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Zidén L, Erhag HF, Wijk H. Person-centered care as a tool to reduce behavioral and psychological symptoms in older adults with dementia living in residential care facilities. Geriatr Nurs 2024; 57:51-57. [PMID: 38522128 DOI: 10.1016/j.gerinurse.2024.03.003] [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: 11/23/2023] [Revised: 02/21/2024] [Accepted: 03/07/2024] [Indexed: 03/26/2024]
Abstract
Among older adults living in dementia residential care facilities (RCF) behavioral and psychological symptoms (BPSD) are common, affecting the quality of life (QOL) for the residents as well as being challenging for the staff. The person-centered care (PCC) approach addresses BPSD by giving trained staff mandate to focus on the relation and to adapt the encounter and the environment to increase QoL for the person with dementia. The aims with this study were to improve PCC, decrease BPSD and improve QOL among older persons with dementia living in RCFs, and to explore leaders' and healthcare staff's experiences of a PCC intervention. An educational program was implemented at two RCFs. Data was collected through questionnaires, from national quality registries and through focus group interviews. A significant increase in PCC and QOL at three months was seen. However, no significant difference in BPSD was seen. The interviews showed the importance of a trust-based relationship, and support from an active management to improve PCC, as well as changing old patterns and recognising competence among staff. Factors that affect implementation of PCC in RCF are discussed in the article.
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Affiliation(s)
- Lena Zidén
- Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Neuroscience and Physiology, Dept of Rehabilitation, Sahlgrenska Academy, University of Gothenburg, Sweden.
| | - Hanna Falk Erhag
- Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Neuroscience and Physiology, Dept of Rehabilitation, Sahlgrenska Academy, University of Gothenburg, Sweden; Institute of Health and Care Science, Sahlgrenska Academy, University of Gothenburg, Sweden; Centre for Ageing and Health - AgeCap, University of Gothenburg, Sweden.
| | - Helle Wijk
- Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Health and Care Science, Sahlgrenska Academy, University of Gothenburg, Sweden; Chalmers University, Gothenburg, Sweden.
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Appel L, Appel E, Kisonas E, Lewis-Fung S, Pardini S, Rosenberg J, Appel J, Smith C. Evaluating the Impact of Virtual Reality on the Behavioral and Psychological Symptoms of Dementia and Quality of Life of Inpatients With Dementia in Acute Care: Randomized Controlled Trial (VRCT). J Med Internet Res 2024; 26:e51758. [PMID: 38289666 PMCID: PMC10865216 DOI: 10.2196/51758] [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: 08/11/2023] [Revised: 11/07/2023] [Accepted: 11/27/2023] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Virtual reality (VR) is increasingly considered a valuable therapeutic tool for people with dementia. However, rigorous studies are still needed to evaluate its impact on behavioral and psychological symptoms of dementia (BPSDs) and quality of life (QoL) across care settings. OBJECTIVE The primary aim of this study was to evaluate the impact of VR therapy on managing BPSDs, falls, length of stay, and QoL in inpatients with dementia admitted to an acute care hospital. The secondary aim was to evaluate the intervention's feasibility in terms of acceptability, safety, and patient experience. METHODS A prospective, open-label, mixed methods, randomized controlled clinical trial was conducted between April 2019 and March 2020. A total of 69 participants (aged ≥65 years with a diagnosis of dementia and who did not meet the exclusion criteria) were randomly assigned to either the control (n=35, 51%) or VR (n=34, 49%) arm. Participants in the experimental (VR) arm were visited by a researcher and watched 360° VR films on a head-mounted display for up to 20 minutes every 1 to 3 days, whereas individuals in the control arm received standard of care. Instances of daily BPSDs and falls were collected from nurses' daily notes. QoL was measured through semistructured interviews and the Quality of Life in Late-Stage Dementia scale. Structured observations and semistructured interviews were used to measure treatment feasibility. The primary outcomes were analyzed at a 95% significance level based on the intention-to-treat method. RESULTS VR therapy had a statistically significant effect on reducing aggressiveness (ie, physical aggression and loud vociferation; P=.01). Substantial impact of VR therapy was not found for other BPSDs (eg, apathy), falls, length of stay, or QoL as measured using the Quality of Life in Late-Stage Dementia scale. The average VR therapy session lasted 6.8 (SD 6.6; range 0-20) minutes, and the intervention was overall an acceptable and enjoyable experience for participants. No adverse events occurred as a result of VR therapy. CONCLUSIONS Immersive VR therapy appears to have an effect on aggressive behaviors in patients with dementia in acute care. Although the randomized controlled trial was stopped before reaching the intended sample size owing to COVID-19 restrictions, trends in the results are promising. We suggest conducting future trials with larger samples and, in some cases, more sensitive data collection instruments. TRIAL REGISTRATION ClinicalTrials.gov NCT03941119; https://clinicaltrials.gov/study/NCT03941119. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/22406.
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Affiliation(s)
- Lora Appel
- School of Health Policy and Management, Faculty of Health, York Universtiy, Toronto, ON, Canada
- OpenLab, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Michael Garron Hospital, Toronto, ON, Canada
| | - Eva Appel
- OpenLab, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Erika Kisonas
- OpenLab, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Samantha Lewis-Fung
- OpenLab, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | | | | | - Julian Appel
- Ted Rogers School of Management, Toronto Metropolitan University, Toronto, ON, Canada
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Loftus KL, Wand APF, Breen JL, Hunt GE, Peisah C. Factors Associated with Psychotropic Medication Use in People Living with Dementia in the Community: A Systematic Review and Meta-Analysis. Drugs Aging 2023; 40:1053-1084. [PMID: 37943474 PMCID: PMC10682283 DOI: 10.1007/s40266-023-01070-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND There has been considerable focus on the use of psychotropic agents in people living with dementia in long-term care. However, psychotropic use often commences well before transitioning to long-term care. OBJECTIVES To synthesize the available literature to identify factors associated with psychotropic medication use in people living with dementia in the community. METHODS This PROSPERO-registered review reports findings from a comprehensive search of Embase, PsycINFO, and PubMed (including MEDLINE) databases according to predefined inclusion and exclusion criteria (2010-2022). Inclusion criteria were original prospective or retrospective design research papers enrolling people diagnosed with dementia utilizing a psychotropic medication and living at home. Quality and risk of bias was assessed Newcastle-Ottawa Quality Assessment Scale. The last search was conducted in November 2022. Thematic analysis was used to synthesize the emergent factors identified, and a meta-analysis was undertaken on suitable data. RESULTS The search identified 619 articles. After review and exclusions, 39 articles were included for synthesis, including 1,338,737 people. The majority of papers (67%) were rated as low risk of bias and corresponding good quality. Thematic analysis suggested associations between psychotropic prescribing and patient and environmental factors, with little data concerning carer and prescriber factors. Such factors included age (< 75 years, > 90 years), sex, more advanced functional decline, and living alone. Meta-analysis identified significant associations between psychotropic use and respite (temporary full-time care or hospitalization) and comorbid psychiatric illness. CONCLUSIONS While it is clear from this review that there remains a significant lack of clarity as to the reasons why these medications are being utilized in this population, this review provides greater insight and understanding into the context of psychotropic use. The study has highlighted an opportunity for further targeted research to be conducted and provides a much-needed context for this to occur. PROSPERO REGISTRATION NUMBER CRD42021286322.
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Affiliation(s)
- Kerryn L Loftus
- Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia.
- JARA UNIT, Concord Centre for Mental Health, Concord Hospital, 1 Hospital Road, Concord, NSW, 2137, Australia.
| | - Anne P F Wand
- Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- Specialty of Psychiatry, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Juanita L Breen
- Wicking Dementia Research and Education Centre, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
- Capacity Australia, Australian Centre for Capacity, Ethics and the Prevention of Exploitation of People with Disabilities, Sydney, NSW, Australia
| | - Glenn E Hunt
- Specialty of Psychiatry, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Carmelle Peisah
- Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- Specialty of Psychiatry, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Capacity Australia, Australian Centre for Capacity, Ethics and the Prevention of Exploitation of People with Disabilities, Sydney, NSW, Australia
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Chen KX, Hsu PC, Lin JN, Lee FP, Wang JJ. Exploring the Difficulties and Strategies of Family Caregivers in Caring for Patients With Dementia in Acute Care Wards. J Nurs Res 2023; 31:e297. [PMID: 37548951 DOI: 10.1097/jnr.0000000000000575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Providing appropriate care to patients with dementia in acute care settings can be a challenge for healthcare professionals. A key factor is working closely with family caregivers. PURPOSE This study aims to explore the difficulties and strategies involved in caring for patients with dementia who have been admitted to an acute care ward from the perspective of family caregivers. METHODS Exploratory research was conducted using a qualitative data collection approach. Data were collected by means of in-depth interviews carried out with participants. Semistructured interviews were conducted with nine participants. Content analysis was performed to analyze the data. RESULTS A number of themes and subthemes were identified based on the primary research purposes. The first theme is "vicious cycle due to multiple factors," with the following subthemes: (a) communication disturbance, (b) endless worries, (c) inadequate care skills of paid caregivers, and (d) physical and psychological exhaustion. The second theme is "do everything," with the following subthemes: (a) management of the behavioral and psychological symptoms of dementia, (b) constant accompaniment of the patient, and (c) seeking sources of support. CONCLUSIONS/IMPLICATIONS FOR PRACTICE The results may be used to help healthcare professionals better anticipate the difficulties faced by family caregivers while providing assistance to patients with dementia and understand the related strategies they use. Acute care wards should consider the specific needs of family caregivers to ensure patients with dementia receive adequate care from the relevant parties in the ecological care chain during the care process.
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Affiliation(s)
- Ko-Xin Chen
- MS, RN, Doctoral Student, Department of Nursing, College of Medicine, National Cheng Kung University, Taiwan
| | - Pei-Chen Hsu
- MS, RN, Doctoral Student, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Taiwan
| | - Jong-Ni Lin
- PhD, RN, Assistant Professor, Department of Nursing, Da-Yeh University, Taiwan
| | - Feng-Ping Lee
- PhD, RN, Associate Professor, Department of Nursing, California State University, USA
| | - Jing-Jy Wang
- PhD, RN, Professor, Department of Nursing, College of Medicine, National Cheng Kung University, Taiwan
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Jagoda T, Dharmaratne S, Rathnayake S. Informal carers' information needs in managing behavioural and psychological symptoms of people with dementia and related mHealth applications: a systematic integrative review to inform the design of an mHealth application. BMJ Open 2023; 13:e069378. [PMID: 37169501 PMCID: PMC10439342 DOI: 10.1136/bmjopen-2022-069378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 04/25/2023] [Indexed: 05/13/2023] Open
Abstract
OBJECTIVE To review and synthesise the evidence on informal carers' information needs in managing behavioural and psychological symptoms of dementia (BPSD) of their care recipients and related mobile health (mHealth) applications to inform the design of an mHealth application. DESIGN This is a systematic integrative review guided by Whittemore and Knafl's five-stages framework. Six databases were searched: Cochrane, CINAHL, Embase, MEDLINE, ProQuest and PsycINFO. The key concepts included 'dementia', 'behavioural and psychological symptoms', 'informal carers' and ('information need' or 'mHealth application'). Peer-reviewed full-text articles published in English from 2000 to 2022 were included. The methodological rigour of studies was analysed using the Mixed Methods Appraisal Tool V.2018. Preferred Reporting Items for Systematic Reviews and Meta-Analyses-2020 reporting guidelines were followed. RESULTS This review included 34 studies, including quantitative (n=13), qualitative (n=17) and mixed-method (n=4) studies. Four major themes emerged from the reported studies: the need for addressing information needs on managing BPSD, the role of support systems in managing BPSD, self-care for carers and the role of mHealth applications in providing education and support for carers. In managing BPSD, carers seek knowledge about dementia and BPSD, the roles of the carers and misconceptions about BPSD. One study reported an mHealth application to monitor the behavioural issues of people with dementia. CONCLUSION Informal carers of people with dementia face a number of challenges when providing care for BPSD of their care recipients. The lack of knowledge on managing BPSD is a significant challenge. Support systems such as professional, social, residential, legal and eHealth have a significant role in managing the BPSD of people with dementia in the community. mHealth interventions are sparse to support BPSD management. These findings can be used in designing an mHealth application that addresses needs related to managing BPSD of informal carers of people with dementia. PROSPERO REGISTRATION NUMBER CRD42021238540.
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Affiliation(s)
- Thilanka Jagoda
- Department of Community Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Nursing and Midwifery, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Samath Dharmaratne
- Department of Community Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Postgraduate Institute of Medical Sciences, University of Peradeniya, Peradeniya, Sri Lanka
- Institute for Health Metrics and Evaluation, Department of Health Metrics Sciences, School of Medicine University of Washington, Seattle, Washington, USA
| | - Sarath Rathnayake
- Department of Nursing, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka
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Brown P, Harrison Dening K. Assessing and managing agitation as a symptom of dementia. Nurs Older People 2023; 35:e1433. [PMID: 36883890 DOI: 10.7748/nop.2023.e1433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2023] [Indexed: 03/09/2023]
Abstract
Behavioural and psychological symptoms of dementia (BPSD) affect more than one third of people with dementia at some point during the course of their condition. Agitation is the third most common BPSD but is the least well understood in terms of identification and management. Furthermore, agitation as a symptom of dementia is often confused with agitation as a way of expressing an emotion or unmet need. Psychosocial interventions are recommended to support the person with dementia and their family carers to manage agitation as a symptom of dementia, as well as other BPSD, in a person-centred manner. Some psychosocial interventions for managing agitation as a symptom of dementia have shown benefits, but further investigation of the usefulness of a range of interventions is needed. This article discusses the assessment and management of agitation as a symptom of dementia and illustrates their application through a case study.
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Affiliation(s)
- Pat Brown
- Dementia UK, London, England and PhD student, University College London, London, England
| | - Karen Harrison Dening
- Dementia UK, London, England and honorary professor of dementia nursing, De Montfort University, Leicester, England
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Views of people living with dementia and their families/care partners: helpful and unhelpful responses to behavioral changes. Int Psychogeriatr 2023; 35:77-93. [PMID: 36330686 DOI: 10.1017/s1041610222000849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES This study investigated the views of people living with dementia and their families/care partners on (i) what they find helpful or unhelpful regarding behavioral changes, i.e. which coping strategies they used for themselves and/or which responses from others, and (ii) what they consider to be appropriate terminology to describe behavioral changes. DESIGN & SETTING One-on-one semi-structured interviews were conducted with people living with dementia and families/care partners face to face, online, or over the telephone. MEASUREMENTS Data from open-ended questions were analyzed inductively. Common themes were derived from the data using an iterative approach. RESULTS Twenty-one people living with dementia and 20 family members/care partners were interviewed. Four main themes were derived for helpful responses, and three main themes for unhelpful responses. Helpful responses included providing clear professional support pathways and supportive environments where people living with dementia can engage in physical, cognitive, social, and spiritual activities. Unhelpful responses included discriminatory treatment from others and use of medicalized terminology. Views toward terminology varied; people with lived experience most favored using "changed behaviors" over other terminology. Areas for improvement included targeting dementia stigma, societal education on dementia, and building confidence in people living with dementia by focusing on living well with dementia. CONCLUSION Knowledge of the views of people living with dementia may assist healthcare professionals to provide more appropriate care for people living with dementia.
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Eikelboom WS, Lazaar N, van Bruchem-Visser RL, Mattace-Raso FUS, Coesmans M, Ossenkoppele R, van den Berg E, Papma JM. The recognition and management of neuropsychiatric symptoms in early Alzheimer's disease: a qualitative study among Dutch memory clinic physicians. Psychogeriatrics 2022; 22:707-717. [PMID: 35811380 PMCID: PMC9541792 DOI: 10.1111/psyg.12874] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/14/2022] [Accepted: 06/19/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Timely recognition and treatment of neuropsychiatric symptoms (NPS) in Alzheimer's disease (AD) dementia may improve quality of life, reduce caregiver burden, and delay disease progression. However, management of NPS in early AD dementia remains challenging. To date, little is known about the specific challenges for memory clinic-based physicians. The aims of this qualitative study were to obtain insights regarding the recognition and treatment of NPS in AD dementia in the memory clinic, to identify challenges experienced by physicians while managing NPS, and to examine the attitudes of memory clinic physicians on the role of the memory clinic in the care for NPS in early AD dementia. METHODS Semi-structured interviews were conducted with 13 physicians working at a memory clinic in the Netherlands (n = 7 neurologist, n = 6 geriatrician, 46% female). The data were analyzed by two independent researchers using thematic analysis. RESULTS We observed large variation among Dutch memory clinic physicians regarding care practices, expertise, and attitudes on the role of the memory clinic considering NPS in AD dementia. The most prominent challenges that memory clinic physicians experienced while managing NPS included that the outpatient setting complicates the recognition and treatment of NPS, a lack of experience, knowledge, and/or resources to adequately apply non-pharmacological interventions, and a lack of consensus among physicians on the role of the memory clinic in NPS recognition and management. CONCLUSIONS We identified challenges that need to be addressed to improve the early recognition and adequate management of NPS in AD dementia at the memory clinic.
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Affiliation(s)
- Willem S Eikelboom
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Najoua Lazaar
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | | | - Francesco U S Mattace-Raso
- Department of Geriatrics and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Michiel Coesmans
- Department of Psychiatry, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Rik Ossenkoppele
- Department of Neurology & Alzheimer Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, The Netherlands.,Clinical Memory Research Unit, Lund University, Malmö, Sweden
| | - Esther van den Berg
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Janne M Papma
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Caulfield M, Seddon D, Williams S, Hedd Jones C. Planning, commissioning and delivering bespoke short breaks for carers and their partner living with dementia: Challenges and opportunities. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e1255-e1267. [PMID: 34363262 DOI: 10.1111/hsc.13533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 06/17/2021] [Accepted: 07/21/2021] [Indexed: 06/13/2023]
Abstract
The importance of supporting unpaid carers for people living with dementia (PLWD) is recognised in adult social care policy both nationally and internationally. In the UK, social care legislation emphasises care and support should help people achieve the outcomes that matter to them in their life; this includes the opportunity to take a break from caring routines and responsibilities. Accordingly, there is growing policy and practice interest in short breaks provision to address the diversity of carer break needs and preferences and deliver meaningful outcomes for carers and those they support. This paper reports findings from qualitative staff interviews that offered strategic and operational insights into short breaks provision. It presents a dynamic model of the short break landscape in a region of Wales, describing factors shaping local and regional decision-making. The model identifies key challenges (barriers) and opportunities (enablers) that shape the planning, commissioning and delivery of bespoke short breaks for spousal carers and their partner living with dementia. Through highlighting the interplay between complex context-specific processes and contingences, the model informs initial theory development in short breaks provision.
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Affiliation(s)
- Maria Caulfield
- Ageing & Dementia @ Bangor, Dementia Services Development Centre (DSDC) Wales Research Centre, School of Health Sciences, Bangor University, Gwynedd, Wales, UK
| | - Diane Seddon
- Ageing & Dementia @ Bangor, Dementia Services Development Centre (DSDC) Wales Research Centre, School of Health Sciences, Bangor University, Gwynedd, Wales, UK
- Centre for Ageing and Dementia Research (CADR), DSDC Wales Research Centre, School of Health Sciences, Bangor University, Gwynedd, Wales, UK
| | - Sion Williams
- Ageing & Dementia @ Bangor, Dementia Services Development Centre (DSDC) Wales Research Centre, School of Health Sciences, Bangor University, Gwynedd, Wales, UK
| | - Catrin Hedd Jones
- Ageing & Dementia @ Bangor, Dementia Services Development Centre (DSDC) Wales Research Centre, School of Health Sciences, Bangor University, Gwynedd, Wales, UK
- Centre for Ageing and Dementia Research (CADR), DSDC Wales Research Centre, School of Health Sciences, Bangor University, Gwynedd, Wales, UK
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Jagoda T, Rathnayake S, Dharmaratne S. Information needs and mHealth applications for carers of people with dementia in managing behavioural and psychological symptoms of care recipients: an integrative review protocol. BMJ Open 2022; 12:e060414. [PMID: 35768110 PMCID: PMC9244663 DOI: 10.1136/bmjopen-2021-060414] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION This integrative review aims to synthesise, appraise and analyse the evidence on informal carers' information needs, features and functions of available mHealth applications, and informal carers' usability and engagement with mHealth applications for managing behavioural and psychological symptoms of dementia (BPSD). METHODS AND ANALYSIS This integrative review will include quantitative, qualitative and mixed-methods studies and follow the 'Preferred Reporting for Systematic Reviews and Meta-Analyses 2020' guidelines. Peer-reviewed articles published in English from 2000 to 2021 will be included from Cochrane Library, CINHAL, Embase, MEDLINE, ProQuest and PsycINFO. Five broader concept categories will be included: 'dementia', 'behavioural and psychological symptoms', 'informal carers', '(information need' OR 'mHealth application)'. In title and abstract review, first, the researchers will independently screen 10% of sources for consensus, and one reviewer will screen the rest. In full-text review, two reviewers will conduct the screening process and assess the relevancy of the full-text articles using a two-point scale (high-low) and the methodological quality of included articles using the Mixed Methods Appraisal Tool. Narrative synthesis will be employed to synthesise themes. The findings may identify the need for planning interventions for carers of people with dementia concerning the management of BPSD. ETHICS AND DISSEMINATION Ethics approval not required. This review will be published in a peer-review journal and be presented at national and international conferences. PROSPERO REGISTRATION NUMBER CRD42021238540.
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Affiliation(s)
- Thilanka Jagoda
- Department of Nursing and Midwifery, Faculty of Allied Health Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Sarath Rathnayake
- Department of Nursing, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka
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Wolverson E, Moniz-Cook E, Dunn R, Dunning R. Family carer perspectives on the language of behaviour change in dementia: an online mixed methods survey. Age Ageing 2022; 51:6540141. [PMID: 35231095 DOI: 10.1093/ageing/afac047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 12/16/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE following the #BanBPSD campaign there has been critical interest in common terminology used for 'changes in behaviour' associated with dementia. However, commentaries and emerging studies have not fully considered family carer perspectives. This study explores the views of family carers on terminology and language for this paradigm. METHOD a mixed methods online survey was conducted with family carers. Language preferences were scoped and examined with supporting open-ended questions that explored the reasons for choices. RESULTS about 229 family carers completed the survey. Terms such as Challenging Behaviour, Behaviour that Challenges and Behavioural and Psychological Symptoms of dementia were mostly disliked. The most preferred term was a new concept called 'Behavioural and Emotional Expressions of Need' that few people had previously heard of. Overall, carers preferred positively construed, easily understood, person-centred terms that attributed changes in behaviour to unmet need, which also acknowledged the carer's role in management. CONCLUSIONS given that carers are often the agents of change for this paradigm-where they may also be called on to act as proxy decision makers, it is important that professionals take time to explore their understandings and give due consideration to the language used when offering tailored interventions. These findings suggest that frequently used terms for changes in behaviour associated with dementia, such as Challenging Behaviour, BtC and BPSD, should be avoided.
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Affiliation(s)
- Emma Wolverson
- Department of Psychological Health, Wellbeing and Social Work, University of Hull, Hull, UK
- Humber Teaching NHS Foundation Trust, UK
| | - Esme Moniz-Cook
- Department of Psychological Health, Wellbeing and Social Work, University of Hull, Hull, UK
| | - Rosie Dunn
- Department of Psychological Health, Wellbeing and Social Work, University of Hull, Hull, UK
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Cheon H, Song JA, Kim J, Jung S. The Competence Scale in Managing Behavioral and Psychological Symptoms of Dementia (CS-MBPSD) for Family Caregivers: Instrument Development and Cross-sectional Validation Study. Int J Nurs Stud 2022; 129:104205. [DOI: 10.1016/j.ijnurstu.2022.104205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 02/08/2022] [Accepted: 02/09/2022] [Indexed: 11/27/2022]
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Lu X, Ye R, Wu J, Rao D, Liao X. Comparing Behavioral and Psychological Symptoms of Dementia and Caregiver Distress Caused Between Older Adults With Dementia Living in the Community and in Nursing Homes. Front Psychiatry 2022; 13:881215. [PMID: 35651819 PMCID: PMC9150772 DOI: 10.3389/fpsyt.2022.881215] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 03/29/2022] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES To investigate differences in behavioral and psychological symptoms of dementia (BPSD) and caregiver distress caused between older adults with dementia living in the community and in nursing homes. DESIGN A comparative cross-sectional study. SETTING AND PARTICIPANTS Participants were recruited from outpatient clinics of a tertiary psychiatric hospital and dementia units of a nursing home in Guangzhou, China. METHODS Neuropsychiatric Inventory was used to assess symptoms and caregiver distress. Dementia severity was determined using the Clinical Dementia Rating. RESULTS This study included 157 community and 112 nursing home residents with dementia. Clinically significant symptoms (item score ≥ 4) were found in 88.5% of the former and 75% of the latter. Caregivers of 79.6% of the former and 26.8% of the latter reported that at least one of these caused them moderate-to-severe distress (distress score ≥ 3). Among the community patients, anxiety was the most frequent "very severe" symptom, while sleep disorders and agitation caused the most frequent "very severe" caregiver distress. After controlling for dementia severity and medication use, family caregiving remained an independent risk predictor for clinically significant symptoms and moderate-to-severe caregiver distress. The prediction of caregiver distress based on symptom scores varied across caregiver types and individual symptoms (R2 0.36-0.82). Group differences in clinically significant symptoms and moderate-to-severe caregiver distress showed at the stage of moderate-to-severe dementia. CONCLUSIONS AND IMPLICATIONS Tailored management strategies to relieve family caregivers' BPSD-induced distress are needed, especially at the stage of moderate-to-severe dementia. An effective service system should be established for supporting family caregivers to cope with BPSD.
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Affiliation(s)
- Xuejiao Lu
- Department of Nursing, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Nursing School, Southern Medical University, Guangzhou, China
| | - Rui Ye
- Department of Nursing, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Nursing School, Southern Medical University, Guangzhou, China
| | - Jialan Wu
- Department of Nursing, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Geriatric Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Dongping Rao
- Geriatric Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaoyan Liao
- Department of Nursing, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Nursing School, Southern Medical University, Guangzhou, China
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14
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Moermans VR, Mengelers AM, Bleijlevens MH, Verbeek H, de Casterle BD, Milisen K, Capezuti E, Hamers JP. Caregiver decision-making concerning involuntary treatment in dementia care at home. Nurs Ethics 2021; 29:330-343. [PMID: 34872409 PMCID: PMC8958636 DOI: 10.1177/09697330211041742] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Dementia care at home often involves decisions in which the caregiver must weigh safety concerns with respect for autonomy. These dilemmas can lead to situations where caregivers provide care against the will of persons living with dementia, referred to as involuntary treatment. To prevent this, insight is needed into how family caregivers of persons living with dementia deal with care situations that can lead to involuntary treatment. OBJECTIVE To identify and describe family caregivers' experiences regarding care decisions for situations that can lead to involuntary treatment use in persons living with dementia at home. RESEARCH DESIGN A qualitative descriptive interview design. Data were analysed using the Qualitative Analysis Guide of Leuven. PARTICIPANTS AND RESEARCH CONTEXT A total of 10 family caregivers providing care for 13 persons living with dementia participated in in-depth semi-structured interviews. Participants were recruited by registered nurses via purposive sampling. ETHICAL CONSIDERATION The study protocol was approved by the Ethics Committee of the University Hospitals Leuven and the Medical Ethical Test Committee Zuyderland. FINDINGS Family caregivers experience the decision-making process concerning care dilemmas that can lead to involuntary treatment as complicated, stressful and exhausting. Although they consider safety and autonomy as important values, they struggle with finding the right balance between them. Due to the progressive and unpredictable nature of dementia, they are constantly seeking solutions while they adapt to new situations. Family caregivers feel responsible and experience social pressure for the safety of persons living with dementia. They may be blamed if something adverse happens to the persons living with dementia, which increases an already stressful situation. Their experience is influenced by characteristics of the care triad (persons living with dementia, professional and family caregivers) such as practical and emotional support, knowledge, and previous experiences. DISCUSSION AND CONCLUSION To prevent involuntary treatment, professionals need to proactively inform family caregivers, and they need to support each other in dealing with complex care situations.
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Affiliation(s)
- Vincent Ra Moermans
- Maastricht University, The Netherlands; White Yellow Cross Limburg, Belgium; Living Lab in Ageing and Long-Term Care, the Netherlands
| | | | | | - Hilde Verbeek
- Maastricht University, The Netherlands; Living Lab in Ageing and Long-Term Care, The Netherlands
| | | | - Koen Milisen
- KU Leuven, Belgium; University Hospitals Leuven, Belgium
| | | | - Jan Ph Hamers
- Maastricht University, The Netherlands; Living Lab in Ageing and Long-Term Care, The Netherlands
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15
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Meng X, Su J, Li H, Ma D, Zhao Y, Li Y, Zhang X, Li Z, Sun J. Effectiveness of caregiver non-pharmacological interventions for behavioural and psychological symptoms of dementia: An updated meta-analysis. Ageing Res Rev 2021; 71:101448. [PMID: 34416379 DOI: 10.1016/j.arr.2021.101448] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 07/17/2021] [Accepted: 08/11/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND The behavioural and psychological symptoms of dementia (BPSD) have significant negative effects on the health of both patients with dementia and their caregivers. However, the reported effectiveness of non-pharmacological interventions targeting caregivers of patients with dementia for BPSD is inconsistent. METHODS We systematically searched the databases PubMed, PsycINFO, CINAHL, Embase, Cochrane Library and four Chinese databases from 2010 through April 2021. The Standardised mean difference (SMD) was calculated using random-effects models. Risk of bias in individual studies was assessed using Cochrane Collaboration's tool, and the certainty of evidence was assessed using the five GRADE criteria. RESULTS Thirty-one randomised controlled trials (RCTs) involving 3501 dyads were included. The meta-analysis indicated that non-pharmacological interventions showed small but significant effects on both BPSD in patients with dementia (SMD = -0.14; 95% CI, -0.22 to -0.06; P = 0.001) and caregiver reactions to BPSD (SMD = -0.16; 95% CI, -0.25 to -0.07; P = 0.001). The effect sizes of BPSD in patients at follow-up (SMD = -0.24; 95% CI, -0.38 to -0.09; P = 0.002) were larger than those at post-test. Tailored interventions were associated with more substantial reductions in BPSD in patients (SMD = -0.24; 95% CI, -0.37 to -0.11; P < 0.001) than standardised interventions (SMD = -0.07; 95% CI, -0.18 to 0.04; P = 0.218). CONCLUSIONS Non-pharmacological interventions targeting caregivers have the potential to reduce BPSD in patients with dementia and improve caregiver negative reactions to BPSD. Moreover, tailored interventions seemed to be more effective in reducing BPSD, and more significant improvements in BPSD may be observed in long-term follow-up.
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16
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Yeh TP, Chen HC, Ma WF. A Qualitative Exploration of the Needs of Community-Dwelling Patients Living with Moderate Dementia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8901. [PMID: 34501495 PMCID: PMC8430645 DOI: 10.3390/ijerph18178901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/05/2021] [Accepted: 08/18/2021] [Indexed: 11/16/2022]
Abstract
Few studies have focused on developing a better understanding of the needs of patients with moderate-stage dementia. This study aimed to explore the needs of people living with moderate dementia and receiving home-care services from a local mental hospital. The study adopted a descriptive qualitative approach with purposive sampling to recruit patients with moderate dementia and receiving home-care services. Data were collected by face-to-face interviews and content analysis was used to interpret the experiences in the dialogue data. The results showed that the needs of people living with moderate dementia receiving home-care services contained four themes: the demand for company and care, the wish to recall familiar images, the need of reaffirming life purpose and value through reflection and reminiscence, and the desire for making autonomous end-of-life decisions. In addition to daily care, people living with moderate dementia crave companionship, expect meaningful exchanges of experiences to share their life, and have demands to have a voice in going through the final stage of life. The participants tended to focus more on issues related to the connections between living and dying. The results provide caregivers and home-care service providers with some insights into offering better care for people living with moderate dementia.
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Affiliation(s)
- Tzu-Pei Yeh
- School of Nursing, China Medical University, Taichung 406040, Taiwan;
- Nursing Department, China Medical University Hospital, Taichung 406404, Taiwan
| | - Hsing-Chia Chen
- Department of Nursing, Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nantou 54249, Taiwan;
| | - Wei-Fen Ma
- Nursing Department, China Medical University Hospital, Taichung 406404, Taiwan
- Ph.D. Program for Health Science and Industry, College of Health Care, China Medical University, Taichung 406040, Taiwan
- School of Nursing, China Medical University Hospital, Taichung 406040, Taiwan
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17
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Chang CYM, Baber W, Dening T, Yates J. "He Just Doesn't Want to Get Out of the Chair and Do It": The Impact of Apathy in People with Dementia on Their Carers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126317. [PMID: 34207955 PMCID: PMC8296153 DOI: 10.3390/ijerph18126317] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/04/2021] [Accepted: 06/07/2021] [Indexed: 12/20/2022]
Abstract
Apathy, defined as a lack of motivation, is a prevalent and persistent behavioural and psychological symptom of dementia. Limited research suggests that apathy is associated with increased carer burden, but there are no studies investigating carers’ subjective experiences of apathy. This study aimed to fill this gap and explore the lived experience of apathy in dementia from the perspectives of the people with dementia and their carers. This article reports on the carers’ perspectives. Six dyads of people with dementia and carers participated in semi-structured interviews, which were analysed using interpretative phenomenological analysis. Three superordinate themes were identified: (1) achieving a balance of conflicting emotions—the challenges of apathy led to feelings of guilt, acceptance, and frustration; (2) new roles imposed by caring, which involved taking on new responsibilities and promoting remaining interests of person with dementia; and (3) having a life of one’s own—coping with apathy by talking to others, and spending time away from the caring role. This study highlighted that carers are caught in a struggle between wanting to involve the person with dementia in decisions and finding that they cannot if they want to overcome the hurdle of apathy. Implications of this study suggest that a wider understanding of apathy at a societal level could lead to the provision of a helpful forum for carers to share their experiences.
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Affiliation(s)
- Chern Yi Marybeth Chang
- Clinical Neurosciences and Mental Health, School of Medicine, University of Nottingham, Nothingham NG7 2UH, UK; (C.Y.M.C.); (T.D.)
| | - Waqaar Baber
- The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London WC1N 3BG, UK;
| | - Tom Dening
- Clinical Neurosciences and Mental Health, School of Medicine, University of Nottingham, Nothingham NG7 2UH, UK; (C.Y.M.C.); (T.D.)
| | - Jennifer Yates
- Clinical Neurosciences and Mental Health, School of Medicine, University of Nottingham, Nothingham NG7 2UH, UK; (C.Y.M.C.); (T.D.)
- Correspondence:
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18
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Burley CV, Casey AN, Chenoweth L, Brodaty H. Reconceptualising Behavioral and Psychological Symptoms of Dementia: Views of People Living With Dementia and Families/Care Partners. Front Psychiatry 2021; 12:710703. [PMID: 34484001 PMCID: PMC8415310 DOI: 10.3389/fpsyt.2021.710703] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 07/22/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Behavioral and psychological symptoms of dementia (BPSD, also known as neuropsychiatric symptoms (NPS), changed behaviors and responsive behaviors), occur in up to 90 percent of people living with dementia (PLWD). These symptoms and behaviors strongly correlate with functional and cognitive impairment and contribute to ~30% of overall dementia costs. As decisions regarding care and strategies for BPSD are generally based on professional frames of reference, this study investigates whether the perspectives of PLWD and families/care partner on BPSD terminology can inform a more nuanced conceptualization of BPSD. Methods: PLWD and families/care partners participated in one-on-one semi-structured interviews. A thematic iterative approach was used to code the data and identify common themes until theoretical saturation was reached. Themes were compared between groups. Data were analyzed deductively in relation to pre-existing terminology regarding BPSD, and inductively to discover new ideas on use of such terminology as perceived by PLWD and others. Results: Forty-one volunteers were interviewed: 21 PLWD, mean age 71 yrs, mean Mini-Mental State Examination score 25, and 20 family members/care partners. Three main themes emerged from the data: (1) descriptions of BPSD from people with lived experience compared to clinical terms, (2) viewpoints on interpreting causes, and (3) experiences of concurrent BPSD. The experiences described and terms used by PLWD and families/care partners differed from terms used in existing professional frameworks (e.g., "disinhibition" described as 'loss of filter') and there were differences between PLWD and family members' interpretations of BPSD causes. Discussion/Conclusion: Reports from PLWD and families/carers describing their experiences of BPSD suggest a reconceptualization of BPSD terminology is needed to understand and de-stigmatize these symptoms and behaviors. For example, the term "agitated/hard to handle" would benefit by clearer, contextualized description, such as "frustrated with cognitive decline, discriminatory behavior and inadequate support systems." In better understanding individual expressions of BPSD, families, professionals and societies will be able to respond in ways that are helpful for PLWD. An informed, integrated understanding of BPSD and improved terminology use will have the potential to improve the quality of care and support for PLWD.
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Affiliation(s)
- Claire V Burley
- School of Psychiatry, Dementia Centre for Research Collaboration, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Anne-Nicole Casey
- School of Psychiatry, Dementia Centre for Research Collaboration, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia.,School of Psychiatry, Centre for Healthy Brain Ageing, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Lynn Chenoweth
- School of Psychiatry, Centre for Healthy Brain Ageing, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Henry Brodaty
- School of Psychiatry, Dementia Centre for Research Collaboration, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia.,School of Psychiatry, Centre for Healthy Brain Ageing, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia.,Academic Department for Old Age Psychiatry, Prince of Wales Hospital, South Eastern Sydney Local Health District, Sydney, NSW, Australia
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19
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Eikelboom WS, van Rooij JGJ, van den Berg E, Coesmans M, Jiskoot LC, Singleton E, Ossenkoppele R, van Swieten JC, Seelaar H, Papma JM. Neuropsychiatric Symptoms Complicating the Diagnosis of Alzheimer's Disease: A Case Report. J Alzheimers Dis 2019; 66:1363-1369. [PMID: 30412494 DOI: 10.3233/jad-180700] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Neuropsychiatric symptoms (NPS) are increasingly recognized as a core element of Alzheimer's disease (AD); however, clinicians still consider AD primarily as a cognitive disorder. We describe a case in which the underrecognition of NPS as part of AD resulted in substantial delay of an AD diagnosis, a wrong psychiatric diagnosis, and the organization of inappropriate care. The aim of this paper is to acknowledge NPS as an (early) manifestation of AD and to suggest features that may point toward underlying AD in older adults with late-life behavioral changes.
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Affiliation(s)
- Willem S Eikelboom
- Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Jeroen G J van Rooij
- Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Esther van den Berg
- Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Michiel Coesmans
- Department of Psychiatry, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Lize C Jiskoot
- Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Ellen Singleton
- Department of Neurology, VUmc Alzheimer Center, Amsterdam, the Netherlands
| | - Rik Ossenkoppele
- Department of Neurology, VUmc Alzheimer Center, Amsterdam, the Netherlands.,Clinical Memory Research Unit, Lund University, Malmö, Sweden
| | - John C van Swieten
- Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Harro Seelaar
- Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Janne M Papma
- Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
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20
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Xanthopoulou P, McCabe R. Subjective experiences of cognitive decline and receiving a diagnosis of dementia: qualitative interviews with people recently diagnosed in memory clinics in the UK. BMJ Open 2019; 9:e026071. [PMID: 31375604 PMCID: PMC6688685 DOI: 10.1136/bmjopen-2018-026071] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 03/18/2019] [Accepted: 06/25/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To explore people's experiences of cognitive decline and receiving a diagnosis of dementia. DESIGN 61 semistructured interviews within 2 weeks of diagnosis. Audio recordings were transcribed, line-by-line coded using NVIVO V.11 and analysed using thematic analysis. SETTING 9 memory clinics (UK). PARTICIPANTS People with mild/moderate dementia. RESULTS Most participants were diagnosed with Alzheimer's disease (56% female, mean age 81 years). 104 codes were grouped into 22 categories, feeding into 9 subthemes and 4 overarching themes: (1) dissonance, threat to identity and visibility of dementia: dementia was associated with a progressive loss of competence, culminating in being an idiot, crazy and losing the plot. The stigma of dementia led people to hide their diagnosis from others, even close family members. However, decreasing competence in everyday tasks was becoming increasingly visible in family and wider social networks. (2) Vulnerability and being in limbo: people were frustrated by the impact of dementia on their lives and felt vulnerable. Moreover, people were disturbed by not knowing how much and when they would deteriorate further. (3) Loss of control and agency: loneliness, increasing dependence and becoming a burden foreshadowed increasing diminished personal agency. (4) Maintaining agency and self-worth: some people focused on what they could do and the benefits of diagnosis. This involved accepting the diagnosis, adapting to changes by using coping strategies and accepting support from others. This helped people to maintain personal agency and self-worth. CONCLUSION While personal acceptance of dementia is challenging, people are additionally troubled about disclosing their diagnosis to others. Limited time in diagnostic appointments and limited postdiagnostic support leave few opportunities to address the emotional impact of a dementia diagnosis. There may be opportunities for healthcare professionals to discuss with patients the benefits of staying positive, implementing coping strategies and accepting support to live well with dementia.
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Affiliation(s)
| | - Rose McCabe
- School of Health Sciences, City, University of London, London, UK
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21
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Greenwood N, Pound C, Brearley S, Smith R. A qualitative study of older informal carers' experiences and perceptions of their caring role. Maturitas 2019; 124:1-7. [PMID: 31097172 PMCID: PMC6528777 DOI: 10.1016/j.maturitas.2019.03.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 03/06/2019] [Accepted: 03/07/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Unpaid family carers, or caregivers as they are also known, often play a vital role in supporting others with illness or disability living in the community. Overall numbers of carers are growing but numbers of older carers are increasing particularly rapidly as populations age worldwide. However, little research has focused on this important older group. This qualitative study therefore investigated older carers' experiences and their perceptions of their role. METHODS Five digitally recorded focus groups with carers from Greater London were undertaken. Recordings were transcribed and analysed thematically. FINDINGS Forty-four carers aged 70-87 years participated. Most were female and two-thirds were spouses or partners. Overall, the carers thought their experiences were similar to those of younger adult carers and included both satisfying and challenging facets. However, they thought that some of the more negative aspects of the role were more difficult for older carers. Their own declining physical and emotional health and strength were seen as making it harder to access support and maintain social contacts. Loneliness both outside and within relationships featured prominently and was perceived as especially significant for housebound carers and when caring for someone with dementia. Many of these older carers also worried about the future when they might no longer be able to be a carer due to their own ill-health or death. CONCLUSIONS Older carers find their role challenging and future investigations should focus on identifying means of reducing their isolation and supporting them with planning for the future.
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Affiliation(s)
- Nan Greenwood
- Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, 6th Floor Hunter Wing, St George's, University of London, London SW17 0RE, United Kingdom.
| | - Carole Pound
- Bournemouth University, Faculty of Health and Social Sciences, Royal London House, Lansdowne Campus, Bournemouth University, Bournemouth BH1 3LT, United Kingdom.
| | - Sally Brearley
- Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, 6th Floor Hunter Wing, St George's, University of London, London SW17 0RE, United Kingdom.
| | - Raymond Smith
- Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, 6th Floor Hunter Wing, St George's, University of London, London SW17 0RE, United Kingdom.
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22
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Eikelboom WS, Singleton E, van den Berg E, Coesmans M, Mattace Raso F, van Bruchem RL, Goudzwaard JA, de Jong FJ, Koopmanschap M, den Heijer T, Driesen JJM, Vroegindeweij LJHM, Thomeer EC, Hoogers SE, Dijkstra AA, Zuidema SU, Pijnenburg YAL, Scheltens P, van Swieten JC, Ossenkoppele R, Papma JM. Early recognition and treatment of neuropsychiatric symptoms to improve quality of life in early Alzheimer's disease: protocol of the BEAT-IT study. Alzheimers Res Ther 2019; 11:48. [PMID: 31122267 PMCID: PMC6533693 DOI: 10.1186/s13195-019-0503-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 05/07/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Neuropsychiatric symptoms (NPS) are very common in patients with mild cognitive impairment (MCI) and Alzheimer's disease (AD) dementia and are associated with various disadvantageous clinical outcomes including a negative impact on quality of life, caregiver burden, and accelerated disease progression. Despite growing evidence of the efficacy of (non)pharmacological interventions to reduce these symptoms, NPS remain underrecognized and undertreated in memory clinics. The BEhavioural symptoms in Alzheimer's disease Towards early Identification and Treatment (BEAT-IT) study is developed to (1) investigate the neurobiological etiology of NPS in AD and (2) study the effectiveness of the Describe, Investigate, Create, Evaluate (DICE) approach to structure and standardize the current care of NPS in AD. By means of the DICE method, we aim to improve the quality of life of AD patients with NPS and their caregivers who visit the memory clinic. This paper describes the protocol for the intervention study that incorporates the latter aim. METHODS We aim to enroll a total of 150 community-dwelling patients with MCI or AD and their caregivers in two waves. First, we will recruit a control group who will receive care as usual. Next, the second wave of participants will undergo the DICE method. This approach consists of the following steps: (1) describe the context in which NPS occur, (2) investigate the possible causes, (3) create and implement a treatment plan, and (4) evaluate whether these interventions are effective. Primary outcomes are the quality of life of patients and their caregivers. Secondary outcomes include NPS change, caregiver burden, caregivers' confidence managing NPS, psychotropic medication use, the experiences of patients and caregivers who underwent the DICE method, and the cost-effectiveness of the intervention. CONCLUSIONS This paper describes the protocol of an intervention study that is part of the BEAT-IT study and aims to improve current recognition and treatment of NPS in AD by structuring and standardizing the detection and treatment of NPS in AD using the DICE approach. TRIAL REGISTRATION The trial was registered on the Netherlands Trial Registry ( NTR7459 ); registered 6 September 2018.
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Affiliation(s)
- Willem S. Eikelboom
- Department of Neurology, Erasmus MC University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Ellen Singleton
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam University Medical Center, PO Box 7057, 1007 MB Amsterdam, the Netherlands
| | - Esther van den Berg
- Department of Neurology, Erasmus MC University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Michiel Coesmans
- Department of Psychiatry, Erasmus MC University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Francesco Mattace Raso
- Department of Internal Medicine, Erasmus MC University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Rozemarijn L. van Bruchem
- Department of Internal Medicine, Erasmus MC University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Jeannette A. Goudzwaard
- Department of Internal Medicine, Erasmus MC University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Frank Jan de Jong
- Department of Neurology, Erasmus MC University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Marc Koopmanschap
- Erasmus School of Health Policy & Management, Erasmus University, PO Box 1738, 3000 DR Rotterdam, the Netherlands
| | - Tom den Heijer
- Department of Neurology, Franciscus Gasthuis, PO Box 10900, 3004 BA Rotterdam, the Netherlands
| | - Jan J. M. Driesen
- Department of Neurology, Franciscus Vlietland, PO Box 215, 3100 AE Schiedam, the Netherlands
| | | | - Elsbeth C. Thomeer
- Department of Neurology, Maasstad Hospital, PO Box 9100, 3007 AC Rotterdam, the Netherlands
| | - Susanne E. Hoogers
- Department of Neurology, Spijkenisse Medical Center, PO Box 777, 3200 GA Spijkenisse, the Netherlands
| | - Anke A. Dijkstra
- Department of Anatomy and Neurosciences, Amsterdam University Medical Center, PO Box 7057, 1007 MB Amsterdam, the Netherlands
| | - Sytse U. Zuidema
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, PO Box 30,001, 9700 RB Groningen, the Netherlands
| | - Yolande A. L. Pijnenburg
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam University Medical Center, PO Box 7057, 1007 MB Amsterdam, the Netherlands
| | - Philip Scheltens
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam University Medical Center, PO Box 7057, 1007 MB Amsterdam, the Netherlands
| | - John C. van Swieten
- Department of Neurology, Erasmus MC University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Rik Ossenkoppele
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam University Medical Center, PO Box 7057, 1007 MB Amsterdam, the Netherlands
- Clinical Memory Research Unit, Lund University, Simrisbanvägen 14, 212 24 Malmö, Sweden
| | - Janne M. Papma
- Department of Neurology, Erasmus MC University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands
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