Understanding factors influencing residential respite service use by carers of people living with dementia using Andersen's behavioural model of health services use: A qualitative study

OBJECTIVES

Residential respite (RR) provides a valuable break for family carers, but little known about its offer, take-up or experiences of carers of people living with dementia. This paper aims to further understandings of factors influencing RR use.

DESIGN

RR stakeholder workshop and qualitative interviews.

SETTING

Stakeholder or living in the community in own home.

PARTICIPANTS

RR stakeholders (13); family carers with experience of RR, or had declined it, or were planning to use it for the first time (n = 36).

METHODS

Stakeholders participated in a workshop to discuss provision, models and funding of RR. Family carer interviews focused on expectations, experiences and outcomes of use of RR. Data were analysed thematically and mapped against Andersen's model of health service use.

RESULTS

Identifying need for RR does not necessarily transpire into use. Planning and ease of booking were crucial for carers, but many felt there was little support with this. Systemic factors concerning funding, planning and booking RR act as barriers to its use.

CONCLUSION

Findings highlight how systemic factors influence RR use. Discussing respite need in routine care planning or reviews may support carers and people living with dementia to consider RR, but system changes are needed to address barriers.

Los aspectos morales bioéticos y científicos guían las decisiones en el contexto de recursos escasos durante la pandemia por COVID-19

Introducción

Las instituciones de salud podrán verse enfrentadas al desbordamiento en la atención médica y disminución de recursos en tiempos de la pandemia por COVID-19. De ser así tendrán que tomar decisiones basadas en el principio de justicia distributiva para beneficiar a quien más lo necesite y generar así el mayor bien social.

Objetivo

Analizar los aspectos morales, bioéticos y científicos en las decisiones que se toman en el contexto de recursos escasos por la pandemia por COVID-19.

Metodología

Se realizó un análisis y reflexión sobre los aspectos morales, bioéticos y científicos, basados en conceptos éticos reportados en la literatura médica y emitidos durante la pandemia por COVID-19.

Resultados

Para el análisis y reflexión se tomaron en cuenta tres aspectos: 1. El fundamento moral de la decisión (acción moral, dilema ético y conflicto de interés y teorías morales). 2. El fundamento bioético de la decisión (profesión médica, comités de ética hospitalaria, la ética clínica, principios de la bioética). 3. El fundamento científico de la decisión (triaje en la pandemia con sus prioridades, otras escalas de triaje).

Estadística

Por el tipo de estudio de reflexión no se utilizaron medidas estadísticas.

Conclusión

La sensibilidad moral, el razonamiento bioético y el conocimiento científico son fundamentales ante la toma de decisiones en tiempo de escasez y asignación del recurso. Siempre estarán acompañando la decisión de la justicia distributiva, haciendo respetar la dignidad y los derechos de los pacientes a la salud y la muerte digna.

Day centres for older people: a systematically conducted scoping review of literature about their benefits, purposes and how they are perceived

With a policy shift towards personalisation of adult social care in England, much attention has focused on individualised support for older people with care needs. This article reports the findings of a scoping review of United Kingdom (UK) and non-UK literature, published in English from 2005-2017, about day centres for older people without dementia and highlights the gaps in evidence. This review, undertaken to inform new empirical research, covered the perceptions, benefits and purposes of day centres. Searches, undertaken in October/November 2014 and updated in August 2017, of electronic databases, libraries, websites, research repositories and journals, identified seventy-seven relevant papers, mostly non-UK. Day centres were found to play a variety of roles for individuals and in care systems. The largest body of evidence concerned social and preventive outcomes. Centre attendance and participation in interventions within them impacted positively on older people's mental health, social contacts, physical function and quality of life. Evidence about outcomes is mainly non-UK. Day centres for older people without dementia are under-researched generally, particularly in the UK. In addition to not being studied as whole services, there are considerable evidence gaps about how day centres are perceived, their outcomes, what they offer, to whom and their wider stakeholders, including family carers, volunteers, staff and professionals who are funding, recommending or referring older people to them.

Literature review: use of respite by carers of people with dementia

Respite care is a cornerstone service for the home management of people with dementia. It is used by carers to mitigate the stress related to the demands of caring by allowing time for them to rest and do things for themselves, thus maintaining the caring relationship at home and perhaps forestalling long-term placement in a residential aged care facility. Despite numerous anecdotal reports in support of respite care, its uptake by carers of people with dementia remains relatively low. The aim of this paper was to examine the factors that constitute the use of respite by carers of people with dementia by reviewing quantitative and qualitative research predominantly from the years 1990 to 2012. Seventy-six international studies of different types of respite care were included for this review and their methods were critically appraised. The key topics identified were in relation to information access, the barriers to carers realising need for and seeking respite, satisfaction with respite services including the outcomes for carers and people with dementia, the characteristics of an effective respite service and the role of health workers in providing appropriate respite care. Finally, limitations with considering the literature as a whole were highlighted and recommendations made for future research.