Stability of home-based care arrangements for people living with dementia: protocol of a meta-study on mixed research

INTRODUCTION

Worldwide, most people with dementia live at home and are cared for by informal carers. During the dementia care trajectory, creating and maintaining a stable care situation is a guiding principle of informal carers and a desirable outcome of contemporary healthcare policies. However, though there is an extensive body of research focusing on the course of dementia care trajectories, it remains unclear how stability of home-based care arrangements is constituted and what are the essential factors that influence this stability. This paper outlines a protocol of a systematic review that aims to address these gaps in knowledge.

METHODS AND ANALYSIS

To theorise the complex phenomenon of stability of home-based care arrangements for people with dementia, we will conduct a meta-study. Meta-studies include three analytical components (meta-data analysis, meta-method and meta-theory) that are combined and finally culminate in an integrative knowledge synthesis. Originally, meta-study was designed to include qualitative studies only. To capture relevant contributions to our target phenomenon from all types of evidence, we will extend the original methodology and apply it to studies with qualitative, quantitative and mixed-methods designs and to (systematic) reviews. Eligible studies will be identified by systematic database searches (PubMed, CINAHL and PsycINFO), backward/forward citation tracking, snowballing and theoretical sampling. All identified studies will be screened against predefined inclusion criteria. The main analytical approach for all analyses is thematic synthesis. The meta-study will generate a more comprehensive understanding of dementia care trajectories and will be used to identify research gaps, develop future research questions and define relevant outcomes.

DISSEMINATION

The findings of the meta-study will be published in a series of articles in peer-reviewed scientific journals and will be presented at national and international scientific conferences.

PROSPERO REGISTRATION NUMBER

CRD42016041727.

Does vigilance in decision-making matter for dementia family caregivers?

OBJECTIVES

Family responsibilities and social expectations often prompt conflict in caregivers' decision-making processes. Janis and Mann's (1977) conflict model describes vigilance as high-quality decision-making resulting in optimal outcomes. The purpose of our research was threefold: (1) to describe decision styles in a population of family caregivers of persons with dementia; (2) to examine the socio-economic characteristics associated with caregivers who are more likely to be vigilant decision-makers; and (3) to assess differences in caregiving experiences between vigilant and non-vigilant caregivers.

METHOD

Our analysis was based on 639 survey respondents recruited from a university-affiliated memory disorders clinic.

RESULTS

Our typical caregiver was Caucasian non-Hispanic, was currently married, and had two children. Approximately half of our sample used a 'pure vigilant' decision style. Vigilance was associated with more positive and fewer negative caregiving outcomes.

CONCLUSION

Supporting caregivers to become vigilant decision-makers is a functionally viable intervention that could significantly improve the caregiving experience.

Supporting a Relative’s Move into Long-term Care: Starting Point Shapes Family Members’ Experiences

Cette étude fondée sur la théorie a exploré les expériences des membres de la famille qui soutenaient leurs proches qui sont déplacés dans les foyers de soins de longue durée (FSLD). Chaque étape du processus de transition a été examinée, y compris le rôle du point de départ à façonner l’expérience. Dans les six semaines suivant le déménagement, une vingtaine de membres des familles qui avaient quitté un parent dans un FSLD ont été interviewés. Les résultats ont révelé que le point de départ a eu un effet profond sur les expériences des membres des familles en acceptant la nécessité et le moment où il faut faire le déplacement de leur parent en un FSLD (avant le déménagement), et à croire que le FSLD choisi est un environnement positif pour leur parent (après le déménagement). Les politiques et les processus des FSLD sont aussi importants. Cependant, quand l’acceptation du pré-déménagement a été compromise par des circonstances imputables au point de départ, ces politiques et procédures ont été moins efficaces dans la promotion de l’acceptation de l’après-déménagement. Nous discutons des conditions qui soutient les transitions positives avant, pendant et après le déménagement de chaque point de départ.

Understanding the experience of moving a loved one to a long-term care facility:family members' perspectives

This project was designed to develop an understanding of family members' experiences of moving a loved one to a long-term care facility and to identify ways in which facilities might help ease this process. Twenty-one semi-structured interviews were conducted with family members who had recently moved a relative into one of three long-term care facilities in Southern Ontario, Canada. Several factors appeared to contribute to the overall experience of the move to long-term care and either served to impede or facilitate a positive transition for families. These factors included: the experience during the waiting process, preparation for the move, ease of the actual move, control over decisions, communication throughout the process, support from others, and family and resident perceptions and attitudes towards the move. Easing the difficult aspects of moving a loved one to a long-term care setting can be facilitated with better preparation and support from facilities and community services.

Living arrangements and health status in later life: a review of recent literature

The living arrangements of older persons play a key role in their use of formal and informal care, as well as in their health and well-being. Nurses engaged in primary care, discharge planning, and home care are strategically positioned to contribute to an optimal fit between older persons and their home environment. This article describes the demographic significance of late-life living arrangements and proposes a model for organizing the complex web of factors associated with household composition and late-life migration. The article then summarizes qualitative and quantitative evidence in support of the proposed model. Key areas for nursing research and strategies for applying available research are identified.