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Kuo LM, Shyu YIL, Lin YK, Hsu WC. Mediating effects of predictability between caregiving demands and caregiving consequences for persons living with dementia: A longitudinal study. Geriatr Nurs 2024; 58:430-437. [PMID: 38905965 DOI: 10.1016/j.gerinurse.2024.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 05/14/2024] [Accepted: 05/22/2024] [Indexed: 06/23/2024]
Abstract
OBJECTIVES The purpose of this study was to examine the role of predictability in the relationship between caregiving demands and caregiving consequences. DESIGN This 2-year longitudinal survey study collected from self-report questionnaires. A convenience sample of family caregivers of older persons living with dementia were recruited from a neurology clinic. RESULTS A total of 200 family caregivers were recruited to participate. Analysis indicated predictability was a partial mediator between caregiving demand and caregiver consequences of role strain, depressive symptoms and both physical and mental components of health-related quality of life at the 2-year follow. Predictability accounted for 25 %, 28.8 %, 15.3 % and 46.5 % of the relationship between caregiving demand and caregiving consequences of role strain, depressive symptoms, physical- and mental-health related quality of life, respectively. CONCLUSIONS The contributions of caregiving demand to outcomes of caregiver consequences were in part due family caregivers perceived predictability for caregiving.
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Affiliation(s)
- Li-Min Kuo
- Department of Gerontological Health Care, College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Yea-Ing L Shyu
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan; Dementia Center, Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Gerontology and Health Care Management, Chang Gung University of Science and Technology, Taoyuan, Taiwan; Department of Nursing, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
| | - Yen-Kuang Lin
- Graduate Institute of Athletics and Coaching Science, National Taiwan Sport University, Taoyuan, Taiwan
| | - Wen-Chuin Hsu
- Department of Neurology, Chang Gung Memorial Hospital, Taoyuan, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan
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2
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Takechi H, Yoshino H, Suzuki M, Maeda A, Suzumura S, Kamiya E. Characteristics of Changes in Caregiver Burden during Follow-up at a Memory Clinic: A Retrospective Cohort Study. J Alzheimers Dis Rep 2024; 8:151-162. [PMID: 38405344 PMCID: PMC10894603 DOI: 10.3233/adr-230069] [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: 07/14/2023] [Accepted: 12/26/2023] [Indexed: 02/27/2024] Open
Abstract
Background Because dementia is a long-term condition, the appropriate involvement of health-care professionals is considered important. However, little is known about the factors associated with changes in family caregiver burden. Objective To clarify changes in family caregiver burden and associated factors during follow-up at a memory clinic. Methods A retrospective cohort study was conducted, enrolling 495 pairs of patients with dementia or mild cognitive impairment and their family caregivers. A total of 120 pairs completed the second evaluation. The caregiver burden was assessed using the Zarit Burden Interview (ZBI). Data at the initial visit and after an average follow-up of about 2 years were compared and analyzed. Results At initial visit, the patients' mean age, Mini-Mental State Examination (MMSE) and ZBI scores were 78.6±5.6 years, 23.3±3.5, and 22.6±16.7, respectively. At follow-up, MMSE scores decreased (21.4±4.5, p < 0.001), but ZBI scores remained similar (22.5±13.6). When the difference in ZBI scores between the two time points was defined as ΔZBI, and the related factors were analyzed by multiple regression analysis, ZBI scores at the initial visit, start of psychotropic drug, and decrease of neuropsychiatric symptoms were identified as significant factors (p < 0.001, p = 0.003, p < 0.001, respectively). A significant negative correlation was found between ZBI scores at the initial visit and ΔZBI (r = -0.588, p < 0.001). Conclusions These findings suggest the importance of assessing changes in the burden experienced by family caregivers during the disease follow-up.
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Affiliation(s)
- Hajime Takechi
- Department of Geriatrics and Cognitive Disorders, School of Medicine, Fujita Health University, Aichi, Japan
| | - Hiroshi Yoshino
- Department of Geriatrics and Cognitive Disorders, School of Medicine, Fujita Health University, Aichi, Japan
| | - Megumi Suzuki
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Aichi, Japan
| | - Akiko Maeda
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Aichi, Japan
| | - Shota Suzumura
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Aichi, Japan
| | - Eiko Kamiya
- Department of Geriatrics and Cognitive Disorders, School of Medicine, Fujita Health University, Aichi, Japan
- Graduate School of Health Sciences, Fujita Health University, Aichi, Japan
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Slachevsky A, Grandi F, Thumala D, Baez S, Santamaria-García H, Schmitter-Edgecombe M, Parra MA. A Multidimensional, Person-Centered Framework for Functional Assessment in Dementia: Insights from the 'What', 'How', 'To Whom', and 'How Much' Questions. J Alzheimers Dis 2024; 99:1187-1205. [PMID: 38758997 PMCID: PMC11178450 DOI: 10.3233/jad-230376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2024]
Abstract
Dementia is a syndrome characterized by cognitive and neuropsychiatric symptoms associated with progressive functional decline (FD). FD is a core diagnostic criterion for dementia, setting the threshold between its prodromal stages and the full-blown disease. The operationalization of FD continues to generate a great deal of controversy. For instance, the threshold of FD for the diagnosis of dementia varies across diagnostic criteria, supporting the need for standardization of this construct. Moreover, there is a need to reconsider how we are measuring FD to set boundaries between normal aging, mild cognitive impairment, and dementia. In this paper, we propose a multidimensional framework that addresses outstanding issues in the assessment of FD: i) What activities of daily living (ADLs) are necessary to sustain an independent living in aging? ii) How to assess FD in individuals with suspected neurocognitive disorders? iii) To whom is the assessment directed? and iv) How much does FD differentiate healthy aging from mild and major neurocognitive disorders? Importantly, the To Whom Question introduces a person-centered approach that regards patients and caregivers as active agents in the assessment process of FD. Thus, once impaired ADLs have been identified, patients can indicate how significant such impairments are for them in daily life. We envisage that this new framework will guide future strategies to enhance functional assessment and treatment of patients with dementia and their caregivers.
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Affiliation(s)
- Andrea Slachevsky
- Gerosciences Center for Brain Health and Metabolism (GERO), Santiago, Chile
- Memory and Neuropsychiatric Center (CMYN) Neurology Department, Hospital del Salvador & Faculty of Medicine, University of Chile, Santiago, Chile
- Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Physiopathology Department – ICBM, Neuroscience and East Neuroscience Departments, Faculty of Medicine, University of Chile, Providencia, Santiago, Chile
- Servicio de Neurología, Departamento de Medicina, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
| | - Fabrissio Grandi
- Gerosciences Center for Brain Health and Metabolism (GERO), Santiago, Chile
- School of Psychology, Universidad de los Andes, Santiago, Chile
| | - Daniela Thumala
- Gerosciences Center for Brain Health and Metabolism (GERO), Santiago, Chile
- Psychology Department, Faculty of Social Sciences, Universidad de Chile, Santiago, Chile
| | - Sandra Baez
- Universidad de los Andes, Bogotá, Colombia
- Atlantic Fellow for Equity in Brain Health at the Global Brain Health Institute (GBHI), Trinity College Dublin (TCD), Dublin, Ireland
| | - Hernando Santamaria-García
- Pontificia Universidad Javeriana, PhD Program of Neuroscience, Bogotá, Colombia
- Center for Brain and Memory Intellectus. Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Maureen Schmitter-Edgecombe
- Herbert L. Eastlick Distinguished Professor in the Department of Psychology, Washington State University, Pullman, WA, USA
| | - Mario A. Parra
- Department of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
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4
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Kuzmik A, BeLue R, Resnick B, Rodriguez M, Berish D, Galvin JE, Boltz M. Caregiver preparedness is associated with desire to seek long-term care admission of hospitalized persons with dementia. Int J Geriatr Psychiatry 2023; 38:e6006. [PMID: 37715936 DOI: 10.1002/gps.6006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 09/06/2023] [Indexed: 09/18/2023]
Abstract
INTRODUCTION Hospitalized patients with dementia are more likely to be discharged to long-term care compared to persons without dementia. Little research has been conducted to examine the associations of caregiver preparedness and strain with desire to seek long-term care in hospitalized persons with dementia at discharge. The purpose of this study was to examine caregiver preparedness and strain as factors associated with desire to seek long-term care admission in caregivers of persons with dementia at hospital discharge. METHODS Patient baseline and discharge data, and caregiver discharge data of 424 patient and caregiver dyads from a cluster randomized trial was used. Stepwise multiple linear regression was conducted to examine factors associated with caregiver desire to seek long-term care. RESULTS After controlling for caregiver and patient characteristics, lower caregiver preparedness (β = -0.069; p < 0.016) was significantly associated with increased desire to seek long-term care. DISCUSSION Findings underscore the need for clinicians and service providers to provide further attention to caregiver preparedness throughout the course of hospitalization.
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Affiliation(s)
- Ashley Kuzmik
- Pennsylvania State University, Ross and Nese College of Nursing, University Park, Pennsylvania, USA
| | - Rhonda BeLue
- University of Texas at San Antonio, College for Health Community and Policy, San Antonio, Texas, USA
| | - Barbara Resnick
- University of Maryland, School of Nursing, Baltimore, Maryland, USA
| | - Marleny Rodriguez
- Department of Psychology and Counseling, Immaculata University, Immaculata, Pennsylvania, USA
| | - Diane Berish
- Pennsylvania State University, Ross and Nese College of Nursing, University Park, Pennsylvania, USA
| | - James E Galvin
- Comprehensive Center for Brain Health, University of Miami, Miller School of Medicine, Boca Raton, Florida, USA
| | - Marie Boltz
- Pennsylvania State University, Ross and Nese College of Nursing, University Park, Pennsylvania, USA
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Paulson D, McClure N, Wharton T, Gendron E, Allen Q, Irfan H. Caregiver Preparedness: A Therapeutic Mechanism and Moderating Factor on Outcomes for the Savvy Caregiver Program. Clin Gerontol 2023:1-15. [PMID: 37530457 PMCID: PMC10834848 DOI: 10.1080/07317115.2023.2242357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
OBJECTIVES Evidence-based interventions for dementia caregivers, such as the Savvy Caregiver Program (SC), seek to address skills and knowledge deficits, caregiver burden, depressive symptoms, and grief. Little research has examined mechanisms by which these interventions accomplish their goals. Caregiver preparedness may be a possible mechanism by which caregiver interventions may confer benefits. METHODS The sample included 76 dementia caregivers who completed the 6-session SC. Participants completed the Anticipatory Grief Scale, Center for Epidemiological Studies-Depression Scale, the Preparedness for Caregiving Scale, and the Zarit Burden Interview-Short Form. RESULTS A repeated measures ANOVA was utilized to determine the interaction between baseline scores and pre-post change in caregiver preparedness. Analysis significantly predicted caregiver burden, (F(1) = 6.68, p=.012, partial η2=.10), depressive symptom endorsement, (F(1) = 6.41, p=.014, partial η2=.09, and anticipatory grief, (F(1) = 6.22, p=.02, partial η2=.1), post-treatment. CONCLUSIONS Pre-post change in caregiver preparedness significantly predicted pre-post change across measures of caregiver burden, depressive symptom endorsement, and anticipatory grief. Findings suggest that caregiver preparedness may be one mechanism by which the SC confers positive outcomes. These findings provide an empirical and theoretical basis for tailoring future dementia caregiver interventions. CLINICAL IMPLICATIONS Clinical Interventions may seek to improve caregiver preparedness and subsequent outcomes through utilization of programs like SC.
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Affiliation(s)
- Daniel Paulson
- Department of Psychology, University of Central Florida, Alzheimer's and Dementia Resource Center, Orlando, Florida, USA
| | - Nicole McClure
- Department of Psychology, University of Central Florida, Orlando, Florida, USA
| | - Tracy Wharton
- Principal Research Scientist, National Network of Public Health Institutes, Washington, USA
| | - Edith Gendron
- Chief Operating Officer of ADRC, Winter Park, Florida, USA
| | - Quinn Allen
- Psychology, University of Central Florida, Orlando, USA
| | - Hanya Irfan
- Health Sciences, University of Central Florida, Orlando, USA
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Völter C, Fricke H, Faour S, Lueg G, Nasreddine ZS, Götze L, Dawes P. Validation of the German Montreal-Cognitive-Assessment-H for hearing-impaired. Front Aging Neurosci 2023; 15:1209385. [PMID: 37539344 PMCID: PMC10394634 DOI: 10.3389/fnagi.2023.1209385] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 06/26/2023] [Indexed: 08/05/2023] Open
Abstract
Background Hearing loss and dementia are highly prevalent in older age and often co-occur. Most neurocognitive screening tests are auditory-based, and performance can be affected by hearing loss. To address the need for a cognitive screening test suitable for people with hearing loss, a visual version of the Montreal-Cognitive-Assessment was developed and recently validated in English (MoCA-H), with good sensitivity and specificity for identifying cases of dementia. As the MoCA is known to perform differently across languages, revalidation of the German MoCA-H was necessary. The aim of the present study was to assess the diagnostic accuracy of the German MoCA-H among those with normal cognition, mild cognitive impairment (MCI) and dementia and to determine an appropriate performance cut- off. Materials and methods A total of 346 participants aged 60-97 years (M = 77.18, SD = 9.56) were included; 160 were cognitively healthy, 79 with MCI and 107 were living with dementia based on the GPCOG and a detailed medical questionnaire as well as a comprehensive examination by a neurologist in case of cognitive impairment. Performance cut-offs for normal cognition, MCI and dementia were estimated for the MoCA-H score and z-scores using the English MoCA-H cut-off, the balanced cut-off and the Youden's Index. Results A mean score of 25.49 (SD = 3.01) points in the German MoCA-H was achieved in cognitively healthy participants, 20.08 (SD = 2.29) in the MCI and 15.80 (SD = 3.85) in the dementia group. The optimum cut-off for the detection of dementia was ≤21 points with a sensitivity of 96.3% and a specificity of 90%. In the MCI group, a cut-off range between 22 and 24 points is proposed to increase diagnostic accuracy to a sensitivity and specificity of 97.5 and 90%, respectively. Conclusion The German MoCA-H seems to be a sensitive screening test for MCI and dementia and should replace commonly used auditory-based cognitive screening tests in older adults. The choice of a cut-off range might help to better reflect the difficulty in clinical reality in detecting MCI. However, screening test batteries cannot replace a comprehensive cognitive evaluation.
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Affiliation(s)
- Christiane Völter
- Department of Otorhinolaryngology, Head and Neck Surgery, Catholic Hospital Bochum, Ruhr University Bochum, Bochum, Germany
| | - Hannah Fricke
- Department of Otorhinolaryngology, Head and Neck Surgery, Catholic Hospital Bochum, Ruhr University Bochum, Bochum, Germany
| | - Sarah Faour
- Department of Otorhinolaryngology, Head and Neck Surgery, Catholic Hospital Bochum, Ruhr University Bochum, Bochum, Germany
| | - Gero Lueg
- Department of Geriatric Medicine, Marien Hospital Herne, Ruhr University Bochum, Herne, Germany
| | | | - Lisa Götze
- Department of Otorhinolaryngology, Head and Neck Surgery, Catholic Hospital Bochum, Ruhr University Bochum, Bochum, Germany
| | - Piers Dawes
- Centre for Hearing Research (CHEAR), School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD, Australia
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Rhodus EK, Baum C, Kryscio R, Liu C, George R, Thompson M, Lowry K, Coy B, Barber J, Nichols H, Curtis A, Holloman A, Jicha GA. Feasibility of Telehealth Occupational Therapy for Behavioral Symptoms of Adults With Dementia: Randomized Controlled Trial. Am J Occup Ther 2023; 77:7704205010. [PMID: 37624998 PMCID: PMC10494967 DOI: 10.5014/ajot.2023.050124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023] Open
Abstract
IMPORTANCE Supporting community residency of adults with Alzheimer's disease (AD) is a critical public health initiative. Occupational therapy can contribute to this goal. OBJECTIVE To assess the feasibility of a novel telehealth intervention to support occupational engagement in community-residing people with AD. DESIGN Single-blind, three-arm, parallel, randomized controlled trial. SETTING Occupational therapy delivered through telehealth in participants' homes. PARTICIPANTS People with AD who reside in the community with behavioral symptoms and their care partners (dyads). INTERVENTIONS (1) HARMONY (Helping older Adults cReate & Manage OccupatioNs successfully), a telehealth intervention that applies principles of individualized guided discovery with environmental cueing for caregivers of persons with AD to promote activity participation and manage behavioral symptoms; (2) standardized training regarding the use of a sensory-based approach in dementia care; and (3) a control, including home safety education and weekly monitoring of behaviors. OUTCOMES AND MEASURES Feasibility was assessed as the primary outcome measured by completion of at least 75% of the telehealth sessions. Secondary outcomes included change in functional activity performance and neuropsychiatric behavioral symptoms. RESULTS Twenty-eight dyads participated. The intervention was feasible, with high adherence to weekly visits (M number of visits = 5.4 for HARMONY, 4.9 for standardized training, and 4.6 for control), with high participant retention in the intervention arms. HARMONY demonstrated promise in improving patient performance and behavioral symptoms. CONCLUSIONS AND RELEVANCE HARMONY is feasibly delivered through telehealth service and has a positive effect on occupational performance and behavioral symptoms of AD. Additional studies are needed to explore effectiveness in a broader population. What This Article Adds: Use of HARMONY for community-residing adults with AD is feasible and has promise for improving functional activity performance and behavioral symptoms, as well as caregiver satisfaction.
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Affiliation(s)
- Elizabeth K Rhodus
- Elizabeth K. Rhodus, PhD, OTR/L, is Assistant Professor, Sanders-Brown Center on Aging and Department of Behavioral Science, University of Kentucky, Lexington;
| | - Carolyn Baum
- Carolyn Baum, PhD, OTR/L, FAOTA, is Professor, Program in Occupational Therapy, Washington University in St. Louis, St. Louis, MO
| | - Richard Kryscio
- Richard Kryscio, PhD, is Professor, Sanders-Brown Center on Aging and Department of Statistics, University of Kentucky, Lexington
| | - Changrui Liu
- Changrui Liu, MS, is Graduate Assistant, Department of Statistics, University of Kentucky, Lexington
| | - Rosmy George
- Rosmy George, MS, BS, CCRP, is Clinical Trial Coordinator, Sanders-Brown Center on Aging, University of Kentucky, Lexington
| | - MaryEllen Thompson
- MaryEllen Thompson, PhD, OTR/L, is Retired Professor, Department of Occupational Science and Occupational Therapy, Eastern Kentucky University, Richmond
| | - Kimberly Lowry
- Kimberly Lowry, APRN, is Clinician, Sanders-Brown Center on Aging, University of Kentucky, Lexington
| | - Beth Coy
- Beth Coy, APRN, is Clinician, Sanders-Brown Center on Aging, University of Kentucky, Lexington
| | - Justin Barber
- Justin Barber, MS, CCRP, is Alzheimer's Disease Research Center & Affiliated Studies Team Leader, Sanders-Brown Center on Aging, University of Kentucky, Lexington
| | - Heather Nichols
- Heather Nichols, BS, CCRP, is Administrative Research Assistant Senior, Sanders-Brown Center on Aging, University of Kentucky, Lexington
| | - Alexandra Curtis
- Alexandra Curtis, MPH, CCRP, is Clinical Trials Research Manager, Sanders-Brown Center on Aging, University of Kentucky, Lexington
| | - Angela Holloman
- Angela Holloman, BS, is Program Manager Senior, Sanders-Brown Center on Aging, University of Kentucky, Lexington
| | - Gregory A Jicha
- Gregory A. Jicha, MD, PhD, is Professor, Sanders-Brown Center on Aging and Department of Neurology, University of Kentucky, Lexington
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Brenner RJ, Hansen J, Brintz BJ, Bouldin ED, Pugh MJ, Rupper R, Munoz R, Garcia-Davis S, Dang S. Association between specific unmet functional needs and desire to institutionalize among caregivers of older veterans. J Am Geriatr Soc 2023. [PMID: 36815450 DOI: 10.1111/jgs.18307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 12/23/2022] [Accepted: 01/28/2023] [Indexed: 02/24/2023]
Abstract
OBJECTIVES To evaluate the associations between specific functional needs of older Veterans and the desire to institutionalize (DTI) among their caregivers. METHODS Cross-sectional multivariable logistic regression analysis of 3579 Hero Care survey responses from caregivers of Veterans at five US sites from July to December 2021. Unmet needs were areas in which the caregiver reported the Veteran needed a little more or a lot more help. Caregiver DTI was defined as the caregiver reporting that they had discussed, considered, or taken steps toward a nursing home or assisted living placement for the Veteran or that they felt the Veteran would be better off in such a setting or they were likely to move the Veteran to another living arrangement. RESULTS Caregivers were largely white, retired, females with an average age of 71 and with some college education who spent an average of 8-9 h per day 6 days a week caring for a Veteran spouse. There was evidence of associations between the following needs and a DTI: managing incontinence, using the telephone, transportation, and arranging services in the home such as visiting nurses, home care aides, or meals on wheels. Unmet functional needs in other selected domains were not associated with the DTI. CONCLUSION Among caregivers of older Veterans, a need for more assistance managing incontinence, telephone use, transportation, and arranging in-home services were associated with the DTI. These may represent functional markers of important clinical determinants for institutionalization as well as potential targets for intervention to reduce caregiver DTI, such as programs that provide more caregiver or Veteran support in the home to meet these needs and reduce caregiver burden.
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Affiliation(s)
- Rachel J Brenner
- Salt Lake City VA Geriatric Research Education and Clinical Center, Division of Geriatrics, University of Utah, Salt Lake City, Utah, USA
| | - Jared Hansen
- Salt Lake City VA IDEAS Center, Division of Epidemiology, University of Utah, Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, Salt Lake City, Utah, USA
| | - Ben J Brintz
- Salt Lake City VA IDEAS Center, Division of Epidemiology, University of Utah, Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, Salt Lake City, Utah, USA
| | - Erin D Bouldin
- Salt Lake City VA IDEAS Center, Division of Epidemiology, University of Utah, Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, Salt Lake City, Utah, USA
| | - Mary Jo Pugh
- Salt Lake City VA IDEAS Center, Division of Epidemiology, University of Utah, Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, Salt Lake City, Utah, USA
| | - Randall Rupper
- Division of Geriatrics, Salt Lake City VA Geriatric Research Education and Clinical Center, University of Utah, Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, Salt Lake City, Utah, USA
| | - Richard Munoz
- Department of Health Policy & Management, Florida International University, Robert Stempel College of Public Health & Social Work, Miami, Florida, USA
| | - Sandra Garcia-Davis
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Stuti Dang
- Miami VA Geriatric Research Education and Clinical Center, University of Miami Miller School of Medicine, Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, Miami, Florida, USA
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9
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Tolea MI, Camacho S, Cohen IR, Galvin JE. Mindfulness and Care Experience in Family Caregivers of Persons Living with Dementia. J Alzheimers Dis Rep 2023; 7:151-164. [PMID: 36891256 PMCID: PMC9986707 DOI: 10.3233/adr-220069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 01/06/2023] [Indexed: 02/05/2023] Open
Abstract
Background Greater mindfulness, the practice of awareness and living in the moment without judgement, has been linked to positive caregiving outcomes in dementia caregivers and its impact attributed to greater decentering and emotion regulation abilities. Whether the impact of these mindfulness-based processes varies across caregiver subgroups is unclear. Objective Analyze cross-sectional associations between mindfulness and caregiver psychosocial outcomes, considering different caregiver and patient characteristics. Methods A total of 128 family caregivers of persons living with Alzheimer's disease and related disorders were assessed on several mindfulness measures (i.e., global; decentering, positive emotion regulation, negative emotion regulation) and provided self-reported appraisals of caregiving experience; care preparedness; confidence, burden, and depression/anxiety. Bivariate relationships between mindfulness and caregiver outcomes were assessed with Pearson's correlations and stratified by caregiver (women versus men; spouse versus adult child) and patient (mild cognitive impairment (MCI) versus Dementia; AD versus dementia with Lewy bodies; low versus high symptom severity) characteristics. Results Greater mindfulness was associated with positive outcomes and inversely associated with negative outcomes. Stratification identified specific patterns of associations across caregiver groups. Significant correlations were found between all mindfulness measures and caregiving outcomes in male and MCI caregivers while the individual mindfulness component of positive emotion regulation was significantly correlated to outcomes in most caregiver groups. Conclusion Our findings support a link between caregiver mindfulness and improved caregiving outcomes and suggest directions of inquiry into whether the effectiveness of dementia caregiver-support interventions may be improved by targeting specific mindfulness processes or offering a more inclusive all-scope approach depending on individual caregiver or patient characteristics.
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Affiliation(s)
- Magdalena I Tolea
- Comprehensive Center for Brain Health, Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Simone Camacho
- Comprehensive Center for Brain Health, Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Iris R Cohen
- Comprehensive Center for Brain Health, Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - James E Galvin
- Comprehensive Center for Brain Health, Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA
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10
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Guzzon A, Rebba V, Paccagnella O, Rigon M, Boniolo G. The value of supportive care: A systematic review of cost-effectiveness of non-pharmacological interventions for dementia. PLoS One 2023; 18:e0285305. [PMID: 37172047 PMCID: PMC10180718 DOI: 10.1371/journal.pone.0285305] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 04/20/2023] [Indexed: 05/14/2023] Open
Abstract
BACKGROUND Almost 44 million people are currently living with dementia worldwide. This number is set to increase threefold by 2050, posing a serious threat to the sustainability of healthcare systems. Overuse of antipsychotic drugs for the management of the symptoms of dementia carries negative consequences for patients while also increasing the health expenditures for society. Supportive care (SC) interventions could be considered a safer and potentially cost-saving option. In this paper we provide a systematic review of the existing evidence regarding the cost-effectiveness and cost-utility of SC interventions targeted towards persons living with dementia and their caregivers. METHODS A systematic literature review was performed between February 2019 and December 2021 through searches of the databases PubMed (MEDLINE), Cochrane Library, CENTRAL, Embase and PsycINFO. The search strategy was based on PRISMA 2020 recommendations. We considered studies published through December 2021 with no lower date limit. We distinguished between five categories of SC strategies: cognitive therapies, physical activity, indirect strategies (organisational and environmental changes), interventions primarily targeted towards family caregivers, and multicomponent interventions. RESULTS Of the 5,479 articles retrieved, 39 met the inclusion criteria. These studies analysed 35 SC programmes located at different stages of the dementia care pathway. Eleven studies provided evidence of high cost-effectiveness for seven interventions: two multicomponent interventions; two indirect interventions; two interventions aimed at caregivers of community-dwelling persons with dementia; one community-based cognitive stimulation and occupational programme. CONCLUSION We find that the most promising SC strategies in terms of cost-effectiveness are multicomponent interventions (targeted towards both nursing home residents and day-care service users), indirect strategies (group living and dementia care management at home), some forms of tailored occupational therapy, together with some psychosocial interventions for caregivers of community-dwelling persons with dementia. Our results suggest that the adoption of effective SC interventions may increase the economic sustainability of dementia care.
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Affiliation(s)
- Angelica Guzzon
- CRIEP (Interuniversity Research Centre on Public Economics), Veneto, Italy
- Department of Economics, Ca' Foscari University of Venice, Venice, Italy
| | - Vincenzo Rebba
- CRIEP (Interuniversity Research Centre on Public Economics), Veneto, Italy
- Department of Economics and Management "Marco Fanno", University of Padova, Padova, Italy
| | - Omar Paccagnella
- Department of Statistical Sciences, University of Padova, Padova, Italy
| | | | - Giovanni Boniolo
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
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Contreras M, Van Hout E, Farquhar M, McCracken LM, Gould RL, Hornberger M, Richmond E, Kishita N. Internet-delivered guided self-help Acceptance and Commitment Therapy for family carers of people with dementia (iACT4CARERS): a qualitative study of carer views and acceptability. Int J Qual Stud Health Well-being 2022; 17:2066255. [PMID: 35435153 PMCID: PMC9037213 DOI: 10.1080/17482631.2022.2066255] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- Milena Contreras
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Elien Van Hout
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Morag Farquhar
- School of Health Sciences, University of East Anglia, Norwich, UK
| | | | - Rebecca L Gould
- Division of Psychiatry, University College London, London, UK
| | | | - Erica Richmond
- Older People’s Community Team, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Naoko Kishita
- School of Health Sciences, University of East Anglia, Norwich, UK
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12
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sm-Rahman A, Meinow B, Hydén LC, Kelfve S. Long-term care use among people living with dementia: a retrospective register-based study from Sweden. BMC Geriatr 2022; 22:998. [PMID: 36572863 PMCID: PMC9793631 DOI: 10.1186/s12877-022-03713-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 12/20/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Although many people with dementia need progressive support during their last years of life little is known to what extent they use formal long-term care (LTC). This study investigates the use of LTC, including residential care and homecare, in the month preceding death, as well as the number of months spent in residential care, among Swedish older decedents with a dementia diagnosis, compared with those without a dementia diagnosis. METHODOLOGY This retrospective cohort study identified all people who died in November 2019 in Sweden aged 70 years and older (n = 6294). Dementia diagnoses were collected from the National Patient Register (before death) and the National Cause of Death Register (death certificate). The use of LTC was based on the Social Services Register and sociodemographic factors were provided by Statistics Sweden. We performed regression models (multinomial and linear logistic regression models) to examine the association between the utilization of LTC and the independent variables. RESULTS Not only dementia diagnosis but also time spent with the diagnosis was crucial for the use of LTC in the month preceding death, in particular residential care. Three out of four of the decedents with dementia and one fourth of those without dementia lived in a residential care facility in the month preceding death. People who were diagnosed more recently were more likely to use homecare (e.g., diagnosis for 1 year or less: home care 29%, residential care 56%), while the predicted proportion of using residential care increased substantially for those who had lived longer with a diagnosis (e.g., diagnosis for 7 + years: home care 11%, residential care 85%). On average, people with a dementia diagnosis stayed six months longer in residential care, compared with people without a diagnosis. CONCLUSIONS People living with dementia use more LTC and spend longer time in residential care than those without dementia. The use of LTC is primarily influenced by the time with a dementia diagnosis. Our study suggests conducting more research to investigate differences between people living with different dementia diagnoses with co-morbidities.
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Affiliation(s)
- Atiqur sm-Rahman
- grid.5640.70000 0001 2162 9922Department of Culture and Society (IKOS), Division Ageing and Social Change (ASC), Linköping University, Norrköping, Sweden
| | - Bettina Meinow
- grid.10548.380000 0004 1936 9377Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden ,grid.419683.10000 0004 0513 0226Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Lars-Christer Hydén
- grid.5640.70000 0001 2162 9922Department of Culture and Society (IKOS), Division Ageing and Social Change (ASC), Linköping University, Norrköping, Sweden ,grid.5640.70000 0001 2162 9922Center for Dementia Research (CEDER), Linköping University, Norrköping, Sweden
| | - Susanne Kelfve
- grid.5640.70000 0001 2162 9922Department of Culture and Society (IKOS), Division Ageing and Social Change (ASC), Linköping University, Norrköping, Sweden ,grid.10548.380000 0004 1936 9377Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden ,grid.5640.70000 0001 2162 9922Department of Culture and Society (IKOS), Division Social Work (SOCARB), Linköping University, Norrköping, Sweden
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13
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Dorell Å, Konradsen H, Kallström AP, Kabir ZN. “A friend during troubled times”: Experiences of family caregivers to persons with dementia when receiving professional support via a mobile app. PLoS One 2022; 17:e0271972. [PMID: 35917295 PMCID: PMC9345357 DOI: 10.1371/journal.pone.0271972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 07/11/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- Åsa Dorell
- Department of Neurobiology, Care Sciences and Society, NVS, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Hanne Konradsen
- Department of Neurobiology, Care Sciences and Society, NVS, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Gastroenterology, Herley and Gentofte Hospital, Herlev, Denmark
| | - Ana Paula Kallström
- Department of Neurobiology, Care Sciences and Society, NVS, Karolinska Institutet, Stockholm, Sweden
| | - Zarina Nahar Kabir
- Department of Neurobiology, Care Sciences and Society, NVS, Karolinska Institutet, Stockholm, Sweden
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14
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Mueller A, Thao L, Condon O, Liebzeit D, Fields B. A Systematic Review of the Needs of Dementia Caregivers Across Care Settings. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2022. [DOI: 10.1177/10848223211056928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The U.S. population of older adults living with dementia is projected to double by 2060. They rely on over 16 million family and unpaid caregivers to provide for their increasingly complex needs and care transitions. Caregivers frequently feel underprepared and without adequate support or access to resources. This systematic review seeks to identify the needs of family and unpaid caregivers of older adults living with dementia across various care settings in the U.S. A systematic search was conducted to identify articles pertaining to the needs of caregivers of older adults living with dementia. The data extraction tool was developed using aspects from the Care Transitions Framework and the Family Caregiver Alliance. Data were organized based on 3 domains of caregiver needs and the care setting(s) of the older adults living with dementia and their caregivers. A total of 31 articles were eligible for inclusion. The majority met the MMAT screening criteria, but more than half only met 2 or less of the 5 quality criteria. Caregivers’ needs were identified in the care settings of home/community-residing, assisted living, long-term care, skilled nursing, and memory care. Most articles either did not specify a care setting or included more than 1 and did not report the findings separately. Caregivers in each care setting, except memory care, identified needs in all 3 of the following domains: (1) social support—formal and informal, (2) confidence, competence, and strengths in the caregiving role, and (3) values and preferences.
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15
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Pierse T, Keogh F, Challis D, O'Shea E. Resource allocation in dementia care: comparing the views of people with dementia, carers and health and social care professionals under constrained and unconstrained budget scenarios. Aging Ment Health 2022; 26:679-687. [PMID: 33663288 DOI: 10.1080/13607863.2021.1889969] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND People with dementia and their carers have a wide range of health and social care needs. People with dementia, carers and health and social care professionals (HSCPs) all have different perspectives on dementia care. Differences among these groups are important for commissioners of services and for front-line HSCPs. OBJECTIVE To compare the service recommendations of people with dementia and carers with those of HSCPs, under different budgetary conditions. METHODS A mixed-methods approach, which builds on the Balance of Care method, was used. Nine workshops were held with 41 participants from three groups: people with dementia, carers and HSCPs. Participants were asked to make decisions on a set of services for case types of dementia under two scenarios: a no budget constraint (NBC) scenario and a budget constraint (BC) scenario. RESULTS While each group allocated resources in broadly similar overall proportions, important differences in emphasis emerged: (i) people with dementia and carers placed more emphasis on psychosocial supports than HSCPs; (ii) carers put more emphasis on respite opportunities for carers; and (iii) carers identified residential care as the most suitable setting for the person with dementia more frequently than health care professionals. CONCLUSION Our findings suggest that the importance of psychosocial interventions, including counselling and peer support programmes, are currently underestimated by HSCPs. The provision of in-home respite is highly valued by carers. Even with unconstrained resources, some carers do not judge home care to be a viable option for dementia case types with high-level care needs.
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Affiliation(s)
- Tom Pierse
- Centre for Economic and Social Research on Dementia, National University of Ireland Galway, Galway, Ireland
| | - Fiona Keogh
- Centre for Economic and Social Research on Dementia, National University of Ireland Galway, Galway, Ireland
| | - David Challis
- Institute of Mental Health, University of Nottingham Innovation Park, Nottingham, UK
| | - Eamon O'Shea
- Centre for Economic and Social Research on Dementia, National University of Ireland Galway, Galway, Ireland
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16
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Rolland Y, Baziard M, De Mauleon A, Dubus E, Saidlitz P, Soto ME. COVID-19 in older people with cognitive impairment. Clin Geriatr Med 2022; 38:501-517. [PMID: 35868669 PMCID: PMC8934719 DOI: 10.1016/j.cger.2022.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Yves Rolland
- Gerontopole of Toulouse, Institute on Aging, Toulouse University Hospital (CHU Toulouse), 20 rue du Pont Saint-Pierre, Cité de la Santé, CHU de Toulouse, Toulouse 31059, France; CERPOP Centre d'Epidémiologie et de Recherche en santé des POPulations UPS/INSERM UMR 1295, Toulouse, France.
| | - Marion Baziard
- Gerontopole of Toulouse, Institute on Aging, Toulouse University Hospital (CHU Toulouse), 20 rue du Pont Saint-Pierre, Cité de la Santé, CHU de Toulouse, Toulouse 31059, France
| | - Adelaide De Mauleon
- Gerontopole of Toulouse, Institute on Aging, Toulouse University Hospital (CHU Toulouse), 20 rue du Pont Saint-Pierre, Cité de la Santé, CHU de Toulouse, Toulouse 31059, France
| | - Estelle Dubus
- Gerontopole of Toulouse, Institute on Aging, Toulouse University Hospital (CHU Toulouse), 20 rue du Pont Saint-Pierre, Cité de la Santé, CHU de Toulouse, Toulouse 31059, France
| | - Pascal Saidlitz
- Gerontopole of Toulouse, Institute on Aging, Toulouse University Hospital (CHU Toulouse), 20 rue du Pont Saint-Pierre, Cité de la Santé, CHU de Toulouse, Toulouse 31059, France
| | - Maria Eugenia Soto
- Gerontopole of Toulouse, Institute on Aging, Toulouse University Hospital (CHU Toulouse), 20 rue du Pont Saint-Pierre, Cité de la Santé, CHU de Toulouse, Toulouse 31059, France; CERPOP Centre d'Epidémiologie et de Recherche en santé des POPulations UPS/INSERM UMR 1295, Toulouse, France
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17
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McKenna O, Fakolade A, Cardwell K, Langlois N, Jiang K, Pilutti LA. Towards conceptual convergence: A systematic review of psychological resilience in family caregivers of persons living with chronic neurological conditions. Health Expect 2021; 25:4-37. [PMID: 34676951 PMCID: PMC8849377 DOI: 10.1111/hex.13374] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/31/2021] [Accepted: 09/17/2021] [Indexed: 01/28/2023] Open
Abstract
Background The demand for family caregiving in persons with chronic neurological conditions (CNCs) is increasing. Psychological resilience may empower and protect caregivers in their role. Thus, a synthesis of resilience evidence within this specific population is warranted. Aim In this systematic review we aimed to: (1) examine the origins and conceptualizations of resilience; (2) summarize current resilience measurement tools; and (3) synthesize correlates, predictors and outcomes of resilience in family caregivers of persons with CNCs. Design We sourced English articles published up to July 2020 across five databases using search terms involving CNCs, family caregivers and resilience. Results A total of 50 studies were retained. Nearly half (44%) of the studies used trait‐based resilience definitions, while about one third (36%) used process‐based definitions. Twelve different resilience scales were used, revealing mostly moderate to high‐resilience levels. Findings confirmed that resilience is related to multiple indicators of healthy functioning (e.g., quality of life, social support, positive coping), as it buffers against negative outcomes of burden and distress. Discordance relating to the interaction between resilience and demographic, sociocultural and environmental factors was apparent. Conclusions Incongruity remains with respect to how resilience is defined and assessed, despite consistent definitional concepts of healthy adaptation and equilibrium. The array of implications of resilience for well‐being confirms the potential for resilience to be leveraged within caregiver health promotion initiatives via policy and practice. Patient or Public Contribution The findings may inform future recommendations for researchers and practitioners to develop high‐quality resilience‐building interventions and programmes to better mobilize and support this vulnerable group.
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Affiliation(s)
- Odessa McKenna
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | | | - Katherine Cardwell
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Nigèle Langlois
- Health Sciences Library, University of Ottawa, Ottawa, Canada
| | - Karen Jiang
- Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Lara A Pilutti
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada.,Brain and Mind Research Institute, Faculty of Medicine, University of Ottawa, Ottawa, Canada
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18
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Gómez-Gallego M, Gómez-Gallego JC. Predictors of Caregiver Burden of Patients with Alzheimer Disease Attending Day-Care Centres. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010707. [PMID: 34682452 PMCID: PMC8535802 DOI: 10.3390/ijerph182010707] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 10/01/2021] [Accepted: 10/07/2021] [Indexed: 11/29/2022]
Abstract
Nowadays, there are plenty of programs and resources to prevent caregiver burden of patients with Alzheimer’s disease. In spite of that, many caregivers suffer high levels of burden and stress, which leads to an earlier institutionalization of patients. This study aimed to explore the predictors of burden in relative caregivers of patients attending day-care centers and the moderating role of caregiver kinship in these associations. A sample of a hundred and two patient–caregiver dyads was recruited. Burden was measured with a Zarit Burden Interview. Measures of patients’ cognition, insight, depression, behavioral disturbances, functional ability and overall physical health were considered as predictors. We found that apathy, irritability and delusions and, patients’ mobility are the main determinants of caregivers’ burden. The strength of relationship between delusions and irritability was higher in spouse caregivers. Interventions to reduce burden should be adapted to the specific needs of a particular type caregiver.
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Affiliation(s)
- María Gómez-Gallego
- Clinical Neuroscience Research Group, Faculty of Health Sciences, Catholic University of Murcia, 30107 Murcia, Spain;
| | - Juan Cándido Gómez-Gallego
- Department of Applied Economics, Faculty of Economic, Espinardo Campus, University of Murcia, 30100 Murcia, Spain
- Correspondence:
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19
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Spiegl K, Luttenberger K, Graessel E, Becker L, Scheel J, Pendergrass A. Predictors of institutionalization in users of day care facilities with mild cognitive impairment to moderate dementia. BMC Health Serv Res 2021; 21:1009. [PMID: 34556085 PMCID: PMC8461860 DOI: 10.1186/s12913-021-07017-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 08/27/2021] [Indexed: 11/10/2022] Open
Abstract
Background Most people with dementia wish to remain at home for as long as possible. Therefore, it is important to know the predictors of institutionalization, especially those that can be influenced. The aim of the present study is to identify predictors of the institutionalization of people with mild cognitive impairment (MCI) to moderate dementia who attend day care facilities (DCFs) throughout Germany. Methods This study is a secondary analysis of longitudinal data from 371 dyads comprising a cognitively impaired care receiver (CR) and a caregiver (CG). The data were collected in DCFs and via telephone interviews at three measurement points. To investigate the extent to which 16 variables could predict the institutionalization of the CRs between the 6- and 12-month follow-up, in the first step bivariate Cox regressions were calculated. In the second step, significant predictors were included in a model using multivariate Cox regression. Results Between the 6- and 12-month evaluations, 39 CRs moved into an institution. The risk of institutionalization of people with MCI to moderate dementia attending a DCF increased significantly (p < .05) when the CRs showed more neuropsychiatric symptoms (Hazard ratio (HR) = 1.237), when the CRs and their CGs did not live together in the same house (HR = 2.560), or when the care level of the CRs is low (HR = 2.241). Conclusions Neuropsychiatric symptoms could be a possible starting point for therapeutic interventions that are designed to delay or prevent institutionalization. CG who do not live with their CR in the same house and CG who care for a CR with impairment in performing daily routine tasks care are particularly likely to make the decision to institutionalize the CR. For this group, advice and support are particularly important. Trail registration ISRCTN16412551.
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Affiliation(s)
- Klara Spiegl
- Department of Medical Psychology and Medical Sociology, University Clinic for Psychiatry and Psychotherapy, Erlangen University Hospital, Friedrich-Alexander University Erlangen Nuremberg, Erlangen, Germany, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Katharina Luttenberger
- Department of Medical Psychology and Medical Sociology, University Clinic for Psychiatry and Psychotherapy, Erlangen University Hospital, Friedrich-Alexander University Erlangen Nuremberg, Erlangen, Germany, Schwabachanlage 6, 91054, Erlangen, Germany.
| | - Elmar Graessel
- Department of Medical Psychology and Medical Sociology, University Clinic for Psychiatry and Psychotherapy, Erlangen University Hospital, Friedrich-Alexander University Erlangen Nuremberg, Erlangen, Germany, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Linda Becker
- Department of Health Psychology, Friedrich-Alexander University Erlangen-Nuernberg, Nägelsbachstr. 49a, 91052, Erlangen, Germany
| | - Jennifer Scheel
- Department of Medical Psychology and Medical Sociology, University Clinic for Psychiatry and Psychotherapy, Erlangen University Hospital, Friedrich-Alexander University Erlangen Nuremberg, Erlangen, Germany, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Anna Pendergrass
- Department of Medical Psychology and Medical Sociology, University Clinic for Psychiatry and Psychotherapy, Erlangen University Hospital, Friedrich-Alexander University Erlangen Nuremberg, Erlangen, Germany, Schwabachanlage 6, 91054, Erlangen, Germany
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20
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Angeles RC, Berge LI, Gedde MH, Kjerstad E, Vislapuu M, Puaschitz NG, Husebo BS. Which factors increase informal care hours and societal costs among caregivers of people with dementia? A systematic review of Resource Utilization in Dementia (RUD). HEALTH ECONOMICS REVIEW 2021; 11:37. [PMID: 34536149 PMCID: PMC8449888 DOI: 10.1186/s13561-021-00333-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 08/30/2021] [Indexed: 05/02/2023]
Abstract
BACKGROUND Nearly 19 million people across OECD countries are living with dementia, and millions of family caregivers are affected by the disease. The costs of informal care are estimated to represent 40-75% of the total dementia cost exceeding formal care time and medical costs. OBJECTIVE To conduct a systematic review to evaluate the methodological quality and factors associated with high informal care hours per month that increase societal costs, and to identify what type of interventions may alleviate the entire burden of informal and formal caregiving. METHODS The systematic review was registered at PROSPERO (15.12.2020). A search in Medline, Embase, PsycINFO, and web of science for observational studies, cost-effectiveness, and cost of illness (COI) analyses on resource utilization in dementia (RUD) was conducted on 1 December 2020. Our inclusion criteria included a requirement that studies had to use the original RUD, RUD-FOCA or RUD lite in terms of hours or days per month, and costs as primary or secondary outcome, OECD countries, within the last 20 years and a sample population comprising persons with dementia (PwD) ≥65 years and their caregivers. We followed the PRISMA, GRADE, PICO guidelines and Drummond criteria to assess the methodology and quality of the studies. RESULTS Of 307 studies, 26 cross-sectional and 3 longitudinal cohort studies were included in the analyses. Two studies had a randomized controlled trial (RCT) design. The methods and cost categories in each study varied widely. Disease severity, caregiver factors, and behavioural and psychological symptoms of dementia (BPSD) were associated with high informal care hours and societal cost. One RCT found no effect of a non-pharmacological intervention on informal care hours, yet another RCT found a cost-effective impact of an in-home respite care programme reducing informal care burden and costs. CONCLUSION The divergent use of the RUD components within included studies encourage more harmonized analyses. There are only two RCTs on RUD, one of which shows a significant treatment effect. Larger sample sizes and longer follow-up periods are required in future RCTs with dedicated focus on cost-enhancing and resource intensive factors such as disease severity and BPSD. Novel interventions must diversify between caregiver and PwD groups. PROSPERO REGISTRATION CRD42021226388 .
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Affiliation(s)
- Renira C Angeles
- NORCE Norwegian Research Centre AS, Department of Social Science, Health Services and Health Economics Research Group, Bergen, Norway.
- Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
| | - Line I Berge
- Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- NKS Olaviken Gerontopsychiatric Hospital, Askoy, Norway
| | - Marie H Gedde
- Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Egil Kjerstad
- NORCE Norwegian Research Centre AS, Department of Social Science, Health Services and Health Economics Research Group, Bergen, Norway
| | - Maarja Vislapuu
- Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Nathalie G Puaschitz
- Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Centre for Care Research West, Western Norway University of Applied Sciences, Bergen, Norway
| | - Bettina S Husebo
- Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Municipality of Bergen, Bergen, Norway
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21
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van der Heide I, Heins M, Verheij R, van Hout HPJ, Francke A, Joling K. Prevalence of Health Problems and Health-Care Use in Partners of People with Dementia: Longitudinal Analysis with Routinely Recorded Health and Administrative Data. Gerontology 2021; 68:442-452. [PMID: 34261067 DOI: 10.1159/000517163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/12/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION This study aims to provide insight into the prevalence of health problems and the frequency of general practitioner (GP) contacts in cohabiting partners of persons with dementia, during the year prior to the dementia diagnosis and up to 3 years after the diagnosis. METHODS Partners of persons with dementia and a matched control group of partners of persons without dementia were identified in the routinely recorded electronic health records of 451 Dutch general practices in 2008-2015. These data were used to examine the prevalence of the partners' health problems. Differences between these partners and comparison partners in the prevalence of 16 groups of health problems (diagnostic chapters) and in the frequency of GP contacts were examined using generalized estimating equation models. RESULTS 1,711 partners of persons with dementia and 6,201 comparison partners were included in the analyses. Social problems, more specifically problems related to the illness and/or the loss of the partner, were significantly more prevalent in partners than in comparison partners across the years (p < 0.01), as were musculoskeletal problems (p < 0.01). Respiratory and psychological problems increased over time in partners and remained stable in comparison partners. Across the years, partners contacted their GP more often than comparison partners (p < 0.01). DISCUSSION/CONCLUSION Having a cohabiting partner with dementia has consequences for caregiver's physical and psychosocial health. The specific health problems found in this study and the increase in GP contacts might be relevant indicators of overburdening in partners of persons with dementia.
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Affiliation(s)
- Iris van der Heide
- Nivel, Netherlands Institute of Health Services Research, Utrecht, The Netherlands
| | - Marianne Heins
- Nivel, Netherlands Institute of Health Services Research, Utrecht, The Netherlands
| | - Robert Verheij
- Nivel, Netherlands Institute of Health Services Research, Utrecht, The Netherlands
| | - Hein P J van Hout
- Amsterdam Public Health Research Institute, Amsterdam UMC, location VU University Medical Center, Amsterdam, The Netherlands
| | - Anneke Francke
- Nivel, Netherlands Institute of Health Services Research, Utrecht, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam UMC, location VU University Medical Center, Amsterdam, The Netherlands
| | - Karlijn Joling
- Amsterdam Public Health Research Institute, Amsterdam UMC, location VU University Medical Center, Amsterdam, The Netherlands
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22
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Halminen O, Vesikansa A, Mehtälä J, Hörhammer I, Mikkola T, Virta LJ, Ylisaukko-Oja T, Linna M. Early Start of Anti-Dementia Medication Delays Transition to 24-Hour Care in Alzheimer's Disease Patients: A Finnish Nationwide Cohort Study. J Alzheimers Dis 2021; 81:1103-1115. [PMID: 33843673 DOI: 10.3233/jad-201502] [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: 11/15/2022]
Abstract
BACKGROUND Dementia is one of the strongest predictors of admission to a 24-hour care facility among older people, and 24-hour care is the major cost of Alzheimer's disease (AD). OBJECTIVE The aim of this study was to evaluate the association of early start of anti-dementia medication and other predisposing factors with 2-year risk of transition to 24-hour care in the nationwide cohort of Finnish AD patients. METHODS This was a retrospective, non-interventional study based on individual-level data from Finnish national health and social care registers. The incident cohort included 7,454 AD patients (ICD-10, G30) comprised of two subgroups: those living unassisted at home (n = 5,002), and those receiving professional home care (n = 2,452). The primary outcome was admission to a 24-hour care facility. Exploratory variables were early versus late anti-dementia medication start, sociodemographic variables, care intensity level, and comorbidities. RESULTS Early anti-dementia medication reduced the risk of admission to 24-hour care both in patients living unassisted at home, with a hazard ratio (HR) of 0.58 (p < 0.001), and those receiving professional home care (HR, 0.84; p = 0.039). Being unmarried (HR, 1.69; p < 0.001), having an informal caregiver (HR, 1.69; p = 0.003), or having a diagnosis of additional neurological disorder (HR, 1.68; p = 0.006) or hip fracture (HR, 1.61; p = 0.004) were associated with higher risk of admission to 24-hour care in patients living unassisted at home. CONCLUSION To support living at home, early start of anti-dementia medication should be a high priority in newly diagnosed AD patients.
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Affiliation(s)
- Olli Halminen
- Department of Industrial Engineering and Management, School of Science, Aalto University, Espoo, Finland
| | | | | | - Iiris Hörhammer
- Department of Industrial Engineering and Management, School of Science, Aalto University, Espoo, Finland
| | | | | | - Tero Ylisaukko-Oja
- MedEngine Oy, Helsinki, Finland.,Faculty of Medicine, Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Miika Linna
- Department of Industrial Engineering and Management, School of Science, Aalto University, Espoo, Finland
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Reckrey JM, Boerner K, Franzosa E, Bollens-Lund E, Ornstein KA. Paid Caregivers in the Community-Based Dementia Care Team: Do Family Caregivers Benefit? Clin Ther 2021; 43:930-941. [PMID: 33972126 DOI: 10.1016/j.clinthera.2021.03.022] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/18/2021] [Accepted: 03/30/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Older adults with dementia often rely on both paid caregivers (ie, home health aides, personal care attendants, other direct care workers) and family caregivers (ie, spouses, children, other unpaid individuals) to remain in the community. This study conceptualizes paid caregivers as part of the collaborative dementia care team and examines the association between receipt of paid care and primary family caregiver experience. METHODS Using data from 3 waves (2011, 2015, and 2017) of the National Health and Aging Trends Study linked to the National Study of Caregiving, community-dwelling Medicare beneficiaries aged ≥67 years with advanced dementia (n = 338 observations) were identified. Primary family caregiver experiences were compared among those with zero, part-time (<40 hours/week), and full-time (≥40 hours/week) paid care, and multivariable models were used to evaluate the associations between full-time paid care and family caregiver strain (eg, being overwhelmed due to caregiving) and activity restriction (eg, being unable to work for pay due to caregiving). FINDINGS About one half of the community-dwelling older adults with advanced dementia received paid care: 30% had part-time paid care and 18% had full-time paid care. The experiences of family caregivers of those receiving part-time and no paid care were not significantly different. After adjusting for family caregiver and care recipient characteristics, receipt of full-time paid care was associated with a nearly 70% reduced odds of having activity restrictions due to caregiving (odds ratio, 0.31; P = 0.01) and a reduction in mean caregiver strain score (-0.73; P = 0.04). There was no statistically significantly association between the odds of high caregiver strain (score ≥5) and receipt of paid care (odds ratio, 0.65; P = 0.33). IMPLICATIONS The provision of paid care for individuals with dementia in the community may benefit family caregivers. Future work should acknowledge the important ways that paid caregivers contribute to outcomes for all members of the collaborative dementia care team.
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Affiliation(s)
- Jennifer M Reckrey
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Kathrin Boerner
- Department of Gerontology, McCormack Graduate School of Policy and Global Studies, University of Massachusetts, Boston, MA
| | - Emily Franzosa
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai and Geriatrics Research, Education, and Clinical Center, James J. Peters VA Medical Center, New York, NY
| | - Evan Bollens-Lund
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Katherine A Ornstein
- Department of Geriatrics and Palliative Medicine and Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY
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The Carers' Needs Assessment for Dementia (CNA-D): a validation study in the Italian population. Neurol Sci 2021; 43:275-284. [PMID: 33942173 PMCID: PMC8724169 DOI: 10.1007/s10072-021-05285-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 04/22/2021] [Indexed: 12/13/2022]
Abstract
Background Dementia has devastating consequences for families with important physical, psychological, social, and financial effects. Evaluation of caregiver’s needs may be an important step to reduce the burden of family caregivers of dementia patients. An Austrian scale, the Carers’ Needs Assessment for Dementia, is now available for measuring the caregiver’s needs. The aim of our study was to evaluate the psychometric properties of the Italian version of the CNA-D (iCNA-D). Methods A sample of 214 voluntary caregivers of dementia patients was recruited at the Department of Neuroscience, University of Turin (Italy). All participants were administered the iCNA-D. Validity and reliability of the instrument were evaluated using Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Symptom Checklist-90 (SCL-90), and the Italian version of Zarit Burden Interview (I-ZBI). Results The most common unmet need reported for the iCNA-D was “counseling and emotional support” (31.5%). This item demonstrates adequate reliability with moderate internal consistency for all “summary scores” of iCNA-D (α ≥ 0.75) and split-half correlation of more than 0.80 for two of them. We also found positive correlations in two out of three “summary scores” of iCNA-D and in the overall outcomes of BDI, BAI, SCL-90, and I-ZBI. Conclusions The iCNA-D could be a valid and reliable tool for a comprehensive assessment of needs and possible social supports proposed to relatives who take care of patients with dementia. Better understanding of family caregivers’ needs could improve planning of local services and reduce caregivers’ perception of distress and burden.
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Abstract
OBJECTIVE Despite the policy relevance of carer burden, limited research focuses on family carers' experience of carer burden among different disease groups. This study aimed to examine differences in carer burden among family carers of people with and without dementia. DESIGN Secondary data analysis was conducted on a national cross-sectional dataset. Multivariable ordered logistic regression was used to analyze four levels of carer burden (low, mild, moderate, high). The main independent variable was dementia diagnosis, and controls included variables relating to the care recipient, family carer, and context of care. SETTING The original survey was funded by Irish Health Service Executive and undertaken by the National Centre for the Protection of Older People in Ireland. PARTICIPANTS The original dataset consisted of 2,311 family carers of older people in Ireland. Approximately, one-fifth of this sample had a diagnosis of dementia. MEASUREMENTS Carer burden was measured using the standardized 22-item Zarit Burden Interview. Care-recipient dependency was measured using the Activities for Daily Living Scale. Sociodemographic details and information about the context of caring were collected using self-report scales. RESULTS In our model, dementia diagnosis and dependency level were significantly associated with carer burden. Family carer and context of care variables including gender, marital status, education, residence, co-residence, and perceived support showed significant relationships with carer burden. Our results highlighted significant differences in carer burden distribution; in particular, family carers of people with dementia were less likely to report low or mild carer burden (-6.95 ppts and -3.64 ppts, respectively) and more likely to report moderate or high carer burden (8.46 ppts and 2.13 ppts, respectively). CONCLUSION Our findings suggest that family carers of people with dementia may experience additional challenges associated with caring. Therefore, family carers of people with dementia may require tailored social supports to maintain good health and well-being.
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Zafeiridi E, McMichael AJ, Passmore AP, McGuinness B. Factors influencing transition to care homes for people with dementia in Northern Ireland. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2021; 7:e12120. [PMID: 33748397 PMCID: PMC7968123 DOI: 10.1002/trc2.12120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 10/12/2020] [Accepted: 11/04/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The increasing number of people with dementia (PwD) is a significant health and financial challenge for countries. PwD often transition to a care home. This study explored factors predicting transition to care homes for PwD and the place and causes of death. METHODS Data about dementia medication, care home transitions, demographic characteristics, deaths, and hospital admissions were extracted from national databases from 2010 to 2016. RESULTS PwD (n = 25,418) were identified through prescriptions of dementia medication, from which 11,930 transitioned to care homes. A logistic regression showed that increased age, female sex, living in less deprived and urban areas, and hospital admissions predicted this transition. PwD who transition to care homes are more likely to die there. The most common cause of death was dementia. DISCUSSION Certain demographic characteristics are significant predictors for care home transitions and they should be considered in the development of early community-based care services to delay transitions. In the last decades, dementia has been reported more frequently in death certificates.
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Affiliation(s)
- Evi Zafeiridi
- Centre for Public HealthQueen's University BelfastBelfastUK
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Fagundes DF, Costa MT, Alves BBDS, Benício MMS, Vieira LP, Carneiro LSF, Nascimento OJM, Monteiro Junior RS. Prevalence of dementia in long-term care institutions: a meta-analysis. JORNAL BRASILEIRO DE PSIQUIATRIA 2021. [DOI: 10.1590/0047-2085000000298] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
ABSTRACT Objective: This study comprises a systematic review and meta-analysis that aimed to estimate the prevalence of dementia in long-term care institutions (LTCIs). Methods: We used the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). Original transversal and longitudinal articles published until July 2020 were eligible in this review. Databases PubMed/MedLine, Web of Science, Scopus and ScienceDirect were searched. Overall prevalence and confidence intervals were estimated. Heterogeneity was calculated according to the index of heterogeneity (I2). Results: One hundred seventy-five studies were found in all databases and 19 studies were meta-analyses, resulting in an overall prevalence of 53% (CI 46-59%; p < 0.01) of demented older adults living in LTCIs. Conclusion: Prevalence of dementia is higher in older adults living in LTCIs than those living in general communities. This data shows a worrying reality that needs to be changed. There is a need for a better understanding of the elements that cause this increase in dementia in LTCFs to direct actions to improve the quality of life and health of institutionalized elderly.
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Affiliation(s)
| | | | | | | | | | - Lara S. F. Carneiro
- Instituto Superior de Ciências Educativas do Douro, Portugal; Instituto Universitário da Maia, Portugal; Desporto e Desenvolvimento Humano, Portugal
| | | | - Renato Sobral Monteiro Junior
- Universidade Estadual de Montes Claros, Brasil; Universidade Federal Fluminense, Brasil; Instituto de Neurociência do Exercício, Brasil
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Miranda R, Smets T, Van Den Noortgate N, Deliens L, Van den Block L. Higher Prevalence of Dementia but No Change in Total Comfort While Dying among Nursing Home Residents with Dementia between 2010 and 2015: Results from Two Retrospective Epidemiological Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18042160. [PMID: 33672123 PMCID: PMC7926426 DOI: 10.3390/ijerph18042160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/12/2021] [Accepted: 02/18/2021] [Indexed: 11/16/2022]
Abstract
Important policy developments in dementia and palliative care in nursing homes between 2010 and 2015 in Flanders, Belgium might have influenced which people die in nursing homes and how they die. We aimed to examine differences between 2010 and 2015 in the prevalence and characteristics of residents with dementia in nursing homes in Flanders, and their palliative care service use and comfort in the last week of life. We used two retrospective epidemiological studies, including 198 residents in 2010 and 183 in 2015, who died with dementia in representative samples of nursing homes in Flanders. We found a 15%-point increase in dementia prevalence (p-value < 0.01), with a total of 11%-point decrease in severe to very severe cognitive impairment (p = 0.04). Controlling for residents’ characteristics, in the last week of life, there was an increase in the use of pain assessment (+20%-point; p < 0.03) but no change in total comfort. The higher prevalence of dementia in nursing homes with no change in residents’ total comfort while dying emphasizes an urgent need to better support nursing homes in improving their capacities to provide timely and high-quality palliative care services to more residents dying with dementia.
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Affiliation(s)
- Rose Miranda
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, 1090 Brussels, Belgium; (T.S.); (L.D.); (L.V.d.B.)
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium
- Correspondence:
| | - Tinne Smets
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, 1090 Brussels, Belgium; (T.S.); (L.D.); (L.V.d.B.)
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium
| | | | - Luc Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, 1090 Brussels, Belgium; (T.S.); (L.D.); (L.V.d.B.)
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium
- Department of Public Health and Primary Care, Ghent University Hospital, 9000 Ghent, Belgium
| | - Lieve Van den Block
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, 1090 Brussels, Belgium; (T.S.); (L.D.); (L.V.d.B.)
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium
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29
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Marengoni A, Tazzeo C, Calderón-Larrañaga A, Roso-Llorach A, Onder G, Zucchelli A, Rizzuto D, Vetrano DL. Multimorbidity Patterns and 6-Year Risk of Institutionalization in Older Persons: The Role of Social Formal and Informal Care. J Am Med Dir Assoc 2021; 22:2184-2189.e1. [PMID: 33556330 DOI: 10.1016/j.jamda.2020.12.040] [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] [Received: 10/14/2020] [Revised: 12/29/2020] [Accepted: 12/31/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim was to evaluate patterns of multimorbidity that increase the risk of institutionalization in older persons, also exploring the potential buffering effect of formal and informal care. DESIGN Prospective cohort study. SETTING AND PARTICIPANTS The population-based Swedish National study on Aging and Care in Kungsholmen, Stockholm, Sweden. MEASURES In total, 2571 community-dwelling older adults were grouped at baseline according to their underlying multimorbidity patterns, using a fuzzy c-means cluster algorithm, and followed up for 6 years to test the association between multimorbidity patterns and institutionalization. RESULTS Six patterns of multimorbidity were identified: psychiatric diseases; cardiovascular diseases, anemia, and dementia; metabolic and sleep disorders; sensory impairments and cancer; musculoskeletal, respiratory, and gastrointestinal diseases; and an unspecific pattern including diseases of which none were overrepresented. In total, 110 (4.3%) participants were institutionalized during the follow-up, ranging from 1.7% in the metabolic and sleep disorders pattern to 8.4% in the cardiovascular diseases, anemia, and dementia pattern. Compared with the unspecific pattern, only the cardiovascular diseases, anemia, dementia pattern was significantly associated with institutionalization [relative risk ratio (RRR) = 2.23; 95% confidence interval (CI) 1.07‒4.65)], after adjusting for demographic characteristics and disability status at baseline. In stratified analyses, those not receiving formal care in the psychiatric diseases pattern (RRR 3.34; 95% CI 1.20‒9.32) and those not receiving formal or informal care in the 'cardiovascular diseases, anemia, dementia' pattern (RRR 2.99; 95% CI 1.20‒7.46; RRR 2.79; 95% CI 1.16‒6.71, respectively) had increased risks of institutionalization. CONCLUSIONS AND IMPLICATIONS Older persons suffering from specific multimorbidity patterns have a higher risk of institutionalization, especially if they lack formal or informal care. Interventions aimed at preventing the clustering of diseases could reduce the associated burden on residential long-term care. Formal and informal care provision may be effective strategies in reducing the risk of institutionalization.
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Affiliation(s)
- Alessandra Marengoni
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
| | - Clare Tazzeo
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Amaia Calderón-Larrañaga
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Albert Roso-Llorach
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, (IDIAPJGol), Barcelona, Spain; Universitat Autònoma de Barcelona, Campus de la UAB, Bellaterra (Cerdanyola del Vallès), Spain
| | - Graziano Onder
- Department of Cardiovascular, Endocrine-metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy
| | - Alberto Zucchelli
- Department of Information Engineering, University of Brescia, Brescia, Italy
| | - Debora Rizzuto
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Stockholm Gerontology Research Centrum, Stockholm, Sweden
| | - Davide Liborio Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
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30
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Nunez FE. Factors influencing decisions to admit family members with dementia to long-term care facilities. Nurs Forum 2021; 56:372-381. [PMID: 33537986 DOI: 10.1111/nuf.12555] [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: 03/12/2020] [Revised: 01/21/2021] [Accepted: 01/25/2021] [Indexed: 11/28/2022]
Abstract
With an aging global population and changes in family structure, there will be a need for increased formal and informal caregivers for family members with alzheimer's disease or other related dementias. Caregivers experience exhaustion, mental health issues, and competing demands; deciding to admit family members with dementia into long-term care compounds the stress. The article reports on factors that influence caregivers' decisions regarding institutionalizing their family members with dementia. Eighteen articles were included in this integrative review. Influential decision-making factors were: caregiver characteristics, care recipient characteristics, complexity of care, caregiver and family relationships, experiences with healthcare providers, financial challenges, and long-term care facility selection. Addressing these factors can provide a layer of support to caregivers and their families during the decision-making process.
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Affiliation(s)
- Franchesca E Nunez
- School of Nursing, The University of Texas at El Paso, El Paso, Texas, USA
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31
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Lau JH, Abdin E, Jeyagurunathan A, Seow E, Ng LL, Vaingankar JA, Chong SA, Subramaniam M. The association between caregiver burden, distress, psychiatric morbidity and healthcare utilization among persons with dementia in Singapore. BMC Geriatr 2021; 21:67. [PMID: 33468059 PMCID: PMC7816438 DOI: 10.1186/s12877-021-02014-2] [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] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 01/06/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Caregivers of persons with dementia (PWD) face high caregiving burden, distress related to responsive behaviours, and psychiatric morbidity. The present paper examines how these are associated with healthcare utilization of the PWD in Singapore. METHODS The data of 399 caregiver-PWD dyads were extracted from a national cross-sectional survey. PWD completed the Client Service Receipt Inventory, which provided information on their healthcare utilization (i.e. emergency service use, hospital admission, length of stay in hospital, and number of outpatient visits) within a frame of 3 months. The Zarit Burden Interview (ZBI), Neuropsychiatric Inventory Questionnaire (NPI-Q), and Self Reporting Questionnaire (SRQ-20) were administered to caregivers. Information on severity of dementia, physical multimorbidity of the PWD, household composition, and caregivers' sociodemographic characteristics such as age, gender, and education were collected. Variables significantly associated with healthcare utilization in the univariate analyses were selected and included in the final regression models. Emergency service use and hospital admission were investigated using logistic regression analyses, whilst negative binomial models were utilized for length of stay in hospital and number of outpatient visits. RESULTS After adjusting for significant correlates such as dementia severity and multimorbidity, only caregiver distress from responsive behaviours was positively associated with emergency room utilization, while caregiver burden was positively associated with length of hospital stay in the final regression model. Psychiatric morbidity was associated with healthcare utilization outcomes at the univariate level but did not reach statistical significance in final models. CONCLUSION The study identifies caregiver variables associated with the healthcare utilization of PWD. Policy makers and healthcare professionals should provide interventions to ease burden and distress amongst caregivers of PWD.
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Affiliation(s)
- Jue Hua Lau
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, Singapore.
| | - Edimansyah Abdin
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, Singapore
| | - Anitha Jeyagurunathan
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, Singapore
| | - Esmond Seow
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, Singapore
| | - Li Ling Ng
- Department of Rheumatology & Immunology, Singapore General Hospital, SingHealth, Singapore, Singapore
| | - Janhavi Ajit Vaingankar
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, Singapore
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, Singapore
| | - Mythily Subramaniam
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, Singapore
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Dufournet M, Moutet C, Achi S, Delphin-Combe F, Krolak-Salmon P, Dauphinot V. Proposition of a corrected measure of the Lawton instrumental activities of daily living score. BMC Geriatr 2021; 21:39. [PMID: 33430781 PMCID: PMC7802257 DOI: 10.1186/s12877-020-01995-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 12/29/2020] [Indexed: 11/18/2022] Open
Abstract
Background We aimed to propose a correction of the Lawton instrumental activity of daily living (IADL) score to take into account the possibility to have never done some activities, and measured its agreement and reliability with the usual IADL score. Methods A cross-sectional study was conducted in outpatients attending French memory clinics between 2014 and 2017. Lawton IADL, cognitive performance, diagnosis, neuropsychiatric symptoms, and sociodemographics characteristics were collected. A corrected IADL was calculated and its agreement with the usual IADL was assessed. Results The study included of 2391 patients (79.9 years old, 61.7% female). Based on the usual IADL, 36.9% of patients had never carried out at least one of the activities. This proportion reached 68.8% for men and 17.7% for women. Women had a mean IADL higher than men: 4.72 vs 3.49, this difference decreased when considering the corrected IADL: 4.82 vs 4.26 respectively. Based on Bland-Altman method, 93.5% of observations lied within the limits agreement. The ICC between the 2 scores was 0.98. The relationships between patients’ characteristics and the IADL scores were similar, regardless the usual or corrected version. Conclusions This corrected IADL score had an excellent degree of agreement with the usual version based the ICC. This simple correction could benefit both for the clinical practice by providing a more accurate description of the real clinical state of the patients allowing to manage them more precisely, and for research involving the evaluation of the functional abilities of patients.
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Affiliation(s)
- Marine Dufournet
- Clinical and Research Memory Centre of Lyon of Lyon (CMRR Lyon), Lyon Institute For Elderly (Institut du vieillissement I-Vie), Hospices civils de Lyon, Lyon, France
| | - Claire Moutet
- Clinical and Research Memory Centre of Lyon of Lyon (CMRR Lyon), Lyon Institute For Elderly (Institut du vieillissement I-Vie), Hospices civils de Lyon, Lyon, France
| | - Sarah Achi
- Clinical and Research Memory Centre of Lyon of Lyon (CMRR Lyon), Lyon Institute For Elderly (Institut du vieillissement I-Vie), Hospices civils de Lyon, Lyon, France
| | - Floriane Delphin-Combe
- Clinical and Research Memory Centre of Lyon of Lyon (CMRR Lyon), Lyon Institute For Elderly (Institut du vieillissement I-Vie), Hospices civils de Lyon, Lyon, France
| | - Pierre Krolak-Salmon
- Clinical and Research Memory Centre of Lyon of Lyon (CMRR Lyon), Lyon Institute For Elderly (Institut du vieillissement I-Vie), Hospices civils de Lyon, Lyon, France.,Research Clinic Centre Aging Brain Frailty (CRC - VCF), Lyon Institute For Elderly (Institut du vieillissement I-Vie), Hospices civils de Lyon, Lyon, France.,University Lyon 1, INSERM, U1028, UMR CNRS 5292, Research Centre of Neurosciences of Lyon, Lyon, France
| | - Virginie Dauphinot
- Clinical and Research Memory Centre of Lyon of Lyon (CMRR Lyon), Lyon Institute For Elderly (Institut du vieillissement I-Vie), Hospices civils de Lyon, Lyon, France. .,Hôpital des Charpennes, 27 avenue Gabriel Péri, 69 100, Villeurbanne, France.
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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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González-Fraile E, Ballesteros J, Rueda JR, Santos-Zorrozúa B, Solà I, McCleery J. Remotely delivered information, training and support for informal caregivers of people with dementia. Cochrane Database Syst Rev 2021; 1:CD006440. [PMID: 33417236 PMCID: PMC8094510 DOI: 10.1002/14651858.cd006440.pub3] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Many people with dementia are cared for at home by unpaid informal caregivers, usually family members. Caregivers may experience a range of physical, emotional, financial and social harms, which are often described collectively as caregiver burden. The degree of burden experienced is associated with characteristics of the caregiver, such as gender, and characteristics of the person with dementia, such as dementia stage, and the presence of behavioural problems or neuropsychiatric disturbances. It is a strong predictor of admission to residential care for people with dementia. Psychoeducational interventions might prevent or reduce caregiver burden. Overall, they are intended to improve caregivers' knowledge about the disease and its care; to increase caregivers' sense of competence and their ability to cope with difficult situations; to relieve feelings of isolation and allow caregivers to attend to their own emotional and physical needs. These interventions are heterogeneous, varying in their theoretical framework, components, and delivery formats. Interventions that are delivered remotely, using printed materials, telephone or video technologies, may be particularly suitable for caregivers who have difficulty accessing face-to-face services because of their own health problems, poor access to transport, or absence of substitute care. During the COVID-19 pandemic, containment measures in many countries required people to be isolated in their homes, including people with dementia and their family carers. In such circumstances, there is no alternative to remote delivery of interventions. OBJECTIVES To assess the efficacy and acceptability of remotely delivered interventions aiming to reduce burden and improve mood and quality of life of informal caregivers of people with dementia. SEARCH METHODS We searched the Specialised Register of the Cochrane Dementia and Cognitive Improvement Group, MEDLINE, Embase and four other databases, as well as two international trials registries, on 10 April 2020. We also examined the bibliographies of relevant review papers and published trials. SELECTION CRITERIA We included only randomised controlled trials that assessed the remote delivery of structured interventions for informal caregivers who were providing care for people with dementia living at home. Caregivers had to be unpaid adults (relatives or members of the person's community). The interventions could be delivered using printed materials, the telephone, the Internet or a mixture of these, but could not involve any face-to-face contact with professionals. We categorised intervention components as information, training or support. Information interventions included two key elements: (i) they provided standardised information, and (ii) the caregiver played a passive role. Support interventions promoted interaction with other people (professionals or peers). Training interventions trained caregivers in practical skills to manage care. We excluded interventions that were primarily individual psychotherapy. Our primary outcomes were caregiver burden, mood, health-related quality of life and dropout for any reason. Secondary outcomes were caregiver knowledge and skills, use of health and social care resources, admission of the person with dementia to institutional care, and quality of life of the person with dementia. DATA COLLECTION AND ANALYSIS Study selection, data extraction and assessment of the risk of bias in included studies were done independently by two review authors. We used the Template for Intervention Description and Replication (TIDieR) to describe the interventions. We conducted meta-analyses using a random-effects model to derive estimates of effect size. We used GRADE methods to describe our degree of certainty about effect estimates. MAIN RESULTS We included 26 studies in this review (2367 participants). We compared (1) interventions involving training, support or both, with or without information (experimental interventions) with usual treatment, waiting list or attention control (12 studies, 944 participants); and (2) the same experimental interventions with provision of information alone (14 studies, 1423 participants). We downgraded evidence for study limitations and, for some outcomes, for inconsistency between studies. There was a frequent risk of bias from self-rating of subjective outcomes by participants who were not blind to the intervention. Randomisation methods were not always well-reported and there was potential for attrition bias in some studies. Therefore, all evidence was of moderate or low certainty. In the comparison of experimental interventions with usual treatment, waiting list or attention control, we found that the experimental interventions probably have little or no effect on caregiver burden (nine studies, 597 participants; standardised mean difference (SMD) -0.06, 95% confidence interval (CI) -0.35 to 0.23); depressive symptoms (eight studies, 638 participants; SMD -0.05, 95% CI -0.22 to 0.12); or health-related quality of life (two studies, 311 participants; SMD 0.10, 95% CI -0.13 to 0.32). The experimental interventions probably result in little or no difference in dropout for any reason (eight studies, 661 participants; risk ratio (RR) 1.15, 95% CI 0.87 to 1.53). In the comparison of experimental interventions with a control condition of information alone, we found that experimental interventions may result in a slight reduction in caregiver burden (nine studies, 650 participants; SMD -0.24, 95% CI -0.51 to 0.04); probably result in a slight improvement in depressive symptoms (11 studies, 1100 participants; SMD -0.25, 95% CI -0.43 to -0.06); may result in little or no difference in caregiver health-related quality of life (two studies, 257 participants; SMD -0.03, 95% CI -0.28 to 0.21); and probably result in an increase in dropouts for any reason (12 studies, 1266 participants; RR 1.51, 95% CI 1.04 to 2.20). AUTHORS' CONCLUSIONS Remotely delivered interventions including support, training or both, with or without information, may slightly reduce caregiver burden and improve caregiver depressive symptoms when compared with provision of information alone, but not when compared with usual treatment, waiting list or attention control. They seem to make little or no difference to health-related quality of life. Caregivers receiving training or support were more likely than those receiving information alone to drop out of the studies, which might limit applicability. The efficacy of these interventions may depend on the nature and availability of usual services in the study settings.
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Affiliation(s)
| | - Javier Ballesteros
- Department of Neuroscience, University of the Basque Country, CIBER Salud Mental (CIBERSAM), Leioa, Spain
| | - José-Ramón Rueda
- Department of Preventive Medicine and Public Health, University of the Basque Country, Leioa, Spain
| | - Borja Santos-Zorrozúa
- Scientific coordination Unit, Biocruces Health Research Institute, Cruces University Hospital, Barakaldo, Spain
| | - Ivan Solà
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
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Lee KH, Lee JY, Kim B. Person-Centered Care in Persons Living with Dementia: A Systematic Review and Meta-Analysis. THE GERONTOLOGIST 2020; 62:e253-e264. [PMID: 33326573 PMCID: PMC9019632 DOI: 10.1093/geront/gnaa207] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Indexed: 11/14/2022] Open
Abstract
Background and Objectives The concept of person-centered care has been utilized/adapted to various interventions to enhance health-related outcomes and ensure the quality of care delivered to persons living with dementia. A few systematic reviews have been conducted on the use of person-centered interventions in the context of dementia care, but to date, none have analyzed intervention effect by intervention type and target outcome. This study aimed to review person-centered interventions used in the context of dementia care and examine their effectiveness. Research Design and Methods A systematic review and meta-analysis were conducted. We searched through 5 databases for randomized controlled trials that utilized person-centered interventions in persons living with dementia from 1998 to 2019. Study quality was assessed using the National Institute for Health and Clinical Excellence checklist. The outcomes of interest for the meta-analysis were behavioral and psychological symptoms in dementia (BPSD) and cognitive function assessed immediately after the baseline measurement. Results In total, 36 studies were systematically reviewed. Intervention types were reminiscence, music, and cognitive therapies, and multisensory stimulation. Thirty studies were included in the meta-analysis. Results showed a moderate effect size for overall intervention, a small one for music therapy, and a moderate one for reminiscence therapy on BPSD and cognitive function. Discussion and Implications Generally speaking, person-centered interventions showed immediate intervention effects on reducing BPSD and improving cognitive function, although the effect size and significance of each outcome differed by intervention type. Thus, health care providers should consider person-centered interventions as a vital element in dementia care.
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Affiliation(s)
- Kyung Hee Lee
- Yonsei University College of Nursing, Seoul, South Korea.,Mo-Im Kim Nursing Research Institute, Seoul, South Korea
| | - Ji Yeon Lee
- Yonsei University College of Nursing, Seoul, South Korea
| | - Bora Kim
- Yonsei University College of Nursing, Seoul, South Korea
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Mjørud M, Selbæk G, Bjertness E, Edwin TH, Engedal K, Knapskog AB, Strand BH. Time from dementia diagnosis to nursing-home admission and death among persons with dementia: A multistate survival analysis. PLoS One 2020; 15:e0243513. [PMID: 33275638 PMCID: PMC7717539 DOI: 10.1371/journal.pone.0243513] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/22/2020] [Indexed: 12/28/2022] Open
Abstract
Objectives To estimate transition times from dementia diagnosis to nursing-home (NH) admission or death and to examine whether sex, education, marital status, level of cognitive impairment and dementia aetiology are associated with transition times. Design Markov multistate survival analysis and flexible parametric models. Setting Participants were recruited from the Norwegian Registry of Persons Assessed for Cognitive Symptoms (NorCog) in specialist healthcare between 2008 and 2017 and followed until August 2019, a maximum of 10.6 years follow-up time (mean 4.4 years, SD 2.2). Participants’ address histories, emigration and vital status were retrieved from the National Population Registry from time of diagnosis and linked to NorCog clinical data. Participants 2,938 home-dwelling persons with dementia, ages 40–97 years at time of diagnosis (mean 76.1, SD 8.5). Results During follow-up, 992 persons (34%) were admitted to nursing-homes (NHs) and 1,556 (53%) died. Approximately four years after diagnosis, the probability of living in a NH peaked at 19%; thereafter, the probability decreased due to mortality. Median elapsed time from dementia diagnosis to NH admission among those admitted to NHs was 2.28 years (IQR 2.32). The probability of NH admission was greater for women than men due to women´s lower mortality rate. Persons living alone, particularly men, had a higher probability of NH admission than cohabitants. Age, dementia aetiology and severity of cognitive impairment at time of diagnosis did not influence the probability of NH admission. Those with fewer than 10 years of education had a lower probability of NH admission than those with 10 years or more, and this was independent of the excess mortality in the less-educated group. Conclusion Four years after diagnosis, half of the participants still lived at home, while NH residency peaked at 19%. Those with fewer than 10 years of education were less often admitted to NH.
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Affiliation(s)
- Marit Mjørud
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
- * E-mail:
| | - Geir Selbæk
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Espen Bjertness
- Faculty of Medicine, Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Trine Holt Edwin
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Knut Engedal
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | | | - Bjørn Heine Strand
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
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Comorbid Conditions Among Adults 50 Years and Older With Traumatic Brain Injury: Examining Associations With Demographics, Healthcare Utilization, Institutionalization, and 1-Year Outcomes. J Head Trauma Rehabil 2020; 34:224-232. [PMID: 30829819 DOI: 10.1097/htr.0000000000000470] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To assess the relationship of acute complications, preexisting chronic diseases, and substance abuse with clinical and functional outcomes among adults 50 years and older with moderate-to-severe traumatic brain injury (TBI). DESIGN Prospective cohort study. PARTICIPANTS Adults 50 years and older with moderate-to-severe TBI (n = 2134). MEASURES Clusters of comorbid health conditions empirically derived from non-injury International Classification of Diseases, Ninth Revision codes, demographic/injury variables, and outcome (acute and rehabilitation length of stay [LOS], Functional Independence Measure efficiency, posttraumatic amnesia [PTA] duration, institutionalization, rehospitalization, and Glasgow Outcome Scale-Extended (GOS-E) at 1 year). RESULTS Individuals with greater acute hospital complication burden were more often middle-aged men, injured in motor vehicle accidents, and had longer LOS and PTA. These same individuals experienced higher rates of 1-year rehospitalization and greater odds of unfavorable GOS-E scores at 1 year. Those with greater chronic disease burden were more likely to be rehospitalized at 1 year. Individuals with more substance abuse burden were most often younger (eg, middle adulthood), black race, less educated, injured via motor vehicle accidents, and had an increased risk for institutionalization. CONCLUSION Preexisting health conditions and acute complications contribute to TBI outcomes. This work provides a foundation to explore effects of comorbidity prevention and management on TBI recovery in older adults.
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Rathnayake S, Moyle W, Jones C, Calleja P. Co-design of an mHealth application for family caregivers of people with dementia to address functional disability care needs. Inform Health Soc Care 2020; 46:1-17. [DOI: 10.1080/17538157.2020.1793347] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Sarath Rathnayake
- Menzies Health Institute Queensland, Griffith University, Nathan, Australia
- School of Nursing and Midwifery, Griffith University, Brisbane, Australia
- Department of Nursing, University of Peradeniya, Kandy, Sri Lanka
| | - Wendy Moyle
- Menzies Health Institute Queensland, Griffith University, Nathan, Australia
- School of Nursing and Midwifery, Griffith University, Brisbane, Australia
| | - Cindy Jones
- Menzies Health Institute Queensland, Griffith University, Nathan, Australia
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Pauline Calleja
- Menzies Health Institute Queensland, Griffith University, Nathan, Australia
- School of Nursing and Midwifery, Griffith University, Brisbane, Australia
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Fakolade A, Walters AJ, Cameron J, Latimer-Cheung AE, Pilutti LA. Healthy together: A systematic review of theory and techniques used in health interventions for persons with chronic neurological conditions and their caregivers. PATIENT EDUCATION AND COUNSELING 2020; 103:788-803. [PMID: 31767245 DOI: 10.1016/j.pec.2019.10.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 09/03/2019] [Accepted: 10/28/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To evaluate the level of theory application and use of behaviour change techniques (BCTs) in dyadic health interventions for persons with chronic neurological conditions (CNCs) and their caregivers. METHODS A systematic review of five databases was conducted to locate articles published before January 2019. Methodological quality was assessed, study characteristics, theory application and BCTs were narratively summarized. RESULTS More than half of the studies identified (59% [16/27]) did not mention theory, and only 22% (6/27) were explicitly theory-based. Across the 27 studies, two to 17 BCTs (mean = 6.8 ± 4.02) were used. Common BCTs were related to intervention implementation (e.g., credible source), knowledge (e.g., instruction on how to perform behaviour) and skill development (e.g., behavioural practice/rehearsal). CONCLUSIONS Researchers need to incorporate theory-based dyadic techniques that target both people with CNCs and their caregivers into the design and implementation of future health interventions. PRACTICE IMPLICATIONS Health professionals require explicitly theory-based interventions to provide dyads with CNCs techniques that they can apply in their daily life to the benefit of each individual and the partnership.
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Affiliation(s)
- Afolasade Fakolade
- Interdisciplinary School of Health Sciences, Brain and Mind Research Institute, University of Ottawa, Ottawa, Canada
| | - Alexandra J Walters
- School of Kinesiology and Health Studies, Queen's University, Kingston, Canada
| | - Julie Cameron
- Interdisciplinary School of Health Sciences, Brain and Mind Research Institute, University of Ottawa, Ottawa, Canada
| | | | - Lara A Pilutti
- Interdisciplinary School of Health Sciences, Brain and Mind Research Institute, University of Ottawa, Ottawa, Canada.
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Joling KJ, Janssen O, Francke AL, Verheij RA, Lissenberg-Witte BI, Visser PJ, van Hout HPJ. Time from diagnosis to institutionalization and death in people with dementia. Alzheimers Dement 2020; 16:662-671. [PMID: 32072728 PMCID: PMC7984226 DOI: 10.1002/alz.12063] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 10/14/2019] [Accepted: 01/03/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Reliable estimates of time from diagnosis until institutionalization and death in people with dementia from routine nationally representative databases are lacking. METHODS We selected 9230 people with dementia and 24,624 matched controls from family physicians' electronic records linked with national administrative databases to analyze time until institutionalization and death and associated factors. RESULTS Median time from recorded diagnosis until institutionalization and until death for people with dementia was 3.9 and 5.0 years, respectively, which was considerably shorter than for controls. Once institutionalized, median time to death was longer for persons with dementia (2.5 years) than for controls (1.2 years). Older age and receiving home care were the strongest predictors of shorter time until institutionalization and death in people with dementia. Gender, cohabitation, migration status, frailty, polypharmacy, and dementia medication were other significant factors. DISCUSSION The estimates could help to inform patients, their families, and policymakers about probable trajectories.
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Affiliation(s)
- Karlijn J Joling
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Olin Janssen
- Alzheimer Centre Limburg, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Anneke L Francke
- Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Robert A Verheij
- Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Birgit I Lissenberg-Witte
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Pieter-Jelle Visser
- Alzheimer Centre Limburg, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Neurology, Alzheimer Centre Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Hein P J van Hout
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, Amsterdam, The Netherlands
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Vezmar-Kovačević S. Pharmaceutical care in Alzheimer's disease. ARHIV ZA FARMACIJU 2020. [DOI: 10.5937/arhfarm2002069v] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Nuutinen M, Leskelä RL, Torkki P, Suojalehto E, Tirronen A, Komssi V. Developing and validating models for predicting nursing home admission using only RAI-HC instrument data. Inform Health Soc Care 2019; 45:292-308. [PMID: 31696753 DOI: 10.1080/17538157.2019.1656212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE In recent years research has identified important predictors for nursing home admission (NHA). However, as far as we know, the previous risk models use complex variable sets from many sources and the output is a single risk value. The objective of this study was to develop an NHA risk model with a variable set from single data source and richer output information. METHODS In this study, we developed a model selecting variables only from the RAI-HC (Resident Assessment Instrument - Home Care) system. Furthermore, we used principal component analysis and K-means clustering to target proper interventions for high-risk clients. RESULTS The performance of the model was close to the complex previous model (recall [Formula: see text] vs. [Formula: see text] and specificity [Formula: see text] vs. [Formula: see text]). For the risk clients, three intervention clusters (deficiency in physical functionality, deficiency in cognitive functionality and depression and mood disorders) were found. CONCLUSION The NHA risk model and intervention clusters are important because they enable the identification of proper interventions for the right clients. The fact that the model with RAI-HC data alone was accurate enough simplifies the integration of the NHA risk model into practice because it uses data from one system and the algorithm can be integrated easily into the source system.
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Affiliation(s)
- M Nuutinen
- Nordic Healthcare Group , Helsinki, Finland
| | | | - P Torkki
- Nordic Healthcare Group , Helsinki, Finland
| | | | | | - V Komssi
- Nordic Healthcare Group , Helsinki, Finland
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Packer R, Ben Shlomo Y, Whiting P. Can non-pharmacological interventions reduce hospital admissions in people with dementia? A systematic review. PLoS One 2019; 14:e0223717. [PMID: 31634375 PMCID: PMC6802851 DOI: 10.1371/journal.pone.0223717] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 09/26/2019] [Indexed: 12/21/2022] Open
Abstract
Background People with dementia who are admitted to hospital have worse outcomes than those without dementia. Identifying interventions that could reduce the risk of hospitalisation in people with dementia has the potential to positively impact on lives of people with dementia. This review aimed to investigate whether there are non-pharmacological interventions that successfully reduce hospitalisation risk, length of stay and mortality in people with dementia. Methods 7 electronic databases and trial registries were searched from inception to October 2018. We included randomised controlled trials that evaluated non-pharmacological interventions in out of hospital settings and targeted people with any type of dementia. All stages of the review process were performed by two reviewers. Risk of bias was assessed using the Cochrane Risk of Bias tool. We grouped studies based on intervention: care management, counselling/self-help, enhanced GP services or memory clinics, and physiotherapy or occupational therapy. Data were pooled within intervention categories using random effects meta-analysis. Results There was no evidence that any of the intervention categories were associated with reduced hospital admission or mortality. There was very weak evidence to suggest that care management interventions (mean difference, MD, -0.16, 95% CI -0.32, 0.01), physiotherapy/occupational therapy (MD -0.16, 95% CI -0.36, 0.03) and enhanced GP/memory clinics (MD -0.14, 95% CI -0.31, 0.03) were associated with small reductions in hospital stay. There was no evidence for an effect of counselling/self-help interventions on length of hospital stay. Conclusions Current evidence from randomised trials suggests no clear benefit or harm associated with any of interventions on risks of hospitalisation, duration of hospitalisation or death. Further research with the primary aim to reduce hospitalisation in people with dementia is required.
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Affiliation(s)
- Richard Packer
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Yoav Ben Shlomo
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Penny Whiting
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- * E-mail:
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Dufournet M, Dauphinot V, Moutet C, Verdurand M, Delphin-Combe F, Krolak-Salmon P, Krolak-Salmon P, Dauphinot V, Delphin-Combe F, Makaroff Z, Federico D, Coste MH, Rouch I, Dorey JM, Lepetit A, Danaila K, Vernaudon J, Bathsavanis A, Sarciron A, Guilhermet Y, Gaujard S, Grosmaître P, Moutet C, Verdurand M. Impact of Cognitive, Functional, Behavioral Disorders, and Caregiver Burden on the Risk of Nursing Home Placement. J Am Med Dir Assoc 2019; 20:1254-1262. [DOI: 10.1016/j.jamda.2019.03.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 03/21/2019] [Accepted: 03/22/2019] [Indexed: 01/10/2023]
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Terum TM, Testad I, Rongve A, Aarsland D, Svendsboe E, Andersen JR. The association between specific neuropsychiatric disturbances in people with Alzheimer's disease and dementia with Lewy bodies and carer distress. Int J Geriatr Psychiatry 2019; 34:1421-1428. [PMID: 31050041 DOI: 10.1002/gps.5134] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 04/12/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Neuropsychiatric symptoms (NPSs) are identified as important care-recipient variables in terms of the impact on carer distress. The aim of this study was to determine whether specific neuropsychiatric disturbances in people with Alzheimer disease (AD) and dementia with Lewy bodies (DLB) differentially impact carer distress. METHODS This was a cross-sectional study of people diagnosed with AD and DLB and their primary carers. The Relatives' Stress Scale (RSS) was used to assess the level of reported distress in carers, and the Neuropsychiatric Inventory (NPI) was used to assess NPSs. The effect of NPSs on carer distress was analyzed using correlation analysis and partial least squares regression. RESULTS This study included 159 participants diagnosed with AD (n = 97) and DLB (n = 62) and their primary carers (spouses and adult children). The majority of people diagnosed with dementia were women (64.2%), with a mean age of 75.9 years (SD, 7.4) and a mean Mini-Mental State Examination (MMSE) score of 23.5 (SD, 2.9). The main analysis identified apathy as the most important NPS contributing to carer distress. Compared with AD, the explained variance in the DLB group was higher (r2 = 37.3 vs r2 = 53.7). In addition, more NPSs were considered clinically important in the DLB group. CONCLUSION The findings of this study identify apathy as the most important NPS contributing to carer distress among carers of people with AD and DLB. These findings help us identify the support needs of families dealing with dementia.
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Affiliation(s)
- Toril Marie Terum
- Faculty of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, Norway.,Centre for Age-related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Center of Health Research, Førde Hospital Trust, Førde, Norway
| | - Ingelin Testad
- Centre for Age-related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway.,University of Exeter Medical School, St Luke's Campus, University of Exeter, Exeter, UK.,Department of Old Age Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Arvid Rongve
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Research and Innovation, Helse Fonna, Haugesund, Norway
| | - Dag Aarsland
- Centre for Age-related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway.,Department of Old Age Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Ellen Svendsboe
- Centre for Age-related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway.,Faculty of Health and Caring Sciences, Western Norway University of Applied Sciences, Stord, Norway
| | - John Roger Andersen
- Faculty of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, Norway.,Center of Health Research, Førde Hospital Trust, Førde, Norway
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Miranda R, Bunn F, Lynch J, Van den Block L, Goodman C. Palliative care for people with dementia living at home: A systematic review of interventions. Palliat Med 2019; 33:726-742. [PMID: 31057088 PMCID: PMC6620864 DOI: 10.1177/0269216319847092] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
BACKGROUND The European Association for Palliative Care White Paper defined optimal palliative care in dementia based on evidence and expert consensus. Yet, we know little on how to achieve this for people with dementia living and dying at home. AIMS To examine evidence on home palliative care interventions in dementia, in terms of their effectiveness on end-of-life care outcomes, factors influencing implementation, the extent to which they address the European Association for Palliative Care palliative care domains and evidence gaps. DESIGN A systematic review of home palliative care interventions in dementia. DATA SOURCES The review adhered to the PRISMA guidelines and the protocol was registered with PROSPERO (CRD42018093607). We searched four electronic databases up to April 2018 (PubMed, Scopus, Cochrane library and CINAHL) and conducted lateral searches. RESULTS We retrieved eight relevant studies, none of which was of high quality. The evidence, albeit of generally weak quality, showed the potential benefits of the interventions in improving end-of-life care outcomes, for example, behavioural disturbances. The interventions most commonly focused on optimal symptom management, continuity of care and psychosocial support. Other European Association for Palliative Care domains identified as important in palliative care for people with dementia, for example, prognostication of dying or avoidance of burdensome interventions were under-reported. No direct evidence on facilitators and barriers to implementation was found. CONCLUSIONS The review highlights the paucity of high-quality dementia-specific research in this area and recommends key areas for future work, for example, the need for process evaluation to identify facilitators and barriers to implementing interventions.
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Affiliation(s)
- Rose Miranda
- 1 End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Brussels, Belgium.,2 Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussels, Belgium
| | - Frances Bunn
- 3 Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, United Kingdom
| | - Jennifer Lynch
- 3 Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, United Kingdom
| | - Lieve Van den Block
- 1 End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Brussels, Belgium.,2 Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussels, Belgium
| | - Claire Goodman
- 3 Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, United Kingdom
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Vandepitte S, Putman K, Van Den Noortgate N, Verhaeghe S, Mormont E, Van Wilder L, De Smedt D, Annemans L. Factors Associated with the Caregivers' Desire to Institutionalize Persons with Dementia: A Cross-Sectional Study. Dement Geriatr Cogn Disord 2019; 46:298-309. [PMID: 30453298 DOI: 10.1159/000494023] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 09/21/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Dementia is one of the main reasons for institutionalization among the elderly. Few studies have explored factors associated with the caregivers' (CG) desire to institutionalize (DTI) a person with dementia (PWD). The objective of this study is to identify modifiable and non-modifiable psychosocial and sociodemographic factors associated with a caregiver's DTI. METHODS Cross-sectional data of 355 informal CG of community-dwelling PWD were analyzed. Several characteristics were identified in CG and PWD to be included in a multivariable regression model based on the purposeful selection method. RESULTS Positively modifiable associated factors were: higher CG burden, being affected by behavioral problems, and respite care use. Positively associated non-modifiable factors were: CG older age, being professionally active, and CG higher educational level. Cohabitation and change of professional situation were negatively associated. CONCLUSION Although no causality can be assumed, several practical recommendations can be suggested. First of all, these results reconfirm the importance of multicomponent strategies, especially support aimed at decreasing burden and in learning coping strategies. Also, CG might benefit from information about support options, such as respite care services. Finally, special attention should be given to older and working CG. In the latter, flexible and adaptive working conditions might alleviate burden and therefore reduce the DTI of the PWD.
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Affiliation(s)
- Sophie Vandepitte
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium,
| | - Koen Putman
- Department of Medical Sociology, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Nele Van Den Noortgate
- Department of Internal Medicine, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Sofie Verhaeghe
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Eric Mormont
- CHU UCL Namur, Service de Neurologie, Yvoir, Belgium.,Université Catholique de Louvain, Institute of NeuroScience, Louvain-la-Neuve, Belgium
| | - Lisa Van Wilder
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Delphine De Smedt
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Lieven Annemans
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Deeken F, Rezo A, Hinz M, Discher R, Rapp MA. Evaluation of Technology-Based Interventions for Informal Caregivers of Patients With Dementia-A Meta-Analysis of Randomized Controlled Trials. Am J Geriatr Psychiatry 2019; 27:426-445. [PMID: 30642650 DOI: 10.1016/j.jagp.2018.12.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 11/14/2018] [Accepted: 12/03/2018] [Indexed: 01/17/2023]
Abstract
OBJECTIVE The aim of this study was to estimate the efficacy of technology-based interventions for informal caregivers of people with dementia (PWD). METHODS PubMed, PsycINFO, and Cochrane Library databases were searched in August 2018, with no restrictions in language or publication date. Two independent reviewers identified 33 eligible randomized controlled trials (RCTs) conducting a technology-based intervention for informal carers of PWD. Meta-analyses for the outcome measures caregiver depression and caregiver burden were conducted with subgroup analyses according to mode of delivery (telephone, computer/web-based, combined interventions). To assess methodologic quality, the Cochrane risk-of-bias assessment was rated. RESULTS Meta-analyses revealed a small but significant postintervention effect of technology-based interventions for caregiver depression and caregiver burden. Combined interventions showed the strongest effects. CONCLUSION Technology-based interventions have the potential to support informal caregivers of PWD. Because of advantages such as high flexibility and availability, technology-based interventions provide a promising alternative compared with "traditional services," e.g., those for people living in rural areas. More high-quality RCTs for specific caregiver groups are needed.
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Affiliation(s)
- Friederike Deeken
- Social and Preventive Medicine (FD, AR, MH, RD, MAR), University of Potsdam, Potsdam, Germany
| | - Anna Rezo
- Social and Preventive Medicine (FD, AR, MH, RD, MAR), University of Potsdam, Potsdam, Germany
| | - Matthias Hinz
- Social and Preventive Medicine (FD, AR, MH, RD, MAR), University of Potsdam, Potsdam, Germany
| | - Robert Discher
- Social and Preventive Medicine (FD, AR, MH, RD, MAR), University of Potsdam, Potsdam, Germany
| | - Michael A Rapp
- Social and Preventive Medicine (FD, AR, MH, RD, MAR), University of Potsdam, Potsdam, Germany.
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49
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Belger M, Haro JM, Reed C, Happich M, Argimon JM, Bruno G, Dodel R, Jones RW, Vellas B, Wimo A. Determinants of time to institutionalisation and related healthcare and societal costs in a community-based cohort of patients with Alzheimer's disease dementia. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2019; 20:343-355. [PMID: 30178148 PMCID: PMC6438944 DOI: 10.1007/s10198-018-1001-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 08/27/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To examine the costs of caring for community-dwelling patients with Alzheimer's disease (AD) dementia in relation to the time to institutionalisation. METHODS GERAS was a prospective, non-interventional cohort study in community-dwelling patients with AD dementia and their caregivers in three European countries. Using identified factors associated with time to institutionalisation, models were developed to estimate the time to institutionalisation for all patients. Estimates of monthly total societal costs, patient healthcare costs and total patient costs (healthcare and social care together) prior to institutionalisation were developed as a function of the time to institutionalisation. RESULTS Of the 1495 patients assessed at baseline, 307 (20.5%) were institutionalised over 36 months. Disease severity at baseline [based on Mini-Mental State Examination (MMSE) scores] was associated with risk of being institutionalised during follow up (p < 0.001). Having a non-spousal informal caregiver was associated with a faster time to institutionalisation (944 fewer days versus having a spousal caregiver), as was each one-point worsening in baseline score of MMSE, instrumental activities of daily living and behavioural disturbance (67, 50 and 30 fewer days, respectively). Total societal costs, total patient costs and, to a lesser extent, patient healthcare-only costs were associated with time to institutionalisation. In the 5 years pre-institutionalisation, monthly total societal costs increased by more than £1000 (€1166 equivalent for 2010) from £1900 to £3160 and monthly total patient costs almost doubled from £770 to £1529. CONCLUSIONS Total societal costs and total patient costs rise steeply as community-dwelling patients with AD dementia approach institutionalisation.
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Affiliation(s)
- Mark Belger
- Lilly Research Centre, Eli Lilly and Company Limited, Erl Wood Manor, Sunninghill Road, Windlesham, Surrey, GU20 6PH, UK.
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Sant Boi de Llobregat, Barcelona, Spain
| | - Catherine Reed
- Lilly Research Centre, Eli Lilly and Company Limited, Erl Wood Manor, Sunninghill Road, Windlesham, Surrey, GU20 6PH, UK
| | - Michael Happich
- Lilly Research Centre, Eli Lilly and Company Limited, Erl Wood Manor, Sunninghill Road, Windlesham, Surrey, GU20 6PH, UK
| | - Josep Maria Argimon
- Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, Spain
| | - Giuseppe Bruno
- Clinica della Memoria, Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Richard Dodel
- Geriatrie-Zentrum Haus Berge, Essen University Hospital, Essen, Germany
| | - Roy W Jones
- RICE (The Research Institute for the Care of Older People), Royal United Hospital, Bath, UK
| | - Bruno Vellas
- Gérontopôle, Toulouse University Hospital, INSERM 1027, Toulouse, France
| | - Anders Wimo
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Centre for Research and Development, Uppsala University/County Council of Gävleborg, Gävle, Sweden
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50
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Rokstad AMM, Engedal K, Kirkevold Ø, Benth JŠ, Selbæk G. The impact of attending day care designed for home-dwelling people with dementia on nursing home admission: a 24-month controlled study. BMC Health Serv Res 2018; 18:864. [PMID: 30445937 PMCID: PMC6240251 DOI: 10.1186/s12913-018-3686-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 11/05/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Day care services offer meaningful activities, a safe environment for attendees and respite for family caregivers while being expected to delay the need for nursing home (NH) admission. However, previous research has shown inconsistent results regarding postponement of NH admission. The objective of the study was to explore the influence of a day care programme designed for home-dwelling people with dementia on NH admission. METHOD A quasi-experimental trial explored the proportion of patients permanently admitted to nursing homes after 24 months as the main outcome by comparing a group of day care attendees (DG) and a group of participants without day care (CG). In all, 257 participants were included (181 in DG and 76 in CG). A logistic regression model was developed with NH admission as the outcome. Participant group (DG or CG) was the main predictor, baseline patient and family caregiver characteristics and interactions were used as covariates. RESULTS The mean age of participants was 81.5 (SD 6.4), 65% were women and 53% lived alone. The mean MMSE score was 20.4 (SD 3.5). In all, 128 (50%) of the participants were admitted to a nursing home by the 24-month follow-up, 63 participants (25%) completed the follow-up assessment and 66 (26%) dropped out due to death (8%) and other reasons (18%). In the logistic unadjusted regression model for NH admission after 24 months, participant group (DG or CG) was not found to be a significant predictor of NH admission. The results from the adjusted model revealed that the participant group was associated with NH admission through the interactions with age, living conditions, affective symptoms, sleep symptoms and practical functioning, showing a higher probability for NH admission in DG compared to CG. CONCLUSION The study reveals no evidence to confirm that day care services designed for people with dementia postpone the need for NH admission. Admission to nursing homes seems to be based on a complex mix of personal and functional characteristics both in the person with dementia and the family caregivers. The findings should be considered in accordance with the limitation of inadequate power and the high drop-out rate. TRIAL REGISTRATION The study is registered in Clinical Trials ( NCT01943071 ).
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Affiliation(s)
- Anne Marie Mork Rokstad
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Postbox 2136, 3103 Tønsberg, Norway
- Faculty of Health Sciences and Social care, Molde University College, Molde, Norway
| | - Knut Engedal
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Postbox 2136, 3103 Tønsberg, Norway
| | - Øyvind Kirkevold
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Postbox 2136, 3103 Tønsberg, Norway
- Department of Care and Nursing, Faculty of Health, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway
- The Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
| | - Jūratė Šaltytė Benth
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway
- Health Services Research Unit, Research Centre, Akershus University Hospital, Postbox 1000, Lørenskog, 1478 Oslo, Norway
| | - Geir Selbæk
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Postbox 2136, 3103 Tønsberg, Norway
- The Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
- Department of Nursing Science, Faculty of Medicine, University of Oslo, Oslo, Norway
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