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Pitkänen LJ, Niskanen J, Malmivaara A, Torkki P. Measuring outcomes of rehabilitation among the elderly-a feasibility study. FRONTIERS IN HEALTH SERVICES 2023; 3:1187713. [PMID: 37786486 PMCID: PMC10541954 DOI: 10.3389/frhs.2023.1187713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 09/04/2023] [Indexed: 10/04/2023]
Abstract
A feasible system for measuring patient outcomes of rehabilitation is required for assessing the real-world cost-effectiveness of rehabilitation. This study aims to assess the feasibility of measuring outcomes of rehabilitation among elderly individuals with early-stage Alzheimer's. We used the principles of Design Science to construct a set of metrics consisting of standardized PROM (Patient-Reported Outcome Measure) questionnaires, clinician-reported measures, and observational measures of functioning. We used standardized questionnaires whenever possible to ensure the validity and reliability of the questionnaires. The set of metrics was piloted on 16 individuals living at home with regular home care services. After the pilot, we further refined the set of metrics based on relevance, sensitivity to change, and applicability. We found that measurement was feasible and we propose the final set of metrics as a minimum set, which could be further improved upon by addition of metrics relevant to each subgroup of elderly individuals. We also found that using self-reported questionnaires in this population is not without difficulties. We therefore suggest that the role of informal caregivers be considered, and that accessibility of outcome questionnaires be improved.
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Affiliation(s)
- Laura J. Pitkänen
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jyri Niskanen
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Antti Malmivaara
- Unit for Performance Assessment of the Health and Social Service System, Finnish Institute of Health and Welfare, Helsinki, Finland
| | - Paulus Torkki
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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Scerri A, Innes A, Scerri C. Healthcare professionals' perceived challenges and solutions when providing rehabilitation to persons living with dementia-A scoping review. J Clin Nurs 2023; 32:5493-5513. [PMID: 36710398 DOI: 10.1111/jocn.16635] [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] [Received: 09/08/2022] [Revised: 01/04/2023] [Accepted: 01/10/2023] [Indexed: 01/31/2023]
Abstract
AIM This review aimed to map studies related to healthcare professionals' perceptions and attitudes towards the rehabilitation for persons living with dementia and extract what they perceive are the barriers and solutions. BACKGROUND Rehabilitation can improve the quality of life and integration of persons living with dementia into society. However, there are several barriers to accessing rehabilitation services. Healthcare professionals are a source of information to understand the challenges and provide solutions to improve these services. DESIGN Arksey and O' Malley (International Journal of Social Research Methodology, 8, 2005 and 19) five-step framework for scoping reviews and the PRISMA-ScR checklist was used. The PAGER (Patterns, Advances, Gaps, Evidence for practice and Research recommendations) framework was used to identify research and practice recommendations. METHOD Seven databases including Medline Complete, Academic Search Ultimate, Ageline, CINAHL, PsycInfo, Pubmed and Google Scholar were searched. The healthcare professionals' perceived challenges and solutions were categorised using Braun & Clarke (Qualitative Research in Psychology, 3, 2006 and 77) thematic analysis. RESULTS Fifteen articles were selected for review. The challenges and solutions were organised according to their association with three stakeholders; the persons living with dementia/informal caregivers, healthcare professionals and the organisation providing the service. Nine of the studies focused on persons living with dementia following a fall or a hip fracture. Most of the studies focused on the perceptions of allied healthcare professionals, with nurses working in rehabilitation settings being underrepresented. CONCLUSION Healthcare professionals have to consider the complexity of rehabilitating persons living with dementia irrespective of the rehabilitation speciality. Moreover, more studies are needed that focus on the views of rehabilitation nurses. RELEVANCE TO CLINICAL PRACTICE This review provides further evidence of the healthcare professionals' misconceptions about the rehabilitation potential of persons living with dementia. There is a need to educate healthcare professionals about the societal, attitudinal and environmental barriers faced by persons living with dementia and their caregivers. PATIENT CONTRIBUTION No Patient or Public Contribution-scoping review.
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Affiliation(s)
- Anthony Scerri
- Department of Nursing, Faculty of Health Sciences, University of Malta, Msida, Malta
| | - Anthea Innes
- Gilbrea Chair Aging and Mental Health (Health, Aging and Society), McMaster University, Hamilton, Ontario, Canada
| | - Charles Scerri
- Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
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Graff L, Timm H, Thuesen J. Organizational narratives in rehabilitation-focused dementia care - Negotiating identities, interventions and personhood. DEMENTIA 2023; 22:709-726. [PMID: 36919376 PMCID: PMC10088340 DOI: 10.1177/14713012231161487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
BACKGROUND Rehabilitation is increasingly being introduced in dementia care but studies highlight extensive heterogeneity in practices, conceptual confusion and divergent perceptions of its relevance across care organizations and national contexts. As this have implications for development of dementia care as well as for people with dementia's access to care it is important to study the organizational narratives and practices in rehabilitation-oriented dementia care organizations. METHODS The study build on qualitative interviews (individual and group interviews) with health professionals (N = 26) engaged with dementia care and rehabilitation in two Danish municipalities. The interviews were conducted in 2018-2019. The empirical data was analyzed using abductive analysis and theory-based narrative analysis, using Loseke's conceptualizations of and approach to analyzing formula stories. FINDINGS Four dominant organizational narratives were constructed from the data. Each narrative produced a specific organizational narrative of client identity: the active participant in individualized rehabilitation, the inactive individual benefitting from enhanced social environments, the disengaging self and the vulnerable self. CONCLUSION Introducing rehabilitation in dementia care may amplify the organizational polyphonic and provide a plurality of organizational identities each expressing different perceptions of personhood and agency for people with dementia. The organizational narratives were negotiated within a specific structural context where national regulation and dominant discourses on economic challenges and ageing gave precedence to some narratives more than others. In Danish elder care, the first narrative is the most influential but risks excluding people with dementia. Instead, rehabilitation in dementia care is positioned within a social and relational perspective, which may silence important discussion of agency and resistance.
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Affiliation(s)
- Lea Graff
- The Danish Center for Social Science Research
| | - Helle Timm
- The National Institute of Public Health, 74340University of Southern Denmark; UCSF - Center for Health Research, Rigshospitalet; University of the Faroe Islands
| | - Jette Thuesen
- University of Southern Denmark, Department of Public Health, Center for User Perspectives and Community-based Interventions; Absalon University College, Center for Nutrition and Rehabilitation; REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care
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Thuesen J, Graff L. Ageing, dementia and the future - ambivalent futurework in rehabilitation-focused dementia care. DEMENTIA 2022; 21:2210-2230. [PMID: 35921632 PMCID: PMC9483685 DOI: 10.1177/14713012221117412] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Due to its goal-orientation, rehabilitation may be considered a future-oriented practice.
As rehabilitation is increasingly recognized as contributing to dementia care it is
important to explore how rehabilitation corresponds with the future orientation of older
people with dementia. The aim of this study was to explore the futurework of home-dwelling people with mild to
moderate dementia in the context of rehabilitation-focused municipal dementia care, that
is, their thinking and practices regarding their future and how these correspond with
institutionalized practices. The study was conducted as a case-study inspired by the methodology of Institutional
Ethnography (IE). The study setting was two Danish municipalities sampled as a
paradigmatic case. Eight older people living with early-stage dementia (mean age: 78
years, age range: 65–91) were strategically sampled and each interviewed recurringly
within a period of six through 15 months. In total, 29 interviews were completed. An
abductive analysis was subsequently conducted based on these interviews. Findings included three dimensions of futurework: Extending the present state into the
near future; avoiding being confronted with an anticipated future; and adjusting to
decline and preparing for future losses. Based on these findings, a notion of ‘ambivalent
futurework’ is suggested. The futurework of older people did not always correspond with
the institutional arrangements in a rehabilitation-focused dementia care. Findings show
that the institutional arrangements in dementia care may support as well as challenge the
futurework of the participants. Paying attention to the ambivalences of older people
living with dementia and recognizing the ambivalent futurework may be essential in
rehabilitation-focused dementia care.
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Affiliation(s)
- Jette Thuesen
- Department of Public Health, 6174University of Southern Denmark, Syddanmark, Denmark.,Centre for Nutrition and Rehabilitation, 165104Absalon University College, Sjælland, Denmark.,REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, 6174University of Southern Denmark, Syddanmark, Denmark
| | - Lea Graff
- The Danish Center for Social Science Research, 4298VIVE, Copenhagen, Denmark
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Abstract
Dementia is an eurodegenerative disorder, which causes significant disability, especially among the elderly population worldwide. The affected person shows a progressive cognitive decline, which interferes with the independence in performing the activities of daily living. Other than the cognitive domain, the patient tends to have neuropsychiatric, behavioral, sensorimotor, speech, and language-related issues. It is expected that the global burden of the disease will rise with more people entering the geriatric age group. By 2050 close, to 140 million people will be living with one or the other type of dementia. Alzheimer's disease contributes to more than 60% of cases worldwide, followed by vascular dementia. Pharmacotherapy has a limited role to play in the treatment, and at present, no drug is available, which can halt or reverse the progress of the disease. World Health Organization has mandated rehabilitation as a core recommendation in the global action plan on the public health response to dementia. Rehabilitation services are widely recognized as a practical framework to maximize independence and community participation in dementia care. The rehabilitation program is customized to achieve the desired goals, as each person has different experiences, preferences, motivations, strengths, and requirements based on type, course, and severity of the illness. It is an interdisciplinary-team approach with the involvement of several health care professionals. This article reviews the existing literature and outlines the effective rehabilitation strategies concisely in dementia care.
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Affiliation(s)
- Anupam Gupta
- Dept. of Neurological Rehabilitation, NIMHANS, Bangalore, Karnataka, India
| | - Naveen B Prakash
- Dept. of Neurological Rehabilitation, NIMHANS, Bangalore, Karnataka, India
| | - Gourav Sannyasi
- Dept. of Neurological Rehabilitation, NIMHANS, Bangalore, Karnataka, India
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Alva-Dìaz C, Malaga M, Rodriguez-Calienes A, Morán-Mariños C, Velásquez-Rimachi V, Custodio N. Costs Related to Frontotemporal Dementia in Latin America: A Scoping Review of Economic Health Studies. Front Neurol 2021; 12:684850. [PMID: 34497574 PMCID: PMC8419437 DOI: 10.3389/fneur.2021.684850] [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: 03/24/2021] [Accepted: 06/30/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction: Frontotemporal dementia (FTD) is a complex syndrome characterized by changes in behavior, language, executive control, and motor symptoms. Its annual economic burden per patient in developed countries has been classified as considerable, amounting to US$119,654 per patient, almost double the patient costs reported for Alzheimer's disease. However, there is little information regarding cost-of-illness (COI) for FTD in Latin-America (LA). Aim: To describe the costs related to FTD in LA. Methods: We included COI studies on FTD conducted in LA published in English, Spanish, or Portuguese from inception to September 2020. We carried out a systematic search in Pubmed/Medline, Scopus, Web of Science, Scielo, Cochrane, and gray literature. For quality assessment, we used a COI assessment tool available in the literature. All costs were reported in USD for 1 year and adjusted for inflation. Results: We included three studies from Argentina, Brazil, and Peru. Direct costs (DCs) included medication (from US$959.20 to US$ 4,279.20), health care costs (from US$ 2,275.80 to US$7,856.16), and caregiver costs (from US$9,634.00 to US$28,730.28). Indirect costs (ICs) amounted to US$43,076.88. Conclusions: In LA countries, the reporting of costs related to FTD continues to be oriented toward DCs. They remain lower than in developed countries, possibly due to the limited health budget allocated. Only one Brazilian report analyzed ICs, representing the highest percentage of the total costs. Therefore, studies on the COI of this disease in LA are essential, focusing on both out-of-pocket spending and the potential economic loss to patients' homes and families.
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Affiliation(s)
- Carlos Alva-Dìaz
- Grupo de Investigación Neurociencia, Efectividad Clínica y Salud Pública, Universidad Científica del Sur, Lima, Peru
| | - Marco Malaga
- Grupo Estudiantil de Investigación en Neurociencias, Sociedad de Estudiantes de Medicina Humana de la Universidad de San Martin de Porres, Lima, Peru
- Facultad de Medicina Humana, Universidad de San Martín de Porres, Lima, Peru
- Red de Eficacia Clínica y Sanitaria, Lima, Peru
| | - Aaron Rodriguez-Calienes
- Grupo Estudiantil de Investigación en Neurociencias, Sociedad de Estudiantes de Medicina Humana de la Universidad de San Martin de Porres, Lima, Peru
- Facultad de Medicina Humana, Universidad de San Martín de Porres, Lima, Peru
- Red de Eficacia Clínica y Sanitaria, Lima, Peru
| | - Cristian Morán-Mariños
- Red de Eficacia Clínica y Sanitaria, Lima, Peru
- Unidad de Investigación en Bibliometría, Universidad San Ignacio de Loyola, Lima, Peru
| | - Victor Velásquez-Rimachi
- Grupo de Investigación Neurociencia, Efectividad Clínica y Salud Pública, Universidad Científica del Sur, Lima, Peru
- Red de Eficacia Clínica y Sanitaria, Lima, Peru
| | - Nilton Custodio
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Peru
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Begali VL. Neuropsychology and the dementia spectrum: Differential diagnosis, clinical management, and forensic utility. NeuroRehabilitation 2020; 46:181-194. [PMID: 32083596 DOI: 10.3233/nre-192965] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The utility of neuropsychology in the treatment and evaluation of neuropsychological disorders and neurodegenerative diseases is supported by scientific study. As a discipline, neuropsychology's value and efficacy when applied to the dementia spectrum are rooted in its inherent adaptability as a practical, cost-effective, and scientifically based resource for differential diagnosis, treatment planning, and forensic decision making. OBJECTIVES This article provides a framework for conceptualizing dementia as a spectrum of disorders and outlines a rationale for preferential reliance upon neuropsychological tenets. The function of neuropsychology in differential diagnosis, clinical management, integrative care, and forensic applications is delineated for use as a contemporary interdisciplinary reference. METHODOLOGY An overview of the literature on dementia as a spectrum of disorders has been integrated with the science and practice of neuropsychology. CONCLUSIONS The utility of neuropsychology emanates from its focus on brain functioning and the discipline's appreciation for the relationship between brain functioning and cognition, mental state, and behavior. Early and routine referral for neuropsychological assessment allows for the objective determination of normal versus abnormal neurocognitive functioning, provides a baseline for serial reassessment, and leads to the more rapid deployment of effective treatments. Beyond the hospital and clinic, neuropsychological expertise is increasingly sought after as integral to the legal system when decisions regarding eligibility for long term care and questions about capacity require objective and reliable measurement.
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Affiliation(s)
- Vivian L Begali
- Neuropsychology and Psychological Healthcare, Fountain Park Medical Offices, 9327 MidlothianTurnpike, Suite 1-C, Richmond, VA 23235, USA Tel.: +1 804 728 2964; E-mail: ; Web: http://www.drvivianbegali.com
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The Impact of a Dementia-Friendly Exercise Class on People Living with Dementia: A Mixed-Methods Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124562. [PMID: 32599916 PMCID: PMC7345571 DOI: 10.3390/ijerph17124562] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 12/22/2022]
Abstract
Exercise has multiple benefits for people living with dementia. A programme of group exercise classes for people with dementia and their family carers has been established in a University sports centre. This study aims to explore the impact of this programme on participants with dementia and their carers. A mixed-methods design including a prospective, repeated measures cohort study followed by focus groups was employed. Physiological and cognitive outcome measures were repeated at baseline and three months in a cohort of people with dementia attending a group exercise class. Focus groups on the participants’ experiences and their perceptions of the impact of the exercise class on their lives were then conducted. The results were analysed and mapped on a model, to illustrate the components that most likely promote participation. Sixteen participants (n = 8 with dementia, and n = 8 carers) were recruited, and completed both baseline and follow up assessments. Positive mean differences were found in physical activity (4.44), loneliness (1.75), mood (1.33) and cognition (1.13). Ten participants were included in the focus groups, which found that accessibility of the exercise venue, opportunities for socialisation and staff who were experienced working with people living with dementia were key to participants reporting benefits. The four key themes from the focus group data were synthesised to produce a model outlining the components that might generate a positive impact of the exercise classes and promote participation. Exercise classes for people with dementia can be delivered with success in novel environments such as University sports centres. There is some indication of improvement over a short period of time. The model derived from this study will inform strategies to promote attendance at dementia-friendly exercise classes.
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Thuesen J, Ravn MB, Petersen KS. Towards person-centred rehabilitation in dementia – a narrative synthesis. Disabil Rehabil 2020; 43:2673-2679. [DOI: 10.1080/09638288.2019.1709910] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Jette Thuesen
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Maiken Bay Ravn
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Kirsten Schultz Petersen
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
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