e-VITA study protocol: EU-Japan virtual coach for smart aging

Aim

The aim of this study is to report a trial protocol for assessing the improvement of older adults' well-being, promoting active and healthy aging, and reducing the risks of social exclusion, using a virtual coach.

Background

Increased longevity brings with it reduced autonomy and independence, and it is therefore necessary to act with preventive measures that can promote active and healthy aging. With the development of technology, new tools have appeared, including virtual coaches, which can enable people to lead a healthy lifestyle by identifying individual needs and goals and providing personalized recommendations and advice. However, it is important that these coaches take into consideration the inter-individual and cross-cultural differences of each person.

Design

A randomized controlled trial is proposed.

Methods

This study will recruit 240 healthy subjects aged 65 years and older. Participants will be assigned to an experimental group that will receive the e-VITA system or to the control group that will receive an information booklet only. The primary outcome measure is the person's quality of life (QoL). Data will be collected at baseline, 3 months after the trial, and at the end of the trial, after 6 months.

Discussion

This study will evaluate the effectiveness of the e-VITA system, consisting of a virtual coach, several sensors for monitoring, a smartphone for use at home, and a booklet, in improving the older person's quality of life. The increased perceived well-being will also be linked to improvements in other areas of the person's life, psychological and cognitive status, the area of sociality, nutrition, and eHealth literacy.

Consequences and Perception of the COVID-19 Pandemic on Patients and Caregivers in an Austrian Memory Clinic Population One Year After Pandemic Onset

BACKGROUND

The COVID-19 pandemic was associated with high mortality and negative consequences for patients with Alzheimer's disease or dementia and their caregivers. Memory clinics play an important role in enabling early dementia diagnosis and providing support for patients and their caregivers.

OBJECTIVE

This study investigates the impact of the COVID-19 pandemic and its restrictions on patients of a memory clinic and their caregivers between March 2020 and March 2021.

METHODS

We conducted a prospective, single-center, questionnaire-based, observational study to assess consequences and perception of the COVID-19 pandemic on emotion, cognitive function, social living, areas of care, and information retrieval.

RESULTS

Results of 255 participants' (mean age 76.78, SD 8.9; 12% cognitively intact, 33% mild cognitive impairment, 55% dementia) and 203 caregivers' COVID-19 questionnaires (valid response rate 71%) could be included in the study. Participants reported a prevalence of psychological symptoms associated with the pandemic between 3-20%. Caregivers living outside compared to those living with the participant reported higher rates of new onset or worsening of neuropsychiatric symptoms in participants since pandemic onset. Patients with dementia showed the lowest use of digital communication before (15.7%) and after (17.1%) pandemic onset in the diagnostic groups.

CONCLUSION

The COVID-19 pandemic frequently led to social isolation and reduced cognitive stimulation due to restrictions in elderly persons with cognitive deficits resulting in negative effects on emotional and social levels. We hypothesize that the implementation and sensitization with digital communication in clinical routine could provide a useful tool to counteract these negative effects.

Family-oriented interventions in long-term care residential facilities for older people: A scoping review of the characteristics and outcomes

INTRODUCTION

Family-oriented interventions in long-term care (LTC) residential facilities are heterogenous in design, characteristics, and outcomes.

OBJECTIVES

To synthesize characteristics (e.g., type, provider, and duration) and outcomes of family-oriented interventions in LTC residential facilities.

METHODS

We followed the JBI methodology and searched seven databases for quantitative, qualitative, and mixed method studies that reported family-oriented interventions in LTC residential settings for older people; defined in this review as ≥60 years. Interventions that included residents, resident families, health professionals, or any combinations of these three were included if the study reported post-intervention assessment of at least one family-related outcome.

RESULTS

Thirteen studies met the inclusion criteria. Interventions were found to be multifaceted, and education was the most common element. Nurses were the most common intervenors, and most interventions had more than one target (residents, resident families, or staff). Most outcomes were related to family involvement, satisfaction with care, quality of life, communication, symptom management, and shared decision making, and none of the studies reported a negative impact.

CONCLUSIONS

Family-oriented interventions were associated with high care quality and better resident-staff-family partnership. Staff education and staff-family conversation are relatively cheap interventions to help family involvement, facilitate shared decision-making, and improve family satisfaction.

How the Cognitive Status of Older People Affects Their Care Dependency Level and Needs: A Cross-Sectional Study

INTRODUCTION

The decline in health and abilities as a result of the aging process leads to a growing need for care and various forms of support. The aim of this study was to find out the level and the main areas of care dependency among older persons with cognitive impairment versus those without cognitive impairment.

MATERIALS AND METHODS

A cross-sectional study was conducted among 200 older persons hospitalized in the years 2017-2018 at a geriatric ward in Poland. The research took into consideration the socio-demographic variables of the older people (age, sex, marital status, mode of dwelling, health self-evaluation, and loneliness) and the results of the assessment of their functional status, including their physical functional status according to the Barthel scale and the I-ADL, locomotion, the risk of falls and pressure sores, emotional state, cognitive function status, vision, hearing, and the Polish version of the Care Dependency Scale.

RESULTS

People with cognitive impairment significantly more often have poorer results in regard to ADL and I-ADL physical functions, locomotion, risk of depression, falls, pressure sores, as well as hearing and vision problems, than people with good cognitive status. The results of the study indicate that the advancing impairment of cognitive functions in older people has an impact on the level of care dependency.

CONCLUSION

The results of this original research show that persons with cognitive impairment are significantly more often dependent on external assistance in regard to all the needs assessed in the CDS than people without such impairment. The spectrum and number of needs in which the older person requires help grows significantly with the advancement of cognitive impairment. Older people with cognitive impairment who live alone require special support from formal caregivers in their home environment. Identification of the level of dependency and the needs of older people with cognitive impairment is of key importance for planning caregiving resources.

Impact of interventions by a community pharmacist on care burden for people with dementia: development and randomized feasibility trial of an intervention protocol

BACKGROUND

Traditionally, the role of pharmacists has been to manage and monitor pharmacotherapy for patients with dementia. However, additional intervention by community pharmacists to collect and share patient information with other professionals may help reduce the care burden among caregivers. The aims of this study were to examine (1) the feasibility of a designed community pharmacist working procedure in dementia care and (2) the expected impact of pharmacist intervention on care burden.

METHODS

This was a randomized, open-label, parallel-group feasibility study, involving eight Nara City pharmaceutical association member pharmacies that provided consent to participate. These pharmacies were assigned to an intervention group or a control group at a 1:1 ratio. The subjects were patients with dementia and their primary caregivers that visited the participating pharmacies and provided consent to participate. Pharmacists in the intervention group actively collected information from the patients' family physicians and care managers and intervened to address medication-related problems, while those in the control group only performed their normal duties. The primary endpoint was a change in the caregiver's score on the Japanese version of Zarit Caregiver Burden interview (J-ZBI) from the baseline to after 5 months of follow-up. The changes in mean J-ZBI scores from the beginning to the end of the study period of the two groups were compared.

RESULTS

Obtaining consent from caregivers was certainly difficult, but possible. Pharmacists managed to fill out the survey form while practising pharmaceutical care. Totally, nine patients and nine caregivers in the intervention group and nine patients and eight caregivers in the control group completed the study. The changes in J-ZBI scores could be calculated for seven cases in the intervention group and five cases in the control group. The J-ZBI scores were found to decrease by 1.0 in the intervention group and increase by 3.0 in the control group.

CONCLUSIONS

The protocol presented was considered feasible, but, the intervention process needs to be simplified in order to conduct a large study. Also, improvements are needed in the various survey forms and in the explanatory documents for caregivers. Although the sample size was small, the effect sizes suggested that community pharmacist interventions for patient with dementia may reduce the care burden for caregivers.

TRIAL REGISTRATION

UMIN000039949 (registration date: 1 April 2020, retrospectively registered).

Understanding dementia care in care home setting in China: An exploratory qualitative study

Dementia education for healthcare providers has gained growing attention in China. This study aimed to explore the current dementia care practices in care home setting in China because people with dementia have increased need for residential care as the cognitive function worsens. An exploratory qualitative study was conducted among care staff and residents with dementia in four care homes in a metropolitan city in China between May and August 2019. Participant observations were conducted to understand how the care environment and activities affect residents with dementia. Care records were reviewed to explore the kind of care provided. In-depth individual interviews were conducted with a purposive sample of 15 care staff members of different ranks to clarify the care practices and understand their training needs with dementia care. Field notes of observations, nursing care records and interviews transcripts were triangulated for qualitative content analysis. The theme emerged is 'suboptimal dementia care practices'. Four categories about dementia care practices in care homes were identified: (a) care environment (hospital-like layout, inappropriate lighting, environmental noise, inappropriate use of colour and unclear signage), (b) care culture (being medical-oriented, overlooking individual uniqueness and privacy), (c) attitudes towards dementia (treating as children, being authoritative, adopting punitive approaches, trying to respect the residents and having a positive learning attitude) and (d) dementia care competence (questing for specific training and resources, questing for culturally specific practices and strengthening communication with family). Creating a dementia-friendly and enabling environment, shifting the care culture paradigm from disease-oriented to person-centred and developing culturally sensitive care practices are imperative. Dementia care education for care home staff using a systematic, comprehensive approach is fundamental to achieve these goals.

Family-oriented interventions in long-term care residential settings: a scoping review protocol

OBJECTIVES

The objective of this review will be to identify the characteristics (eg, type, duration, and provider) of family-oriented interventions in long-term care residential settings. The authors will also identify which outcomes are reported in the literature when implementing family-oriented interventions.

INTRODUCTION

An array of family-oriented interventions in long-term care residential settings exist. Given the heterogeneity of current literature, mapping characteristics and intended outcomes of family-oriented interventions is an essential step to inform how best to support families of patients in long-term care residential settings.

INCLUSION CRITERIA

This review will consider studies describing family-oriented interventions for families of elderly patients in long-term care residential settings, with no exclusion based on country, gender, or comorbidities. Interventions that address any family-related issue, such as quality of life, psychological burden, and family involvement in patient care, are eligible for inclusion. Studies will be excluded if the patients are cared for at their own homes or institutionalized care is provided on a temporary basis. Quantitative, qualitative, and mixed method study designs will be considered for inclusion.

METHODS

A scoping review will be conducted using the JBI methodological approach. Seven databases will be systematically searched: MEDLINE, CINAHL, Scopus, Evidence-Based Medicine Reviews including Cochrane Library, PsycINFO, OpenGrey, and the Grey Literature Report. Citations will be screened against the inclusion criteria by two reviewers independently. Relevant data will be extracted from the included studies, and will be synthesized, summarized, and reported following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. Findings will be published in a peer-reviewed journal.

The Difficult Balance between Ensuring the Right of Nursing Home Residents to Communication and Their Safety

The COVID-19 epidemic has had a profound impact on healthcare systems worldwide. The number of infections in nursing homes for the elderly particularly is significantly high, with a high mortality rate as a result. In order to contain infection risks for both residents and employees of such facilities, the Italian government passed emergency legislation during the initial stages of the pandemic to restrict outside visitor access. On 30 November 2020, the Italian President of the Council of Ministers issued a new decree recognizing the social and emotional value of visits to patients from family and friends. In addition, it indicated prevention measures for the purposes of containing the infection risk within nursing homes for the elderly. This article comments on these new legislative provisions from the medicolegal perspective, providing indications that can be used in clinical practice.

"Invisible Voices": A Critical Incident Study of Family Caregivers' Experience of Nursing Homes After Their Elder Relative's Death

PURPOSE

The literature provides few examples of family caregivers' retrospective evaluation of nursing home services. This study aimed at analyzing narratives of Italian family caregivers of elders who experienced nursing home placement.

DESIGN AND METHODS

Data were gathered through in-depth interviews with family members after their relatives' death. The interviews were based on the Critical Incident Technique, which allowed the categorization of the most memorable positive and negative events from the perspective of family members of elders deceased in nursing homes. Interviews were interpreted with a phenomenologically inspired thematic analysis approach. Participants were screened for complicated grief disorder as a confounding variable in relatives' accounts of the treatment.

RESULTS

Results suggested that positive long-term recollection of the nursing home was associated with different themes emerging from the interviews: medical reliability and expertise, active demonstrations of care that extend beyond the contract with the facility, individualized attention, responsiveness, openness to dialog with family members about routines, management of the first impression, and family engagement. Lack of professionals' expertise and medical failures, lack of care for patients' personal goods, lack of family involvement, lack of individualized attention, lack of responsiveness, poor patient surveillance, and structural limits of the facilities were the themes that were more frequently negatively associated with the nursing home experience.

IMPLICATIONS FOR PRACTICE

Focusing on the key dimensions connected to the quality of the experience of family members can enrich the quality of existing nursing home services and allow healthcare policymakers and managers to design better facilities for the patients.

Interventions to foster family inclusion in nursing homes for people with dementia: a systematic review

BACKGROUND

Family inclusion in nursing homes is central to the provision of individualized care for people with dementia. Although positive effects can be recognized, barriers have been identified that hamper family inclusion in nursing homes. Specifically for people with dementia, insight into the content of interventions to foster family inclusion is lacking.

METHODS

A systematic review was performed by systematically searching the databases PubMed, Cinahl, PsycInfo and Embase. Studies were eligible if they examined (1) nursing home settings, (2) interventions to foster the inclusion of family members from people with dementia, (3) were original research articles in which effects/experiences of/with these interventions were evaluated, and (4) were written in English, Dutch or German. Findings were summarized systematically.

RESULTS

Twenty-nine studies were included. Two interventions were targeted at creating family-staff partnerships from a two-way perspective. Other interventions focused on single components, such as including family members in formal decisions (n = 9), enabling them to make better informed decisions and/or participate more actively (n = 7), or providing psychoeducation for family members (n = 3). Within the interventions, family and staff members are often treated differently. Effects on actual increase in family inclusion remain unclear.

CONCLUSIONS

Very few interventions exist that try to enhance equal family-staff partnerships in nursing homes. Future interventions should pay specific attention to mutual exchange and reciprocity between family and staff. As little is known about promising (components of) interventions to foster family inclusion in nursing homes for people with dementia, more effectiveness research is needed.

Preferred Music Listening Intervention in Nursing Home Residents with Cognitive Impairment: A Randomized Intervention Study

BACKGROUND

The current trend in addressing symptoms of dementia comprises non-pharmacological strategies such as music interventions for the management and improvement of cognitive function, memory, agitation, depression, or anxiety.

OBJECTIVE

To determine the impact of a preferred music listening group intervention upon the functional, cognitive, and emotional dimensions in nursing home residents.

METHODS

A randomized intervention study was carried out. The study was conducted from June to August 2015, and involved a preferred music listening group intervention lasting 60 minutes, 5 days/week during 8 weeks. A total of 119 adults aged ≥65 years, with annual permanent residence in the nursing home (Málaga, Spain) were included in the study. 47 (39.5%) subjects were randomized to the music group intervention. The nurses and physiotherapists were blinded to the assessments.

RESULTS

The sample had a mean age of 80.52 (SD7.44) years, with female predominance. The subjects presented dependency in Barthel, and cognitive impairment as determined by the MMSE. The Tinetti scores yielded fall risk and depression as evidenced by the Yesavage scale. The Cornell scores evidenced no depression in elderly people with dementia. Following the intervention, function improved significantly with a medium effect size, as did emotional state, with a large effect size. Cognitive function was seen to worsen in the control group, but remained stable in the intervention group, with a large effect size.

CONCLUSIONS

A preferred music listening group intervention among elderly people in nursing homes is effective, resulting in improvements in functional and emotional condition.

Family and friends: Supporting oral care in care homes

Objective

To consider the role of family and friends in supporting oral care.

Background

People who live in care homes are susceptible to oral health problems, which can be detrimental to their health and personal and social well‐being. External support from family members and friends has been indicated as being important for maintaining oral health for this vulnerable group of care home residents.

Materials and methods

Qualitative one‐to‐one interviews were undertaken with care home residents, in Cardiff, UK. Further interviews were undertaken with care home personnel with responsibility for oral health care in order to contextualise residents’ interview data. Interviews were audio recorded, transcribed and analysed using a thematic approach.

Results

A total of 26 interviews were conducted with care home residents and four interviews with care home personnel, across five care homes. Three main themes emanated from the data relating to co‐supporting oral care: supplying oral care products; accessing dental care and enabling self‐management of oral care problems. There were no spouse caregivers; family and friends acted as co‐supporters of oral care providing a link to residents’ pre‐care home lives by informing the care home personnel of their relatives’ normal routines. An overarching theme “balancing roles – maintaining the equilibrium” emerged from the data reflecting the roles that both care home personnel and family and friends had in balancing the needs, care and well‐being of the resident.

Conclusion

This study suggests that there are opportunities to improve oral health by providing support for family and friends of those people who are living in care, especially in relation to supplying oral care products, enabling self‐management of oral care problems and accessing dental care.

The Economic Value of Informal Caregiving for Persons With Dementia: Results From 38 States, the District of Columbia, and Puerto Rico, 2015 and 2016 BRFSS

OBJECTIVES

To estimate the economic value from a societal perspective of informal caregiving of persons with dementia in 38 states, the District of Columbia, and Puerto Rico.

METHODS

Using a cost replacement method and data from the 2015 and 2016 Behavioral Risk Factor Surveillance System caregiver module, the US Bureau of Labor Statistics May 2016 Occupation Profiles, and the US Department of Labor, we estimated the number and economic direct cost of caregiving hours.

RESULTS

An estimated 3.2 million dementia caregivers provided more than 4.1 billion hours of care, with an average of 1278 hours per caregiver. The median hourly value of dementia caregiving was $10.28. Overall, we valued these caregiving hours at $41.5 billion, with an average of $13 069 per caregiver.

CONCLUSIONS

Caregivers of persons with dementia provide care that has important economic implications. Without these efforts, many people would either not receive needed care or have to pay for that support. Surveillance data can be used to estimate the contributions of informal caregivers and the economic value of the care they provide.

Family involvement in timely detection of changes in health of nursing homes residents: A qualitative exploratory study

Aims and objectives

To explore family perspectives on their involvement in the timely detection of changes in their relatives' health in UK nursing homes.

Background

Increasingly, policy attention is being paid to the need to reduce hospitalisations for conditions that, if detected and treated in time, could be managed in the community. We know that family continue to be involved in the care of their family members once they have moved into a nursing home. Little is known, however, about family involvement in the timely detection of changes in health in nursing home residents.

Design

Qualitative exploratory study with thematic analysis.

Methods

A purposive sampling strategy was applied. Fourteen semi‐structured one‐to‐one interviews with family members of people living in 13 different UK nursing homes. Data were collected from November 2015–March 2016.

Results

Families were involved in the timely detection of changes in health in three key ways: noticing signs of changes in health, informing care staff about what they noticed and educating care staff about their family members' changes in health. Families suggested they could be supported to detect timely changes in health by developing effective working practices with care staff.

Conclusion

Families can provide a special contribution to the process of timely detection in nursing homes. Their involvement needs to be negotiated, better supported, as well as given more legitimacy and structure within the nursing home.

Relevance to clinical practice

Families could provide much needed support to nursing home nurses, care assistants and managers in timely detection of changes in health. This may be achieved through communication about their preferred involvement on a case‐by‐case basis as well as providing appropriate support or services.