The experiences, priorities, and perceptions of informal caregivers of people with dementia in nursing homes: A scoping review

Understanding the Experiences of Family Caregivers of Nursing Home Residents With Dementia: A Grounded Theory Study

BACKGROUND AND OBJECTIVES

Alzheimer's disease and related dementias progress over time and result in cognitive decline, loss of independence, and behavioral and psychiatric symptoms of dementia that can lead to nursing home placement. Research has focused on examining the effects of nursing home placement on the family caregiver; however, their experiences are less understood. We sought to investigate the experiences and perceptions of family caregivers of nursing home residents with dementia. The objective was to create a conceptual model that explains the complex nature of the family caregiver experience.

RESEARCH DESIGN AND METHODS

This study is part of a larger randomized controlled trial. Following a grounded theory approach, we completed 30 in-depth, one-on-one interviews with family caregivers of nursing home residents with dementia. Data analysis followed an iterative process that employed open, axial, and selective coding.

RESULTS

Our conceptual model depicts the interrelationship between contributing factors that interrelate and impact family caregiver satisfaction with nursing home care. Six factors contribute to family caregiver satisfaction: family caregiver interactions with nursing home staff; staff management of resident behavioral symptoms; nursing home context; family caregiver knowledge of dementia; family caregiver strain; and the resident experience.

DISCUSSION AND IMPLICATIONS

Our findings revealed family caregiver experiences that are unique to the institutional nursing home setting and not reflected in prior work focusing on experiences within community-based settings. Understanding family caregiver experiences and the contributors to how satisfaction in care is perceived, may foster collaboration and teamwork among families and staff.

Implementation of equine-assisted intervention for older adults with Alzheimer's disease residing in a nursing home: Brakes and levers

OBJECTIVE

Although research on equine-assisted intervention (EAI) for older adults is beginning to be published, no scientific study has examined the various elements that can limit or facilitate the implementation of EAI with older adults suffering from Alzheimer's disease (AD) residing in nursing homes. The aim of this study was to identify the possible brakes and levers of implementing EAI with AD patients. A focus on professional affiliation was conducted.

METHOD

The survey was posted online on 2 February 2021 via the Sphinx software. As this study was aimed at gerontology professionals working in nursing homes, they were contacted through various specialized social networks. A total of 663 people answered the survey.

RESULTS

The results indicate that for 45% of the participants, the main brake to implementing EAI is related to the institutional burden. As for the levers, 29% of the people indicated that it would mainly be beneficial due to the cognitive stimulation that EAI would provide. People who were not familiar with EAI reported more brakes to its implementation. Finally, it was observed that the caregivers were those who put forward the most levers for the implementation of EAI with AD patients living in nursing homes.

CONCLUSION

Thus, this study allows us to understand some of the reasons why nursing homes are reluctant to set up EAI. Communication on this subject is currently a lever to be developed.

IMPLICATIONS FOR PRACTICE

By highlighting the brakes and levers on the implementation of EAIs, we are able to identify suitable guidelines for developing this type of intervention in nursing homes, which could be used as a complement to nursing care to help Alzheimer's patients overcome physical or psychological health problems.

Developing a question prompt list for family caregivers concerning the progression and palliative care needs of nursing home residents living with dementia

Objective

Communication around a palliative approach to dementia care often is problematic or occurs infrequently in nursing homes (NH). Question prompt lists (QPLs), are evidence-based lists designed to improve communication by facilitating discussions within a specific population. This study aimed to develop a QPL concerning the progression and palliative care needs of residents living with dementia.

Methods

A mixed-methods design in 2 phases. In phase 1, potential questions for inclusion in the QPL were identified using interviews with NH care providers, palliative care clinicians and family caregivers. An international group of experts reviewed the QPL. In phase 2, NH care providers and family caregivers reviewed the QPL assessing the clarity, sensitivity, importance, and relevance of each item.

Results

From 127 initial questions, 30 questions were included in the first draft of the QPL. After review by experts, including family caregivers, the QPL was finalized with 38 questions covering eight content areas.

Conclusion

Our study has developed a QPL for persons living with dementia in NHs and their caregivers to initiate conversations to clarify questions they may have regarding the progression of dementia, end of life care, and the NH environment. Further work is needed to evaluate its effectiveness and determine optimal use in clinical practice.

Innovation

This unique QPL is anticipated to facilitate discussions around dementia care, including self-care for family caregivers.

Always on alert: How relatives of family members with dementia experience the transition from home to permanent nursing home placement

AIM

Our aim was to gain insight into how the relatives of family members with dementia have experienced their family members' transition from home to permanent nursing home placement.

DESIGN

Our research was a qualitative case study.

METHODS

Inspired by Kvale and Brinkmann's phenomenological-hermeneutic approach, we performed the thematic analysis of semi-structured interviews describing how the relatives of family members with dementia have experienced the dementia trajectory.

RESULTS

Twelve relatives of family members with dementia living in nursing homes agreed to participate. The descriptions of relatives' experiences indicated four primary themes: mismatches between healthcare services and the family members' needs, witnessing the family members' cognitive decline, the effects of the experiences on the relatives' health and well-being and what matters to the relatives during their family members' transition to nursing home. Mismatches between available resources in the municipalities and the family members' healthcare needs were the most distressing experiences, along with the family members' gradual cognitive decline. In response, the relatives stressed individualized support, continuity in follow-up care and regular information-sharing between them and staff members caring for their family members. They also highlighted the importance of facilitating seamless transitions from home to nursing homes.

Hogan D, Gruneir A, A. Chamberlain S, Corbett K, E. Griffith L, McGrail KM, E. Amuah J, E. Lane N, J. Maxwell C. Caregivers' Concerns About Assisted Living Residents' Mental Health During the COVID-19 Pandemic: A Cross-Sectional Survey Study

Family or friend caregivers' concerns about assisted living (AL) residents' mental health are reflective of poor resident and caregiver mental health. COVID-19-related visiting restrictions increased caregiver concerns, but research on these issues in AL is limited. Using web-based surveys with 673 caregivers of AL residents in Western Canada, we assessed the prevalence and correlates of moderate to severe caregiver concerns about residents' depressed mood, loneliness, and anxiety in the 3 months before and after the start of the COVID-19 pandemic. Caregiver concerns doubled after the start of the pandemic (resident depressed mood: 23%-50%, loneliness: 29%-62%, anxiety: 24%-47%). Generalized linear mixed models identified various modifiable risk factors for caregiver concerns (e.g., caregivers' perception that residents lacked access to counseling services or not feeling well informed about and involved in resident care). These modifiable factors can be targeted in efforts to prevent or mitigate caregiver concerns and resident mental health issues.

Intermediate care in caring for dementia, the point of view of general practitioners: A key informant survey across Europe

Background

Intermediate care is often defined as healthcare occurring somewhere between traditional primary (community) and secondary (hospital) care settings. High quality intermediate care is important in dementia, may prevent caregiver burnout and also lead to optimal care for people with dementia. However, very little is known about the point of intermediate care for persons with dementia in Europe.

Research questions

What intermediate care services exist and how are they utilized in the care of people with dementia in Europe?

Objective

This study aims at describing the point of view of General Practitioners on intermediate care services for people with dementia across Europe.

Methods

Key informant survey was sent to GPs via a self-developed questionnaire with space for open ended comments. 16 European countries participated to this cross-sectional mixed method study. Given the volunteer nature of the study, no minimum sample size requirements were applied to participation. Convenience sampling technique was used to address variations due to regional variations and regulations within the same country. Descriptive analyses of all intermediate care facilities groups by countries were performed. Qualitative analyses approach was used for the optional-free text to exemplify and/or complete the reasons contained in the closed response categories.

Results

The questionnaire was sent to 16 European countries. 583 questionnaires were analyzed. The responding physicians were 48 (± 11) years old on average and they had been in practice for an average of 18 (+ /11) years. The types of intermediate care considered were integrated at-home services, respite and relief services, day care centers and nursing homes. Their availability was considered very inhomogeneous by the majority of respondents. The main benefits of intermediate care cited were better medical care for the patient (78%), better quality of life for the caregiver (67%), prevention of the caregiver burden (73%) and a break for the caregiver (59%). The reported difficulties were: accessing these facilities due to limited financial support (76%) and cumbersome administrative procedures (67%). Many other facets of our findings were captured in the qualitative themes that emerged.

Conclusion

Intermediate care in Europe is diverse and heterogeneous. Major concerns of GPs are about the cost issues and the cumbersome administrative procedures to access them.

A Systematic Review of Tools Assessing the Perspective of Caregivers of Residents With Dementia

In collaboration with stakeholders, we conducted a systematic review of psychometric evidence for self-report tools measuring the perspective of family caregivers of nursing home residents with dementia. Our rationale for this review was based on evidence that nonpharmacological interventions can ameliorate dementia symptoms in nursing home residents. Such interventions require caregiver participation, which is influenced by perspectives. Yet, no existing tool measures the multidomain caregiver perspective. Our review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. The final sample included 42 articles describing 33 tools measuring domains of nursing home dementia care such as behavioral and psychological symptoms of dementia, resident quality of life, dementia-specific knowledge, communication, and medication use. We uncovered evidence gaps for tools measuring dementia-specific knowledge, communication, and medication use, all of which were important to our stakeholders. Future research should focus on development of psychometrically sound tools in alignment with the multidomain caregiver perspective.

Experiences of long-term care and supportive living residents and families during the COVID-19 pandemic: "It's a lot different for us than it is for the average Joe"

Long-term care and supportive living (LTC/SL) residents are among the most at risk for severe outcomes of COVID-19. As such, early public health measures focused on this population. This study examined the experiences and perspectives of residents and family members of residents living in LTC/SL centres in Alberta, Canada during the COVID-19 pandemic. Between July and October 2020, we conducted semi-structured interviews with 14 residents and 18 family members of residents from 10 centres. Interviews were audio-recorded and analyzed using qualitative content analysis. Analysis revealed 5 categories from resident interviews (Living with Rules and Restrictions; COVID-19 Knowledge and Information; Wellbeing; Centre Operational Response; Criticisms and Suggestions for Improvement) and 6 categories from family interviews (Family Role; Navigating the New Normal; COVID-19 Knowledge and Information; Policy Limitations; Policy Impact; Centre Response). The results highlight the importance of engaging residents and families during pandemic preparation, response, and follow-up evaluation.