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Sánchez-Alcón M, Sánchez-Ramos JL, Garrido-Fernández A, Sosa-Cordobés E, Ortega-Galán ÁM, Ramos-Pichardo JD. Effectiveness of interventions aimed at improving grief and depression in caregivers of people with dementia: A systematic review and meta-analysis. Int J Ment Health Nurs 2023; 32:1211-1224. [PMID: 36971150 DOI: 10.1111/inm.13142] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 03/03/2023] [Accepted: 03/12/2023] [Indexed: 06/18/2023]
Abstract
Caregivers of people suffering from dementia may go through a grieving process prior to the death of the cared-for person, which is related to mental health and physical problems. Interventions aimed at improving grief and depression are being used in response to these difficulties. The aim of this study was to synthesize and evaluate the evidence for the effectiveness of interventions aimed at improving the grief process in home-based caregivers of people with dementia with the aim of reducing grief and depression. A systematic review, including a meta-analysis, was designed. Following the PRISMA guideline, original articles were searched in the databases: Medline, WOS, Scopus and PsycINFO, up to September 2022. Articles that evaluated interventions aimed at improving the grief process in caregivers of people with dementia, whose care recipients were alive at the beginning of the study at minimum and living at home were selected. Grief and depression were considered outcome variables. A meta-analysis was carried out with a fixed effects model for these variables and for the domains of the Caregiver Grief Scale (CGS). Eight articles met the inclusion and exclusion criteria. Most of the interventions aimed at improving the grief process showed an improvement in grief and depression. The 'emotional pain' and 'absolute loss' domains of the CGS stood out with an improvement in these variables. Interventions aimed at improving the grief process are relatively effective in reducing grief and depression. Interventions that are even more effective and more robust studies are needed.
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Loup J, Smith K, Snow AL, Hilgeman MM. Illustrating Resource Needs through Data Visualization: Creation of Life-Space Maps for Rural Veterans with Dementia and their Caregivers. J Appl Gerontol 2023; 42:1631-1641. [PMID: 36812462 DOI: 10.1177/07334648231159084] [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: 02/24/2023] Open
Abstract
Rural-dwelling individuals with dementia and their caregivers face unique challenges compared to urban-dwelling peers. Barriers to accessing services and supports are common, and individual resources and informal networks available to support rural families can be difficult to track for providers and healthcare systems outside of the local community. This study uses qualitative data from rural-dwelling dyads, individuals with dementia (n = 12) and informal caregivers (n = 18), to demonstrate how rural patients' daily life needs can be summarized through life-space map visualizations. Thirty semi-structured qualitative interviews were analyzed using a two-step process. First, rapid qualitative analysis was completed to generate daily-life needs of the participants' home and community context. Next, life-space maps were developed to synthesize and visualize dyads' met and unmet needs. Results suggest life-space mapping may offer a pathway for improved needs-based information integration for busy care providers and time-sensitive quality improvement efforts by learning healthcare systems.
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Affiliation(s)
- Julia Loup
- Department of Psychology, The University of Alabama System, Tuscaloosa, AL, USA
- Alabama Research Institute on Aging, The University of Alabama System, Tuscaloosa, AL, USA
- Research and Development Service, Tuscaloosa VA Medical Center, Tuscaloosa, AL, USA
| | - Kate Smith
- Department of Psychology, The University of Alabama System, Tuscaloosa, AL, USA
- Alabama Research Institute on Aging, The University of Alabama System, Tuscaloosa, AL, USA
| | - A Lynn Snow
- Department of Psychology, The University of Alabama System, Tuscaloosa, AL, USA
- Alabama Research Institute on Aging, The University of Alabama System, Tuscaloosa, AL, USA
- Research and Development Service, Tuscaloosa VA Medical Center, Tuscaloosa, AL, USA
| | - Michelle M Hilgeman
- Department of Psychology, The University of Alabama System, Tuscaloosa, AL, USA
- Alabama Research Institute on Aging, The University of Alabama System, Tuscaloosa, AL, USA
- Research and Development Service, Tuscaloosa VA Medical Center, Tuscaloosa, AL, USA
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Ott SD, Cheema SK, Ryder A, Schatz P, Gonzalez LA, Duran J, Schulz PE. Information seeking behaviors and attitudes of wives of former football players regarding chronic traumatic encephalopathy. APPLIED NEUROPSYCHOLOGY. ADULT 2022:1-8. [PMID: 36420766 DOI: 10.1080/23279095.2022.2145892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study examines CTE-related knowledge and information-seeking behaviors of caregivers of persons who are at high risk of CTE. Online survey responses were collected from 64 females, ages 18-74, who were married to former college, semiprofessional, or professional football players and were fluent in English. Ranging from 0 to 18, a score was calculated to represent level of CTE knowledge. Participants were classified into groups based on their spouse's reported symptoms and diagnosis. Approximately 87% of participants reported that their spouses have been diagnosed with a football-related concussion and were significantly more likely to seek out information from a healthcare provider, a scientific journal or article, and post/comment on social media compared to spouses of symptomatic/undiagnosed and non-symptomatic groups. Participants reported 77% of available information as probably true, with social media thought to be highly credible. Highest levels of dissatisfaction were reported for league-sponsored websites and physicians/healthcare providers. Although the majority of participants sought CTE related information on regular or social media, and the internet, information sources differed amongst the groups. These findings may help healthcare providers and organizations develop more effective health-related educational programs that will help the wives make informed decisions regarding care for their spouses with respect to CTE.
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Affiliation(s)
- Summer D Ott
- Department of Orthopedic Surgery, McGovern Medical School at UTHealth Houston, Houston, TX, USA
| | - Sukhnandan K Cheema
- Department of Orthopedic Surgery, McGovern Medical School at UTHealth Houston, Houston, TX, USA
| | - Alexa Ryder
- McGovern Medical School at UTHealth Houston, Houston, TX, USA
| | - Philip Schatz
- Department of Psychology, Saint Joseph's University, Philadelphia, PA, USA
| | - Lorie A Gonzalez
- Department of Orthopedic Surgery, McGovern Medical School at UTHealth Houston, Houston, TX, USA
| | - Jecenia Duran
- Department of Psychology, Saint Joseph's University, Philadelphia, PA, USA
| | - Paul E Schulz
- Department of Neurology, McGovern Medical School at UTHealth Houston, Houston, TX, USA
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Evaluation of the Reitman Centre CARERS program for supporting dementia family caregivers: a pre-post intervention study. Int Psychogeriatr 2022; 34:827-838. [PMID: 33455610 DOI: 10.1017/s1041610220004019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES While family caregivers (CGs) of persons with dementia are cost-effective for the health system, this form of caregiving leads to disproportionate vulnerability to physical, mental, and social adverse health consequences among CGs. The study goal was to determine the effect of the Reitman Centre CARERS program on key outcomes in family CGs of people with dementia. The Reitman Centre CARERS program is an innovative, group psychotherapeutic skills training intervention based on integrated problem-solving techniques (PST), simulation learning, and group psychotherapy designed to address each CGs' unique situation. DESIGN A quasi-experimental, non-randomized, pre-post evaluation, multiple groups, multisite trial. SETTING Multisite group intervention provided in community agencies and hospital-based locations. PARTICIPANTS Spousal or adult child family CGs (n = 264) living in the community and providing care to community-dwelling family members with dementia. MEASUREMENT CGs were assessed for depression (CES-D); stress (PSS); burden (12-item SZBI); role overload, mastery, caregiving competence, and role captivity (Perlin scales), coping (CISS - Coping Inventory for Stressful Situations), CG reactions to CR's memory and behavioral symptoms (RMBPC). Care recipients (CRs) were assessed on basic and complex activities of daily living (Katz and Lawton). Paired t-tests and Wilcoxon signed-rank test were used for statistical analysis of both the whole group and a more compromised subgroup of CGs. RESULTS For the group as a whole, CGs showed significant positive change on post-intervention outcome measures of stress, depression, burden, competence, role captivity, overload, mastery, coping, and reaction to memory issues. The intervention showed especially robust effect sizes (ES) in more compromised CGs. These positive outcomes emerged despite a significant measured deterioration in CRs' function. CONCLUSION The CARERS program may be an effective multicomponent intervention to improve the well-being, functioning, and coping skills of dementia CGs.
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Dietzel N, Graessel E, Kürten L, Meuer S, Klaas-Ickler D, Hladik M, Chmelirsch C, Kolominsky-Rabas PL. The Dementia Assessment of Service Needs (DEMAND): Development and Validation of a Standardized Needs Assessment Instrument. J Alzheimers Dis 2022; 89:1051-1061. [PMID: 35964189 PMCID: PMC9535555 DOI: 10.3233/jad-220363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: Dementia is one of the main triggers for care dependency among older adults who are predominantly cared for at home by relatives. To provide support in the care situation, health systems need valid information about the central needs of the affected people. Objective: The present study aimed to develop a research instrument to assess the most important needs of people with dementia and their family caregivers. Methods: The development of the ‘Dementia Assessment of Service Needs (DEMAND)’ took place within the project ‘Digital Dementia Registry Bavaria (digiDEM Bayern)’. A focus group and an online survey with dementia experts were conducted to identify the most relevant support services and to develop the design of the instrument. The questionnaire was deployed in the digiDEM baseline data collection. Participants were asked to evaluate the comprehensibility of the questionnaire. Readability was assessed using the Flesch reading ease score. Results: Seventeen experts participated in the focus group and 59 people in the online survey. The final questionnaire included 13 support services. One hundred eighty-three participants (50 people with dementia and 133 family caregivers) completed the questionnaire at baseline. The mean comprehensibility score was 3.6 (SD = 2.3). The Flesch reading ease score result was 76. Conclusion: A research instrument could be developed, enabling people with dementia and family caregivers to directly express their individual needs for specific support services. Results show that the DEMAND is easy to understand and short in execution. Therefore, supply gaps can be identified and transformed into a specific health care plan.
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Affiliation(s)
- Nikolas Dietzel
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Interdisciplinary Center for HealthTechnology Assessment (HTA) and Public Health (IZPH), Erlangen, Germany
| | - Elmar Graessel
- University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Center for Health Services Research in Medicine, Department of Psychiatryand Psychotherapy, Erlangen, Germany
| | - Lara Kürten
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Interdisciplinary Center for HealthTechnology Assessment (HTA) and Public Health (IZPH), Erlangen, Germany
| | - Sebastian Meuer
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Interdisciplinary Center for HealthTechnology Assessment (HTA) and Public Health (IZPH), Erlangen, Germany
| | - Dorothee Klaas-Ickler
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Interdisciplinary Center for HealthTechnology Assessment (HTA) and Public Health (IZPH), Erlangen, Germany
| | - Markus Hladik
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Interdisciplinary Center for HealthTechnology Assessment (HTA) and Public Health (IZPH), Erlangen, Germany
| | - Christina Chmelirsch
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Interdisciplinary Center for HealthTechnology Assessment (HTA) and Public Health (IZPH), Erlangen, Germany
| | - Peter L Kolominsky-Rabas
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Interdisciplinary Center for HealthTechnology Assessment (HTA) and Public Health (IZPH), Erlangen, Germany
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Ong ZL, Chew EYH, Glass GF, Chan EY. Four of a kind: Salient caregiver archetypes to better understand the psychosocial needs and behavioral patterns of dementia caregivers in Singapore. Geriatr Nurs 2022; 43:299-308. [PMID: 34991053 DOI: 10.1016/j.gerinurse.2021.12.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/15/2021] [Accepted: 12/17/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Family caregivers' lived experiences are often perceived as a homogenous entity, preventing effective identification of unique caregiving needs and appropriate support. Our study examined and classified the varying dementia caregiving experiences in an Asian setting, through establishing caregiver archetypes. METHODS Secondary analysis of semi-structured interviews conducted with 16 dementia family caregivers in a Singapore hospital was performed. Thematic analysis and typological analysis were utilized. RESULTS Four caregiver archetypes (Reluctant, Ambivalent, Enlightened, and Selfless) were identified: Reluctant caregivers possessed poor understanding of dementia and experienced immeasurable distress; Ambivalent caregivers carried mixed feelings towards caregiving and felt unsupported; Enlightened caregivers preserved care-recipients' dignity and accepted challenges with priority on sustainable care; Selfless caregivers were overly-devoted and enmeshed in the caregiver identity. CONCLUSION Our findings are useful in providing a framework for: (1) rapid understanding of informal caregivers' varying needs, (2) targeted support in a holistic caregiver-centered manner.
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Affiliation(s)
- Zhi Lei Ong
- Nursing Research Unit, Nursing Service, Tan Tock Seng Hospital, Singapore
| | | | | | - Ee-Yuee Chan
- Nursing Research Unit, Nursing Service, Tan Tock Seng Hospital, Singapore; Alice Lee Center of Nursing Studies, National University of Singapore, Singapore.
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Needs Detection for Carers of Family Members with Dementia. Healthcare (Basel) 2021; 10:healthcare10010045. [PMID: 35052209 PMCID: PMC8775551 DOI: 10.3390/healthcare10010045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/20/2021] [Accepted: 12/24/2021] [Indexed: 11/29/2022] Open
Abstract
Aim: To determine the perceived needs of carers of non-institutionalized family members that suffer from dementia. Methods: Two-steps qualitative study by focus groups of relatives in three centres of different characteristics from the Girona Health Region (step 1) and two in-depth interviews with significant professionals in dementia care (step 2). The analysis was performed based on the interpretation of the transcribed data and the bottom-up coding of categories and themes. The information was triangulated and coding was agreed upon. Results: There were three groups, 26 main carers of community-dwelling relatives with dementia in step 1 and two in-depth interviews with dementia-specialised healthcare and social care professionals in step 2. The demands were categorised according to three main themes: whether they were addressed to the members of care services for more direct and close care, to the agencies for a better joint working and less fragmented system, or to society for better comprehension and social recognition. We emphasize the need for a consultation-liaison reference figure throughout the process both for aspects of greater efficiency in the management of resources and for greater empowerment of carers.
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Griffin JM, Riffin C, Bangerter LR, Schaepe K, Havyer RD. Provider Perspectives on Integrating Family Caregivers into Patient Care Encounters. Health Serv Res 2021; 57:892-904. [PMID: 34957543 PMCID: PMC9264458 DOI: 10.1111/1475-6773.13932] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 11/05/2021] [Accepted: 12/14/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To examine and compare healthcare provider perceptions for integrating family caregivers into patient encounters and other processes of care by medical specialty. DATA SOURCES/SETTING Data were from nineteen interviews conducted in 2018, ten with primary care or palliative care providers and nine with proceduralists or interventionists in practices located in Minnesota, Florida, and Arizona. STUDY DESIGN This was a qualitative study using data collected from one-on-one, semi-structured interviews with physicians. DATA COLLECTION Using purposeful 'maximum variation' sampling to capture differences between primary and palliative care providers and proceduralists/interventionists, data were collected, reviewed, coded, and then analyzed using inductive content analysis with a constant comparison approach. PRIMARY FINDINGS Primary care providers described a lack of organizational and institutional resources to support caregivers. Accordingly, they were compelled to curb caregiver engagement in order to meet patients' clinical care needs within the time and workflow demands in encounters. Proceduralists and interventionists described the need to assess caregivers for suitability to provide care during intense periods of treatment. They reported having access to more formal organizational resources for supporting caregivers. Overall, providers described a paradox, where caregivers are seen as contributing value to patient encounters until they need training, education, or support to provide care, at which point they become burdensome and require more time and resources than are typically available. CONCLUSIONS Results highlight how organizational constraints inhibit caregiver engagement in patient encounters and influence provider attitudes about engaging caregivers and assessing their unmet needs. Findings also provide insights into challenges across practice types for implementing state and federal laws that promote caregiver engagement. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Joan M Griffin
- Mayo Clinic, 200 First Avenue SW, Rochester, Minnesota, United States
| | - Catherine Riffin
- Weill Cornell Medicine, 420 East 70th Street, 3rd Floor (LH-317), New York, New York, United States
| | | | - Karen Schaepe
- Mayo Clinic, 200 First Avenue SW, Rochester, Minnesota, United States
| | - Rachel D Havyer
- Mayo Clinic, 200 First Avenue SW, Rochester, Minnesota, United States
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9
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Drewelow E, Altiner A, Biedenweg B, Buchhholz M, Henning E, Hoffmann W, Kohlmann T, Lücker P, Michalowsky B, Oppermann RF, Rädke A, Zorn D, Wollny A. [Task sharing in outpatient dementia care - Focus groups with GPs and nurses]. Pflege 2021; 35:215-222. [PMID: 34814707 DOI: 10.1024/1012-5302/a000851] [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] [Indexed: 11/19/2022]
Abstract
Task sharing in outpatient dementia care - Focus groups with GPs and nurses Abstract. Background: Caring for people with dementia (PWD) is challenging for the health system and family carers and can only be managed through interprofessional medical and nursing care. AIM The AHeaD study investigated attitudes of general practitioners (GPs) and nurses towards the transfer of activities previously performed by GPs to advanced nurses in the outpatient care of PWDs. METHODS In four focus group discussions with 10 GPs and 13 nurses, qualitative content analysis was used to investigate attitudes towards the transfer of certain tasks and to identify opportunities and barriers to their introduction. RESULTS GPs primarily preferred the transfer of nursing activities such as blood sampling, assessments, their monitoring or follow-up prescriptions for nursing aids. "Classical" medical tasks (e. g. diagnosis of diseases, initial prescription of medication) are still seen in the hands of GPs. Nurses demanded more appreciation and recognition for the relationship between GPs and nurse and criticised the lack of trust and insufficient communication. Both sides pointed to tight time budgets that were hardly oriented towards the actual needs of the PWD. CONCLUSIONS The implementation of a redistribution of tasks requires the creation of legal and financial framework conditions, time resources, concrete task descriptions as well as a stronger cooperation between the professional groups involved. Innovative concepts could contribute to the sensible use of the resources GP and nurses and strengthen the care of PWDs.
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Affiliation(s)
- Eva Drewelow
- Institut für Allgemeinmedizin der Universitätsmedizin Rostock, Rostock
| | - Attila Altiner
- Institut für Allgemeinmedizin der Universitätsmedizin Rostock, Rostock
| | - Bianca Biedenweg
- Institut für Community Medicine, Abteilung Methoden der Community Medicine der Universitätsmedizin Greifswald, Greifswald
| | - Maresa Buchhholz
- Institut für Community Medicine, Abteilung Methoden der Community Medicine der Universitätsmedizin Greifswald, Greifswald
| | - Esther Henning
- Institut für Community Medicine, Abteilung Methoden der Community Medicine der Universitätsmedizin Greifswald, Greifswald
| | - Wolfgang Hoffmann
- Institut für Community Medicine Abteilung Versorgungsepidemiologie und Community Health der Universitätsmedizin Greifswald, Greifswald
| | - Thomas Kohlmann
- Institut für Community Medicine, Abteilung Methoden der Community Medicine der Universitätsmedizin Greifswald, Greifswald
| | - Petra Lücker
- Institut für Community Medicine Abteilung Versorgungsepidemiologie und Community Health der Universitätsmedizin Greifswald, Greifswald
| | | | - Roman F Oppermann
- Fachbereich Gesundheit, Pflege, Management der Hochschule Neubrandenburg, Neubrandenburg
| | - Anika Rädke
- Deutsches Zentrum für Neurodegenerative Erkrankungen DZNE e. V., Greifswald
| | - Daniela Zorn
- Fachbereich Gesundheit, Pflege, Management der Hochschule Neubrandenburg, Neubrandenburg
| | - Anja Wollny
- Institut für Allgemeinmedizin der Universitätsmedizin Rostock, Rostock
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Parmar J, Anderson S, Duggleby W, Holroyd-Leduc J, Pollard C, Brémault-Phillips S. Developing person-centred care competencies for the healthcare workforce to support family caregivers: Caregiver centred care. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:1327-1338. [PMID: 32949440 DOI: 10.1111/hsc.13173] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/30/2020] [Accepted: 08/19/2020] [Indexed: 06/11/2023]
Abstract
Family caregivers (FCGs) are an integral part of the healthcare system. Currently, FCGs provide 70%-90% of the care required by community-dwelling children and adults living with complex chronic conditions and frailty. Despite FCG's contributions and the growing proportion of distressed caregivers, support for FCGs has not been a health system priority. Researchers have proposed training to enhance the competencies of health providers to work effectively with FCGs. In the absence of best practices for the competency indicators for caregiver-centred care, we have developed a competency framework for training the health workforce to support FCGs. The objectives in this paper are fourfold: (a) a brief review of stakeholder engagement that led to the development of the competencies the health workforce needs to support FCGs, (b) a description of the process used to name the competency domains, (c) a report on the Modified Delphi process (conducted 2019) used to validate the domain indicators, and (d) a description of the competency framework. We adopted a caregiver and a multilevel interdisciplinary stakeholder codesign approach throughout the competency development process. The competency domains include: (a) Recognising the Caregiver Role, (b) Communicating with FCGs, (c) Partnering with FCGs, (d) Fostering Resilience in FCGs, (e) Navigating Health and Social Systems and Accessing Resources, and, (f) Enhancing the Culture and Context of Healthcare. Our Caregiver-Centred Care Competencies for the health workforce are only a first step in supporting FCGs in their vital roles. There are few education and training resources to enable and empower health providers to support FCGs, there is an urgent need to develop training resources for the health workforce to recognise and support FCGs.
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Affiliation(s)
- Jasneet Parmar
- Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
- Edmonton Zone Home Living, Alberta Health Services, Edmonton, AB, Canada
| | - Sharon Anderson
- Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
| | - Wendy Duggleby
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Jayna Holroyd-Leduc
- Department of Medicine, Brenda Strafford Foundation Chair in Geriatric Medicine, University of Calgary, Calgary, AB, Canada
| | - Cheryl Pollard
- Bachelor of Science in Nursing, McEwan University, Edmonton, AB, Canada
| | - Suzette Brémault-Phillips
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, USA
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Steenfeldt VØ, Aagerup LC, Jacobsen AH, Skjødt U. Becoming a Family Caregiver to a Person With Dementia: A Literature Review on the Needs of Family Caregivers. SAGE Open Nurs 2021; 7:23779608211029073. [PMID: 35155770 PMCID: PMC8832314 DOI: 10.1177/23779608211029073] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 06/12/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction The dementia disease affects both the family caregivers’ health and
social and psychological well-being. The aim of this review was
to identify and describe the needs of family caregivers living
with a person with dementia at home. Method The literature review, conducted using the matrix method, was also
inspired by Thomas and Harden’s thematic synthesis. Results Three themes were identified: (1) the family caregiver’s new roles
and relationships; (2) caregiver burdens; and (3) the
caregiver’s need for information and support. Conclusion When family caregivers gradually lose their reciprocal relationship
with the person with dementia, and sometimes also with family
and friends, the need for other kinds of social contact arises
e.g. with others in a similar situation. They also need to have
some respite to provide room to pursue their own interests and
take care of their own health. Also, a high level of
individually tailored information is needed.
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Affiliation(s)
| | | | | | - Ulla Skjødt
- Center for Nursing, University College Absalon, Roskilde, Denmark
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12
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Klein OA, Boekholt M, Afrin D, Dornquast C, Dreier-Wolfgramm A, Keller A, Michalowsky B, Zwingmann I, Teipel S, Thyrian JR, Kilimann I, Hoffmann W. Effectiveness of a digitally supported care management programme to reduce unmet needs of family caregivers of people with dementia: study protocol for a cluster randomised controlled trial (GAIN). Trials 2021; 22:401. [PMID: 34134744 PMCID: PMC8206900 DOI: 10.1186/s13063-021-05290-w] [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: 11/24/2020] [Accepted: 04/23/2021] [Indexed: 11/28/2022] Open
Abstract
Background Up to two-thirds of dementia care is provided by family caregivers who often experience high burden, little support and adverse health outcomes. Enabling and supporting family caregivers to provide care at home prevents early institutionalisation of the person with dementia and alleviates the economic burden of dementia in the long term. General practitioners (GPs), as the first point of contact, have a key role in identifying and managing burden and care needs of family caregivers. However, in routine care, this opportunity is often limited by time constraints and even if caregiver needs are recognised, detailed information about regionally available support and advice on healthcare services is often lacking. Methods This is a cluster randomised, controlled trial investigating the clinical use and cost-effectiveness of a digitally supported care management programme for caregivers of people with dementia (PwD). Five hundred family caregivers will be randomised at GP offices, specialist practices and memory clinics, with about n=250 participants per arm. Participants are eligible if they are the primary family caregiver of a PwD, are at least 18 years of age and provide informed consent. Participants in the intervention group will receive an individualised care management plan, which will be carried out by qualified study nurses in collaboration with the treating GP. All participants will receive a baseline assessment and a 6-months follow-up assessment. Participants in the wait-list control group will receive usual care. Starting at the 6 months’ follow-up, the former controls will also receive an individualised management plan. Primary outcomes are the number of unmet needs (incl. the Camberwell Assessment of Need for the Elderly, CANE) and health-related quality of life (EQ-5D-5L) at 6 months. Secondary outcomes include caregiver burden (Zarit Burden Interview, ZBI), social support (Lubben Social Network Scale, LSNS), the use of medical and non-medical services (Questionnaire for the Use of Medical and Non-Medical Services, FIMA) and resource utilisation (Resource Utilisation in Dementia, RUD). The primary analysis will be based on intention-to-treat. Between- and within-group analyses and a cost-effectiveness analysis will be conducted to estimate the effect of the tablet PC-based care management programme. This trial is funded by the German Federal Joint Committee (G-BA) Innovation Fund. Discussion The findings of this trial will be useful in informing and improving current healthcare system structures and processes to support family dementia caregivers within routine care practices. Trial registration ClinicalTrials.gov NCT04037501. Registered on 30 July 2019. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05290-w.
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Affiliation(s)
- Olga A Klein
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Rostock, Germany.
| | - Melanie Boekholt
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany
| | - Dilshad Afrin
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany
| | - Christina Dornquast
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany
| | - Adina Dreier-Wolfgramm
- Hamburg University of Applied Sciences (HAW), Faculty of Business and Social Sciences, Department of Nursing and Management, Hamburg, Germany
| | - Armin Keller
- Institute of Medical Psychology and Medical Sociology, Medical Faculty, University of Rostock, Rostock, Germany
| | - Bernhard Michalowsky
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany
| | - Ina Zwingmann
- European University of Applied Sciences (EU FH), Rostock, Germany
| | - Stefan Teipel
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Rostock, Germany.,Department for Psychosomatic and Psychotherapeutical Medicine, University Hospital Rostock, Rostock, Germany
| | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany.,Institute for Community Medicine, Section Epidemiology and Community Health, University Medicine Greifswald, Greifswald, Germany
| | - Ingo Kilimann
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Rostock, Germany.,Department for Psychosomatic and Psychotherapeutical Medicine, University Hospital Rostock, Rostock, Germany
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany.,Institute for Community Medicine, Section Epidemiology and Community Health, University Medicine Greifswald, Greifswald, Germany
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13
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Sadavoy J, Sajedinejad S, Chiu M. A quasi-experimental study of the effectiveness of the Reitman Centre CARERS group intervention on family caregivers of persons with dementia. Int J Geriatr Psychiatry 2021; 36:811-821. [PMID: 33271636 DOI: 10.1002/gps.5481] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 11/29/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES This study aims to determine the effectiveness of the Reitman Centre CARERS program on key outcomes in family caregivers (CGs) of people with dementia (PWD). The Reitman Centre CARERS program is an innovative, group psychotherapeutic skills-training intervention based on integrated problem solving techniques (PST), simulation learning and group psychotherapy designed to address each CGs' unique situation. METHOD Family CGs of PWD (n = 264) that were referred to Reitman Center and the partner sites were evaluated before and after completion of the 8-week CARERS program in comparison with a wait-list control group (n = 83) who received regular care in a quasi-experimental, non-randomized, multiple group, multisite trial. General linear model was used to compare the results after adjusting for baseline measures and changes in the care recipients' daily activities (Katz Index of Independence in Activities of Daily Living). RESULTS The results indicated the effectiveness and superiority of the CARERS program over usual care on measures of CG's perceived stress, depression, burden, competence, role overload, emotion and avoidance-focused coping. CONCLUSION The CARERS program as a multi-component intervention is an effective intervention that significantly improves functioning, coping skills and well-being of dementia CGs.
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Affiliation(s)
- Joel Sadavoy
- Department of Psychiatry, Reitman Centre and Enhancing Care Program, Sinai Health, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, The Cyril & Dorothy, Joel & Jill Reitman Centre for Alzheimer's Support and Training, Sinai Health, Toronto, Ontario, Canada
| | - Sima Sajedinejad
- Department of Psychiatry, The Cyril & Dorothy, Joel & Jill Reitman Centre for Alzheimer's Support and Training, Sinai Health, Toronto, Ontario, Canada
| | - Mary Chiu
- Department of Psychiatry, The Cyril & Dorothy, Joel & Jill Reitman Centre for Alzheimer's Support and Training, Sinai Health, Toronto, Ontario, Canada
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14
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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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15
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Horton MC, Oyebode J, Clare L, Megson M, Shearsmith L, Brayne C, Kind P, Hoare Z, Al Janabi H, Hewison V, Tennant A, Wright P. Measuring Quality of Life in Carers of People With Dementia: Development and Psychometric Evaluation of Scales measuring the Impact of DEmentia on CARers (SIDECAR). THE GERONTOLOGIST 2021; 61:e1-e11. [PMID: 31688902 PMCID: PMC8023371 DOI: 10.1093/geront/gnz136] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Indexed: 02/07/2023] Open
Abstract
Background and Objectives A 2008 European consensus on research outcome measures in dementia care concluded that measurement of carer quality of life (QoL) was limited. Three systematic reviews (2012, 2017, and 2018) of dementia carer outcome measures found existing instruments wanting. In 2017, recommendations were published for developing reliable measurement tools of carers’ needs for research and clinical application. The aim of this study was to develop a new instrument to measure the QoL of dementia carers (family/friends). Methods Items were generated directly from carers following an inductive needs-led approach. Carers (n = 566) from 22 English and Welsh locations then completed the items and comparator measures at three time points. Rasch, factor, and psychometric (reliability, validity, responsiveness, and minimally important differences [MIDs]) analyses were undertaken. Results Following factor analysis, the pool of 70 items was refined to three independent scales: primary SIDECAR-D (direct impact of caring upon carer QOL, 18 items), secondary SIDECAR-I (indirect impact, 10 items), and SIDECAR-S (support and information, 11 items). All three scales satisfy Rasch model assumptions. SIDECAR-D, I, S psychometrics: reliability (internal ≥ .70; test–retest ≥ .85); convergent validity (as hypothesized); responsiveness (effect sizes: D: moderate; I and S: small); MIDs (D = 9/100, I = 10/100, S = 11/100). Discussion and Implications SIDECAR scales demonstrate robust measurement properties, meeting COSMIN quality standards for study design and psychometrics. SIDECAR provides a theoretically based needs-led QoL profile specifically for dementia carers. SIDECAR is free for use in public health, social care, and voluntary sector services, and not-for-profit organizations.
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Affiliation(s)
- Mike C Horton
- Psychometric Laboratory for Health Sciences, University of Leeds, UK
| | - Jan Oyebode
- Centre for Applied Dementia Studies, University of Bradford, UK
| | - Linda Clare
- Centre for Research in Ageing and Cognitive Health, University of Exeter, UK
| | - Molly Megson
- Leeds Institute of Medical Research at St James's, University of Leeds, UK
| | - Leanne Shearsmith
- Leeds Institute of Medical Research at St James's, University of Leeds, UK
| | - Carol Brayne
- Cambridge Institute of Public Health, University of Cambridge, UK
| | - Paul Kind
- Leeds Institute of Health Sciences, University of Leeds, UK
| | - Zoe Hoare
- School of Health Sciences, Bangor University, UK
| | - Hareth Al Janabi
- Institute of Applied Health Research, University of Birmingham, UK
| | | | - Alan Tennant
- Psychometric Laboratory for Health Sciences, University of Leeds, UK
| | - Penny Wright
- Centre for Research in Ageing and Cognitive Health, University of Exeter, UK
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16
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Abramsohn EM, Paradise KM, Glover CM, Benjamins M, Douglas L, Jerome J, Kim ML, Kostas T, Mata D, Padron F, Shah RC, Lindau ST. CommunityRx: Optimizing a Community Resource Referral Intervention for Minority Dementia Caregivers. J Appl Gerontol 2021; 41:113-123. [PMID: 33834890 DOI: 10.1177/07334648211005594] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Community resource referral systems have been implemented into care settings that serve persons with dementia but with little input from caregivers. Focus groups were conducted with African American, Hispanic, and Asian caregivers to describe their preferences for community resource referral information. Caregivers discussed the significance of a community resource list for dementia caregiving and self-care and articulated strategies for effective information delivery during a medical visit. Most caregivers acknowledged that resource needs change with progression of dementia, but no patterns emerged with regard to preference for information delivered incrementally based on disease stage or all at once. Hispanic and Asian caregivers felt that resource information should specify service providers' language and cultural capabilities. All caregivers agreed that delivery by a member of the care team with knowledge of dementia-specific resources would be most effective. Optimal delivery of community resource referrals is caregiver-centered and customizable to individual and subgroup preferences.
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Affiliation(s)
| | | | - Crystal M Glover
- Rush University Medical Center, Chicago, IL, USA.,Rush Alzheimer's Disease Center, Chicago, IL, USA
| | | | | | | | | | | | - David Mata
- Sinai Urban Health Institute, Chicago, IL, USA
| | | | - Raj C Shah
- Rush University Medical Center, Chicago, IL, USA.,Rush Alzheimer's Disease Center, Chicago, IL, USA
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17
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Abstract
OBJECTIVES Caring for a person with dementia is associated with poor mental, physical, and social health, which makes it important to consider how carers are best supported in their caring role to preserve both their and the person with dementia's well-being. At present, a robust instrument to assess carers' support needs does not exist. This study aimed to develop a self-reported questionnaire to assess the support needs of carers of people with dementia. The objectives were to: (1) generate items, (2) pilot test, and (3) field-test the questionnaire. DESIGN Development and field-testing of a new questionnaire. SETTINGS Primary and secondary health and social care of informal carers and people with dementia in nine municipalities and one dementia clinic in a hospital in Denmark. PARTICIPANTS Eight experts, 12 carers, and 7 digital users participated in pilot testing. 301 carers participated in field-testing. MEASUREMENTS Items for inclusion were generated based on interviews and literature review. An iterative process of data collection was applied to establish face and content validity of the Dementia Carer Assessment of Support Needs Tool (DeCANT) using Content Validity Index among experts and cognitive interviews with carers. Field-testing of DeCANT among carers included using the 12-item Short Form Health Survey, the Barthel-20 Index, and the Neuropsychiatric Inventory. RESULTS Initially, an item pool of 63 items was generated, and pilot testing reduced this to 42 items. Subsequent field-testing resulted in a 25-item version of DeCANT, and confirmatory factor analysis of three hypothesized models demonstrated a marginally better fit to a four-factor model with fit indices of: χ2 = 775.170 (p < 0.001), root mean square error of approximation = 0.073, Comparative Fit Index = 0.946, the Tucker-Lewis Index = 0.938, and weighted root mean residual (WRMR) = 1.265. CONCLUSIONS DeCANT is a 25-item carer-reported questionnaire that can be used to help identify their support needs when caring for a person with dementia to enable supportive interventions and improve carers' health and well-being.
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18
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Assessing caregiver needs. Int Psychogeriatr 2021; 33:331-334. [PMID: 33970062 DOI: 10.1017/s1041610220003877] [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: 11/07/2022]
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19
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Campione JR, Zebrak KA. Predictors of Unmet Need Among Informal Caregivers. J Gerontol B Psychol Sci Soc Sci 2021; 75:2181-2192. [PMID: 31907540 DOI: 10.1093/geronb/gbz165] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study investigates the relationship of caregiver demographics, caregiving intensity, caregiver support use, and aspects of the caregiving situation to a self-reported measure of unmet need among U.S. informal caregivers of older adults living at home with various conditions. METHODS Response data from 1,558 caregiver participants interviewed by telephone during the December 2016 baseline period of the Outcome Evaluation of the National Family Caregiver Support Program were used. Caregivers who responded "Definitely No" to the question "Are you receiving all the help you need?" were classified as reporting unmet need. Logistic regression was used to find significant factors associated with unmet need among the full sample and among caregivers tiered by three levels of burden. RESULTS Unmet need was reported by 22% of the caregivers. In a fully adjusted model, unmet need was predicted by higher levels of caregiving intensity, non-White race of the caregiver, and the caregiver not feeling appreciated by their care recipient. Other predictors associated with unmet need were no use of caregiver educational services, fewer respite hours, not living in a rural area, and caregiver having an education past high school. DISCUSSION Caregivers who do not feel appreciated by their care recipient and non-White caregivers should be identified as potential targets for intervention to address unmet need, especially if they are also reporting higher levels of caregiver burden. Understanding the factors associated with self-reported unmet need can assist caregiver support programs in measuring and addressing the needs of informal caregivers to support their continued caregiving.
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Affiliation(s)
- Joanne R Campione
- Department of Healthcare Delivery Research and Evaluation, Westat, Inc., Rockville, Maryland
| | - Katarzyna A Zebrak
- Department of Healthcare Delivery Research and Evaluation, Westat, Inc., Rockville, Maryland
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20
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Bravo-Benítez J, Cruz-Quintana F, Fernández-Alcántara M, Pérez-Marfil MN. Intervention Program to Improve Grief-Related Symptoms in Caregivers of Patients Diagnosed With Dementia. Front Psychol 2021; 12:628750. [PMID: 33643160 PMCID: PMC7905313 DOI: 10.3389/fpsyg.2021.628750] [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: 11/12/2020] [Accepted: 01/21/2021] [Indexed: 11/14/2022] Open
Abstract
The objectives of the present study were to adapt a grief intervention program to family caregivers of patients with dementia, and assess its effectiveness in improving the symptoms of grief and other health-related variables. The intervention was based on Shear and Bloom's grief intervention program, with the necessary adaptations for use in the grieving process for a family member's illness. A total of 52 family caregivers of individuals with dementia participated. They were evaluated using a battery of self-report measures assessing grief, overload, resilience, post-traumatic growth, experiential avoidance, health-related quality of life, and benefits of care. The results suggest that the program is effective in improving grief symptoms, caregiver burden, resilience, post-traumatic growth, and quality of life of family caregivers. It is necessary to create and implement interventions targeting caregivers' feelings and manifestations of ambiguous grief, because there is a lack of programs providing an efficient solution for the mental and physical health of caregivers, and because of the human and socioeconomic cost involved in neglecting this group.
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Affiliation(s)
- Jorge Bravo-Benítez
- Mind, Brain, and Behavior Resarch Center (CIMCYC, Centro de Investigación Mente, Cerebro y Comportamiento), University of Granada, Granada, Spain
| | - Francisco Cruz-Quintana
- Mind, Brain, and Behavior Resarch Center (CIMCYC, Centro de Investigación Mente, Cerebro y Comportamiento), University of Granada, Granada, Spain.,Faculty of Psychology, University of Granada, Granada, Spain
| | | | - María Nieves Pérez-Marfil
- Mind, Brain, and Behavior Resarch Center (CIMCYC, Centro de Investigación Mente, Cerebro y Comportamiento), University of Granada, Granada, Spain.,Faculty of Psychology, University of Granada, Granada, Spain
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21
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Szcześniak D, Rymaszewska J, Saibene FL, Lion KM, D'arma A, Brooker D, Evans SB, Evans SC, Chattat R, Scorolli C, Meiland F, Hendriks I, Dröes RM, Farina E. Meeting centres support programme highly appreciated by people with dementia and carers: a European cross-country evaluation. Aging Ment Health 2021; 25:149-159. [PMID: 31684754 DOI: 10.1080/13607863.2019.1683814] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND The Meeting Centres Support Programme (MCSP) offers a combined approach to providing practical, emotional and social support to people living with mild to moderately severe dementia and their family carers in the community. METHODS A mixed methods explanatory design was used. The evaluation took place within the framework of the international Joint Programme - Neurodegenerative Disease Research (JPND) - MEETINGDEM study in nine Meeting Centres in Italy, Poland and the United Kingdom. Eighty-seven people with dementia and 81 family carers completed a user evaluation survey after three months and 83 people with dementia and 84 carers after 6 months of participation in MCSP. Thirty-two people with dementia and 30 carers took part in focus groups after nine months. RESULTS The percentage of people with dementia who were very satisfied with the programme increased significantly over time (p = 0.05). The majority of carers reported that they felt less burdened after three months of participation in MCSP (48.1% much less; 35.4% a little less). After six months, this percentage increased significantly to 91% (p = 0.04, 57.7% much less; 33.3% little less). Focus group analysis showed that people with dementia and carers in all countries/centres improved their ability to maintain emotional balance. CONCLUSIONS The MCSP is highly appreciated by people with dementia and carers in all countries and it confirms the results of previous research into MCSP in the Netherlands. Our findings indicate that MCSP is a model that can help its users to increase their capacity to deal with the challenges caused by dementia and can promote emotional balance.
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Affiliation(s)
- Dorota Szcześniak
- Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | | | | | | | | | - Dawn Brooker
- Association for Dementia Studies, University of Worcester, United Kingdom
| | - Shirley B Evans
- Association for Dementia Studies, University of Worcester, United Kingdom
| | - Simon C Evans
- Association for Dementia Studies, University of Worcester, United Kingdom
| | - Rabih Chattat
- Department of Philosophy and Communication Studies, University of Bologna, Bologna, Italy
| | - Claudia Scorolli
- Department of Philosophy and Communication Studies, University of Bologna, Bologna, Italy
| | - Franka Meiland
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Location VU University Medical Center, Amsterdam, The Netherlands
| | - Iris Hendriks
- Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
| | - Rose-Marie Dröes
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Location VU University Medical Center, Amsterdam, The Netherlands
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Ferreira BADS, Gomes TJB, Baixinho CRSL, Ferreira ÓMR. Transitional care to caregivers of dependent older people: an integrative literature review. Rev Bras Enferm 2020; 73:e20200394. [PMID: 33175000 DOI: 10.1590/0034-7167-2020-0394] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 06/26/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To identify the needs of caregivers of dependent older people related to self-care in the transition from hospital to home. METHODS Integrative literature review that followed a predefined protocol, carried out from March to May 2019 in the platforms EBSCO, B-On, Scopus, Web of Science, and Joanna Briggs Institute. Descriptors and eligibility criteria were defined for the bibliographic sample, which was ten articles. The search was limited to articles published between 2015 and 2019 to guarantee evidence topicality. RESULTS The needs of caregivers related to transitional care can be grouped into five categories: needs in the transition into the role of caregiver; needs related to self-care of caregivers themselves; health needs; economic needs; and social and collective needs. FINAL CONSIDERATIONS The work developed by nurses regarding transitional care of caregivers must have two focuses: managing care provided to dependent older people and managing the needs of caregivers and the care offered to them.
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Turró-Garriga O, Viñas-Díez V, Conde-Sala JL, Calvó-Perxas L, Cullell-Juncà M, Mas-Vall-Llosera G, Flaqué M, Turon-Estrada A, Juvinyà-Canal D, Mioshi E, Garre-Olmo J. Caregivers' Sense of Coherence: Implications on Direct and Indirect Costs of Dementia Care. J Alzheimers Dis 2020; 78:117-126. [PMID: 32925037 DOI: 10.3233/jad-200350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Dementia care is associated with physical, emotional, and monetary impact on the informal carers providing unpaid care. Differences in the personal characteristics of caregivers may help explain the variations in the costs of dementia care. OBJECTIVE The aim of this study was to analyze the effect of caregivers' sense of coherence (SOC) on direct and indirect costs in dementia care. METHODS A cross-sectional study was conducted in community dwelling caregivers of patients with Alzheimer's disease. Data of healthcare services were obtained from clinical registries, and information was collected from caregivers regarding their use of social care resources and time spent caregiving. The transformation of all costs into Euros was made assigning a fixed cost of 10.29 € /h and 16.24 € /h for assisting in instrumental and basic activities of daily living, respectively. Caregivers' SOC was assessed using the Orientation to Life Questionnaire (OLQ-13). Adjusted regression models were developed, with different types of costs as dependent variables. RESULTS A sample of 147 caregivers was recruited. The mean OLQ-13 score was 73.3 points (SD = 11.6). The regression models showed a small association between caregivers' SOC and direct costs, mainly linked to the use of social care resources (r2 = 0.429; β= -15.6 € /month), and a greater association between SOC and indirect costs (r2 = 0.562; β= -222.3 € /month). CONCLUSION Increasing caregivers' SOC could reduce dementia care costs by decreasing the use of social care resources and caregiving time.
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Affiliation(s)
- Oriol Turró-Garriga
- Aging, Disability and Health Research Group of Girona Biomedical Research Institute [IdIBGI], Salt, Catalonia.,Registry of Dementia of Girona (ReDeGi), Institut d'Assistència Sanitària, Salt, Catalonia
| | - Vanesa Viñas-Díez
- Faculty of Psychology, University of Barcelona, Barcelona, Catalonia
| | - Josep Lluís Conde-Sala
- Aging, Disability and Health Research Group of Girona Biomedical Research Institute [IdIBGI], Salt, Catalonia.,Faculty of Psychology, University of Barcelona, Barcelona, Catalonia
| | - Laia Calvó-Perxas
- Aging, Disability and Health Research Group of Girona Biomedical Research Institute [IdIBGI], Salt, Catalonia
| | - Marta Cullell-Juncà
- Centre Socio Sanitari Bernat Jaume, Fundació Salut Empordà, Figueres, Catalonia
| | | | - Margarida Flaqué
- Centre Socio Sanitari Palamós Gent Gran, Serveis Sanitaris Integrats del Baix Empordà, Palamós, Catalonia
| | - Antoni Turon-Estrada
- Registry of Dementia of Girona (ReDeGi), Institut d'Assistència Sanitària, Salt, Catalonia
| | | | - Eneida Mioshi
- School of Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Josep Garre-Olmo
- Aging, Disability and Health Research Group of Girona Biomedical Research Institute [IdIBGI], Salt, Catalonia.,Registry of Dementia of Girona (ReDeGi), Institut d'Assistència Sanitària, Salt, Catalonia.,Department of Medical Sciences, University of Girona, Girona, Catalonia
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24
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Morrisby C, Ciccarelli M, Joosten A. Mind the gap: Comparing perspectives of service providers to the needs of people with dementia living in the community. DEMENTIA 2020; 20:1425-1441. [PMID: 32755229 DOI: 10.1177/1471301220947837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Research with West Australian people with dementia and their carers living in the community identified that they have a diverse range of needs. However, little is known about the needs of people with dementia and their carers from the perspectives of service providers who provide formal support. This study aimed to investigate the needs of people with dementia and their carers living in the community from the perspectives of service providers, and compare this to service recipients. METHOD This interpretive descriptive study used focus groups to collect qualitative data from service providers (N = 10). Data were analysed using a hybrid inductive-deductive approach to compare the needs identified by service providers to those identified by people with dementia and their carers. RESULTS Three major themes were identified: (i) services and supports required by people with dementia and their carers should be flexible, tailored, and equitable; (ii) building capacity to support carers and people with dementia; and (iii) systems designed to care were fragmented and difficult to navigate. Service providers prioritise needs that are limited to their current capacity to provide in contrast to the holistic needs of people with dementia and their carers. CONCLUSION There was poor alignment between the perceived needs of people with dementia and their carers and the needs prioritised by service providers in the West Australian community. This gap may reduce the ability of services to effectively support people with dementia to remain living in the community.
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25
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Brandão T, Brites R, Pereira FM, Hipólito J, Nunes O. The Perceived Needs Questionnaire for Dementia Informal Caregivers (PNQ-DIC): development and initial validation. Psychogeriatrics 2020; 20:533-535. [PMID: 31984613 DOI: 10.1111/psyg.12512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 12/27/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Tânia Brandão
- The Centre for Research in Psychology, Department of Psychology, Autonomous University of Lisbon, Lisbon, Portugal.,Center for Psychology at University of Porto, Porto, Portugal
| | - Rute Brites
- The Centre for Research in Psychology, Department of Psychology, Autonomous University of Lisbon, Lisbon, Portugal
| | | | - João Hipólito
- Center for Psychology at University of Porto, Porto, Portugal
| | - Odete Nunes
- The Centre for Research in Psychology, Department of Psychology, Autonomous University of Lisbon, Lisbon, Portugal
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26
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Clemmensen TH, Lauridsen HH, Andersen-Ranberg K, Kristensen HK. 'I know his needs better than my own' - carers' support needs when caring for a person with dementia. Scand J Caring Sci 2020; 35:586-599. [PMID: 32410395 PMCID: PMC8246922 DOI: 10.1111/scs.12875] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 02/27/2020] [Accepted: 04/21/2020] [Indexed: 12/21/2022]
Abstract
Background Caring for a person with dementia predisposes informal carers (carers) to mental and physical disability. Carers tend to focus on the needs of the person with dementia and have difficulties expressing their own needs for support. No instrument has yet been developed to directly assess carers’ support needs. The aim of this study is to clarify the main categories of carers’ support needs to inform future development of an instrument to assess carers’ support needs. Methods A qualitative approach combining focus group interviews with carers and professionals and individual interviews were used. Results Carers’ support needs were categorised into four areas: (i) daily life when caring for a person with dementia, (ii) focus on themselves, (iii) maintain own well‐being, and (iv) communicate and interact with surroundings. Discussion Carers have support needs in common regardless of the relation to the person with dementia. Carers tend to focus on the needs of the person with dementia, thus not knowing their own needs. The four main categories clarified in this study may inform the foundation of developing an instrument to facilitate dialogue between carers and professionals with the purpose of assessing carers’ support needs.
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Affiliation(s)
- Trine Holt Clemmensen
- Health Sciences Research Centre, UCL University College, Odense, Denmark.,Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Henrik Hein Lauridsen
- Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Karen Andersen-Ranberg
- Department of Public Health, University of Southern Denmark, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Hanne Kaae Kristensen
- Health Sciences Research Centre, UCL University College, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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27
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Zwingmann I, Michalowsky B, Esser A, Kaczynski A, Monsees J, Keller A, Hertel J, Wucherer D, Thyrian JR, Eichler T, Kilimann I, Teipel S, Dreier Wolfgramm A, Hoffmann W. Identifying Unmet Needs of Family Dementia Caregivers: Results of the Baseline Assessment of a Cluster-Randomized Controlled Intervention Trial. J Alzheimers Dis 2020; 67:527-539. [PMID: 30584136 PMCID: PMC6398541 DOI: 10.3233/jad-180244] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Caregivers providing informal care for people with dementia (PwD) often report unmet needs, burden, and health impairments. Optimal support for family dementia caregivers will likely benefit from better understanding and assessment of the prevalence and types of caregivers' unmet needs and associated socio-demographic and clinical characteristics. OBJECTIVE The present study investigates 1) the number and types of caregivers' unmet needs, 2) socio-demographic and clinical characteristics of both PwD and caregivers, and 3) caregivers' burden and health-related outcomes that are related to caregivers' unmet needs. METHODS The present analyses are based on cross-sectional data of n = 226 dyads of caregivers and their community-dwelling PwD participating in a comprehensive standardized, computer-based caregivers' needs assessment within a general practitioner (GP)-based, cluster-randomized intervention trial. RESULTS A total of n = 505 unmet needs were identified for n = 171 caregivers from the intervention group at baseline. Only 24.3% caregivers reported no unmet need (n = 55), whereas 75.7% caregivers had at least one unmet need (n = 171). Caregivers had on average 2.19 unmet needs (mean = 2.19, SD = 2.15). Specifically, 53.1% of caregivers had one up to three unmet needs (n = 120), 18.6% (n = 42) had three up to six unmet needs, and 4.0% (n = 9) had more than six unmet needs. DISCUSSION Our results underline the importance of a comprehensive needs assessment for family dementia caregivers to develop and implement concepts that can provide family dementia caregivers with optimal support.
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Affiliation(s)
- Ina Zwingmann
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany
| | - Bernhard Michalowsky
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany
| | - Alexander Esser
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany
| | - Anika Kaczynski
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany
| | - Jessica Monsees
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany
| | - Armin Keller
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany.,Institute of Medical Psychology and Medical Sociology, University Medicine Rostock, Rostock, Germany
| | - Johannes Hertel
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany.,Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Diana Wucherer
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany
| | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany
| | - Tilly Eichler
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany
| | - Ingo Kilimann
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany.,Department of Psychosomatic Medicine, University Medicine Rostock, Rostock, Germany
| | - Stefan Teipel
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany.,Department of Psychosomatic Medicine, University Medicine Rostock, Rostock, Germany
| | - Adina Dreier Wolfgramm
- Department Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany.,Department Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
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28
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Miller LM, Whitlatch CJ, Lee CS, Caserta MS. Care Values in Dementia: Patterns of Perception and Incongruence Among Family Care Dyads. THE GERONTOLOGIST 2020; 59:509-518. [PMID: 29546327 DOI: 10.1093/geront/gny008] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Persons with dementia (PWDs) often place greater importance on their care values (i.e., maintaining autonomy and social relations, choosing caregivers, avoiding being a burden) than family caregivers (CGs) perceive, which can detract from dementia care planning (e.g., care arrangements or surrogate decisions). Notable variability has been found across family care dyads (PWD and CG) in their perceptions of care values, suggesting that there may be multiple patterns of perception. The purpose of this study was to characterize distinct patterns of perception of care values in family care dyads. DESIGN AND METHODS Using cross-sectional data from 228 community-dwelling family care dyads, we quantified dyads' average perceptions and incongruence in perceptions of the importance of everyday care values using multilevel modeling. These scores were then used in a latent class analysis to identify distinct patterns of perception, with the dyad as the unit of analysis. RESULTS Two distinct patterns of care value perception were identified. 25% of dyads were labeled as "CG underestimating" due to lower average estimations of the importance of PWDs' care values, and a significant amount of dyadic incongruence. Underestimating dyads were characterized by a confirmed diagnosis of dementia, lower cognitive function, and younger age in PWDs, and higher relationship strain in the dyad. IMPLICATIONS Care dyads that fall into an underestimating pattern may be at greater risk for inadequate dementia care planning. Interventions to improve care planning in this higher-risk group may include care values identification with the PWD, strategies for alleviating relationship strain, early-stage planning, and disease education.
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Affiliation(s)
| | - Carol J Whitlatch
- Center for Research and Education, Benjamin Rose Institute on Aging, Cleveland, Ohio
| | - Christopher S Lee
- William F. Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts
| | - Michael S Caserta
- College of Nursing and Center on Aging, The University of Utah, Salt Lake City
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29
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Bangerter LR, Fadel M, Riffin C, Splaine M. The Older Americans Act and Family Caregiving: Perspectives from Federal and State Levels. THE PUBLIC POLICY AND AGING REPORT 2019; 29:62-66. [PMID: 31205404 DOI: 10.1093/ppar/prz006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Indexed: 11/12/2022]
Affiliation(s)
- Lauren R Bangerter
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Rochester, MN
| | - Meghan Fadel
- Bureau of Community Integration and Alzheimer's Disease, Division of Long Term Care, New York State Department of Health Office of Health Insurance Programs, Albany
| | - Catherine Riffin
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, NY
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30
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Zwingmann I, Hoffmann W, Michalowsky B, Wucherer D, Eichler T, Teipel S, Dreier-Wolfgramm A, Kilimann I, Thyrian JR. [Unmet needs of family dementia caregivers of persons with dementia : Primary medical care]. DER NERVENARZT 2018; 89:495-499. [PMID: 29619534 DOI: 10.1007/s00115-018-0509-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Results of current research studies revealed that providing informal care for people with dementia (PwD) is associated with caregivers' burden and a variety of health impairments. In order to provide optimal support for family caregivers of PwD, general practitioners and specialists should be able to identify caregivers' unmet needs in primary care. OBJECTIVES The present article provides an overview of unmet needs of family caregivers that are relevant for general practitioners as well as specialists in neurology, psychiatry, psychotherapy and psychosomatics. MATERIAL AND METHODS The present overview is based on current reviews on unmet needs of caregivers of PwD and on results of the general practitioner-based, cluster-randomized controlled intervention trial DelpHi-MV (Life- and person-centred help in Mecklenburg-Western Pomerania, Germany; Identifier: NCT01401582). RESULTS The article provides an overview of unmet needs of family caregivers for PwD, especially in the domains of social integration, psychological and physical health, legal and financial issues, as well as available and valid measurements. DISCUSSION The article illustrates the importance and the possibilities for general practitioners and specialists to identify caregivers' unmet needs. The question to what extent unmet needs' assessments for family caregivers of PwD could be implemented and financed in routine care is still under debate.
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Affiliation(s)
- I Zwingmann
- Standort Rostock/Greifswald, Deutsches Zentrum für Neurodegenerative Erkrankungen e. V. (DZNE), Ellernholzstr. 1-2, 17487, Greifswald, Deutschland.
| | - W Hoffmann
- Standort Rostock/Greifswald, Deutsches Zentrum für Neurodegenerative Erkrankungen e. V. (DZNE), Ellernholzstr. 1-2, 17487, Greifswald, Deutschland
- Institut für Community Medicine, Abteilung Versorgungsepidemiologie und Community Health, Universitätsmedizin Greifswald, Greifswald, Deutschland
| | - B Michalowsky
- Standort Rostock/Greifswald, Deutsches Zentrum für Neurodegenerative Erkrankungen e. V. (DZNE), Ellernholzstr. 1-2, 17487, Greifswald, Deutschland
| | - D Wucherer
- Standort Rostock/Greifswald, Deutsches Zentrum für Neurodegenerative Erkrankungen e. V. (DZNE), Ellernholzstr. 1-2, 17487, Greifswald, Deutschland
| | - T Eichler
- Standort Rostock/Greifswald, Deutsches Zentrum für Neurodegenerative Erkrankungen e. V. (DZNE), Ellernholzstr. 1-2, 17487, Greifswald, Deutschland
| | - S Teipel
- Standort Rostock/Greifswald, Deutsches Zentrum für Neurodegenerative Erkrankungen e. V. (DZNE), Ellernholzstr. 1-2, 17487, Greifswald, Deutschland
- Klinik für Psychosomatik und Psychotherapeutische Medizin, Universitätsmedizin Rostock, Rostock, Deutschland
| | - A Dreier-Wolfgramm
- Standort Rostock/Greifswald, Deutsches Zentrum für Neurodegenerative Erkrankungen e. V. (DZNE), Ellernholzstr. 1-2, 17487, Greifswald, Deutschland
| | - I Kilimann
- Standort Rostock/Greifswald, Deutsches Zentrum für Neurodegenerative Erkrankungen e. V. (DZNE), Ellernholzstr. 1-2, 17487, Greifswald, Deutschland
- Klinik für Psychosomatik und Psychotherapeutische Medizin, Universitätsmedizin Rostock, Rostock, Deutschland
| | - J R Thyrian
- Standort Rostock/Greifswald, Deutsches Zentrum für Neurodegenerative Erkrankungen e. V. (DZNE), Ellernholzstr. 1-2, 17487, Greifswald, Deutschland
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31
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Shugrue N, Kellett K, Gruman C, Tomisek A, Straker J, Kunkel S, Robison J. Progress and Policy Opportunities in Family Caregiver Assessment: Results From a National Survey. J Appl Gerontol 2017; 38:1319-1341. [DOI: 10.1177/0733464817733104] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Family caregivers play an essential role in long-term services and supports (LTSS). Despite numerous calls for robust caregiver assessment policies to determine needs and treat them as partners in care planning, there has been limited information about whether or how states assess caregiver needs and strengths, or use caregiver information. Using cross-sectional survey data from the 2015 Process Evaluation of the Older Americans Act National Family Caregiver Support Program (NFCSP), this study analyzes caregiver assessment policies and practices in 54 State Units on Aging, 619 Area Agencies on Aging, and 642 local service providers. It examines whether and for what purposes caregiver assessments are used, what domains are included, and how well current policies conform to recommended practice. It also recommends that policy makers who influence NFCSP and other LTSS programs develop caregiver assessment practices using a multidimensional framework including more caregiver-focused domains and utilizing assessment data to measure program outcomes.
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