs) in managing pain for their loved ones with dementia living in community has been significantly burdensome. Surprisingly, research has not delved into the experiences of FCGs' concerning pain management in this context. METHODS A qualitative descriptive study was conducted to gain a deep understanding of FCGs' experiences in managing pain for their loved ones. Family caregivers participated in semi-structured face-to-face or telephone interviews. Inclusion criterion included being an adult providing care to community-dwelling older adults with dementia. Recruitment stopped upon reaching thematic saturation. Basic demographic characteristics was also collected. Constant comparison analytic method was employed. RESULTS The study included 25 FCGs in central Virginia, spanning ages from 29 to 95. Participants were predominantly white, female, married, and had a minimum high school education. Most of them were adult children (52%) or the spouses (28%) of the care recipients. Four thematic categories emerged around exploring FCGs' pain management experiences: (1) Values; (2) Barriers; (3) Support; and (4) Adaptation. Each theme included sub-themes. CONCLUSION Family caregivers follow their values to make decisions in pain management. Barriers existed for effective pain management. Adaptation and support from professional or formal caregivers greatly improved FCGs' perception of their competence in pain management. The finding underscores the need for further research and the development of interventions aimed at enhancing FCGs' perception of self-efficacy in this crucial aspect of caregiving.
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Affiliation(s)
- Hui Zhao
- School of Nursing, James Madison University, Harrisonburg, VA, USA
| | - Pamela A Kulbok
- School of Nursing, University of Virginia, Charlottesville, VA, USA
| | - Ishan C Williams
- School of Nursing, University of Virginia, Charlottesville, VA, USA
| | - Carol Manning
- Department of Neurology, University of Virginia, Charlottesville, VA, USA
| | - Jeongok G Logan
- School of Nursing, University of Virginia, Charlottesville, VA, USA
| | - Rafael D Romo
- Department of Nursing, Dominican University of California, San Rafael, CA, USA
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Hevink M, Linden I, de Vugt M, Brodaty H, Low LF, Phillipson L, Jeon YH, Gresham M, Doucet S, Luke A, Vedel I, McAiney C, Szcześniak D, Błaszkiewicz M, Rymaszewska J, Verhey F, Wolfs C. Moving forward with dementia: an explorative cross-country qualitative study into post-diagnostic experiences. Aging Ment Health 2024:1-10. [PMID: 38656033 DOI: 10.1080/13607863.2024.2342968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 04/08/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVES This explorative cross-country qualitative study aims to describe experiences of receiving a dementia diagnosis and experiences of support following a diagnosis in Australia, Canada, the Netherlands and Poland. METHOD Qualitative study using projective techniques during online focus groups, online and telephone interviews with people with dementia and caregivers. RESULTS Twenty-three people with dementia and 53 caregivers participated. Qualitative content analysis revealed five themes; (1) 'Coming to terms with dementia' helped people deal with complex emotions to move forward. (3) 'The social network as a source of support' and (4) 'The challenges and realities of formal support' and impacted 'Coming to terms with dementia'. (2) 'Navigating life with dementia as a caregiver' highlights caregiver burden and was impacted by (4) 'The challenges and realities of formal support'. People were (5) 'Self-caring and preparing for tomorrow' as they focused on maintaining current health whilst planning the future. Despite differences in healthcare and post-diagnostic support systems, there were more similarities across countries than differences. CONCLUSION Across countries, formal support and support from friends and family are crucial for people with dementia and caregivers to come to terms with dementia and maintain carer wellbeing to ultimately live well with dementia.
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Affiliation(s)
- Maud Hevink
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands
| | - Iris Linden
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands
| | - Marjolein de Vugt
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands
| | - Henry Brodaty
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
| | - Lee-Fay Low
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Lyn Phillipson
- School of Health and Society, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia
| | - Yun-Hee Jeon
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Meredith Gresham
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
| | - Shelly Doucet
- Department of Nursing and Health Sciences, The Centre for Research in Integrated Care, University of New Brunswick, Saint John, Canada
| | - Alison Luke
- Department of Nursing and Health Sciences, The Centre for Research in Integrated Care, University of New Brunswick, Saint John, Canada
| | - Isabelle Vedel
- Department of Family Medicine, McGill University, Lady Davis Institute, Jewish General Hospital, Montreal, Canada
| | - Carrie McAiney
- School of Public Health Sciences, University of Waterloo and Schlegel-UW Research Institute for Aging, Waterloo, Canada
| | - Dorota Szcześniak
- Department of Psychiatry, Wroclaw Medical University, Wrocław, Poland
| | | | | | - Frans Verhey
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands
| | - Claire Wolfs
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands
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Sonntag J, Schwaizer C, Kreyer C. [Support needs of caregivers of people with dementia: An integrative literature review]. Pflege 2023; 36:77-86. [PMID: 36416381 DOI: 10.1024/1012-5302/a000920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Support needs of caregivers of people with dementia: An integrative literature review Abstract: Background: Family caregivers are of great importance in the home care for people with dementia. The care and related stress can have a negative impact on their health. The CSNAT (German: KOMMA) is an approach to support family caregivers in palliative home care that could be used for this group of people. Aim: The aim was to identify support needs for caregivers of people with dementia in the literature and compare these with those that formed the basis for the development of the KOMMA approach. Method: We performed an integrative review. Literature research was conducted in February and March 2021 in the MEDLINE, CINAHL and PsycInfo databases. Relevant studies were identified and assessed using inclusion and exclusion criteria. Using MAXQDA, the data were assigned to categories with a content analytic procedure. Results: 23 studies were included that had been published with peer review procedure. Compared to the KOMMA approach, family caregivers show divergent support needs in the areas of (in)formal assistance, access to knowledge, managing physical and mental health conditions, maintaining the relationship, (temporarily) relinquishing the caregiving role and social integration. Conclusion: The KOMMA tool for identifying support needs cannot be directly adopted for this group of caregivers in its present form. However, given the richness of identified support needs, the development of a person-centered and needs-oriented assessment seems important.
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Affiliation(s)
- Julia Sonntag
- Departement für Pflegewissenschaft und Gerontologie, UMIT TIROL - Privatuniversität für Gesundheitswissenschaften und -technologie, Hall in Tirol, Österreich
| | - Claudia Schwaizer
- Departement für Pflegewissenschaft und Gerontologie, UMIT TIROL - Privatuniversität für Gesundheitswissenschaften und -technologie, Hall in Tirol, Österreich
| | - Christiane Kreyer
- Departement für Pflegewissenschaft und Gerontologie, UMIT TIROL - Privatuniversität für Gesundheitswissenschaften und -technologie, Hall in Tirol, Österreich
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Steinsheim G, Malmedal W, Follestad T, Olsen B, Saga S. Contextual Factors Associated with Abuse of Home-Dwelling Persons with Dementia: A Cross-Sectional Exploratory Study of Informal Caregivers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2823. [PMID: 36833519 PMCID: PMC9957528 DOI: 10.3390/ijerph20042823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 06/18/2023]
Abstract
One in six community-dwelling older adults experience elder abuse yearly, and persons with dementia are especially at risk. Although many risk factors for elder abuse have been identified, there are still knowledge gaps concerning risk and protective factors. This cross-sectional survey among Norwegian informal caregivers (ICGs) aimed to find individual, relational, and community factors associated with psychological and physical abuse of home-dwelling persons with dementia. This study involved 540 ICGs and was conducted from May to December 2021. Statistical analysis using penalized logistic regression with lasso was performed to find covariates associated with psychological and physical elder abuse. The most prominent risk factor for both subtypes of abuse was the caregiver being a spouse. In addition, risk factors for psychological abuse were having a higher caregiver burden, experiencing psychological aggression from the person with dementia, and the person with dementia being followed up by their general practitioner. For physical abuse, the protective factors were the ICG being female and having an assigned personal municipal health service contact, while the risk factors were the ICG attending a caregiver training program and experiencing physical aggression from the person with dementia and the person with dementia having a higher degree of disability. These findings add to the existing knowledge of risk and protective factors in elder abuse among home-dwelling persons with dementia. This study provides relevant knowledge for healthcare personnel working with persons with dementia and their caregivers and for the development of interventions to prevent elder abuse.
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Affiliation(s)
- Gunn Steinsheim
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), 7030 Trondheim, Norway
| | - Wenche Malmedal
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), 7030 Trondheim, Norway
| | - Turid Follestad
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), 7030 Trondheim, Norway
- Clinical Research Unit Central Norway, St. Olavs Hospital, 7030 Trondheim, Norway
| | - Bonnie Olsen
- Department of Family Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA 91803, USA
| | - Susan Saga
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), 7030 Trondheim, Norway
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Dyadic relationship, carer role, and resources: a theory-driven thematic analysis of interviews with informal carers focusing on the stability of home-based care arrangements for people living with dementia. BMC Geriatr 2022; 22:908. [PMID: 36437442 PMCID: PMC9703724 DOI: 10.1186/s12877-022-03618-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 11/14/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Most people with dementia live at home and are supported by informal carers. During the care trajectory, the creation of a stable care situation is a guiding principle of informal carers, who often manage complex care arrangements. A recently developed theory - 'Stability of home-based care arrangements for people living with dementia' (SoCA-Dem) - conceptualises how such care arrangements develop over time, and it highlights the relevance of the dyadic relationship, carer role, and resources with regard to the continuation of home-based care throughout the course of dementia. To further explore these three concepts, and to provide feedback for a further refinement of SoCA-Dem theory, this study aims to gain a deeper understanding of (1) how informal carers perceive their dyadic relationship, their carer role, and the resources of the care arrangement, and (2) how these concepts are interrelated. METHODS This study was a secondary data analysis of n = 11 problem-centred interviews. Data were interpreted by a thematic qualitative text analysis. RESULTS The findings distinguished subthemes within the concepts and uncovered their interrelations. The kinship relation, living situation and character of the dyadic relationship shaped informal carers' self-conception of the carer role. This influenced the integration of resources into the care arrangement. Conversely, the quantity and quality of informal and formal support resulted in a feeling of relief or overload in the carer role, that shaped the informal carers' way of living their dyadic relationship. The respective forming of the concepts had a significant impact with regard to the perceived stability or instability of the care situation in the examined care arrangements. CONCLUSIONS This study provided valuable evidence for future research alignment and targeted refinement of the SoCA-Dem theory. Scholars should further explore the specifics of spousal versus parent-child-dyads to better understand the dyads' diverse strategies in the creation of stable home-based care arrangements. Furthermore, future research should focus on the complex dynamics of dyads, family networks, and service providers, and all actors' perspectives should be integrated in SoCA-Dem theory. Based on this growing knowledge base, innovative care interventions and structures should be developed to support people with dementia and their informal carers in better living and caring in the place of their choice.
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Dreyer J, Bergmann JM, Köhler K, Hochgraeber I, Pinkert C, Roes M, Thyrian JR, Wiegelmann H, Holle B. Differences and commonalities of home-based care arrangements for persons living with dementia in Germany - a theory-driven development of types using multiple correspondence analysis and hierarchical cluster analysis. BMC Geriatr 2022; 22:723. [PMID: 36050645 PMCID: PMC9438141 DOI: 10.1186/s12877-022-03310-1] [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] [Received: 03/30/2022] [Accepted: 07/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Most persons with dementia live at home and want to stay there as long as possible. In most cases, informal carers such as spouses or children care for them. Together with other family members and professional carers, they form care arrangements to address the complex needs of persons with dementia. One major aim of informal carers is to keep the care arrangement stable. The middle-range theory of 'stability of home-based care arrangements for people living with dementia' (SoCA-Dem theory) offers a theory to understand what constitutes and influences the stability of home-based care arrangements. Based on this theory, the aim of this study was to (1) uncover the underlying structures of differences and commonalities of home-based care arrangements for persons living with dementia, (2) construct types of these care arrangements, and (3) compare these types with regard to their stability. METHOD This is a secondary analysis of data from a convenience sample of n = 320 care arrangements for persons with dementia obtained in the observational DemNet-D study. Data were analysed using multiple correspondence analysis and hierarchical cluster analysis. Sociodemographic data and variables related to the structure of the care arrangement (D-IVA), burden of the informal carer (BICS-D), dementia severity (FAST), and quality of life of the person with dementia (QOL-AD) were included. RESULTS The multiple correspondence analysis identified 27 axes that explained the entire variance between all care arrangements. The two axes 'dementia and care trajectory' and 'structure of the dyadic relationship' best distinguished care arrangements from each other and together explained 27.10% of the variance. The subsequent cluster analysis identified four types of care arrangements. Two types included spouse-centred care arrangements, and two types included child-centred care arrangements at different phases of the dementia and care trajectory. The types differ with regard to their stability. CONCLUSION The results highlight the heterogeneity and commonality of care arrangements for persons living with dementia. They contribute to a better understanding of informal dementia home care. Furthermore, the results can guide the development of tailored support for persons living with dementia and their caring families.
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Affiliation(s)
- Jan Dreyer
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), site Witten, Witten, Germany.
| | | | - Kerstin Köhler
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), site Witten, Witten, Germany
| | - Iris Hochgraeber
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), site Witten, Witten, Germany
| | - Christiane Pinkert
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), site Witten, Witten, Germany
| | - Martina Roes
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), site Witten, Witten, Germany
| | - Jochen René Thyrian
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), site Rostock/Greifswald, Greifswald, Germany
| | - Henrik Wiegelmann
- Institute for Public Health and Nursing Research, Health Sciences Bremen, University of Bremen, Bremen, Germany
| | - Bernhard Holle
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), site Witten, Witten, Germany
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Rand SE, Silarova B, Towers A, Jones K. Social care-related quality of life of people with dementia and their carers in England. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e2406-e2418. [PMID: 34921481 PMCID: PMC9541270 DOI: 10.1111/hsc.13681] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 11/16/2021] [Accepted: 12/01/2021] [Indexed: 06/14/2023]
Abstract
People with dementia and their carers are a growing subgroup of people who use community-based social care. These services are designed to maintain people's quality of life while living at home. The ASCOT measure of social care-related quality of life (SCRQoL), designed to evaluate quality and effectiveness of social care, has been adapted for proxy-report when someone is unable to self-report. The ASCOT-Carer has been developed to measure carer's own SCRQoL. This study sought to establish the factors related to SCRQoL of people living with dementia (PLWD, proxy-reported by carers) and their carers. Data were collected via a self-administered postal or online survey of 313 carers in England, from January 2020 to April 2021. Carers were eligible if they supported someone living with dementia at home, who was unable to self-complete questionnaires. The person living with dementia or their carer had to use at least one social care service, e.g. home care. We recruited participants via an online volunteer panel and NHS sites. Multiple regression was applied to explore the factors significantly related to ASCOT SCRQoL by self- and proxy-report. Key influences on carers' own SCRQoL were their health, financial difficulties associated with caring, and satisfaction with social care support. Inadequate home design was significantly negatively associated with SCRQoL for PLWD. The latter stages of the pandemic-related restrictions (the tier system from 2nd December 2020 to study end, April 2021) were associated with significantly worse SCRQoL for PLWD, but not for carers. The study offers insight into the factors associated with SCRQoL. In particular, the findings highlight the importance of adequate home design for people with dementia; satisfactory social care support and limiting any adverse financial impact of caring are important for carers. The findings indicate a negative effect of COVID restrictions on SCRQoL of people with dementia.
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Affiliation(s)
- Stacey E. Rand
- Personal Social Services Research Unit (PSSRU)University of KentCanterburyUK
| | - Barbora Silarova
- Personal Social Services Research Unit (PSSRU)University of KentCanterburyUK
| | - Ann‐Marie Towers
- Centre for Health Services Research (CHSS)University of KentCanterburyUK
| | - Karen Jones
- Personal Social Services Research Unit (PSSRU)University of KentCanterburyUK
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Khemai C, Meijers JM, Mujezinovic I, Bolt SR, Pieters S, Moser A, Schols JMGA, Janssen DJA. Interprofessional collaboration in palliative dementia care through the eyes of informal caregivers. DEMENTIA 2022; 21:1890-1913. [PMID: 35535552 PMCID: PMC9301172 DOI: 10.1177/14713012221098259] [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: 11/17/2022]
Abstract
A qualitative study was conducted to examine the experiences of informal caregivers of persons with dementia pertaining interprofessional collaboration with and among healthcare professionals in home care (HC), nursing homes and during home to nursing home transitions in palliative care. Semi-structured interviews were performed with bereaved informal caregivers. Data were analysed using a critical realist approach. The two main themes that emerged were: (1) Informal caregivers' roles in interprofessional collaboration with healthcare professionals and (2) Informal caregivers' perception of interprofessional collaboration among healthcare professionals. Informal caregivers' roles were identified in three collaboration processes: information exchange, care process and shared decision-making. Interprofessional collaboration among healthcare professionals was more perceptible on the collaboration outcome level (e.g. being up to date with the health status of the person with dementia; acting proactive, being adequate and consistent in the care process; and giving a warm welcome) than on the collaboration processes level (e.g. communicating and being involved in team processes). Our study revealed that intrinsic and extrinsic factors and interprofessional collaboration among healthcare professionals affected informal caregivers' collaborative roles. In summary, our study showed that informal caregivers have important roles as team members in the continuity and quality of palliative care for persons with dementia.
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Affiliation(s)
- Chandni Khemai
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health Medicine and Life Sciences, 5211Maastricht University, Maastricht, Limburg, Netherlands
| | - Judith M Meijers
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health Medicine and Life Sciences, 5211Maastricht University, Maastricht, Limburg, Netherlands; Zuyderland Care, 159205Zuyderland Medical Center, Sittard-Geleen, Limburg, Netherlands
| | - Irma Mujezinovic
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health Medicine and Life Sciences, 5211Maastricht University, Maastricht, Limburg, Netherlands
| | - Sascha R Bolt
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health Medicine and Life Sciences, 5211Maastricht University, Maastricht, Limburg, Netherlands
| | - Sabine Pieters
- 5216Zuyd University of Applied Sciences, Heerlen, Limburg, Netherlands
| | - Albine Moser
- Department Family Medicine, 5211Maastricht University, Maastricht, Limburg, Netherlands
| | - Jos M G A Schols
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health Medicine and Life Sciences, 5211Maastricht University, Maastricht, Limburg, Netherlands
| | - Daisy J A Janssen
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health Medicine and Life Sciences, 5211Maastricht University, Maastricht, Limburg, Netherlands; Department of Research and Education, CIRO, Horn, Hornerheide, Netherlands
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Family involvement with care homes following placement of a relative living with dementia: a review. AGEING & SOCIETY 2021. [DOI: 10.1017/s0144686x21000957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
This review updated a previous review [Gaugler JE (2005) Family involvement in residential long-term care: a synthesis and critical review. Aging and Mental Health9, 105–118] and focused on dementia. Fourteen years of development in family involvement with care homes following placement of a relative was explored. The review aimed to investigate two questions: (1) What types of involvement do families have with care homes following placement of people living with dementia? (2) Which factors influence family involvement with care homes? PsycINFO, MEDLINE and CINAHL Plus were searched for publications between January 2005 and December 2018. Thirty-three papers representing 30 studies were included. Papers were appraised using a quality rating tool designed for use with mixed study designs. Studies were of a reasonable quality though some weaknesses included single-site samples, high attrition rates and poor reporting. Twenty-eight papers highlighted types of involvement including collaboration, family–staff relationship development, decision making and visiting. Twenty-five papers pertained to factors influencing involvement, which included outcome of care quality evaluation, wish for recognition and sense of integration into the care team. Type of family involvement has changed over time with increased emphasis on families’ desire for partnership, to be active rather than passive advocates, and to focus on care monitoring and evaluation. Seven themes of family involvement activities are featured and a non-linear process is proposed. When compared to patient and family-centred care principles, an analysis of family involvement types found good fit overall and potential for framework improvements. Over 30 diverse factors influence inter-family variation in the level and nature of family involvement. Consideration of these factors and resolution of the gaps in evidence, including intergenerational and cultural concerns, can improve care home facilitation of family participation. This dementia-specific review is a comprehensive timely complement to Gaugler's seminal work about older adults in care.
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DiLeone C. Experiences of Daughters Caring for a Parent With Alzheimer's Disease Living at Home. Res Gerontol Nurs 2021; 14:191-199. [PMID: 34288784 DOI: 10.3928/19404921-20210428-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The current study used purposeful and snowball sampling to interview 12 daughters who were care-givers to their parents with Alzheimer's disease. Data were collected through in-depth, semi-structured interviews and were analyzed using Colaizzi's descriptive phenomenological approach. Caregiving years ranged from 1 to 10 years, with a mean of 5 years. Six themes were uncovered: (a) Where Are You When I Need You?; (b) Safety First; (c) I Don't Know What to Say or How to Say It; (d) They Are Beautiful People, but They Aren't Trained; (e) Letting Go of Who They Were; and (f) It Affects Every Area of My Life. Findings suggest that caregiver daughters of parents with AD living at home are struggling and indicate a need for better support of caregivers. Implications for nursing practice, research, and education are significant and require a greater focus on the support of informal caregivers of persons with AD. [Research in Gerontological Nursing, 14(4), 191-199.].
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Köhler K, Dreyer J, Hochgraeber I, von Kutzleben M, Pinkert C, Roes M, Holle B. Towards a middle-range theory of 'Stability of home-based care arrangements for people living with dementia' (SoCA-Dem): findings from a meta-study on mixed research. BMJ Open 2021; 11:e042515. [PMID: 33853798 PMCID: PMC8054086 DOI: 10.1136/bmjopen-2020-042515] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Most people with dementia and their informal carers live at home and strive to create a stable care situation for as long as possible. This preference of dyads is consistent with the global policy of ageing in place. Therefore, we aimed to develop a middle-range theory of stability guided by two research questions: How is stability of home-based care arrangements for people living with dementia constituted? What are the essential factors influencing stability? METHODS Within the 'Stability of home-based care arrangements for people living with dementia' project (SoCA project) at the German Center for Neurodegenerative Diseases (DZNE), we conducted a meta-study on mixed research. The analytical steps of meta-data analysis, meta-method and meta-theory are merged in an integrative synthesis. Eligible publications were identified through systematic database searches (MEDLINE, CINAHL and PsycINFO; last searched on 3 January 2017), backward/forward citation tracking and snowballing. All publications were screened against predefined inclusion criteria and evaluated through a quality appraisal. The analytical approach was thematic synthesis. RESULTS 99 publications were included. The middle-range theory conceptualises stability as a complex phenomenon comprising three components including eight concepts that are dynamically inter-related. The conceptual model visualises: (1) the trajectory of the dementia care arrangement, which involves a cyclic process of change and balancing over time; (2) the characteristics of the care arrangement, including needs, the carer role, the dyadic relationship and resources; and (3) the context, which is determined by society and culture and the respective healthcare system. The relevance of each concept in relation to stability changes over time. The forming of each concept is actively shaped by the informal carer. DISCUSSION This middle-range theory provides a thorough understanding of the stability of home-based care arrangements for people living with dementia and can be used to guide future research and practice. OTHER This meta-study was funded by the DZNE and registered in PROSPERO (registration number CRD42016041727).
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Affiliation(s)
- Kerstin Köhler
- German Centre for Neurodegenerative Diseases (DZNE), Witten, Germany
- Faculty of Health, Department of Nursing Science, Witten/Herdecke University (UW/H), Witten, Germany
| | - Jan Dreyer
- German Centre for Neurodegenerative Diseases (DZNE), Witten, Germany
- Faculty of Health, Department of Nursing Science, Witten/Herdecke University (UW/H), Witten, Germany
| | - Iris Hochgraeber
- German Centre for Neurodegenerative Diseases (DZNE), Witten, Germany
- Faculty of Health, Department of Nursing Science, Witten/Herdecke University (UW/H), Witten, Germany
| | - Milena von Kutzleben
- Department of Health Services Research, School of Medicine and Health Sciences, University of Oldenburg, Oldenburg, Germany
| | - Christiane Pinkert
- German Centre for Neurodegenerative Diseases (DZNE), Witten, Germany
- Faculty of Health, Department of Nursing Science, Witten/Herdecke University (UW/H), Witten, Germany
| | - Martina Roes
- German Centre for Neurodegenerative Diseases (DZNE), Witten, Germany
- Faculty of Health, Department of Nursing Science, Witten/Herdecke University (UW/H), Witten, Germany
| | - Bernhard Holle
- German Centre for Neurodegenerative Diseases (DZNE), Witten, Germany
- Faculty of Health, Department of Nursing Science, Witten/Herdecke University (UW/H), Witten, Germany
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12
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Aaltonen MS, Martin-Matthews A, Pulkki JM, Eskola P, Jolanki OH. Experiences of people with memory disorders and their spouse carers on influencing formal care: "They ask my wife questions that they should ask me". DEMENTIA 2021; 20:2307-2322. [PMID: 33595339 PMCID: PMC8564245 DOI: 10.1177/1471301221994300] [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: 11/17/2022]
Abstract
Background People with memory disorders often need care and help from family carers and health and
social care providers. Due to the deterioration of cognitive capacity and language
skills, they may be unable to convey their thoughts and care preferences to other
people. As a result, their agency may become restricted. We investigated the
descriptions provided by people with memory disorders and spousal carers of their
influence on care in encounters with formal care providers. Methods Qualitative thematic analysis was used to identify, analyze, and report themes that
describe encounters with professionals in different social or healthcare environments.
In-depth interview data were gathered from 19 spouse carers and 15 persons with memory
disorders. Findings Three themes out of four describe how people with memory disorders and their spouse
carers influence formal care: Acquiescence, negotiating care decisions, and taking
control. The fourth theme describes lack of influence. People with memory disorders and
their spouse carers have ways to influence care, but spouse carers identified more ways
of doing so. Both either accepted and followed the care guidelines by the formal carers
or took control of the situation and made their own decisions. Spouse carers also sought
to influence care decisions through negotiations with formal carers. When formal carers’
decisions were experienced as inconsistent or the rationale of their actions difficult
to follow, the possibilities to influence care were limited. Conclusions People with memory disorders and their family carers are often in a disadvantaged
position as they lack power over the health and social care decision-making during the
illness, which is often guided by structural factors. To support the agency of people
with memory disorders and to promote shared decision-making, clarification of the
service structure and clearer communication between the different parties involved in
care are required.
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Affiliation(s)
- Mari S Aaltonen
- Faculty of Social Sciences, (Health Sciences), and Gerontology Research Center (GEREC), 7840Tampere University, Finland; Department of Sociology, University of British Columbia, Canada
| | - Anne Martin-Matthews
- Department of Sociology and Office of the Vice-President, Health, University of British Columbia, Canada
| | - Jutta M Pulkki
- Faculty of Social Sciences, (Health Sciences), and Gerontology Research Center (GEREC), 7840Tampere University, Finland
| | - Päivi Eskola
- Faculty of Sport and Health Sciences, Gerontology Research Center (GEREC) and Open University, University of Jyväskylä, Finland
| | - Outi H Jolanki
- Faculty of Social Sciences, Health Sciences, and Gerontology Research Center (GEREC), 7840Tampere University, Finland; Department of Social Sciences and Philosophy, 4168University of Jyväskylä, Finland
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13
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Dalgarno EL, Gillan V, Roberts A, Tottie J, Britt D, Toole C, Clarkson P. Home care in dementia: The views of informal carers from a co-designed consultation. DEMENTIA 2021; 20:2261-2277. [PMID: 33530737 PMCID: PMC8564226 DOI: 10.1177/1471301221990504] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND In the United Kingdom, there is a current priority for high-quality dementia care provided at home. However, home care or domiciliary care is an area where problems have been reported, in terms of a lack of consistency, coordination and appropriate responses to the specific needs of those with dementia. The views of informal carers, who often must respond to these problems when supporting relatives, are crucial in shedding light on the issues and in seeking to promote solutions. METHODS This study explored the views of informal carers of those with dementia concerning home care, through a consultation using an electronic survey. The survey questions were designed by informal carers, through a public involvement group within an existing programme of dementia research. The survey elicited responses from 52 informal carers in 2017/18. The data were analysed qualitatively using framework analysis. FINDINGS Carers' views focused on the need for investment into meaningful personalisation, recognising the value of providing care and valuing formal carers, systemic failings of care coordination and provision and the importance of ongoing collaboration and care planning. CONCLUSION Based on a framework drawn from the views of informal carers themselves, this study articulated issues of concern for home care and its delivery for people with dementia. Attempts should be made to make dementia home care more consistently personalised, inclusive and collaborative with informal carers and key others involved. Further areas to explore include working conditions of formal carers and current models utilised in homecare provision.
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Affiliation(s)
| | - Vincent Gillan
- Social Care and Society, 5292University of Manchester, Manchester, UK
| | - Amy Roberts
- Social Care and Society, 5292University of Manchester, Manchester, UK
| | - Jean Tottie
- Family Carer, Together in Dementia, Liverpool, UK
| | | | | | - Paul Clarkson
- Social Care and Society, 5292University of Manchester, Manchester, UK
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14
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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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15
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Liu HY, Hsu WC, Shyu YIL, Wang YN, Huang TH, Lin YE, Huang CH. Finding a balance in family caregiving for people with dementia: A correlational longitudinal study. J Adv Nurs 2021; 77:2278-2292. [PMID: 33434343 DOI: 10.1111/jan.14747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 11/11/2020] [Accepted: 12/10/2020] [Indexed: 11/28/2022]
Abstract
AIMS The "Finding a Balance Point" framework was used to explore the caregiving process over time for family caregivers of people with dementia in Taiwan. This study aimed to: (a) identify Taiwanese caregivers' different balance trajectories; (b) explore predictors of trajectory group membership; and (c) examine associations of different balance trajectories with caregiving outcomes. DESIGN A correlational longitudinal design was used. METHODS Data were collected from 200 family caregivers' self-completed questionnaires and they were followed over 2 years (June 2015-May 2017). Discrete balance trajectories were identified by group-based trajectory modelling. Predictors of trajectory group membership were identified from potential predictors of caregiving characteristics and caregiving factors using multivariate logistic regression. Associations of trajectory groups with caregiving outcomes (depressive symptoms and health-related quality of life) were explored using the generalized estimating equation. RESULTS Balance trajectories best fit a two-group trajectory model (poor and good). Caregivers with a poor sense of balance between competing needs were more likely to have more depressive symptoms (b = 11.71, 95% CI [9.04, 14.38], p < .001), worse physical health (b = -6.22, 95% CI [-8.71, -3.74], p < .001), and worse mental health (b = -11.1, 95% CI [-13.58, -8.63], p < .001) than caregivers with a good sense of balance. Caregivers experiencing lower role strain (b = -1.45, SE = 0.48, p = .003) or higher predictability (b = 2.83, SE = 0.76, p < .001) were more likely to belong to the good-balance group. CONCLUSIONS Caregivers with poor balance between competing needs are more likely to have worse caregiving outcomes. Role strain and predictability significantly predicted balance trajectory groups. Family caregivers with lower caregiving task difficulty and/or better knowledge of the care receiver were more likely to be in the good balance trajectory group. IMPACT Our findings support the framework, "Finding a Balance Point," and clarify the family caregiving process for people with dementia. This framework could be used to tailor interventions for home care nurses to improve family caregivers' caregiving outcomes.
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Affiliation(s)
- Hsin-Yun Liu
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan (R.O.C.)
| | - Wen-Chuin Hsu
- Dementia Center, Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan (R.O.C.).,School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan (R.O.C.)
| | - Yea-Ing L Shyu
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan (R.O.C.).,Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan (R.O.C.).,Department of Nursing, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (R.O.C.)
| | - Yu-Nu Wang
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan (R.O.C.)
| | - Tzu-Hsin Huang
- Department of Nursing, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan (R.O.C.)
| | - Yueh-E Lin
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan (R.O.C.).,Department of Nursing, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan (R.O.C.)
| | - Chun-Hsia Huang
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan (R.O.C.)
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16
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Lindeza P, Rodrigues M, Costa J, Guerreiro M, Rosa MM. Impact of dementia on informal care: a systematic review of family caregivers' perceptions. BMJ Support Palliat Care 2020:bmjspcare-2020-002242. [PMID: 33055092 DOI: 10.1136/bmjspcare-2020-002242] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 08/08/2020] [Accepted: 08/14/2020] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Caregivers play a major role in providing all the support and care in daily activities for their relatives with dementia. To fully describe the influence of dementia caregiving on family caregivers' life, we conducted a systematic review including caregivers' perceptions about the positive and negative aspects of caring and the expressed factors. MATERIALS AND METHODS We conducted a systematic review including articles from January 1998 to July 2020. Qualitative studies reporting family caregivers' perceptions about their experiences and the effects/impact of dementia caregiving were eligible. Two authors extracted the data independently, and the analysis focused on the positive and negative aspects of dementia caregiving in caregivers' life. RESULTS Eighty-one studies with 3347 participants were included in this review. The positive aspects of caregiving in caregivers' life encompass personal accomplishment and strengthening relationships, which were enhanced by good medical counselling/formal care support and family/friends support. The negative aspects included emotional and social aspects experienced by caregivers. Other factors such as inappropriate medical/formal care support, illness progression and the costs of dementia contributed to negative appraisal. DISCUSSION AND IMPLICATIONS The findings provide insights into the holistic experience of caring for a person with dementia revelling the major positive and negative aspects underlying the caregiver role. The evidence emphasises the need 'to focus on positive aspects' and targeted interventions aimed at reducing the negative impact of caregiving, which has serious consequences on caregivers' quality of life. A multicomplex intervention for dementia informal caregiving should be developed, committing the society to promote mental health, address these community needs and improve the quality of life of the person with dementia and their family caregivers.
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Affiliation(s)
- Patrícia Lindeza
- ISAMB, Universidade de Lisboa Instituto de Saude Ambiental, Lisboa, Lisboa, Portugal
| | | | - João Costa
- Universidade de Lisboa Centro de Estudos de Medicina Baseada na Evidência, Lisboa, Lisboa, Portugal
| | | | - Mario Miguel Rosa
- Lab Farmacologia Clínica, Universidade de Lisboa Faculdade de Medicina, Lisboa, Portugal
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17
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Pritty B, De Boos D, Moghaddam N. Factors influencing the transition experience of carers for persons with dementia, when the person with dementia moves into residential care: systematic review and meta-synthesis. Aging Ment Health 2020; 24:1371-1380. [PMID: 30977396 DOI: 10.1080/13607863.2019.1602591] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Aims: To understand factors influencing the experience of carers for people with dementia, when that person moves from living in the community to living in residential care. Specifically, we aimed to identify facilitators and inhibitors of carer adjustment during this transition.Method: A systematic search of CINAHL, EMBASE, PubMed, and PsycINFO databases was conducted. Nine qualitative articles published between 2001 and 2017, based on the experiences of 141 carers, were included. Thematic analysis was applied to the data, with the concepts of transition inhibitors and facilitators being used to structure the analytic process.Results: Analysis produced five themes, representing factors that could affect carer experiences of the focal transition-process: modifying the difficulty of this process according to their presence or absence. The themes were (1) Connection, pertaining to the carer feeling connected to the person with dementia and professionals during this transition; (2) Informed & Informing, relating to exchange of information between the carer and facility staff or health professionals; (3) The facility: welcoming & skilful, dealing with carer perceptions of the facility and their confidence in the staff; (4) It's What You Make of It, discussing the meaning the carer made of the admission and the impact this had; and (5) Sharing Responsibility, addressing how carers were affected by the perceived sharing of responsibility for care-provision.Conclusions: A supportive network has a significant role to play in facilitating this transition for carers. However, further research into what carers would find useful during this time is needed.
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Affiliation(s)
- Beth Pritty
- Department of Clinical Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Danielle De Boos
- Department of Clinical Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Nima Moghaddam
- Department of Clinical Psychology, University of Lincoln, Lincoln, UK
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18
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Gaugler JE, Statz TL, Birkeland RW, Louwagie KW, Peterson CM, Zmora R, Emery A, McCarron HR, Hepburn K, Whitlatch CJ, Mittelman MS, Roth DL. The ResidentialCare Transition Module: a single-blinded randomized controlled evaluation of a telehealth support intervention for family caregivers of persons with dementia living in residential long-term care. BMC Geriatr 2020; 20:133. [PMID: 32293314 PMCID: PMC7158110 DOI: 10.1186/s12877-020-01542-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 03/29/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Families do not fully disengage from care responsibilities following relatives' admissions to residential long-term (RLTC) care settings such as nursing homes. Caregiver stress, depression, or other key outcomes remain stable or sometimes increase following a relative's RLTC entry. Some interventions have attempted to increase family involvement after institutionalization, but few rigorous studies have demonstrated whether these interventions are effective in helping families navigate the potential emotional and psychological upheaval presented by relatives' transitions to RLTC environments. The Residential Care Transition Module (RCTM) provides six formal sessions of consultation (one-to-one and family sessions) over a 4-month period to family caregivers who have admitted a relative to a RLTC setting. METHODS In this embedded mixed methods randomized controlled evaluation, family members who have admitted a cognitively impaired relative to a RLTC setting are randomly assigned to the RCTM (n = 120) or a usual care control condition (n = 120). Primary outcomes include reductions in family members' primary subjective stress and negative mental health outcomes; secondary role strains; and residential care stress. The mixed methods design will allow for an analysis of intervention action mechanisms by "embedding" qualitative components (up to 30 semi-structured interviews) at the conclusion of the 12-month evaluation. DISCUSSION This evaluation will fill an important clinical and research gap by evaluating a psychosocial intervention designed for families following RLTC admission that determines whether and how the RCTM can help families better navigate the emotional and psychological challenges of residential care transitions. TRIAL REGISTRATION ClinicalTrials.gov (NCT02915939, prospectively registered).
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Affiliation(s)
- Joseph E Gaugler
- Division of Health Policy and Management, School 8of Public Health, University of Minnesota, D351 Mayo (MMC 729), 420 Delaware Street S.E, Minneapolis, MN, 55455, USA.
| | - Tamara L Statz
- Division of Health Policy and Management, School 8of Public Health, University of Minnesota, D351 Mayo (MMC 729), 420 Delaware Street S.E, Minneapolis, MN, 55455, USA
| | - Robyn W Birkeland
- Division of Health Policy and Management, School 8of Public Health, University of Minnesota, D351 Mayo (MMC 729), 420 Delaware Street S.E, Minneapolis, MN, 55455, USA
| | - Katie W Louwagie
- Division of Health Policy and Management, School 8of Public Health, University of Minnesota, D351 Mayo (MMC 729), 420 Delaware Street S.E, Minneapolis, MN, 55455, USA
| | - Colleen M Peterson
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Rachel Zmora
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Ann Emery
- Division of Health Policy and Management, School 8of Public Health, University of Minnesota, D351 Mayo (MMC 729), 420 Delaware Street S.E, Minneapolis, MN, 55455, USA
| | - Hayley R McCarron
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Kenneth Hepburn
- Nell Hodgson Woodruff School of Nursing, Emory University Alzheimer's Disease Research Center, Emory University, Atlanta, GA, USA
| | | | - Mary S Mittelman
- Department of Psychiatry, NYU School of Medicine, NYU Langone Health, New York, NY, USA
| | - David L Roth
- Center on Aging and Health, Johns Hopkins University, Baltimore, MD, USA
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19
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Non-use of community health-care services – an exploratory cross-sectional study among family care-givers for older, home-dwelling persons with dementia. AGEING & SOCIETY 2020. [DOI: 10.1017/s0144686x2000015x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
AbstractCommunity health-care services for older, home-dwelling persons with dementia tend to be underutilised. Family care-givers provide substantial care, and they often arrange for and co-ordinate health-care services on behalf of persons with dementia. The aim of this study was to examine family care-givers’ knowledge of unused services and their self-reported reasons for non-use of such services. We gathered cross-sectional survey data from 430 family care-givers of older persons with dementia in Northern Norway. Multinomial logistic regression analysis was used to identify predictors of family care-givers’ knowledge of unused services. An open-ended question regarding reasons for non-use of services was analysed by thematic text analysis. Characteristics of family care-givers (e.g. education level) and factors related to the care-giving circumstances (e.g. negative impact of care-giving) predicted family care-givers’ knowledge of unused services. Reasons for non-use of services were multifaceted and complex, and were related to attributes of the person with dementia and/or the family care-giver (e.g. reluctance to use services) and/or the health-care services (e.g. low quality). Although services were unused, several family care-givers indicated substantial needs for the services. Strategies aimed at addressing the non-use of services should emphasise individuals’ and families’ needs and the adaptation of information about available services and their benefits for both care recipients and family care-givers. A relationship-centred care approach is thus recommended in dementia care.
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20
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Söderberg M, Ståhl A, Melin Emilsson U. Dignity as a guiding principle for family care partners in the care of an old relative with dementia. Scand J Caring Sci 2020; 34:87-95. [DOI: 10.1111/scs.12708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 04/10/2019] [Indexed: 11/28/2022]
Affiliation(s)
| | - Agneta Ståhl
- Faculty of Engineering Department of Technology and Society Lund University Lund Sweden
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21
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Henriksen N, Moholt JM, Blix BH. Perceptions of Family Caregivers of Home-Dwelling Persons with Dementia regarding Access to Information and Involvement in Decisions. J Aging Soc Policy 2020; 32:260-275. [DOI: 10.1080/08959420.2019.1707058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Nils Henriksen
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Jill-Marit Moholt
- Centre for Care Research North, Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Bodil H. Blix
- Centre for Care Research North, Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
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22
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Peacock S, Bayly M, Duggleby W, Ploeg J, Pollard L, Swindle J, Lee HJ, Williams A, Markle-Reid M, McAiney C. Women’s Caregiving Experience of Older Persons Living With Alzheimer Disease and Related Dementias and Multiple Chronic Conditions: Using Wuest’s Theory. SAGE Open Nurs 2020; 6:2377960820974816. [PMID: 35155764 PMCID: PMC8832322 DOI: 10.1177/2377960820974816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 10/26/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction Care of persons living with chronic conditions rests heavily on women within
the context of the family. Research demonstrates that women experience more
caregiving strain compared to men, yet less is known about the differences
in experiences between women carers: namely, wives and daughters. Objective The purpose of this study was to examine and compare the experiences of wife
and daughter carers of older adults living with Alzheimer disease and
related dementias, plus at least two other chronic conditions. Methods Using qualitative description with Wuest’s feminist caring theory of
precarious ordering as an analytic framework, interview
transcripts of women carer participants who were from the control group of a
larger multi-site mixed methods study evaluating the web-based intervention
My Tools 4 Care were analyzed. Findings Both wives and daughters experienced daily struggles, altered prospects, and
ambivalent feelings around their caring role. Negotiating the role of
professional carer was an important part of balancing caring demands and
anticipating the future, and women took an active role in trying to harness
caring resources. Findings indicated wives and daughters were generally
similar in how they described their caregiving, although daughters reported
more shared caring and decision-making, and needed to balance paid
employment with caregiving. Conclusion Wives and daughters face similar challenges caring for persons with a
dementia and multiple chronic conditions, and actively engage in strategies
to manage caring demands. The findings illuminate the importance of
accessible, appropriate support from professional carers/health care
providers, and suggest that assistance navigating such supports would
benefit women carers.
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Affiliation(s)
- Shelley Peacock
- College of Nursing, University of Saskatchewan, Saskatoon, Canada
| | - Melanie Bayly
- College of Nursing, University of Saskatchewan, Saskatoon, Canada
| | - Wendy Duggleby
- Faculty of Nursing, University of Alberta, Edmonton, Canada
| | - Jenny Ploeg
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Lori Pollard
- Faculty of Nursing, University of Alberta, Edmonton, Canada
| | | | - Heun Jung Lee
- Faculty of Nursing, University of Alberta, Edmonton, Canada
| | - Allison Williams
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | | | - Carrie McAiney
- School of Public Health and Health Systems, Waterloo University, Waterloo, Ontario, Canada
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23
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Lam A, Ploeg J, Carroll SL, Duggleby W, McAiney C, Julian P. Transition Experiences of Caregivers of Older Adults With Dementia and Multiple Chronic Conditions: An Interpretive Description Study. SAGE Open Nurs 2020; 6:2377960820934290. [PMID: 33415288 PMCID: PMC7774379 DOI: 10.1177/2377960820934290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/21/2020] [Accepted: 05/24/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Family caregivers provide most of the care for older persons living with dementia (PLWD) and multiple chronic conditions (MCCs) in the community. Caregivers experience transitions, such as changes to their health, roles, and responsibilities, during the process of caring. Transitions encompass a time when caregivers undergo stressful responses to change. However, we know little about the transition experiences of caregivers of persons living with both dementia and MCCs. OBJECTIVE This qualitative study explored the transition experiences of caregivers of PLWD within the context of MCCs, from the perspective of both caregivers and practitioners. The research question was the following: What are the transition experiences of family caregivers in providing care to older PLWD and MCCs living in the community? METHODS This study was conducted using an interpretive description approach. Semistructured interviews were conducted with 19 caregivers of older community-dwelling PLWD and MCCs and 7 health-care providers working with caregivers in Ontario, Canada. Concurrent data collection and inductive data analysis were used. RESULTS Caregivers of older PLWD and MCCs experienced four key transitions: (a) taking on responsibility for managing multiple complex conditions, (b) my health is getting worse, (c) caregiving now defines my social life, and (d) expecting that things will change. Findings highlight how the coexistence of MCCs with dementia complicates caregiver transitions and the importance of social networks for facilitating transitions. CONCLUSION The study provided insight on the transition experiences of caregivers of older PLWD and MCCs. MCCs increased the care load and further complicated caregivers' transition experiences. Health-care providers, such as nurses, can play important roles in supporting caregivers during these transitions and engage them as partners in care.
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Affiliation(s)
- Annie Lam
- Lawrence S. Bloomberg Faculty of Nursing, University of
Toronto
| | - Jenny Ploeg
- Aging, Community and Health Research Unit, School of Nursing,
McMaster University, Hamilton, ON, Canada
| | - Sandra L. Carroll
- Faculty of Health Science, School of Nursing, McMaster
University, Hamilton, ON, Canada
| | - Wendy Duggleby
- Aging and Quality of Life, Director of Innovations in Seniors
Care Research Unit, Edmonton Clinic Health Academy, University of Alberta
| | - Carrie McAiney
- Research Institute for Aging, School of Public Health and Health
Systems, University of Waterloo
| | - Patricia Julian
- School of Nursing, McMaster University, Hamilton, ON,
Canada
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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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Garvey JM, Dalton JM, Magny-Normilus C. A Conceptual-Theoretical-Empirical Structure for the Study of Alzheimer Informal Caregivers and Home Health Care Nursing Services. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2019. [DOI: 10.1177/1084822319844263] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this article is to describe the process used to create a conceptual-theoretical-empirical structure for a proposed study of policies for home health care nursing services for informal caregivers of persons with Alzheimer disease. The process consisted of linkage of the Conceptual Model of Nursing and Health Policy with Roy’s Adaptation Model to guide derivation of a middle-range theory of home health care nursing services for Alzheimer disease informal caregiving, and selection of appropriate empirical research methods.
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Lee K, Puga F, Pickering CEZ, Masoud SS, White CL. Transitioning into the caregiver role following a diagnosis of Alzheimer's disease or related dementia: A scoping review. Int J Nurs Stud 2019; 96:119-131. [PMID: 30851954 DOI: 10.1016/j.ijnurstu.2019.02.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 02/05/2019] [Accepted: 02/05/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To identify experiences, needs, interventions and outcomes for caregivers of persons with Alzheimer's disease or related dementia as they transition into this new role following diagnosis. DESIGN Scoping review of published literature. DATA SOURCES A search for published articles was conducted in PsycINFO, Scopus, Ovid and Web of Science databases. REVIEW METHODS The Arksey and O'Malley methodological framework guided the review. Studies were screened independently for inclusion by two persons. A total of 955 studies, after duplicates removed, were found by the database search. From these, 127 full-text articles were retained through the screening of titles and abstracts by two reviewers. The two reviewers assessed 46 full-text articles for eligibility. The final 29 studies identified caregiver experiences, needs, and interventions during the period following a diagnosis of Alzheimer's disease or related dementia in the scoping review. RESULTS Twenty-nine studies were organized around three major categories: i) family caregiver experiences on receiving the diagnosis (n = 23), ii) needs during this time of transition (n = 18), and iii) interventions and outcomes to support their transition into the caregiver role (n = 5). While studies may have addressed more than one topic, 16 studies intersected categories of both caregiver experience and needs, and one study intersected categories of needs and interventions. There were several studies that focused more specifically on the caregiver's initial reactions to a diagnosis of Alzheimer's disease or related dementia (n = 9), the emotional responses to the diagnosis (n = 14), changes in personal relationships and responsibilities with a new role (n = 16). Caregiver needs following the diagnosis included knowledge and information (n = 14), emotional and psychological support (n = 11), and assistance with care planning (n = 7). Five papers examined interventions specifically tailored to caregiver needs at this juncture, which support the transition into the caregiver role. CONCLUSIONS The time of receiving a diagnosis of Alzheimer's disease or related dementia is a critical period in the process of transitioning into caregiver role. This period marks a new phase in the process of caring by family caregivers. Thus, it is important to fully understand the experiences and needs of caregivers and effective interventions in order to better support their transition into this new role.
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Affiliation(s)
- Kyungmi Lee
- School of Nursing, University of Texas Health Center San Antonio, United States
| | - Frank Puga
- School of Nursing, University of Texas Health Center San Antonio, United States
| | | | - Sara S Masoud
- School of Nursing, University of Texas Health Center San Antonio, United States
| | - Carole L White
- School of Nursing, University of Texas Health Center San Antonio, United States.
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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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Moholt JM, Friborg O, Blix BH, Henriksen N. Factors affecting the use of home-based services and out-of-home respite care services: A survey of family caregivers for older persons with dementia in Northern Norway. DEMENTIA 2018; 19:1712-1731. [PMID: 30322275 PMCID: PMC7309361 DOI: 10.1177/1471301218804981] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Family caregivers contribute substantially to the care for older home-dwelling people with dementia, although community healthcare services tend to be underutilized. In this study, we aimed to explore the use and predictors of use of home-based and out-of-home respite care services available to older home-dwelling persons with dementia, as reported by the family caregivers. Method A cross-sectional survey was administered to family caregivers (n = 430) in Northern Norway during April to November 2016. The use of healthcare services was categorized into two types according to principal component analysis: home-based services and out-of-home respite care services (R2 = 44.1%). Predictors of service use were examined with bivariate correlation, multiple linear regression, and Poisson regression analyses. Results The use of home-based services among persons with dementia was significantly higher for persons with advanced age, persons living in urban areas, persons living in an assisted living facility, persons living alone, and persons able to manage being alone for a short period of time. Among the family caregiver variables, higher age, status as a daughter, son, or other family member, higher educational level, and full-time employment also predicted greater use of home-based services. Same ethnicity was associated with use of fewer home-based services. The use of out-of-home respite care services was significantly higher among male persons with dementia and among those living in urban areas. In addition, fewer out-of-home respite care services were used by male caregivers or daughters of the care recipient, while the use was higher when the caregivers experienced more caregiving demands or had provided care for longer periods of time. Conclusions These results indicate areas that policymakers and healthcare providers should consider to identify families who underutilize healthcare services and to achieve a more equal and efficient allocation of services in accordance with families' needs.
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Affiliation(s)
- Jill-Marit Moholt
- Centre for Care Research North, Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Norway
| | - Oddgeir Friborg
- Department of Psychology, Faculty of Health Sciences, UiT The Arctic University of Norway, Norway
| | - Bodil H Blix
- Centre for Care Research North, Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Norway
| | - Nils Henriksen
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Norway
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Kristensson J, Andersson M, Condelius A. The establishment of a shared care plan as it is experienced by elderly people and their next of kin: A qualitative study. Arch Gerontol Geriatr 2018; 79:131-136. [PMID: 30212660 DOI: 10.1016/j.archger.2018.08.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 08/31/2018] [Accepted: 08/31/2018] [Indexed: 12/21/2022]
Abstract
One strategy to achieve coordination of care for older people with complex care needs is the establishment of shared care plans. The aim of this study was to explore the process of establishing a shared care plan from the perspective of elderly people and their next of kin. Data were collected via 12 semi-structured interviews with 12 older persons targeted in joint care planning and 11 next of kin, either alone or together. The analysis was conducted using content analysis. The results reflect the process of establishing a shared care plan in the three categories; Preparation, Content and Results with belonging sub-categories. Preparation showed that the possibility to influence the preparation of the joint care plan meeting was sometimes limited and the purpose was not always clear. The Content category showed that the meeting was sometimes experienced as an unstructured, general conversation or focused on practical matters. And Results of the process were shown to be successful in terms of having positive effects or fulfilling needs, but also sometimes as being pointless. Thus, the results show that the process of establishing a shared care plan is somewhat unclear to the older person and their next of kin and that they are rarely involved in the decisions regarding when and if a shared care plan is needed. If joint care planning is expected to serve as a tool to accomplish a more person-centred care, then the person must be regarded as an equal partner all throughout the decision-making and planning process.
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Affiliation(s)
- Jimmie Kristensson
- Department of Health Sciences, Faculty of Medicine, Lund University, P.O. Box 157, 221 00 Lund, Sweden.
| | | | - Anna Condelius
- Department of Health Sciences, Faculty of Medicine, Lund University, P.O. Box 157, 221 00 Lund, Sweden.
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30
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Moholt JM, Friborg O, Skaalvik MW, Henriksen N. Psychometric validation of the Carers of Older People in Europe Index among family caregivers of older persons with dementia. SAGE Open Med 2018; 6:2050312118792812. [PMID: 35154748 PMCID: PMC8826105 DOI: 10.1177/2050312118792812] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 07/12/2018] [Indexed: 11/17/2022] Open
Abstract
Objectives: The Carers of Older People in Europe Index is a first-stage assessment tool to detect family caregivers in need of support. This instrument assesses caregivers’ subjective perceptions of their caregiving circumstances. The present study examines the psychometric properties of the Norwegian version of the Carers of Older People in Europe Index among family caregivers for older persons with dementia living at home. Methods: Cross-sectional survey data were collected from 430 dementia caregivers. The sample was randomly split as follows: the first half of the sample was used to identify the measurement model using an exploratory factor analysis, and the second half of the sample was used to cross-validate the model using a confirmatory factor analysis. The criterion validity and reliability (internal consistency and test–retest reliability) of the Carers of Older People in Europe Index were also examined. Results: Using an exploratory factor analysis, we extracted three factors that were consistent with previous findings: negative impact of caregiving, positive values of caregiving and quality of support. This model fit the data well using a confirmatory factor analysis. Moreover, a second-order model could replace the three-factor correlated model without sacrificing the model fit, supporting the use of a global impact of caregiving score. The three factors and the global factor correlated with the criteria measures in the expected directions. The internal consistency was assessed using Cronbach’s alpha and was good for the negative impact (α = 0.86) and the quality of support (α = 0.76) factors. The positive values factor was less consistent (α = 0.64). The test–retest reliability was examined using Spearman’s rank order correlation and was good for all three factors. Conclusion: The psychometric properties of the Norwegian version of the Carers of Older People in Europe Index are good. The instrument assesses dementia caregivers’ situations across three primary factors or alternatively validly summarizes the factors in a global impact of caregiving score.
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Affiliation(s)
- Jill-Marit Moholt
- Centre for Care Research, North, Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Oddgeir Friborg
- Department of Psychology, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Mari Wolff Skaalvik
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Nils Henriksen
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
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Dreyer J, Köhler K, Hochgraeber I, Holle B, von Kutzleben M. Stability of home-based care arrangements for people living with dementia: protocol of a meta-study on mixed research. BMJ Open 2018; 8:e021156. [PMID: 30056381 PMCID: PMC6067342 DOI: 10.1136/bmjopen-2017-021156] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Worldwide, most people with dementia live at home and are cared for by informal carers. During the dementia care trajectory, creating and maintaining a stable care situation is a guiding principle of informal carers and a desirable outcome of contemporary healthcare policies. However, though there is an extensive body of research focusing on the course of dementia care trajectories, it remains unclear how stability of home-based care arrangements is constituted and what are the essential factors that influence this stability. This paper outlines a protocol of a systematic review that aims to address these gaps in knowledge. METHODS AND ANALYSIS To theorise the complex phenomenon of stability of home-based care arrangements for people with dementia, we will conduct a meta-study. Meta-studies include three analytical components (meta-data analysis, meta-method and meta-theory) that are combined and finally culminate in an integrative knowledge synthesis. Originally, meta-study was designed to include qualitative studies only. To capture relevant contributions to our target phenomenon from all types of evidence, we will extend the original methodology and apply it to studies with qualitative, quantitative and mixed-methods designs and to (systematic) reviews. Eligible studies will be identified by systematic database searches (PubMed, CINAHL and PsycINFO), backward/forward citation tracking, snowballing and theoretical sampling. All identified studies will be screened against predefined inclusion criteria. The main analytical approach for all analyses is thematic synthesis. The meta-study will generate a more comprehensive understanding of dementia care trajectories and will be used to identify research gaps, develop future research questions and define relevant outcomes. DISSEMINATION The findings of the meta-study will be published in a series of articles in peer-reviewed scientific journals and will be presented at national and international scientific conferences. PROSPERO REGISTRATION NUMBER CRD42016041727.
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Affiliation(s)
- Jan Dreyer
- German Center for Neurodegenerative Diseases (DZNE) Site Witten, Witten, Germany
- Department of Health, School of Nursing Science, Witten/Herdecke University, Witten, Germany
| | - Kerstin Köhler
- German Center for Neurodegenerative Diseases (DZNE) Site Witten, Witten, Germany
- Department of Health, School of Nursing Science, Witten/Herdecke University, Witten, Germany
| | - Iris Hochgraeber
- German Center for Neurodegenerative Diseases (DZNE) Site Witten, Witten, Germany
- Department of Health, School of Nursing Science, Witten/Herdecke University, Witten, Germany
| | - Bernhard Holle
- German Center for Neurodegenerative Diseases (DZNE) Site Witten, Witten, Germany
- Department of Health, School of Nursing Science, Witten/Herdecke University, Witten, Germany
| | - Milena von Kutzleben
- German Center for Neurodegenerative Diseases (DZNE) Site Witten, Witten, Germany
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Nguyen N, Renom-Guiteras A, Meyer G, Stephan A. [Nursing home placement of people with dementia: a secondary analysis of qualitative data and literature review on perspectives of informal caregivers and healthcare professionals]. Pflege 2018. [PMID: 29514552 DOI: 10.1024/1012-5302/a000611] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background: Nursing home placement of people with dementia can become necessary when informal care is no longer sufficient. Informal carers experience the transition period as an additional burden. Aim: Experiences and views of informal carers and healthcare professionals regarding the transition from people with dementia to a nursing home are investigated to improve the support for informal carers. Method: This secondary analysis included data from all five focus groups with n = 30 informal carers and healthcare professionals conducted as part of the “RightTimePlaceCare” project. To supplement the material which resulted from a single interview question, a literature analysis with the same focus was conducted. Results: The merged results indicated that informal carers needed professional support early on at home until after the nursing home placement. Concerns regarding nursing homes, financial aspects and family related issues were important aspects in the decision making. Healthcare professionals recommended provision of early guidance regarding those matters and making own experiences with nursing homes. Healthcare professionals should serve as mediators during the transition process and improve the collaboration between service providers. Conclusions: Empowering families to make informed choices could be facilitated by offering advice at home about their options for formal support services, financial support, and housing solutions. Healthcare professionals should support caregivers to make a decision, coordinate the placement and to cope with the new situation.
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Affiliation(s)
- Natalie Nguyen
- 1 Institut für Gesundheits- und Pflegewissenschaft, Martin-Luther-Universität Halle-Wittenberg
| | - Anna Renom-Guiteras
- 2 Abteilung für Geriatrie, Klinik Parc de Salut Mar, Autonome Universität Barcelona, Barcelona, Spanien
| | - Gabriele Meyer
- 1 Institut für Gesundheits- und Pflegewissenschaft, Martin-Luther-Universität Halle-Wittenberg
| | - Astrid Stephan
- 1 Institut für Gesundheits- und Pflegewissenschaft, Martin-Luther-Universität Halle-Wittenberg
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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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Coluccia A, Ferretti F, Fagiolini A, Pozza A. Psychometric properties and relations with coping and family strain of the Health Services and Caregiver Experience questionnaire (HSCE): an outcome measure of informal caregivers' experience for inpatient care in Italy. BMC Health Serv Res 2017; 17:494. [PMID: 28716130 PMCID: PMC5514471 DOI: 10.1186/s12913-017-2317-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 05/17/2017] [Indexed: 11/16/2022] Open
Abstract
Background In the last decade, the number of patients supported by informal caregivers has substantially increased. In the Italian healthcare context, informal caregivers’ experience of care is a new under-recognized construct, and no assessment tool is available. Measuring caregivers’ experience is important since in Italy the relationship between doctors and patients/relatives is still considered asymmetrical. The current study presented development and initial psychometric properties of the Health Services and Caregiver Experience questionnaire (HSCE), a self-report tool of caregivers’ global experience for inpatient clinical care, including factor structure, reliability and its relations with measures of coping strategies and family strain. Methods The HSCE was administered to a total of 503 informal caregivers of inpatients admitted at an Italian University Hospital (mean age = 48.08 years, SD = 14.82, females = 61.40%). Family Strain Questionnaire-Short Form (FSQ-SF) and Coping Orientations to Problems Experience-New Italian Version (COPE-NVI) were administered to a subgroup of participants. First-grade relatives were 73.10%, whereas 13.20% were second-grade relatives and 13.70% were home-watch caregivers. Results Exploratory and confirmatory factor analyses showed a structure with a single factor, which explained 64.80% of the total variance. All the items had salient loadings. In the two subsamples, HSCE had excellent internal consistency (Cronbach’s alpha = 0.95–0.97). Positive moderate correlations were found between HSCE and FSQ-SF scores (r = 0.45, p < .05), between HSCE and COPE-NVI scale scores, including COPE-NVI positive attitude and COPE-NVI problem solving scores (rs’ range = 0.51–0.57, p < .05). Moreover, a positive large correlation between HSCE and COPE-NVI social support scores emerged (r = 0.72, p < .05). Correlations were not significant between HSCE scores and COPE-NVI turning to religion and avoidance strategies. Conclusions The HSCE resulted to have good psychometric properties. Better caregivers’ experience correlated with stronger family strain but also with better problem solving and social support. The study expanded knowledge on caregiver’s experience in Italy and indicated that HSCE is a valid and reliable tool to measure this under-recognized construct in Italy.
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Affiliation(s)
- Anna Coluccia
- Department of Medical Sciences, Surgery and Neurosciences, Santa Maria alle Scotte University Hospital, Viale Bracci 16, 53100, Siena, Italy.
| | - Fabio Ferretti
- Department of Medical Sciences, Surgery and Neurosciences, Santa Maria alle Scotte University Hospital, Viale Bracci 16, 53100, Siena, Italy
| | - Andrea Fagiolini
- Department of Molecular Medicine, Santa Maria alle Scotte University Hospital, Viale Bracci 16, 53100, Siena, Italy
| | - Andrea Pozza
- Department of Medical Sciences, Surgery and Neurosciences, Santa Maria alle Scotte University Hospital, Viale Bracci 16, 53100, Siena, Italy
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Dorell Å, Östlund U, Sundin K. Nurses' perspective of conducting family conversation. Int J Qual Stud Health Well-being 2016; 11:30867. [PMID: 27104342 PMCID: PMC4841095 DOI: 10.3402/qhw.v11.30867] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/14/2016] [Indexed: 11/30/2022] Open
Abstract
Introduction Nurses are in a prime position to manage to support families that have a family member living in a residential home for older people. Nurses’ attitudes about meeting patients’ family members vary. Studies describe that some nurses consider family members as a burden. But some nurses consider family members a resource and think it is important to establish good relationships with them. Aim The aim of this study was to describe how registered nurses (RNs) experienced to participate in and conduct the intervention Family Health Conversations (FamHCs) with families in residential homes for older people. Methods The intervention FamHC was accomplished at three residential homes for older people. FamHC is a family systems nursing (FSN) intervention developed to support families facing the ill health of someone in the family. One RN from each residential home conducted the conversations. The RNs wrote diary notes directly after each conversation. The RNs were also interviewed 1 month after they had each conducted four FamHCs. The diary notes and the interviews were analysed separately by qualitative content analysis, and the findings were then summarized in one theme and further discussed together. Findings The main findings were that the RNs experience the conversations as a valuable professional tool involving the whole family. The RNs grasped that silence can be a valuable tool and had learned to attentively listen to what the families were saying without interrupting, allowing them and the families to reflect upon what the family members said. Conclusion The findings show that the FamHC can be helpful for RNs in their work, helping them to perceive and understand the needs and desires of the families.
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Affiliation(s)
- Åsa Dorell
- Department of Nursing, Umeå University, Örnsköldsvik, Sweden;
| | | | - Karin Sundin
- Department of Nursing, Umeå University, Örnsköldsvik, Sweden
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Dorell Å, Sundin K. Becoming visible - Experiences from families participating in Family Health Conversations at residential homes for older people. Geriatr Nurs 2016; 37:260-5. [PMID: 26995489 DOI: 10.1016/j.gerinurse.2016.02.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 02/08/2016] [Accepted: 02/15/2016] [Indexed: 10/22/2022]
Abstract
Having a sick family member living at a residential home for older people can be difficult for families, who as a result often suffer from feelings of forsakenness and powerlessness. In response, the purpose of this study was to illuminate family members' experiences with participating in Family Health Conversations at residential homes for older persons 6 months after concluding the conversation series. Twenty-two family members who participated in the conversations later took part in group interviews, the texts of which were analyzed according to qualitative content analysis. Findings showed that participating in Family Health Conversations mediated consolation, since within such a liberating communicative interaction, family members for the first time felt visible as persons with individual significance. Family members reported a positive experience involving both being open to each other and speaking and listening to each other in a new, structured way. As a result, families were able to discover their family members' problems and suffering, as well as to identify their family's resources and strengths.
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Affiliation(s)
- Åsa Dorell
- Umeå University, Department of Nursing, S-891 18 Örnsköldsvik, Sweden.
| | - Karin Sundin
- Umeå University, Department of Nursing, S-891 18 Örnsköldsvik, Sweden
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