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Jeyagurunathan A, Yuan Q, Samari E, Zhang Y, Goveas R, Ng LL, Subramaniam M. Facilitators and barriers of help-seeking for persons with dementia in Asia-findings from a qualitative study of informal caregivers. Front Public Health 2024; 12:1396056. [PMID: 39071142 PMCID: PMC11282579 DOI: 10.3389/fpubh.2024.1396056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 06/24/2024] [Indexed: 07/30/2024] Open
Abstract
Background and aim The deterioration in cognition of persons with dementia (PWD) makes their caregivers key players in their help-seeking process. This study aimed to identify the facilitators and barriers of help-seeking for persons with dementia in Asia from the perspective of their informal caregivers. Methods A qualitative methodology was adopted in the current study. Twenty-nine informal caregivers of PWD in Singapore were interviewed between April 2019 and December 2020. All interviews were audio-recorded and transcribed verbatim for the analysis. Results The transcripts were analyzed using inductive thematic analysis. The results revealed four major themes with 12 sub-themes, including (1) Barriers to diagnosis-seeking (i.e., lack of knowledge and awareness of dementia, emotional denial, resistance from PWD, and delays in the healthcare system); (2) Facilitators of diagnosis-seeking (i.e., synergy between awareness of dementia and an active diagnosis-seeking intention and incidental diagnosis resulting from seeking treatment for comorbid conditions); (3) Barriers to treatment-seeking (i.e., challenges from PWD and disease, challenges faced by caregivers when seeking treatment for PWD, and challenges imposed by the COVID-19 pandemic); (4) Facilitators of treatment-seeking (i.e., caregivers' capabilities of handling PWD, cooperation/compliance from PWD, and an integrated care plan for PWD). Conclusion The findings highlight the importance of raising public awareness, enabling health professionals to tailor psychosocial interventions better, and improving community support through dementia awareness and education.
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Affiliation(s)
| | - Qi Yuan
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Ellaisha Samari
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Yunjue Zhang
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Richard Goveas
- Department of Geriatric Psychiatry, Institute of Mental Health, Singapore, Singapore
| | - Li Ling Ng
- Department of Psychological Medicine, Changi General Hospital, Singapore, Singapore
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Ali Y, Caballero GE, Shatnawi E, Dadich A, Steiner‐Lim GZ, Alliance CBD, DiGiacomo M, Karamacoska D. Assessing the impact of an online dementia awareness initiative co-created with and for English, Arabic and Vietnamese speaking communities: A case study. Health Expect 2024; 27:e14026. [PMID: 38618991 PMCID: PMC11017301 DOI: 10.1111/hex.14026] [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: 11/14/2023] [Revised: 02/11/2024] [Accepted: 03/12/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Awareness and understanding of dementia remain limited in ethnically diverse populations in multicultural societies due to culturally inappropriate and inaccessible information. OBJECTIVE To establish the impact, helpers and hinderers of an online multilingual dementia awareness initiative co-created with and for English, Arabic and Vietnamese speaking people. DESIGN A case study using mixed methods to assess the impact and implementation of an information session on dementia knowledge. SETTING AND PARTICIPANTS The study was conducted with English, Arabic and Vietnamese speaking individuals in Canterbury-Bankstown, Australia. INTERVENTION STUDIED A dementia alliance co-created an online multilingual dementia information session, which was delivered synchronously in English, Arabic and Vietnamese by trained facilitators. MAIN OUTCOME MEASURES In-session group discussions, quizzes and a postsession survey assessed the impact on dementia knowledge. A postimplementation focus group explored the factors that helped and hindered the initiative. RESULTS The online dementia information session successfully supported participants understanding of dementia causes, impacts and care strategies. The initiative was hindered by competing priorities and limited accessibility to target audiences, while it was helped by the support of an established organisation and feedback mechanisms. DISCUSSION Ongoing dementia education and awareness-raising campaigns that are culturally sensitive are needed in communities to promote dementia literacy and help-seeking. CONCLUSIONS An online multilingual dementia information session can be an effective way to improve dementia literacy and advocate for change in multicultural communities. PATIENT OR PUBLIC CONTRIBUTION English, Arabic and Vietnamese speaking members of the Canterbury Bankstown Dementia Alliance participated in the co-creation and evaluation of this initiative.
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Affiliation(s)
- Yousra Ali
- School of PsychologyWestern Sydney UniversityPenrithAustralia
| | | | - Eman Shatnawi
- NICM Health Research InstituteWestern Sydney UniversityPenrithAustralia
| | - Ann Dadich
- Translational Health Research Institute (THRI)Western Sydney UniversityPenrithAustralia
- School of BusinessWestern Sydney UniversityPenrithAustralia
| | - Genevieve Z. Steiner‐Lim
- NICM Health Research InstituteWestern Sydney UniversityPenrithAustralia
- Translational Health Research Institute (THRI)Western Sydney UniversityPenrithAustralia
| | | | - Michelle DiGiacomo
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of HealthUniversity of Technology SydneyBroadwayAustralia
| | - Diana Karamacoska
- NICM Health Research InstituteWestern Sydney UniversityPenrithAustralia
- Translational Health Research Institute (THRI)Western Sydney UniversityPenrithAustralia
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Slachevsky A, Grandi F, Thumala D, Baez S, Santamaria-García H, Schmitter-Edgecombe M, Parra MA. A Multidimensional, Person-Centered Framework for Functional Assessment in Dementia: Insights from the 'What', 'How', 'To Whom', and 'How Much' Questions. J Alzheimers Dis 2024; 99:1187-1205. [PMID: 38758997 PMCID: PMC11178450 DOI: 10.3233/jad-230376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2024]
Abstract
Dementia is a syndrome characterized by cognitive and neuropsychiatric symptoms associated with progressive functional decline (FD). FD is a core diagnostic criterion for dementia, setting the threshold between its prodromal stages and the full-blown disease. The operationalization of FD continues to generate a great deal of controversy. For instance, the threshold of FD for the diagnosis of dementia varies across diagnostic criteria, supporting the need for standardization of this construct. Moreover, there is a need to reconsider how we are measuring FD to set boundaries between normal aging, mild cognitive impairment, and dementia. In this paper, we propose a multidimensional framework that addresses outstanding issues in the assessment of FD: i) What activities of daily living (ADLs) are necessary to sustain an independent living in aging? ii) How to assess FD in individuals with suspected neurocognitive disorders? iii) To whom is the assessment directed? and iv) How much does FD differentiate healthy aging from mild and major neurocognitive disorders? Importantly, the To Whom Question introduces a person-centered approach that regards patients and caregivers as active agents in the assessment process of FD. Thus, once impaired ADLs have been identified, patients can indicate how significant such impairments are for them in daily life. We envisage that this new framework will guide future strategies to enhance functional assessment and treatment of patients with dementia and their caregivers.
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Affiliation(s)
- Andrea Slachevsky
- Gerosciences Center for Brain Health and Metabolism (GERO), Santiago, Chile
- Memory and Neuropsychiatric Center (CMYN) Neurology Department, Hospital del Salvador & Faculty of Medicine, University of Chile, Santiago, Chile
- Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Physiopathology Department – ICBM, Neuroscience and East Neuroscience Departments, Faculty of Medicine, University of Chile, Providencia, Santiago, Chile
- Servicio de Neurología, Departamento de Medicina, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
| | - Fabrissio Grandi
- Gerosciences Center for Brain Health and Metabolism (GERO), Santiago, Chile
- School of Psychology, Universidad de los Andes, Santiago, Chile
| | - Daniela Thumala
- Gerosciences Center for Brain Health and Metabolism (GERO), Santiago, Chile
- Psychology Department, Faculty of Social Sciences, Universidad de Chile, Santiago, Chile
| | - Sandra Baez
- Universidad de los Andes, Bogotá, Colombia
- Atlantic Fellow for Equity in Brain Health at the Global Brain Health Institute (GBHI), Trinity College Dublin (TCD), Dublin, Ireland
| | - Hernando Santamaria-García
- Pontificia Universidad Javeriana, PhD Program of Neuroscience, Bogotá, Colombia
- Center for Brain and Memory Intellectus. Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Maureen Schmitter-Edgecombe
- Herbert L. Eastlick Distinguished Professor in the Department of Psychology, Washington State University, Pullman, WA, USA
| | - Mario A. Parra
- Department of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
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Jiao YC, Chang J, Liu C, Zhou SY, Ji Y, Meng Y. Factors influencing the help-seeking behavior in patients with mild cognitive impairment: a qualitative study. BMC Health Serv Res 2023; 23:1345. [PMID: 38042819 PMCID: PMC10693691 DOI: 10.1186/s12913-023-10281-5] [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: 04/09/2023] [Accepted: 11/06/2023] [Indexed: 12/04/2023] Open
Abstract
BACKGROUND The early diagnosis and intervention of mild cognitive impairment (MCI) patients is expected to delay the progression of AD. Delayed treatment will lead to MCI patients missing the best intervention expectation. At present, the medical help-seeking behavior of this group is not optimistic. This study aimed to explore influencing factors of help-seeking behavior among patients with MCI in China based on the help-seeking behavior model. METHODS Twenty-two patients with MCI were recruited to participate in semi-structured interviews via purposeful sampling with a qualitative, descriptive design. Data were analyzed by qualitative content analysis. RESULTS The study revealed the main influencing factors of help-seeking behavior among MCI patients in China included perceived disease threat, symptom attribution, disease knowledge, use of cognitive compensation strategies, sense of foreseeable burden, social support, economic condition, and accessibility of medical service. CONCLUSIONS The help-seeking behavior of patients with MCI is affected by multiple factors. There are some key factors in different stages of the help-seeking process. Healthcare providers can utilize these factors to design targeted interventions for promoting early help-seeking of patients with MCI.
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Affiliation(s)
- Yu-Chen Jiao
- School of Nursing, Nanjing Medical University, Nanjing, China
- Department of Radiotherapy, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - Jing Chang
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Chang Liu
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Shi-Yu Zhou
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Yan Ji
- School of Nursing, Nanjing Medical University, Nanjing, China.
| | - Yao Meng
- School of Nursing, Nanjing Medical University, Nanjing, China.
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Aguilar BJ, Miller D, Jasuja G, Li X, Shishova E, O'Connor MK, Nguyen A, Morin P, Berlowitz D, Zhang R, Monfared AAT, Zhang Q, Xia W. Rule-Based Identification of Individuals with Mild Cognitive Impairment or Alzheimer's Disease Using Clinical Notes from the United States Veterans Affairs Healthcare System. Neurol Ther 2023; 12:2067-2078. [PMID: 37747662 PMCID: PMC10630261 DOI: 10.1007/s40120-023-00540-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/23/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND Early identification of individuals with mild cognitive impairment (MCI) and Alzheimer's disease (AD) is a clinical and research imperative. Use of diagnostic codes for MCI and AD identification has limitations. We used clinical notes to supplement diagnostic codes in the Veterans Affairs Healthcare System (VAHS) electronic health records (EHR) to identify and establish cohorts of Veterans recorded with MCI or AD. METHODS Targeted keyword searches for MCI ("Mild cognitive impairment;" "MCI") and AD ("Alz*") were used to extract clinical notes from the VAHS EHR from fiscal year (FY) 2010 through FY 2019. Iterative steps of inclusion and exclusion were applied until searches achieved a positive predictive value ≥ 80%. MCI and AD cohorts were identified via clinical notes and/or diagnostic codes (i.e., including Veterans recorded by "Notes Only," "Notes + Code," or "Codes Only"). RESULTS A total of 2,134,661 clinical notes from 339,007 Veterans met the iterative search criteria for MCI due to any cause and 4,231,933 notes from 572,063 Veterans met the iterative search criteria for AD. Over the 10-year study period, the number of clinical notes recording AD was generally stable, whereas the number for MCI more than doubled. More Veterans were identified for the MCI or AD cohorts via clinical notes than by diagnostic codes, particularly in the AD cohort. Among Veterans identified by having "Notes + Code" for MCI, the number first recorded by a code was lower than the number first recorded by a note until FY 2015 and then gradually became comparable after FY 2015. Among Veterans identified by having "Notes + Code" for AD, the number first recorded by a note was more than double the number first recorded by a code AD in each of the FYs. CONCLUSIONS Clinical note-based identification captured more Veterans recorded with MCI and AD than diagnostic code-based identification.
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Affiliation(s)
- Byron J Aguilar
- Geriatric Research Education and Clinical Center, VA Bedford Healthcare System, 200 Springs Road, Bedford, MA, USA
| | - Donald Miller
- Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, MA, USA
| | - Guneet Jasuja
- Center for Healthcare Organization and Implementation, VA Bedford Healthcare System, Bedford, MA, USA
| | - Xuyang Li
- Geriatric Research Education and Clinical Center, VA Bedford Healthcare System, 200 Springs Road, Bedford, MA, USA
| | - Ekaterina Shishova
- Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, MA, USA
| | - Maureen K O'Connor
- Geriatric Research Education and Clinical Center, VA Bedford Healthcare System, 200 Springs Road, Bedford, MA, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Andrew Nguyen
- Geriatric Research Education and Clinical Center, VA Bedford Healthcare System, 200 Springs Road, Bedford, MA, USA
| | - Peter Morin
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Dan Berlowitz
- Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, MA, USA
| | - Raymond Zhang
- Alzheimer's Disease and Brain Health, Eisai Inc., Nutley, NJ, USA
| | - Amir Abbas Tahami Monfared
- Alzheimer's Disease and Brain Health, Eisai Inc., Nutley, NJ, USA
- Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Quanwu Zhang
- Alzheimer's Disease and Brain Health, Eisai Inc., Nutley, NJ, USA
| | - Weiming Xia
- Geriatric Research Education and Clinical Center, VA Bedford Healthcare System, 200 Springs Road, Bedford, MA, USA.
- Department of Pharmacology, Physiology and Biophysics, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
- Department of Biological Sciences, Kennedy College of Sciences, University of Massachusetts Lowell, Lowell, MA, USA.
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Hill NL, Bratlee-Whitaker E, Jang H, Bhargava S, Sillner AY, Do J, Mogle J. Patient-provider communication about cognition and the role of memory concerns: a descriptive study. BMC Geriatr 2023; 23:342. [PMID: 37259029 PMCID: PMC10233998 DOI: 10.1186/s12877-023-04053-3] [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: 02/26/2023] [Accepted: 05/20/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Early identification of cognitive impairment is an important part of health promotion in aging. However, many older adults do not seek help for cognitive problems until their ability to function independently is substantially impacted. The purpose of this descriptive study was to explore older adults' experiences with patient-provider communication specific to cognition as well as compare barriers and facilitators between those with and without memory concerns. METHODS We conducted an online survey with individuals aged 65 + years (n = 409; mean age = 71.4(4.73); 54% female; 79% non-Hispanic White), purposively sampled to include those with and without memory concerns. Questionnaires included measures of subjective memory decline (SMD), memory concerns, past healthcare experiences, as well as open-ended questions regarding patient-provider communication about cognition. Content analysis was used to code open-ended responses. Logistic regression was used to examine differences in facilitators and barriers to communication among three groups: no SMD (n = 130), SMD without memory concerns (n = 143), and SMD with memory concerns (n = 136). RESULTS Only 16.6% of participants reported discussing cognition with a healthcare provider. Of the remaining 83.4%, approximately two-thirds would be open to such discussions in certain circumstances, most frequently if they had worsening memory problems. Over half of participants reported that their provider had never offered cognitive testing. Compared to the no SMD and SMD without memory concerns groups, participants reporting SMD with memory concerns were more likely to: (1) discuss cognition if their healthcare provider initiated the conversation, and (2) avoid discussions of cognitive problems due to fears of losing independence. CONCLUSIONS We found that most participants, including those reporting SMD with memory concerns, had never discussed cognition with their healthcare providers. Patient-reported barriers and facilitators to communication about cognition differed in several areas based on SMD status and the presence or absence of memory concerns. Consideration of these differences can guide future efforts to improve early identification of subtle cognitive changes that would benefit from further monitoring or intervention.
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Affiliation(s)
- Nikki L Hill
- Ross and Carol Nese College of Nursing, Penn State University, 201 Nursing Sciences Building, University Park, PA, 16802, USA.
| | - Emily Bratlee-Whitaker
- RTI Health Solutions, 3040 East Cornwallis Road, PO Box 12194, Research Triangle Park, NC, 27709, USA
| | - Heejung Jang
- Department of Psychology, Clemson University, 418 Brackett Hall, Clemson, SC, 29634, USA
| | - Sakshi Bhargava
- RTI Health Solutions, 3040 East Cornwallis Road, PO Box 12194, Research Triangle Park, NC, 27709, USA
| | - Andrea Yevchak Sillner
- Ross and Carol Nese College of Nursing, Penn State University, 201 Nursing Sciences Building, University Park, PA, 16802, USA
| | - Justin Do
- Sidney Kimmel Medical College, 1025 Walnut St, Philadelphia, PA, 19107, USA
| | - Jacqueline Mogle
- Department of Psychology, Clemson University, 418 Brackett Hall, Clemson, SC, 29634, USA
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Awuol MDA, Innocent BK, Winfred A. Prevalence, factors associated and knowledge of probable dementia among adults 50 years and over attending a faith-based geriatric center in Uganda. Sci Rep 2023; 13:6737. [PMID: 37185948 PMCID: PMC10127194 DOI: 10.1038/s41598-023-33948-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 04/21/2023] [Indexed: 05/17/2023] Open
Abstract
Dementia is on the rise due to increasing proportion of old people in sub-Saharan Africa (SSA). Although dementia is misattributed to normal ageing or supernatural causes in SSA, it is a brain disease with well-established etiologies. Limited knowledge and understanding of dementia means that many older people are suffering without seeking help and are undiagnosed and untreated. The aim of this study was to determine the prevalence and factors associated with probable dementia and to describe the knowledge of the disease among adults 50 years and over attending a faith-based geriatric center in Uganda. This was a cross-sectional study using quantitative methods. A total of 267 adults 50 years and over attending a faith-based geriatric center in Mukono, Uganda were interviewed between 1 April and 15 May 2022. Interviews were administered using the Early Dementia Questionnaire (EDQ) and Dementia Knowledge Assessment Scale (DKAS). Data on participants' socio-demographics, economic income, living arrangement, history of smoking, alcohol consumption, exercise and past medical history was collected using an additional questionnaire. Adults 50 years and over were included in the study. Logistic regression analyses were done. Probable dementia was 46.2% in the sample. The most common symptoms of probable dementia in the order of their severity were memory symptoms, (β co-efficient β 0.08, p < .001), physical symptoms (β 0.08, p < .001), sleep disturbances (β 0.81, p < .001) and emotions (β 0.04, p < .027). The final degree of association as determined by adjusted PR in the multivariable model revealed that only older age (aPR = 1.88, p < .001) and occasional/non-believer (aPR = 1.61, p = .001) remained significantly related to probable dementia. The study also found that 8.0% of the participants had optimal knowledge of dementia. There is high burden of probable dementia among adults 50 years and over attending a faith-based geriatric center in Mukono, Uganda. Factors associated with probable dementia are older age and being an occasional/non-believer. Knowledge of dementia among older adults is low. There is need to promote integrated early dementia screening, care and educational program in primary care to reduce the disease burden. Spiritual support would be a rewarding investment in the lives of the ageing population.
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Affiliation(s)
| | - Besigye K Innocent
- Department of Family Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Ayenyo Winfred
- Soroti Regional Referral Hospital, Sororti District, Uganda
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Matsumoto H, Maeda A, Igarashi A, Weller C, Yamamoto-Mitani N. Dementia education and training for the general public: A scoping review. GERONTOLOGY & GERIATRICS EDUCATION 2023; 44:154-184. [PMID: 34791985 DOI: 10.1080/02701960.2021.1999938] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
The lack of public awareness and understanding of dementia affects the experiences of people living with dementia and their families. Dementia education and training for the general public have been gradually disseminated. We conducted a systematic scoping review guided by PRISMA-ScR to map existing evidence and identify dementia education and training available to the general public. From the four electronic databases, 41 articles were identified. Dementia education has three main purposes: dementia friendliness (n = 25), early diagnosis/help-seeking (n = 10), and prevention (n = 6). Education aimed at dementia friendliness was delivered in the community (n = 6), schools/universities (n =14), workplaces (n = 2), and online (n = 3). Interventions aimed at early diagnosis and prevention were often conducted in communities with middle-aged and older people or specific ethnic groups. Eleven dementia-friendliness studies reported on the interaction with people living with dementia to reduce stigma. Dementia knowledge, attitudes, and preventive behaviors were assessed as outcomes. Though randomized controlled trials were conducted in early diagnosis and prevention studies via e-learning, they were not performed in dementia-friendliness studies. Therefore, there is a need to further accumulate evidence of dementia education for each of these purposes.
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Affiliation(s)
- Hiroshige Matsumoto
- Department of Community Health Nursing, School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akari Maeda
- Department of Community Health Nursing, School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ayumi Igarashi
- Department of Gerontological Home Care and Long-term Care Nursing, School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Carolina Weller
- School of Nursing and Midwifery, Monash University, Melbourne, Australia
| | - Noriko Yamamoto-Mitani
- Department of Gerontological Home Care and Long-term Care Nursing, School of Medicine, The University of Tokyo, Tokyo, Japan
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Parker M, Barlow S, Hoe J, Aitken LM. The Bubble of Normalisation: A Qualitative Study of Carers of People With Dementia Who Do Not Seek Help for a Diagnosis. J Geriatr Psychiatry Neurol 2022; 35:717-732. [PMID: 34951319 PMCID: PMC9386763 DOI: 10.1177/08919887211060018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Improving dementia diagnosis rates are a key feature of dementia strategy and policy worldwide. This study aimed to explore the experience of carers of people diagnosed with dementia during or following a hospital admission in order to identify factors that had prevented them from seeking help beforehand. Semi-structured interviews were conducted with 12 informal carers including adults caring for a parent, a friend or a spouse diagnosed with dementia between 2010-2019, following an acute hospital admission for a physical health problem, having not sought help previously. MAIN FINDINGS Carers created a 'bubble of normalisation' around themselves and the person living with dementia (PLWD) to reject the label of dementia and protect the PLWD from a loss of independence, discrimination and prejudice they felt would be the result of a diagnosis. Carers struggled to talk to the PLWD about dementia reinforcing denial and stigma. Post-diagnosis carers felt unsupported and questioned the value of diagnosis. PRINCIPAL CONCLUSIONS Stigma related to images of dementia as a disease that takes away independence and identity prevented discussion about dementia between carers and the PLWD. A lack of open discussion about memory concerns between health care professionals and carers also served to delay diagnosis.
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Affiliation(s)
- Michelle Parker
- Division of Nursing, City University of London, London, UK,Michelle Parker, Division of Nursing, City University of London, Northampton Square, London EC1V 0HB, UK.
| | - Sally Barlow
- Division of Nursing, City University of London, London, UK
| | - Juanita Hoe
- Division of Nursing, City University of London, London, UK
| | - Leanne M. Aitken
- School of Health Sciences, City University of London, London, UK,School of Nursing & Midwifery, Griffith University, Australia
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Mahomed A, Pretorius C. Understanding the lived experiences of family caregivers of individuals with dementia in Soweto, a South African Township. DEMENTIA 2022; 21:2264-2287. [DOI: 10.1177/14713012221118441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
This study was undertaken to understand South African family caregivers’ lived experiences of individuals living with dementia in a predominantly Black African township. A homogenous sample of thirty family caregivers was recruited using purposeful sampling methods and interviewed using a semi-structured approach. Reflective Thematic Analysis (RTA) yielded four broad themes: Understanding Dementia, Struggles and Sacrifice, Mental Health and Protective Factors. Findings reflect how dementia is understood by family caregivers and their community, the struggles and sacrifices that they endure, the impact of caregiving on caregiver mental health and the protective factors that enable caregivers to cope, despite their difficulties. Our findings lead to new insights regarding dementia caregiving amongst family caregivers in South Africa. First, there appears to be a shift in perception – away from a cultural/spiritual paradigm – and a lack of pressure to conform to community conceptualizations of dementia among individual caregivers. Second, dementia caregiving had a negative effect on caregiver mental health and elicited stress, anxiety and grief reactions. Third, caregivers did not feel emotionally supported and expressed not receiving any assistance with their daily practical tasks. Fourth, before receiving a diagnosis, family caregivers were viewed as the perpetrators of abuse and/or neglect against their family members with dementia, instead of individuals with dementia being stigmatized by the community due to their behavioural symptoms. Additionally, help-seeking was not hindered by fear or stigma, but was motivated by caregiver distress as dementia-related behaviours began to manifest and caregivers feared being perceived as perpetrators of abuse. Psychoeducational interventions should be tailored to targeted population groups that are in need of further training to address the lack of awareness in communities, insufficient knowledge of dementia amongst healthcare professionals and the practical, emotional and psychological difficulties that family caregivers endure to facilitate mental health care and resilience.
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11
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Natural language processing to identify substance misuse in the electronic health record. Lancet Digit Health 2022; 4:e401-e402. [DOI: 10.1016/s2589-7500(22)00096-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 05/10/2022] [Indexed: 11/24/2022]
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Matsumoto H, Igarashi A, Sakka M, Takaoka M, Kugai H, Ito K, Yamamoto-Mitani N. A two-step model for encouraging the general public to exhibit helping behaviors towards people living with dementia. Innov Aging 2022; 6:igac023. [PMID: 35663276 PMCID: PMC9154316 DOI: 10.1093/geroni/igac023] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and Objectives
Dementia awareness initiatives aim to promote helping behaviors towards people living with dementia. We applied the bystander intervention process model in the context of the general public’s helping behaviors towards people living with dementia, and we sought to identify the mechanisms underlying the association between dementia knowledge and helping behaviors.
Research Design and Methods
In a survey featuring vignettes for the general public in Japan (N = 904), we presented four situations in which people could exhibit helping behaviors towards a person with dementia. Guttman scale analysis was used to test this sequential ordering of the bystander intervention process model: (1) interpreting the need to help, (2) perceiving personal responsibility, and (3) intention to provide help. Mediation analysis was used to examine whether the effects of knowledge on helping behaviors were mediated by attitude towards people living with dementia and the bystander intervention process.
Results
The results support the two-step model in which interpreting the situation as one where assistance is required is a prerequisite of helping behavior. Dementia knowledge had a significant total effect on intention to provide help (β = 0.136, p < 0.001). Interpretation (indirect effect: β = 0.092, p < 0.001), as well as attitude (indirect effect: β = 0.044, p < 0.001), was found to completely mediate the effect of dementia knowledge on intention to provide help.
Discussion and Implications
Dementia awareness initiatives designed to promote helping behaviors should focus on knowledge transfer, improving the general public’s attitudes towards people living with dementia, and their ability to interpret when such people need assistance.
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Affiliation(s)
- Hiroshige Matsumoto
- Department of Community Health Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ayumi Igarashi
- Department of Gerontological Home Care and Long-term Care Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mariko Sakka
- Department of Gerontological Home Care and Long-term Care Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Manami Takaoka
- Department of Gerontological Home Care and Long-term Care Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Haruna Kugai
- Department of Gerontological Home Care and Long-term Care Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kenichiro Ito
- Virtual Reality Educational Research Center, The University of Tokyo, Tokyo, Japan
| | - Noriko Yamamoto-Mitani
- Department of Community Health Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Gerontological Home Care and Long-term Care Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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13
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Financial abuse of older people by third parties in banking institutions: a qualitative exploration. AGEING & SOCIETY 2021. [DOI: 10.1017/s0144686x21001574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Financial abuse is a significant form of elder maltreatment and is frequently ranked in the top two most common forms of abuse perpetration. Despite this, it is under-identified, under-reported and under-prosecuted. Financial institutions, such as banks, are important environments for identifying and responding to the financial abuse of older people. Traditionally, banks have not always been part of inter-sectorial responses to financial abuse, yet are important stakeholders. The aim of this study is to explore perceptions and experiences of financial abuse in five national banks. Data were collected from 20 bank managers and five members of the National Safeguarding Committee in the Republic of Ireland. Using thematic analysis, four themes were identified: defining a vulnerable adult; cases of financial abuse of vulnerable adults; case responses to financial abuse of vulnerable adults; and contextual issues. The data demonstrate the multiplicity of manifestations and the complexity of case investigation and management. Findings point to the need to enhance banks’ responses, through additional education and training, and promote integrated inter-sectorial collaboration. In addition, a change in societal beliefs is needed regarding financial entitlement, responding to ageism, public awareness of the consequences of financial decisions and types of financial abuse, as well as ensuring such crimes are addressed within the legal system.
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Help-seeking for cognitive problems in older adults without dementia: A systematic review. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2021. [DOI: 10.1016/j.ijnsa.2021.100050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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15
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Understanding help-seeking decisions in people with subjective cognitive decline: A systematic review of qualitative studies. Geriatr Nurs 2021; 42:1507-1516. [PMID: 34735997 DOI: 10.1016/j.gerinurse.2021.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To synthesize the findings of qualitative research on help-seeking in people with subjective cognitive decline. METHODS Relevant qualitative studies were identified by searching the PubMed, CINAHL, Ovid Medline, PsycInfo, Embase, and Web of Science databases. Studies that investigated help-seeking behavior in older adults with subjective cognitive decline were retrieved. The systematic review was conducted in line with JBI methodology for systematic reviews of qualitative evidence. RESULTS 11 studies were included and three themes related to the process of help-seeking for cognitive problems emerged. These themes included: detected changes, challenges in identifying the need for help and decision to seek professional help. CONCLUSION Making decisions to seek help for people with subjective cognitive decline is a multi-stage process. A better understanding of the complex psychological responses to subjective cognitive decline among older adults may help health care professionals to develop strategies to improve help-seeking in clinical practice.
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Sadafi Kohnehshahri M, Chehardoli G, Bahiraei M, Akbarzadeh T, Ranjbar A, Rastegari A, Najafi Z. Novel tacrine-based acetylcholinesterase inhibitors as potential agents for the treatment of Alzheimer's disease: Quinolotacrine hybrids. Mol Divers 2021; 26:489-503. [PMID: 34491490 DOI: 10.1007/s11030-021-10307-2] [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: 03/12/2021] [Accepted: 08/26/2021] [Indexed: 11/28/2022]
Abstract
A new series of quinolotacrine hybrids including cyclopenta- and cyclohexa-quinolotacrine derivatives were designed, synthesized, and assessed as anti-cholinesterase (ChE) agents. The designed derivatives indicated higher inhibitory effect on the acetylcholinesterase (AChE) with IC50 values of 0.285-100 µM compared to butyrylcholinesterase (BChE) with IC50 values of > 100 µM. Of these compounds, cyclohexa-quinolotacrine hybrids displayed a little better anti-AChE activity than cyclopenta-quinolotacrine hybrids. Compound 8-amino-7-(3-hydroxyphenyl)-5,7,9,10,11,12-hexahydro-6H-pyrano[2,3-b:5,6-c'] diquinolin-6-one (6m) including 3-hydroxyphenyl and cyclohexane ring moieties exhibited the best AChE inhibitory activity with IC50 value of 0.285 µM. The kinetic and molecular docking studies indicated that compound 6m occupied both the catalytic anionic site (CAS) and peripheral anionic site (PAS) of AChE as a mixed inhibitor. Using neuroprotective assay against H2O2-induced cell death in PC12 cells, the compound 6h illustrated significant protection among the assessed compounds. In silico ADME studies estimated good drug-likeness for the designed compounds. As a result, these quinolotacrine hybrids can be very encouraging AChE inhibitors to treat Alzheimer's disease. A novel series of quinolotacrine hybrids were designed, synthesized, and evaluated against AChE and BChE enzymes as potential agents for the treatment of AD. The hybrids showed good to significant inhibitory activity against AChE (0.285-100 μM) compared to butyrylcholinesterase (BChE) with IC50 values of > 100 μM. Among them, compound 8-amino-7-(3-hydroxyphenyl)-5,7,9,10,11,12-hexahydro-6H-pyrano[2,3-b:5,6-c'] diquinolin-6-one (6 m) bearing 3-hydroxyphenyl moiety and cyclohexane ring exhibited the highest anti-AChE activity with IC50 value of 0.285 μM. The kinetic and molecular docking studies illustrated that compound 6 m is a mixed inhibitor and binds to both the catalytic anionic site (CAS) and peripheral anionic site (PAS) of AChE.
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Affiliation(s)
- Mehrdad Sadafi Kohnehshahri
- Department of Medicinal Chemistry, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Gholamabbas Chehardoli
- Department of Medicinal Chemistry, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Masoomeh Bahiraei
- Department of Medicinal Chemistry, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Tahmineh Akbarzadeh
- Department of Medicinal Chemistry, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Akram Ranjbar
- Department of Pharmacology and Toxicology, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Arezoo Rastegari
- Department of Medicinal Chemistry, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Najafi
- Department of Medicinal Chemistry, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, Iran.
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17
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Yap KH, Warren N, Allotey P, Reidpath D. Challenges for Diagnostic Clarity for Post-stroke Cognitive Impairment and Behavioural Issues in Middle-Income Countries: Case Studies From Malaysia. Front Neurol 2021; 12:628876. [PMID: 34149589 PMCID: PMC8206537 DOI: 10.3389/fneur.2021.628876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 05/03/2021] [Indexed: 11/29/2022] Open
Abstract
Following stroke, individuals require ongoing screening, diagnosis and monitoring for cognitive impairment. Services and policies around these vary widely between settings, and reports from many countries highlight persistent under-diagnosis of cognitive impairment in the months and years after stroke. Missed and delayed diagnosis of post-stroke cognitive impairment, including dementia, are important factors in shaping the experiences of people so affected and their family members, especially in low- and middle-income countries. Drawing upon ethnographic research conducted in Malaysia, this article draws upon three case studies to examine the continued health-seeking behaviour after the appearance of salient cognitive and behavioural symptoms that occurred after stroke. Findings highlight the challenges in getting formal diagnostic clarity for cognitive and behavioural symptoms in a rural setting within a middle-income country. No study participants sought help for memory or cognitive problems, partly due to limited lay awareness of cognitive impairment but more significantly due to health service factors. Despite their elevated risk for dementia, participants were not monitored for cognitive impairment during any follow-up care in various health facilities. Furthermore, caregivers' attempts to seek help when behavioural issues became untenable were met with multiple health system barriers. The journey was complicated by the meanings attached to the reactions towards cognitive symptoms at the community level. We suggest that strategies seek to increase the awareness of post-stroke cognitive and behavioural symptoms, and incorporate clear treatment pathways into the long-term care plans of community-dwelling stroke survivors.
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Affiliation(s)
- Kwong Hsia Yap
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia
| | - Narelle Warren
- School of Social Sciences, Monash University, Clayton, VIC, Australia
| | - Pascale Allotey
- International Institute for Global Health, United Nations University, Kuala Lumpur, Malaysia
| | - Daniel Reidpath
- Health Systems and Population Studies Division, icddr, b, Dhaka, Bangladesh
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18
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Smith R, Pinchbeck G, McGowan C, Ireland J, Perkins E. Caring for the Older Horse: A Conceptual Model of Owner Decision Making. Animals (Basel) 2021; 11:1309. [PMID: 34063176 PMCID: PMC8147395 DOI: 10.3390/ani11051309] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 04/29/2021] [Accepted: 04/30/2021] [Indexed: 11/17/2022] Open
Abstract
The number of aged horses in the UK has been growing over recent years, with many horses remaining active and being cared for into old age. However, increasing age is paralleled with a heightened risk of morbidity and mortality; therefore, owners of older horses must manage changes in their horse, making decisions about management and health care provision. In this paper, we discuss data collected from an open-access online discussion forum, where forum users sought advice arising from concerns about their older horse. Qualitative data analysis was performed using grounded theory methods. A conceptual model was developed to demonstrate the multifaceted ways in which ageing affects the human-horse relationship and impacts upon outcomes for the horse. The model reflects the dynamic nature of caring for an older horse to accommodate change over time-outcomes for the horse shift as the context of day-to-day life changes. The model provides novel insight into how decisions around older horse care are made.
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Affiliation(s)
- Rebecca Smith
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Chester High Road, Neston, Cheshire CH64 7TE, UK; (G.P.); (C.M.); (J.I.)
| | - Gina Pinchbeck
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Chester High Road, Neston, Cheshire CH64 7TE, UK; (G.P.); (C.M.); (J.I.)
| | - Catherine McGowan
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Chester High Road, Neston, Cheshire CH64 7TE, UK; (G.P.); (C.M.); (J.I.)
| | - Joanne Ireland
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Chester High Road, Neston, Cheshire CH64 7TE, UK; (G.P.); (C.M.); (J.I.)
| | - Elizabeth Perkins
- Institute of Population Health, University of Liverpool, Waterhouse Building, Block B, Brownlow Street, Liverpool L69 3GL, UK;
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19
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Tyagi S, Koh GCH, Luo N, Tan KB, Hoenig H, Matchar DB, Yoong J, Chan A, Lee KE, Venketasubramanian N, Menon E, Chan KM, De Silva DA, Yap P, Tan BY, Chew E, Young SH, Ng YS, Tu TM, Ang YH, Kong KH, Singh R, Merchant RA, Chang HM, Yeo TT, Ning C, Cheong A, Ng YL, Tan CS. Role of caregiver factors in outpatient medical follow-up post-stroke: observational study in Singapore. BMC FAMILY PRACTICE 2021; 22:74. [PMID: 33853544 PMCID: PMC8048235 DOI: 10.1186/s12875-021-01405-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 02/22/2021] [Indexed: 11/10/2022]
Abstract
Background Outpatient medical follow-up post-stroke is not only crucial for secondary prevention but is also associated with a reduced risk of rehospitalization. However, being voluntary and non-urgent, it is potentially determined by both healthcare needs and the socio-demographic context of stroke survivor-caregiver dyads. Therefore, we aimed to examine the role of caregiver factors in outpatient medical follow-up (primary care (PC) and specialist outpatient care (SOC)) post-stroke. Method Stroke survivors and caregivers from the Singapore Stroke Study, a prospective, yearlong, observational study, contributed to the study sample. Participants were interviewed 3-monthly for data collection. Counts of PC and SOC visits were extracted from the National Claims Database. Poisson modelling was used to explore the association of caregiver (and patient) factors with PC/SOC visits over 0–3 months (early) and 4–12 months (late) post-stroke. Results For the current analysis, 256 stroke survivors and caregivers were included. While caregiver-reported memory problems of a stroke survivor (IRR: 0.954; 95% CI: 0.919, 0.990) and caregiver burden (IRR: 0.976; 95% CI: 0.959, 0.993) were significantly associated with lower early post-stroke PC visits, co-residing caregiver (IRR: 1.576; 95% CI: 1.040, 2.389) and negative care management strategies (IRR: 1.033; 95% CI: 1.005, 1.061) were significantly associated with higher late post-stroke SOC visits. Conclusion We demonstrated that the association of caregiver factors with outpatient medical follow-up varied by the type of service (i.e., PC versus SOC) and temporally. Our results support family-centred care provision by family physicians viewing caregivers not only as facilitators of care in the community but also as active members of the care team and as clients requiring care and regular assessments. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01405-z.
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Affiliation(s)
- Shilpa Tyagi
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Gerald Choon-Huat Koh
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore.
| | - Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Kelvin Bryan Tan
- Policy Research & Economics Office, Ministry of Health, Singapore, Singapore
| | - Helen Hoenig
- Physical Medicine and Rehabilitation Service, Durham VA Medical Centre, Durham, NC, USA
| | - David B Matchar
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Joanne Yoong
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Angelique Chan
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Kim En Lee
- Lee Kim En Neurology Pte Ltd, Singapore, Singapore
| | | | - Edward Menon
- St. Andrew's Community Hospital, Singapore, Singapore
| | | | - Deidre Anne De Silva
- National Neuroscience Institute, Singapore General Hospital Campus, Singapore, Singapore
| | - Philip Yap
- Geriatric Medicine, Khoo Teck Puat Hospital, Singapore, Singapore
| | | | - Effie Chew
- Department of Rehabilitation Medicine, National University Hospital, Singapore, Singapore
| | - Sherry H Young
- Department of Rehabilitation Medicine, Changi General Hospital, Singapore, Singapore
| | - Yee Sien Ng
- Department of Rehabilitation Medicine, Singapore General Hospital, Singapore, Singapore
| | - Tian Ming Tu
- Department of Neurology, National Neuroscience Institute, Neurology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Yan Hoon Ang
- Geriatric Medicine, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Keng He Kong
- Department of Rehabilitation Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Rajinder Singh
- Department of Neurology, National Neuroscience Institute, Neurology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Reshma A Merchant
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Hui Meng Chang
- National Neuroscience Institute, Singapore General Hospital Campus, Singapore, Singapore
| | - Tseng Tsai Yeo
- Department of Neurosurgery, National University Hospital, Singapore, Singapore
| | - Chou Ning
- Department of Neurosurgery, National University Hospital, Singapore, Singapore
| | - Angela Cheong
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Yu Li Ng
- Policy Research & Economics Office, Ministry of Health, Singapore, Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
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20
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Gregg JE, Simpson J, Nilforooshan R, Perez-Algorta G. What is the relationship between people with dementia and their caregiver's illness perceptions post-diagnosis and the impact on help-seeking behaviour? A systematic review. DEMENTIA 2021; 20:2597-2617. [PMID: 33787368 PMCID: PMC8704219 DOI: 10.1177/1471301221997291] [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: 11/17/2022]
Abstract
Background: As the number of people with dementia increases, more families will be affected by the daily challenges of providing effective support, given its current incurable status. Once individuals are diagnosed with dementia, the earlier they access support, the more effective the outcome. However, once people receive a diagnosis, how they make sense of their dementia can impact on their help-seeking intentions. Exploring the illness beliefs of people with dementia and their caregivers and this relationship to help seeking may identify how best to facilitate early support.Aims: To systematically obtain and critically review relevant studies on the relationship between illness perceptions and help seeking of people with dementia and their caregivers.Method: A systematic search was conducted and included both quantitative and qualitative studies. The initial search was conducted in October 2018, with an adjacent search conducted in April 2020.Findings: A total of 14 articles met the inclusion criteria. Conceptually, the studies examined the association of illness perceptions and help-seeking post-diagnosis and revealed that people living with dementia and their caregivers sought help when symptoms became severe. Components of illness perceptions revealed that lack of knowledge, cultural beliefs, complexity of the healthcare system, threat to independence and acceptance were identified as major factors for delaying help seeking.Conclusion: Although research interest in the area of illness perceptions and their impact on help seeking for dementia is increasing, further work is needed to understand this area, particularly regarding the influence of the relationship between the person with dementia and their caregiver.
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Affiliation(s)
- Jane E Gregg
- Department of Health Research, 4396Lancaster University, Lanchester, UK
| | - Jane Simpson
- Department of Health Research, 4396Lancaster University, Lancaster, UK
| | - Ramin Nilforooshan
- Research & Development Department, 9490Surrey and Borders Partnership NHS Foundation Trust, Chertsey, UK
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21
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Perceived Help-Seeking Difficulty, Barriers, Delay, and Burden in Carers of People with Suspected Dementia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18062956. [PMID: 33805808 PMCID: PMC7999253 DOI: 10.3390/ijerph18062956] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/07/2021] [Accepted: 03/09/2021] [Indexed: 11/20/2022]
Abstract
Because of an often complicated and difficult-to-access care system, help-seeking for people with suspected dementia can be stressful. Difficulty in help-seeking may contribute to carer burden, in addition to other known stressors in dementia care. This study examined the relationship between perceived help-seeking difficulty and carer burden, and the barriers contributing to perceived difficulty. We interviewed 110 carers accessing a community-based dementia assessment service for suspected dementia of a family member for their perceived difficulty, delays, and barriers in help-seeking, and carers burden in terms of role strain, self-criticism, and negative emotions. Linear regression models showed that perceived help-seeking difficulty is associated with carer self-criticism, while carer role strain and negative emotions are associated with symptom severity of the person with dementia but not help-seeking difficulty. Inadequate knowledge about symptoms, service accessibility, and affordability together explained more than half of the variance in perceived help-seeking difficulty (Nagelkerke R2 = 0.56). Public awareness about symptoms, support in navigating service, and financial support may reduce perceived difficulty in help-seeking, which in turn may reduce carer self-criticism during the early course of illness.
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22
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Abstract
AIM To describe older persons who had commenced a memory assessment, experiences of living with memory impairment and related symptoms. BACKGROUND Persons with subjective memory impairment are two times more likely to develop dementia over the years than their peers. Older persons seldom seek help from primary health care clinics solely for subjective memory impairment. Of those who seek help, it can take up to 35 months from the person experiencing initial symptoms to referral to a memory clinic. Further research is needed regarding how older persons live with memory impairment with related symptoms before they receive a memory diagnosis. METHOD A qualitative study with 23 participants who had commenced a memory assessment in primary care. Semi-structured interviews were held. During the interviews, the Neuropsychiatric Inventory was completed and discussed with the participants. Interview data were analysed using Interpretive Description. RESULTS The results are presented under four themes: Conflicting views about the situation, Unveiling the presence of neuropsychiatric symptoms, Compensating with external and internal strategies to recall and Worrying about self and future. Persons with memory impairment were encouraged by family members or others to seek a memory assessment. Few persons were self-referred as memory impairment was often seen as a part of aging. Polarised viewpoints existed within the families regarding the impact of memory impairment on daily life. The presence of neuropsychiatric symptoms appeared unexplored in the participants seeking a memory assessment. In this study, the majority of participants experienced neuropsychiatric symptoms at the time of contact for a memory assessment. CONCLUSIONS Memory problems experienced were often viewed by the person as being part of an aging process. The presence of neuropsychiatric symptoms was not acknowledged as being connected to memory impairment. Contextualising 'memory impairment' as a part of a 'cognitive process' may help the person in identifying the presence of neuropsychiatric symptoms.
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Affiliation(s)
- Marie Tyrrell
- Sophiahemmet University, Sweden; NVS, Karolinska Institutet, Sweden
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23
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Birt L, Poland F, Charlesworth G, Leung P, Higgs P. Relational experiences of people seeking help and assessment for subjective cognitive concern and memory loss. Aging Ment Health 2020; 24:1356-1364. [PMID: 30917667 DOI: 10.1080/13607863.2019.1592111] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: To understand the experience of people who seek help for subjective cognitive concern and memory loss, including people not referred for further assessment. To understand the patients' perspective of the medical process of receiving a cognitive assessment. This work is situated within the context of policy priorities for dementia diagnosis.Methods: Participants with and without dementia were recruited through NHS trusts and community organisations in four regional areas in England. Data were collected using longitudinal qualitative interviews. Transcript data were thematically analysed.Results: Sample of 41 people (mean 75 years, 25 dementia diagnoses). Interpretative thematic analyses focused on the presence or absence of trust in relational experiences. There were three transition points where trust could be specifically developed or undermined: (1) deciding to seek help; (2) healthcare practitioners' response to help-seeking; (3) process and outcome of assessment. Triggers for help-seeking for subjective cognitive concern were being prompted by family and knowing a relative with dementia. When participants perceived healthcare practitioners' behaviour as dismissive, they had less trust in the outcome of the healthcare encounter. Misunderstandings and absence of trust in assessment processes led to participants stating they did not fully agree with the outcomes of the assessment.Conclusions: Healthcare practitioners have an important role in supporting people with subjective cognitive concern ensuring patients have trust in assessment outcomes. Where the validity of the assessment process is seen as ambiguous, people can be left dealing with uncertainty, rather than being clear about ways they can manage their condition, situation or status.
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Affiliation(s)
- Linda Birt
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Fiona Poland
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Georgina Charlesworth
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.,Research and Development Department, North East London NHS Foundation Trust, London, UK
| | - Phuong Leung
- Division of Psychiatry, University College London, London, UK
| | - Paul Higgs
- Division of Psychiatry, University College London, London, UK
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Nguyen H, Zaragoza M, Wussler N, Lee JA. "I was Confused About How to Take Care of Mom Because this Disease is Different Everyday": Vietnamese American Caregivers' Understanding of Alzheimer's Disease. J Cross Cult Gerontol 2020; 35:217-234. [PMID: 32112183 PMCID: PMC8051361 DOI: 10.1007/s10823-020-09396-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Family members provide the majority of caregiving to individuals living with Alzheimer's disease (AD) and related dementias. Asian American families are disproportionately impacted by the burden of caregiving due to limited knowledge about the disease in this community. This study explored how Vietnamese American caregivers understand AD and provide care to family members with AD. Twenty caregivers who have provided care to a family member with AD participated in a semi-structured qualitative interview. Data were analyzed using thematic analysis. Several themes were identified in the caregivers' understanding of AD: (a) "Now I know:" the disruptions, shocks and surprises leading up to the initial diagnosis; (b) The frustrations of managing family members' cognitive impairments; (c)"Going with the flow:" challenges in managing personality and behavioral changes; (d) The exhaustion of around-the-clock caregiving; (e)"Taking it day by day" in the face of progressively worsening symptoms. Underlining the participants' descriptions of AD was a shared understanding of the progressively worsening, complex and unpredictable nature of the disease that makes it challenging for family caregivers on a daily basis. Findings provide important implications for healthcare workers' outreach to Vietnamese American families to ease the caregiving experience through culturally-responsive education, thereby enhancing the families' ability to recognize the early symptoms and seek appropriate help.
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Affiliation(s)
- Hannah Nguyen
- Department of Human Services, California State University, Dominguez Hills, Carson, CA, USA
| | - Michelle Zaragoza
- Department of Human Services, California State University, Dominguez Hills, Carson, CA, USA
| | - Natalie Wussler
- Department of Social Work, St. Olaf College, Northfield, MN, USA
| | - Jung-Ah Lee
- Sue and Bill Gross School of Nursing, University of California, 100A Berk Hall, Irvine, CA, 92697-3959, USA.
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Wong LX, Bloom GM, Chee B. The Complex Maze of the Informed Consent Process: Helping to Improve Comprehension in Clinical Trial Participants with Alzheimer's Disease. J Alzheimers Dis Rep 2020; 4:161-164. [PMID: 32587949 PMCID: PMC7306923 DOI: 10.3233/adr-200187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
We intend for this article to provide a foundation toward the creation of a more patient-centric approach to the informed consent process. Our overall objectives are to promote ethical clinical research standards and procedures toward enhanced supportive systems for clinical trial participants. We provide a suggested format which multidisciplinary clinical trial researchers can adapt for their own clinical trial setting.
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Affiliation(s)
- Louis X Wong
- Department of Clinical Research and Leadership, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.,Department of Hematology and Oncology, Gastrointestinal Oncology, University of California, San Francisco, San Francisco, CA, USA
| | - Gail M Bloom
- Department of Clinical Research and Leadership, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Bryant Chee
- Department of Primary Care, Touro University College of Osteopathic Medicine - California, Vallejo, CA, USA
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Parker M, Barlow S, Hoe J, Aitken L. Persistent barriers and facilitators to seeking help for a dementia diagnosis: a systematic review of 30 years of the perspectives of carers and people with dementia. Int Psychogeriatr 2020; 32:1-24. [PMID: 32024558 DOI: 10.1017/s1041610219002229] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To identify barriers and facilitators to help seeking for a dementia diagnosis from the perspective of carers and people with dementia. DESIGN A systematic review of the literature was conducted according to the PRISMA guidelines (PROSPERO protocol registration CRD42018092524). Nine electronic databases were searched for qualitative, quantitative, and mixed methods primary research studies. Two independent reviewers screened titles and abstracts, full texts of eligible studies, and conducted quality appraisal of included articles. A convergent qualitative synthesis approach was used. RESULTS From 7496 articles, 35 papers representing 32 studies from 1986 to 2017 were included. Studies originated from 13 countries across 4 continents. Barriers and facilitators were reported predominantly by carers. A small number of studies included people with dementia. Barriers included denial, stigma and fear, lack of knowledge, normalization of symptoms, preserving autonomy, lack of perceived need, unaware of changes, lack of informal network support, carer difficulties, and problems accessing help. Facilitators included recognition of symptoms as a problem, prior knowledge and contacts, and support from informal network. CONCLUSIONS Studies from a 30-year period demonstrated that barriers to help seeking persist globally, despite increasing numbers of national dementia policies. Barriers and facilitators rarely existed independently demonstrating the complexity of help seeking for a diagnosis of dementia. Multiple barriers compounded the decision-making process and more than one facilitator was often required to overcome them. Multi-faceted interventions to reduce barriers are needed, one approach would be a focus on the development of dementia friendly communities to reduce stigma and empower people with dementia and carers.
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Affiliation(s)
| | - Sally Barlow
- Division of Nursing, City, University of London, London, UK
| | - Juanita Hoe
- Division of Nursing, City, University of London, London, UK
| | - Leanne Aitken
- School of Health Sciences, City, University of London, London, UK
- School of Nursing & Midwifery, Griffith University, Queensland, Australia
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The Diagnostic Pathway From Cognitive Impairment to Dementia in Japan: Quantification Using Real-World Data. Alzheimer Dis Assoc Disord 2019; 33:346-353. [PMID: 31135457 DOI: 10.1097/wad.0000000000000322] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This study aimed to quantify the diagnostic pathway from cognitive impairment (CI) to dementia in Japan. METHODS This was a real-world, cross-sectional survey of patients with CI and their physicians. RESULTS Data for 1107 patients were provided by 106 physicians. Mean time from initial symptoms to the first consultation was 7.4±6.9 months; 42% of patients had moderate/severe CI at first consultation. Mean time from the first consultation to formal diagnosis was 2.9±11.0 months (1.9±8.8 mo if not referred to a secondary physician, and 5.1±14.6 mo if referred). Time from the first consultation to diagnosis was shorter with more severe CI at first consultation (P=0.0072). The highest proportion of patients were diagnosed by neurologists (45.8%). Tests or scales were used to aid diagnosis in 81.2% of patients. There was no association of disease severity and referral to a secondary physician; 30.9% of patients were referred, the majority (57.7%) to a neurologist. CONCLUSIONS A substantial proportion of patients with dementia in Japan experience CI for some time before consulting a physician. Government policy to increase public understanding and awareness of dementia, and a proposed dementia screening system, should increase the proportion of individuals consulting physicians before disease progression.
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Rodríguez‐Gómez O, Rodrigo A, Iradier F, Santos‐Santos MA, Hundemer H, Ciudin A, Sannemann L, Zwan M, Glaysher B, Wimo A, Bonn J, Johansson G, Rodriguez I, Alegret M, Gove D, Pinó S, Trigueros P, Kivipelto M, Mathews B, Ciudad A, Ferreira D, Bintener C, Gurruchaga M, Westman E, Belger M, Valero S, Maguire P, Krivec D, Kramberger M, Simó R, Garro IP, Visser PJ, Dumas A, Georges J, Jessen F, Winblad B, Shering C, Stewart N, Campo L, Boada M. The MOPEAD project: Advancing patient engagement for the detection of “hidden” undiagnosed cases of Alzheimer's disease in the community. Alzheimers Dement 2019; 15:828-839. [DOI: 10.1016/j.jalz.2019.02.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 01/30/2019] [Accepted: 02/25/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Octavio Rodríguez‐Gómez
- Research Center and Memory ClinicFundació ACEInstitut Català de Neurociències Aplicades ‐ Universitat Internacional de CatalunyaBarcelonaSpain
- Networking Research Center on Neurodegenerative Diseases (CIBERNED)Instituto de Salud Carlos IIIBarcelonaSpain
| | | | | | - Miguel A. Santos‐Santos
- Research Center and Memory ClinicFundació ACEInstitut Català de Neurociències Aplicades ‐ Universitat Internacional de CatalunyaBarcelonaSpain
| | - Hans Hundemer
- Eli Lilly and Company (Lilly Deutschland GmbH)Bad HomburgGermany
| | - Andreea Ciudin
- Vall d’Hebron Research Institute (VHIR) and CIBERDEM (ISCIII)BarcelonaSpain
| | - Lena Sannemann
- Department of PsychiatryUniversity of CologneCologneGermany
| | - Marissa Zwan
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam NeuroscienceVrije Universiteit AmsterdamAmsterdam UMCAmsterdamthe Netherlands
| | | | - Anders Wimo
- Division of NeurogeriatricsDepartment of NeurobiologyCare Sciences and SocietyKarolinska InstitutetHuddingeSweden
| | - Jaka Bonn
- Center for Cognitive ImpairmentsDepartment of NeurologyUniversity Medical Center LjubljanaLjubljanaSlovenia
| | - Gunilla Johansson
- Division of NeurogeriatricsDepartment of NeurobiologyCare Sciences and SocietyKarolinska InstitutetHuddingeSweden
| | - Isabel Rodriguez
- Research Center and Memory ClinicFundació ACEInstitut Català de Neurociències Aplicades ‐ Universitat Internacional de CatalunyaBarcelonaSpain
| | - Montse Alegret
- Research Center and Memory ClinicFundació ACEInstitut Català de Neurociències Aplicades ‐ Universitat Internacional de CatalunyaBarcelonaSpain
- Networking Research Center on Neurodegenerative Diseases (CIBERNED)Instituto de Salud Carlos IIIBarcelonaSpain
| | | | - Susana Pinó
- Research Center and Memory ClinicFundació ACEInstitut Català de Neurociències Aplicades ‐ Universitat Internacional de CatalunyaBarcelonaSpain
| | | | - Miia Kivipelto
- Division of Clinical GeriatricsCentre for Alzheimer ResearchDepartment of NeurobiologyCare Sciences and SocietyKarolinska InstitutetStockholmSweden
- Institute of Clinical Medicine/NeurologyUniversity of Eastern FinlandKuopioFinland
| | | | | | - Daniel Ferreira
- Division of Clinical GeriatricsCentre for Alzheimer ResearchDepartment of NeurobiologyCare Sciences and SocietyKarolinska InstitutetStockholmSweden
| | | | - Miren Gurruchaga
- Research Center and Memory ClinicFundació ACEInstitut Català de Neurociències Aplicades ‐ Universitat Internacional de CatalunyaBarcelonaSpain
| | - Eric Westman
- Division of Clinical GeriatricsCentre for Alzheimer ResearchDepartment of NeurobiologyCare Sciences and SocietyKarolinska InstitutetStockholmSweden
- Department of NeuroimagingCentre for Neuroimaging SciencesInstitute of PsychiatryPsychologyand NeuroscienceKing's College LondonLondonUK
| | | | - Sergi Valero
- Research Center and Memory ClinicFundació ACEInstitut Català de Neurociències Aplicades ‐ Universitat Internacional de CatalunyaBarcelonaSpain
- Networking Research Center on Neurodegenerative Diseases (CIBERNED)Instituto de Salud Carlos IIIBarcelonaSpain
| | | | | | - Milica Kramberger
- Center for Cognitive ImpairmentsDepartment of NeurologyUniversity Medical Center LjubljanaLjubljanaSlovenia
| | - Rafael Simó
- Vall d’Hebron Research Institute (VHIR) and CIBERDEM (ISCIII)BarcelonaSpain
| | | | - Pieter Jelle Visser
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam NeuroscienceVrije Universiteit AmsterdamAmsterdam UMCAmsterdamthe Netherlands
- Department of Psychiatry and NeuropsychologySchool for Mental Health and NeuroscienceMaastricht UniversityMaastrichtthe Netherlands
| | | | | | - Frank Jessen
- Department of PsychiatryUniversity of CologneCologneGermany
- German Center for Neurodegenerative Diseases (DZNE)BonnGermany
| | - Bengt Winblad
- Division of NeurogeriatricsDepartment of NeurobiologyCare Sciences and SocietyKarolinska InstitutetHuddingeSweden
- Karolinska Univ HospitalTheme AgingStockholmSweden
| | | | - Neil Stewart
- Modus Research and Innovation LimitedDundeeScotland
| | | | - Mercè Boada
- Research Center and Memory ClinicFundació ACEInstitut Català de Neurociències Aplicades ‐ Universitat Internacional de CatalunyaBarcelonaSpain
- Networking Research Center on Neurodegenerative Diseases (CIBERNED)Instituto de Salud Carlos IIIBarcelonaSpain
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Bell-Davies F, Goyder C, Gale N, Hobbs FDR, Taylor CJ. The role of informal carers in the diagnostic process of heart failure: a secondary qualitative analysis. BMC Cardiovasc Disord 2019; 19:92. [PMID: 31014239 PMCID: PMC6480764 DOI: 10.1186/s12872-019-1075-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 04/10/2019] [Indexed: 11/16/2022] Open
Abstract
Background Heart failure (HF) is a common clinical syndrome, particularly in older people, and symptoms can develop gradually. The aim of this study was to explore the role of informal carers in the HF diagnostic process. Methods Secondary analysis of qualitative interviews with 16 participants with a new diagnosis of HF. Original interviews were conducted in the participant’s home, with carers present in some cases. Interview transcripts were re-analysed using the Framework Method for themes pertaining to informal carers and how they were involved in the diagnostic process. Results Informal carers often noticed symptoms, such as breathlessness, before participants. In some cases, carers colluded with participants in normalising symptoms but over time, when symptoms failed to resolve or got worse, they encouraged participants to seek medical help. Adult children of participants commonly initiated help-seeking behaviour. During the diagnostic process, carers coordinated participants’ healthcare through advocacy and organisation. Carers were keen to be informed about the diagnosis, but both participants and carers struggled to understand some aspects of the term ‘heart failure’. Conclusions Carers play a crucial role in HF diagnosis, particularly in initiating contact with healthcare services, and should be empowered to encourage people with HF symptoms to seek medical help. Improving public awareness of HF could mean informal carers are more likely to notice symptoms. The important role of carers in supporting the patient’s route to diagnosis should be incorporated into future care pathways and explored in further research.
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Affiliation(s)
- Frances Bell-Davies
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Clare Goyder
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Nicola Gale
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - F D Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Clare J Taylor
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK.
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Factors Associated with Having a Will, Power of Attorney, and Advanced Healthcare Directive in Patients Presenting to a Rural and Remote Memory Clinic. Can J Neurol Sci 2019; 46:319-330. [PMID: 30907330 DOI: 10.1017/cjn.2019.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND A Will, Power of Attorney, and Advanced Healthcare Directive are critical to guide decision-making in patients with dementia. We identified characteristics that are associated with the existence of these documents in patients who presented to a rural and remote memory clinic (RRMC). METHODS Ninety-five consecutive patients were included in this study. Patients and caregivers completed questionnaires on initial presentation to the RRMC and patients were asked if they had legal documents. Patients also completed neuropsychological testing. Statistical analysis (t-test and χ2 test) was performed to identify significant variables. RESULTS Seventy (73.7%) patients had a Will, 62 (65.3%) had a Power of Attorney, and 21 (22.1%) had an Advanced Healthcare Directive. Having a Will was associated with good quality of life (p = 0.001), living alone or with a spouse or partner only (p = 0.034), poor verbal fluency (p = 0.055), and European ethnicity (p = 0.028). Factors associated with having a Power of Attorney included good quality of life (p = 0.031), living alone or with a spouse or partner only (p = 0.053), and poor verbal fluency (p = 0.015). Old age (p = 0.015), poor verbal fluency (p = 0.023), and greater severity of cognitive and functional impairment (p = 0.023) were associated with having an Advanced Healthcare Directive. CONCLUSIONS Our results indicate that poor quality of life, good performance on verbal fluency, Indigenous ethnicity, and living with others are associated with a lower likelihood of legal documents in patients with dementia. These factors can help physicians identify patients at risk of leaving their legal affairs unattended to. Physicians should discuss the creation of legal documents early on in patients with signs of dementia.
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Ritchie CW, Black CM, Khandker RK, Wood R, Jones E, Hu X, Ambegaonkar BM. Quantifying the Diagnostic Pathway for Patients with Cognitive Impairment: Real-World Data from Seven European and North American Countries. J Alzheimers Dis 2019; 62:457-466. [PMID: 29439347 DOI: 10.3233/jad-170864] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
To ensure that patients with dementia and their caregivers receive appropriate treatment and support, early diagnosis is essential but remains challenging. Real-world data from a multi-national, cross-sectional survey of physicians and their patients were analyzed to quantify the diagnostic pathway for dementia, including a focus on severity of patients' cognitive impairment (CI) at the time of symptom onset, referral and subsequent diagnosis. Data were collected for 7,620 patients with CI. Most patients saw a healthcare professional within 1 year of first symptoms and received a diagnosis within 3-7 months of initial consultation. However, only 20% of patients received a diagnosis before their disease progressed beyond the prodromal stage and 23.5% already had moderate CI at diagnosis. These findings show that the goal of identifying and diagnosing CI at the earliest stages of disease is, for many patients, not achieved. Efforts toward public awareness and proactive, earlier detection and intervention, must be maintained-indeed where possible invigorated.
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Affiliation(s)
- Craig W Ritchie
- Centre for Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, UK
| | - Christopher M Black
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
| | - Rezaul K Khandker
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
| | | | | | - Xiaohan Hu
- University of Southern California, Los Angeles, CA, USA
| | - Baishali M Ambegaonkar
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
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Ryu YM, Yu M, Oh S, Lee H, Kim H. [Shifting of Centricity: Qualitative Meta Synthetic Approach on Caring Experience of Family Members of Patients with Dementia]. J Korean Acad Nurs 2019; 48:601-621. [PMID: 30396197 DOI: 10.4040/jkan.2018.48.5.601] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 08/02/2018] [Accepted: 09/18/2018] [Indexed: 11/09/2022]
Abstract
PURPOSE This study aimed to synthesize the caring experiences of Korean family members of patients with dementia through a qualitative meta-synthesis method. METHODS By searching through nine Korean and English databases, we compared 37 qualitative studies on caring experiences of family members of patients with dementia. The selected studies were synthesized through meta-synthesis, proposed by Sandelowski and Barroso (2007). RESULTS The meta-synthesis elicited four themes: tough life due to care for patients, changes in relationships, adaptation to caregiver's roles, and new perspectives of life through personal growth. Caregivers were shocked when a sudden diagnosis of dementia was made prior to any preparation on their part. They were tied to their patients all the time and their mind and body got exhausted. Their relationship with patients began to change and they looked at them differently. They experienced conflicts with the other non-caring family members and were alienated from them. They were also socially isolated. However, by building their own care strategies and utilizing social resources, they gradually adapted to their caregiver roles. Finally, they experienced personal growth and acquired a new perspective toward life by accepting their roles and finding meaning in their lives. Shifting the caregiver's centricity from themselves to the patient was the process of becoming human beings who actively constructed their realities while giving meaning to their painful lives and interacting with the environment. CONCLUSION The results of the study can be useful for nurses in understanding the experiences of caregivers of the patients with dementia and in providing them with practical interventions.
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Affiliation(s)
- Young Mi Ryu
- Department of Nursing, Baekseok University, Cheonan, Korea
| | - Mi Yu
- College of Nursing · Institute of Health Sciences, Gyeongsang National University, Jinju, Korea
| | - Seieun Oh
- College of Nursing, Dankook University, Cheonan, Korea
| | - Haeyoung Lee
- Department of Nursing, Hoseo University, Asan, Korea
| | - Haejin Kim
- Department of Nursing, Suwon Women's University, Suwon, Korea.
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Abstract
As the number of persons with dementia grows, an increasing number of families, professionals, and laypersons will come into contact with persons with cognitive deterioration. Assessing dementia illness representations (IRs) among these groups may have great importance for understanding their responses to dementia. The purpose of this study was to summarize and critically review the literature on dementia IRs. A total of 25 articles that satisfied the inclusion criteria were identified. The review revealed that conceptually, research attention on dementia IRs has increased over the past several years as a result of changes in the notion of IRs and in the dementia discourse. Regardless of the population examined, dementia was mostly described as a chronic condition, presenting more cognitive than behavioral symptoms, and as being caused mainly by age, heredity, and abnormal brain changes. Methodologically, the area of dementia IRs is characterized by design, sample, and data collection weaknesses. Findings suggest that although the literature in the area of dementia and IRs is increasing, several conceptual and methodological limitations still have to be resolved in order to advance knowledge in the area. The research and clinical implications of these findings stress the importance of IRs in the area of dementia.
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Affiliation(s)
- Shiri Shinan-Altman
- The Louis and Gabi Weisfeld School of Social Work, Faculty of Social Sciences, Bar Ilan University, Ramat Gan, Israel,
| | - Perla Werner
- Department of Community Mental Health, University of Haifa, Haifa, Israel
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Claveau JS, Presse N, Kergoat MJ, Villalpando JM. The Lost Years: Delay Between the Onset of Cognitive Symptoms and Clinical Assessment at a Memory Clinic. Can Geriatr J 2018; 21:152-156. [PMID: 29977430 PMCID: PMC6028170 DOI: 10.5770/cgj.21.297] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Early assessment of cognitive symptoms is an issue in geriatrics. This study investigated the delay from the onset of cognitive symptoms to initial clinical assessment and its associations with patients’ sociodemographic and clinical characteristics. Methods This is a cross-sectional retrospective study using medical chart review of 316 patients referred for assessment to a university-affiliated memory clinic. Symptom duration was self-reported by patients/carers. Severity of symptoms assessed by the MoCA and FAST instruments was compared according to delay duration (≥3 years vs. <3 years) using chi-squared tests. Logistic regression was used to determine the association between patients’ characteristics and long symptom duration (≥3 years). Results At the initial assessment, 29.4% of patients reported experiencing cognitive symptoms for ≥3 years. They were more likely to have MoCA scores ≤17 (47.8 vs. 34.1%; p=.023) and FAST scores ≥5 (21.5 vs. 10.8%; p=.012). They were also significantly older than 75 years (75–84 yr: OR=2.22 [95%CI: 1.11–4.41]; ≥85 yr: 4.36 [2.08–9.11]), presented more depressive symptoms (2.37 [1.40–4.02]), and were less likely to live alone (0.55 [0.31–0.96]). Conclusions A significant proportion of patients had cognitive symptoms for years when initially assessed, which delayed diagnosis and management. Stigma, depression, and compensatory help from carers may contribute to this delay.
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Affiliation(s)
- Jean-Sébastien Claveau
- Département de médecine, Faculté de médecine, Université de Montréal, Montréal QC, Canada
| | - Nancy Presse
- Centre de recherche, Institut universitaire de gériatrie de Montréal, Montréal QC, Canada
| | - Marie-Jeanne Kergoat
- Département de médecine, Faculté de médecine, Université de Montréal, Montréal QC, Canada.,Centre de recherche, Institut universitaire de gériatrie de Montréal, Montréal QC, Canada
| | - Juan Manuel Villalpando
- Département de médecine, Faculté de médecine, Université de Montréal, Montréal QC, Canada.,Centre de recherche, Institut universitaire de gériatrie de Montréal, Montréal QC, Canada
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Patient and companion concerns when receiving a dementia diagnosis: an observational study of dementia diagnosis feedback meetings. AGEING & SOCIETY 2018. [DOI: 10.1017/s0144686x18000247] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ABSTRACTReceiving a diagnosis of dementia is a life-changing event and can cause strong emotional reactions. The aim of this study was to examine patient and companion concerns expressed during dementia diagnosis feedback meetings. Sixty consultations between 19 health-care professionals (HCPs), 60 patients and 59 companions were video-recorded and transcribed. Concerns were identified from the transcripts and were (a) content analysed, (b) coded aselicitedby the HCP orvolunteeredby the patient or companion, and (c) coded according to whether the HCPencouragedordiscouragedelaboration of the concern. A total of 249 concerns were identified (average four concerns per consultation). There were three areas of findings: (a) patients and companions were concerned about the symptoms of dementia and receiving a diagnosis; other concerns related to patients’ mental and physical health, and prognosis, (b) HCPs elicited more patient than companion concerns and mostly elicited concerns aligned with the agenda of diagnosis feedback, and (c) HCPs were more likely to encourage elaboration when they elicited the concern. Nearly 40 per cent of concerns were discouraged by the HPC changing topic, with concerns about prognosis most commonly discouraged. The findings suggest that there were a wide variety of concerns at dementia diagnosis, many extending beyond the experience of dementia symptoms. HCP avoidance of concerns about prognosis demonstrated delicacy in discussing the deteriorating course of dementia.
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Abstract
BACKGROUND Dementia diagnosis rates are increasing. Guidelines recommend that people with dementia should be told their diagnosis clearly and honestly to facilitate future planning. Aims To analyse how doctors deliver a dementia diagnosis in practice. METHOD Conversation analysis was conducted on 81 video-recorded diagnosis feedback meetings with 20 doctors from nine UK memory clinics. RESULTS All doctors named dementia; 59% (n = 48) approached the diagnosis indirectly but delicately ('this is dementia') and 41% (n = 33) approached this directly but bluntly ('you have Alzheimer's disease'). Direct approaches were used more often with people with lower cognitive test scores. Doctors emphasised that the dementia was mild and tended to downplay its progression, with some avoiding discussing prognosis altogether. CONCLUSIONS Doctors are naming dementia to patients. Direct approaches reflect attempts to ensure clear diagnosis. Downplaying and avoiding prognosis demonstrates concerns about preserving hope but may compromise understanding about and planning for the future. Declaration of interest None.
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Affiliation(s)
- Jemima Dooley
- Population Health Sciences,University of Bristol,Bristol,UK
| | - Nick Bass
- Division of Psychiatry,University College London,London,UK
| | - Rose McCabe
- University of Exeter Medical School,Exeter,UK
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Theed R, Eccles F, Simpson J. Experiences of caring for a family member with Parkinson's disease: a meta-synthesis. Aging Ment Health 2017; 21:1007-1016. [PMID: 27802771 DOI: 10.1080/13607863.2016.1247414] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE The aim of this qualitative meta-synthesis was to search and then synthesise family caregivers' experiences of providing care to individuals with Parkinson's disease (PD). METHOD A systematic search resulted in the identification of 11 qualitative studies. Noblit and Hare's seven-stage approach was used to provide a higher-order interpretation of how family caregivers' experienced the effects of taking on a caregiving role. RESULTS The process of reciprocal translation resulted in four overarching themes: (1) the need to carry on as usual - 'the caregiver must continue with his life'; (2) the importance of support in facilitating coping - 'I'm still going back to the support group'; (3) the difficult balancing act between caregiving and caregiver needs - 'I cannot get sick because I'm a caregiver'; (4) conflicts in seeking information and knowledge - 'maybe better not to know'. CONCLUSION The themes reflected different aspects of family caregivers' lives that were affected as a result of caring for a relative diagnosed with PD and these raise challenges for more simplistic theories of family caring and appropriate support structures. The findings also highlight several recommendations for clinical practice.
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Affiliation(s)
- Rachael Theed
- a Division of Health Research , Lancaster University , Lancaster , United Kingdom
| | - Fiona Eccles
- a Division of Health Research , Lancaster University , Lancaster , United Kingdom
| | - Jane Simpson
- a Division of Health Research , Lancaster University , Lancaster , United Kingdom
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Abstract
Early diagnosis of dementia allows people to access effective treatment and make advance decisions while they still have capacity. We aimed to encourage people to attend memory clinic, in order to boost rates of diagnosis. We created a patient information video about Oxford Health NHS Foundation Trust Memory Clinics, to inform and empower those awaiting assessment and to promote early diagnosis. Fourteen people (patients, carers, and staff) were approached prior to developing the video to ascertain their views on the themes the video should cover. The video consisted of unscripted interviews with patients, carers, and staff. We surveyed participants and new patients attending memory clinic to get feedback on the video and to assess patients' level of understanding and confidence about a memory assessment before and after watching the video. The video content was refined based on this feedback and a final version was produced. Patient feedback demonstrated that confidence and understanding increased after watching the video. Although this study is limited by its small sample size and lack of access to those with undiagnosed dementia, feedback suggested that the video empowered and reassured those awaiting assessment and could be used as a tool to reduce barriers to early diagnosis. Patients and carers involved in making the video found it a therapeutic activity in itself.
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Sikes P, Hall M. ‘Every time I see him he’s the worst he’s ever been and the best he’ll ever be’: grief and sadness in children and young people who have a parent with dementia. ACTA ACUST UNITED AC 2017. [DOI: 10.1080/13576275.2016.1274297] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Pat Sikes
- School of Education, University of Sheffield, Sheffield, UK
| | - Melanie Hall
- School of Education, University of Sheffield, Sheffield, UK
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Hall M, Sikes P. From "What the Hell Is Going on?" to the "Mushy Middle Ground" to "Getting Used to a New Normal": Young People's Biographical Narratives Around Navigating Parental Dementia. ACTA ACUST UNITED AC 2016; 26:124-144. [PMID: 29628752 PMCID: PMC5865472 DOI: 10.1177/1054137316651384] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The number of young people who have a parent with dementia is rising as a result of improvements in diagnosis of young onset variants and demographic shifts. There has, however, been very little research focusing on this group. Accounts elicited as part of the Perceptions and Experiences of Young People With a Parent With Dementia described the period, usually some years, leading up to a diagnosis of a dementia and then the progress of the condition post diagnosis. These narratives were characterized by confusion, uncertainty, trauma, and distress as the young people struggled to make sense of the significant and often extreme, behavioral and attitudinal changes that were symptoms of the illness. This article describes and discusses how the young people experienced and navigated the temporal messiness and consequent biographical disruption arising from parental dementia.
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Affiliation(s)
- Mel Hall
- University of Sheffield, Sheffield, UK
| | - Pat Sikes
- University of Sheffield, Sheffield, UK
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