1
|
Monnet F, Pivodic L, Dupont C, Smets T, De Vleminck A, Van Audenhove C, Van den Block L. Evaluation of interactive web-based tools to stimulate reflection and communication about advance care planning with people with dementia and their family caregivers. BMC Palliat Care 2024; 23:162. [PMID: 38943119 PMCID: PMC11212172 DOI: 10.1186/s12904-024-01486-4] [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] [Received: 03/23/2024] [Accepted: 06/14/2024] [Indexed: 07/01/2024] Open
Abstract
BACKGROUND People with dementia and their family caregivers often encounter challenges in engaging in advance care planning (ACP), such as a lack of information and difficulties in engaging in ACP conversations. Using a user-centred design, we developed two interactive web-based tools as part of an ACP support website to stimulate ACP reflection and communication: (1) the 'Thinking Now About Later' tool, with open-ended questions about 'what matters most', and (2) a digital version of the 'Life Wishes Cards', a card tool with pre-formulated statements that prompt reflection about wishes for future care. This study aimed to evaluate the use of and experiences with two web-based tools by people with dementia and their family caregivers. METHODS During an eight-week period, people with dementia and family caregivers were invited to use the ACP support website in the way they preferred. The mixed-methods evaluation of the ACP tools involved capturing log data to assess website use and semi-structured qualitative interviews to capture experiences. Analyses included descriptive statistics of log data and framework analysis for qualitative data. RESULTS Of 52 participants, 21 people had dementia and 31 were family caregivers. The 'Thinking Now About Later' tool and 'Life Wishes Cards' were accessed 136 and 91 times respectively, with an average session duration of 14 minutes (SD = 27.45 minutes). 22 participants actively engaged with the tools, with the majority using the tools once, and seven revisiting them. Those who used the tools valued the guidance it provided for ACP conversations between people with dementia and their family caregivers. Participants reported that people with dementia experienced barriers to using the tools on their own, hence family caregivers usually facilitated the use and participation of people with dementia. Some highlighted not knowing what next steps to take after completing the tools online. CONCLUSIONS Although less than half the people used the ACP tools, those who used them found them helpful to facilitate communication between people with dementia and their family. Family caregivers of people with dementia played a crucial role in facilitating the use of the web-based tools.
Collapse
Affiliation(s)
- Fanny Monnet
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, Brussels, 1090, Belgium.
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussel, Belgium.
| | - Lara Pivodic
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, Brussels, 1090, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussel, Belgium
| | - Charlèss Dupont
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, Brussels, 1090, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussel, Belgium
| | - Tinne Smets
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, Brussels, 1090, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussel, Belgium
| | - Aline De Vleminck
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, Brussels, 1090, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussel, Belgium
| | | | - Lieve Van den Block
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, Brussels, 1090, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussel, Belgium
| |
Collapse
|
2
|
Dupont C, Smets T, Monnet F, Pivodic L, De Vleminck A, Van Audenhove C, Van den Block L. A website to support people with dementia and their family caregivers in advance care planning: Results of a mixed-method evaluation study. PATIENT EDUCATION AND COUNSELING 2024; 127:108357. [PMID: 38943816 DOI: 10.1016/j.pec.2024.108357] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 05/06/2024] [Accepted: 06/15/2024] [Indexed: 07/01/2024]
Abstract
OBJECTIVE This study aimed to evaluate a theory-based website to support people with dementia and their families in the advance care planning (ACP) process. METHODS We conducted an eight-week evaluation study with a convergent parallel mixed-methods design involving people with mild to moderate dementia and their family caregivers who used the website at their convenience. Interviews were conducted at baseline and after 8 weeks to evaluate usability, acceptability, feasibility, experiences, and effects on ACP knowledge, attitudes, perceived barriers to engaging in ACP, self-efficacy and skills to engage in ACP. RESULTS We included 52 participants (21 people with dementia and 31 family caregivers). In the interviews, all participants considered the website useful and valued the ACP content. Morever, participants reported that family caregivers mostly used the website alone or with the person with dementia. Participants' ACP knowledge, self-efficacy, and skills improved after 8 weeks compared the beginning of the study. CONCLUSION The website may be an ideal introduction for those wanting to start ACP, providing user-friendly content and features for initiating and exploring ACP. PRACTICAL IMPLICATIONS ACP in dementia requires a tailored approach. Extra support is crucial for website adoption, emphasising the role of family caregivers while respecting individuals' autonomy.
Collapse
Affiliation(s)
- Charlèss Dupont
- VUB-UGhent End-of-life Care Research Group, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium; Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium.
| | - Tinne Smets
- VUB-UGhent End-of-life Care Research Group, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium; Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium
| | - Fanny Monnet
- VUB-UGhent End-of-life Care Research Group, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium; Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium
| | - Lara Pivodic
- VUB-UGhent End-of-life Care Research Group, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium; Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium
| | - Aline De Vleminck
- VUB-UGhent End-of-life Care Research Group, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium; Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium
| | | | - Lieve Van den Block
- VUB-UGhent End-of-life Care Research Group, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium; Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium
| |
Collapse
|
3
|
Vandenbogaerde I, Van den Block L, Deliens L, Carduff E, van der Heide A, De Bleecker J, De Vleminck A. Experiences with advance care planning in amyotrophic lateral sclerosis: Qualitative longitudinal study with people with amyotrophic lateral sclerosis and their family carers. Palliat Med 2024; 38:572-581. [PMID: 38610119 DOI: 10.1177/02692163241242320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
BACKGROUND It is unclear when people with amyotrophic lateral sclerosis and their family carers think about their future, what they would prefer in terms of care, and how their ideas change over time. AIM Understanding experiences with advance care planning of persons with amyotrophic lateral sclerosis and their family carers-and if, when, how, and why these experiences change over time. DESIGN A qualitative longitudinal interview study. Analysis involved content analysis, followed by a two-step timeline method to describe changes in advance care planning experiences within and across participants. SETTING/PARTICIPANTS Nine persons with amyotrophic lateral sclerosis and nine family carers who were interviewed three times over a 9-month period. RESULTS All participants thought about future care, but few talked about it. Over time, advance care planning experiences were influenced by intertwined elements: (1) experienced physical decline and related future care needs; (2) how persons with amyotrophic lateral sclerosis identify themselves as patients; (3) obtaining information about diagnosis and prognosis; (4) professionals initiating conversations about medical aspects of end-of-life decisions; (5) balancing between hope to remain stable and worry about the future; and (6) protecting themselves and each other from worries about the future. CONCLUSION This study emphasizes how factors such as coping with the disease and relational dynamics shape individuals' thoughts about future care over time and how psychological, social, and medical factors are interwoven in advance care planning. The findings advocate for a process-oriented perspective, portraying advance care planning as an ongoing dialog, encompassing the needs, concerns, and emotions of both people with amyotrophic lateral sclerosis and their family carers.
Collapse
Affiliation(s)
- Isabel Vandenbogaerde
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Universiteit Gent, Brussels, Belgium
- Department of Public Health and Primary Care, Universiteit Gent, Ghent, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
| | - Lieve Van den Block
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Universiteit Gent, Brussels, Belgium
- Department of Public Health and Primary Care, Universiteit Gent, Ghent, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
| | - Luc Deliens
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Universiteit Gent, Brussels, Belgium
- Department of Public Health and Primary Care, Universiteit Gent, Ghent, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
| | | | - Agnes van der Heide
- Erasmus MC, University Medical Centre Rotterdam, Department of Public Health, Rotterdam, The Netherlands
| | - Jan De Bleecker
- Department of Head and Skin, Ghent University Hospital, Universiteit Gent, Ghent, Belgium
| | - Aline De Vleminck
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Universiteit Gent, Brussels, Belgium
- Department of Public Health and Primary Care, Universiteit Gent, Ghent, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
| |
Collapse
|
4
|
Maters J, van der Steen JT, de Vugt ME, Bakker C, Koopmans RT. Palliative Care in Nursing Home Residents with Young-Onset Dementia: Professional and Family Caregiver Perspectives. J Alzheimers Dis 2024; 97:573-586. [PMID: 38217594 PMCID: PMC10836558 DOI: 10.3233/jad-230486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2023] [Indexed: 01/15/2024]
Abstract
BACKGROUND The evidence underpinning palliative care in dementia is mostly based on research in older populations. Little is known about the palliative care needs of people with young-onset dementia (YOD). OBJECTIVE To describe palliative care practices including advance care planning (ACP) in people with YOD residing in Dutch nursing homes. METHODS The study presents baseline questionnaire data from an observational cohort study. Physicians, family caregivers, and nursing staff completed questionnaires about 185 residents with YOD. The questionnaires included items on sociodemographics, quality of life measured with the quality of life in late-stage dementia (QUALID) scale, dementia-related somatic health problems, symptoms, pain medication, psychotropic drugs, and ACP. RESULTS The mean age was 63.9 (SD 5.8) years. Half (50.3%) of them were female. Alzheimer's disease dementia (42.2%) was the most prevalent subtype. The mean QUALID score was 24.0 (SD 7.9) as assessed by family caregivers, and 25.3 (SD 8.6) as assessed by the nursing staff. Swallowing problems were the most prevalent dementia-related health problem (11.4%). Agitation was often reported by physicians (42.0%) and nursing staff (40.5%). Psychotropics were prescribed frequently (72.3%). A minority had written advance directives (5.4%) or documentation on treatment preferences by the former general practitioner (27.2%). Global care goals most often focused on comfort (73.9%). Proportions of do-not-treat orders were higher than do-treat orders for all interventions except for hospitalization and antibiotics. CONCLUSIONS ACP must be initiated earlier, before nursing home admission. A palliative approach seems appropriate even though residents are relatively young and experience few dementia-related health problems.
Collapse
Affiliation(s)
- Jasper Maters
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
- Radboudumc Alzheimer Center, Nijmegen, the Netherlands
| | - Jenny T. van der Steen
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
- Radboudumc Alzheimer Center, Nijmegen, the Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Marjolein E. de Vugt
- School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Christian Bakker
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
- Radboudumc Alzheimer Center, Nijmegen, the Netherlands
- Groenhuysen, Center for Geriatric Care, Roosendaal, the Netherlands
| | - Raymond T.C.M. Koopmans
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
- Radboudumc Alzheimer Center, Nijmegen, the Netherlands
- Joachim en Anna, Center for Specialized Geriatric Care, Nijmegen, the Netherlands
| |
Collapse
|
5
|
Dupont C, Smets T, Monnet F, Pivodic L, De Vleminck A, Van Audenhove C, Van den Block L. Defining the content of a website on advance care planning in dementia: a focus group study with family and health professionals. BMC Med Inform Decis Mak 2023; 23:254. [PMID: 37940991 PMCID: PMC10633945 DOI: 10.1186/s12911-023-02359-1] [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] [Received: 06/30/2022] [Accepted: 10/30/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Advance care planning (ACP) is a process that enables individuals to define goals and preferences for their future care. It is particularly relevant for people with dementia and their family. Interactive tools, such as websites, that encourage reflection, communication and/or documentation, may support this group in the ACP process. However, considering the specific needs of people with dementia, it is important to develop adapted tools for this population. This study was conducted to define the content of an interactive website for people with dementia and their family caregivers to support them in ACP and to assess the barriers and facilitators for potential users in finding and using such a website from the perspective of family caregivers and healthcare professionals. METHODS Online focus groups with family caregivers (serving both as potential users and proxies for people with dementia) and healthcare professionals caring for people with dementia, using a semi-structured topic guide. To analyse the data, we used thematic framework analysis with a combination of deductive and inductive approaches to coding. RESULTS We conducted 4 focus groups with family caregivers of people with dementia (n = 18) and 3 with healthcare professionals (n = 17). Regarding the content of the website, participants highlighted that information on ACP (what and why) and guidance on how to start talking about ACP throughout the dementia trajectory should be included on the website. To increase the usability of the website, most participants considered a text-to-speech and a print option as important functionalities. A lack of computer literacy was found to be the most significant barrier to finding and using the website. CONCLUSION A website for people with dementia and their family caregivers to support them in ACP should focus on comprehensive content on ACP, peer testimonials, and interactive communication tools. Moreover, there should be certain flexibility in navigating through the website so people with dementia and their family caregivers can use it at their own pace. As the next step, we will include people with dementia in developing the website.
Collapse
Affiliation(s)
- Charlèss Dupont
- VUB-UGhent End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB), Brussels, 1090, Belgium.
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, 1090, Belgium.
| | - Tinne Smets
- VUB-UGhent End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB), Brussels, 1090, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, 1090, Belgium
| | - Fanny Monnet
- VUB-UGhent End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB), Brussels, 1090, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, 1090, Belgium
| | - Lara Pivodic
- VUB-UGhent End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB), Brussels, 1090, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, 1090, Belgium
| | - Aline De Vleminck
- VUB-UGhent End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB), Brussels, 1090, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, 1090, Belgium
| | | | - Lieve Van den Block
- VUB-UGhent End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB), Brussels, 1090, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, 1090, Belgium
| |
Collapse
|
6
|
Van Rickstal R, De Vleminck A, Chambaere K, Van den Block L. People with young-onset dementia and their family caregivers discussing euthanasia: A qualitative analysis of their considerations. PATIENT EDUCATION AND COUNSELING 2023; 115:107882. [PMID: 37487346 DOI: 10.1016/j.pec.2023.107882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 06/27/2023] [Accepted: 07/03/2023] [Indexed: 07/26/2023]
Abstract
OBJECTIVES Research showed that people with young-onset dementia and their family caregivers raised the topic of euthanasia when talking about the broader topic of advance care planning. A better understanding of what people address and why may inform the evolving landscape of physician assisted dying. This study aimed to explore the considerations that people with young-onset dementia and their family caregivers expressed on euthanasia. METHODS A secondary qualitative analysis on interviews with 10 Belgian people with young-onset dementia and 25 family caregivers, using constant comparative analysis. RESULTS Respondents described similar contexts in which euthanasia had been discussed: the topic arose at 'key' moments, mostly with family caregivers, and was motivated by patients considering the impact of disease progression for themselves and their loved-ones. Caregivers shared opinions on the euthanasia law and discussed the emotional impact of discussing euthanasia. CONCLUSIONS Considerations of people with young-onset dementia towards euthanasia appear rooted in personal, as well as in anticipated interpersonal and societal suffering. The negative image associated with dementia and dementia care seemed to influence people's expectations for and thoughts on the future. PRACTICE IMPLICATIONS Patient-physician communication should include detangling motives for euthanasia requests, openly discussing fears and reflecting on prognosis.
Collapse
Affiliation(s)
- Romy Van Rickstal
- Vrije Universiteit Brussel (VUB) and Ghent University, End-of-Life Care Research Group, Brussels, Belgium; Fonds voor Wetenschappelijk Onderzoek-Vlaanderen, Brussels, Belgium.
| | - Aline De Vleminck
- Vrije Universiteit Brussel (VUB) and Ghent University, End-of-Life Care Research Group, Brussels, Belgium; Fonds voor Wetenschappelijk Onderzoek-Vlaanderen, Brussels, Belgium
| | - Kenneth Chambaere
- Vrije Universiteit Brussel (VUB) and Ghent University, End-of-Life Care Research Group, Brussels, Belgium
| | - Lieve Van den Block
- Vrije Universiteit Brussel (VUB) and Ghent University, End-of-Life Care Research Group, Brussels, Belgium; Fonds voor Wetenschappelijk Onderzoek-Vlaanderen, Brussels, Belgium; Francqui Research Professor (2020 - 2023), Belgium
| |
Collapse
|
7
|
De Vleminck A, Van den Block L. How to enhance advance care planning research? Palliat Med 2023; 37:660-662. [PMID: 37246312 DOI: 10.1177/02692163231170658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Aline De Vleminck
- Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussels, Belgium
| | - Lieve Van den Block
- Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussels, Belgium
| |
Collapse
|
8
|
Van Rickstal R, De Vleminck A, Engelborghs S, Van den Block L. Experiences with and perspectives on advance care planning in young- and late- onset dementia: A focus group study with physicians from various disciplines. Front Aging Neurosci 2023; 15:1130642. [PMID: 37056687 PMCID: PMC10088511 DOI: 10.3389/fnagi.2023.1130642] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 03/06/2023] [Indexed: 03/30/2023] Open
Abstract
IntroductionDespite the relevance of advance care planning (ACP) for people with dementia, its uptake in this population is particularly low. Several challenges for ACP in dementia have been identified from physicians’ perspectives. However, the literature available mainly includes general practitioners and focuses exclusively on the context of late-onset dementia. This is the first study to inquire physicians from four highly relevant specialisms in dementia care, with a focus toward potential specificities based on patients’ age. The research question of this study is: “What are physicians’ experiences with and perspectives on discussing ACP with people with young- and/or late-onset dementia?”.MethodsFive online focus groups were conducted with 21 physicians (general practitioners, psychiatrists, neurologists and geriatricians) in Flanders, Belgium. Verbatim transcripts were analyzed through the qualitative method of constant comparative analysis.ResultsPhysicians believed that the societal stigma related to dementia influences people’s reaction to their diagnosis, at times characterized by catastrophic expectations for the future. In this regard, they explained that the topic of euthanasia is sometimes addressed by patients very early in the disease trajectory. Respondents paid ample attention to actual end-of-life decisions, including DNR directives, when discussing ACP in dementia. Physicians felt responsible for providing accurate information on both dementia as a condition, and the legal framework of end-of-life decisions. Most participants felt that patients’ and caregivers’ wish for ACP was more driven by who their personality than by their age. Nonetheless, physicians identified specificities for a younger dementia population in terms of ACP: they believed that ACP covered more domains of life than for older persons. A high consistency regarding the viewpoints of physicians from differing specialisms was noted.DiscussionPhysicians acknowledge the added value of ACP for people with dementia and especially their caregivers. However, they face several challenges for engaging in the process. Attending to specific needs in young-onset, in comparison to late-onset dementia, requires ACP to entail more than solely medical domains. However, a medicalized view on ACP still appears to be dominant in practice as opposed to its broader conceptualization in academia.
Collapse
Affiliation(s)
- Romy Van Rickstal
- End-of-Life Care Research Group (VUB/UGhent), Brussels, Belgium
- Research Foundation—Flanders (FWO), Brussels, Belgium
- *Correspondence: Romy Van Rickstal,
| | - Aline De Vleminck
- End-of-Life Care Research Group (VUB/UGhent), Brussels, Belgium
- Research Foundation—Flanders (FWO), Brussels, Belgium
| | - Sebastiaan Engelborghs
- Department of Neurology, University Hospital Brussels, Brussels, Belgium
- Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium
| | - Lieve Van den Block
- End-of-Life Care Research Group (VUB/UGhent), Brussels, Belgium
- Research Foundation—Flanders (FWO), Brussels, Belgium
| |
Collapse
|
9
|
Abstract
PURPOSE OF REVIEW Young-onset dementia (YOD) refers to a dementia for which symptom onset occurs below the age of 65. This review summarizes the recent literature in this area, focusing on updates in epidemiology, diagnosis and service provision. RECENT FINDINGS In the last year, internationally, the prevalence of YOD was reported as 119 per 100 000, but this may vary according to population types. Although the commonest causes of YOD are Alzheimer's disease (AD) and frontotemporal dementia (FTD), there is increasing recognition that YOD is diagnostically and phenotypically broader than AD and FTD. YOD may be due to many other diseases (e.g. Huntington's disease, vascular dementia) whereas accumulation of the same protein (e.g. amyloid protein) may lead to different phenotypes of Alzheimer's disease (such as posterior cortical atrophy and behavioural-variant/frontal-variant AD). This heterogeneity of phenotypic presentation is also seen in YOD due to known genetic mutations. Biomarkers such as plasma and cerebrospinal fluid proteins, neuroimaging and genetics have shown promise in the early identification of YOD as well as providing further understanding behind the overlap between psychiatric and neurodegenerative conditions occurring in younger people. The management of YOD needs to consider age-specific issues for younger people with dementia and their family networks together with better integration with other health services such as aged, disability and improved access to services and financial assistance. SUMMARY These findings emphasize the need for early identification and appropriate age-specific and person-centred management for people with young-onset dementia.
Collapse
Affiliation(s)
- Samantha M Loi
- Department of Neuropsychiatry, Royal Melbourne Hospital
- Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
| | - Yolande Pijnenburg
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
| | - Dennis Velakoulis
- Department of Neuropsychiatry, Royal Melbourne Hospital
- Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
| |
Collapse
|
10
|
The Experiences and Views on Palliative Care of Older People with Multimorbidities, Their Family Caregivers and Professionals in a Spanish Hospital. Healthcare (Basel) 2022; 10:healthcare10122489. [PMID: 36554013 PMCID: PMC9778218 DOI: 10.3390/healthcare10122489] [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: 10/11/2022] [Revised: 12/06/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022] Open
Abstract
The increasing prevalence of complex chronic diseases in the population over 65 years of age is causing a major impact on health systems. This study aims to explore the needs and preferences of the multimorbid patient and carers to improve the palliative care received. The perspective of professionals who work with this profile of patients was also taken into account. A qualitative study was conducted using semi-structured interviews with open-ended questions. Separate topic guides were developed for patients, careers and health professionals. We included 12 patients, 11 caregivers and 16 health professionals in Spain. The results showed multiple unmet needs of patients and families/caregivers, including feelings of uncertainty, a sense of fear, low awareness and knowledge about palliative care in non-malignant settings, and a desire to improve physical, psychosocial and financial status. A consistent lack of specialized psychosocial care for both patients and caregivers was expressed and professionals highlighted the need for holistic needs assessment and effective and early referral pathways to palliative care. There is a lack of institutional support for multimorbid older patients in need of palliative care and important barriers need to be addressed by health systems to face the significant increase in these patients.
Collapse
|
11
|
Isabel V, Joachim C, Peter H, Chantal VA, Luc D, Aline DV. Support from healthcare professionals in empowering family carers to discuss advance care planning: A population-based survey. Palliat Med 2022; 37:719-729. [PMID: 36349646 DOI: 10.1177/02692163221135032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Family carers have a prominent role in end-of-life care for seriously ill persons. However, most of the Advance Care Planning literature is focused on the role of healthcare professionals. AIMS To investigate (1) what proportion of family carers discussed advance care planning with their relative and associated socio-demographic and clinical characteristics (2) what proportion received support from healthcare professionals for these conversations, (3) what type of support they received and (4) to what extent the type of support received was considered sufficient. DESIGN/PARTICIPANTS Population-based cross-sectional survey in Belgium of bereaved family carers of persons with a serious chronic illness (N = 3000) who died 2-6 months before the sample was drawn, identified through three sickness funds. The survey explored support from healthcare professionals for family carers during the last 3 months of the patient's life. RESULTS Response rate was 55%. The proportion of family carers that engaged in an advance care planning conversation with their relative was 46.9%. Of these family carers, 78.1% received support from a healthcare professional, mostly by doing the advance care planning conversation together (53.8%). Of family carers receiving support from a healthcare professional, 57.4% deemed the support sufficient. CONCLUSION Many family carers engage in advance care planning conversations with their dying relative. Healthcare professionals often support them by performing the advance care planning conversations together. More insight into how family carers can be supported to conduct these advance care planning conversations, both with and without involvement of healthcare professionals, is necessary.
Collapse
Affiliation(s)
- Vandenbogaerde Isabel
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Ghent, Belgium.,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.,Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussel, Belgium
| | - Cohen Joachim
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Ghent, Belgium.,Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussel, Belgium
| | - Hudson Peter
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Ghent, Belgium.,Centre for Palliative Care, St Vincents Hospital, The University of Melbourne, Melbourne, Australia
| | | | - Deliens Luc
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Ghent, Belgium.,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.,Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussel, Belgium
| | - De Vleminck Aline
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Ghent, Belgium.,Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussel, Belgium
| |
Collapse
|