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Galbraith-Olive MA, Safic S, Mwaipopo L, Ernest A, Gray WK, Urasa S, Dotchin C, Fisher E, Spector A, Walker R. Care needs of people with dementia in Tanzania and associated impact on carers: A cross-sectional, observational study. DEMENTIA 2024; 23:1021-1035. [PMID: 38887042 DOI: 10.1177/14713012241262570] [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] [Indexed: 06/20/2024]
Abstract
Objectives: This study aimed to understand the care needs, care arrangements and burden of care for people with dementia in Northern Tanzania. Methods: This was a cross-sectional, observational study. People with dementia and their carers (n = 53) were recruited from an outpatient clinic, and data on carer burden and independence in activities of daily living were collected. Associations with carer burden and characteristics were explored through non-parametric tests and regression analyses. Results: Thirty-six carers were female (68%). Levels of impairment in instrumental activities of daily living were high, with a median score of 38 out of 44 on the Identification and Intervention for Dementia in Elderly Africans - Instrumental Activities of Daily Living (IDEA-IADL). Carer burden was moderate with a median Zarit Burden Interview (ZBI) score of 46 out of 88. Being a female carer was associated with higher carer burden (odds ratio 3.68, 95% CI 1.04-12.99). Discussion: Carer burden was found to be higher than in previous studies based in low-and-middle income countries. Further research is needed to explore this difference, and to identify interventions to support care needs and reduce carer burden.
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Affiliation(s)
| | | | | | | | - William Keith Gray
- Newcastle University and Northumbria Healthcare NHS Foundation Trust, UK
| | - Sarah Urasa
- Kilimanjaro Christian Medical University College, Tanzania
| | - Catherine Dotchin
- Newcastle University, UK
- Northumbria Healthcare NHS Foundation Trust, UK
| | | | | | - Richard Walker
- Newcastle University, UK
- Northumbria Healthcare NHS Foundation Trust, UK
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Walker J. Patient and caregiver experiences of living with dementia in Tanzania. DEMENTIA 2023; 22:1900-1920. [PMID: 37879079 PMCID: PMC10644685 DOI: 10.1177/14713012231204784] [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: 10/27/2023]
Abstract
Introduction: Tanzania is a low-income country with an increasing prevalence of dementia, which provides challenges for the existing healthcare system. People with dementia often don't receive a formal diagnosis, and with a lack of formal healthcare, are often predominantly supported by family relatives. There are very few published data relating to lived experiences of people with dementia in Tanzania. This study aimed to understand people with dementia, and their caregivers' experiences of living with dementia in Tanzania and the perceived needs of people with dementia.Methods: Qualitative, semi-structured interviews were conducted with 14 people with dementia and 12 caregivers in Moshi, Tanzania. Interviews were audio-recorded, translated, transcribed and analysed using a Framework Analysis approach.Results: Three sub-themes were identified within data describing the experience of 'Living with Dementia in Tanzania': 'Deteriorations in Health', 'Challenges to living with Dementia in Tanzanian Culture', and 'Lack of Support': people with dementia faced challenges due to social isolation, stigmatisation, and lack of caregiver knowledge on how best to provide support. Collectively, these impacted on both the physical and mental health of people with dementia. Misconceptions about dementia aetiology related to age, stresses of daily life and other co-morbidities. People with dementia were motivated to access treatment, exhibiting pluralistic health-seeking behaviours. There was an overall preference for non-pharmacological interventions over medication, with high levels of trust in medical professional opinions.Conclusions: Living with dementia in Tanzania is influenced by both cultural and religious factors. More work is needed to target supplementary healthcare (with efforts to promote accessibility), support for caregivers and public health education about dementia to overcome existent misconceptions and stigma.
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Affiliation(s)
- Jessica Walker
- Population Health Sciences Institute, Newcastle University, UK
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Nightingale S, Ances B, Cinque P, Dravid A, Dreyer AJ, Gisslén M, Joska JA, Kwasa J, Meyer AC, Mpongo N, Nakasujja N, Pebody R, Pozniak A, Price RW, Sandford C, Saylor D, Thomas KGF, Underwood J, Vera JH, Winston A. Cognitive impairment in people living with HIV: consensus recommendations for a new approach. Nat Rev Neurol 2023; 19:424-433. [PMID: 37311873 DOI: 10.1038/s41582-023-00813-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2023] [Indexed: 06/15/2023]
Abstract
Current approaches to classifying cognitive impairment in people living with HIV can overestimate disease burden and lead to ambiguity around disease mechanisms. The 2007 criteria for HIV-associated neurocognitive disorders (HAND), sometimes called the Frascati criteria, can falsely classify over 20% of cognitively healthy individuals as having cognitive impairment. Minimum criteria for HAND are met on the basis of performance on cognitive tests alone, which might not be appropriate for populations with diverse educational and socioeconomic backgrounds. Imprecise phenotyping of cognitive impairment can limit mechanistic research, biomarker discovery and treatment trials. Importantly, overestimation of cognitive impairment carries the risk of creating fear among people living with HIV and worsening stigma and discrimination towards these individuals. To address this issue, we established the International HIV-Cognition Working Group, which is globally representative and involves the community of people living with HIV. We reached consensus on six recommendations towards a new approach for diagnosis and classification of cognitive impairment in people living with HIV, intended to focus discussion and debate going forward. We propose the conceptual separation of HIV-associated brain injury - including active or pretreatment legacy damage - from other causes of brain injury occurring in people living with HIV. We suggest moving away from a quantitative neuropsychological approach towards an emphasis on clinical context. Our recommendations are intended to better represent the changing profile of cognitive impairment in people living with HIV in diverse global settings and to provide a clearer framework of classification for clinical management and research studies.
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Affiliation(s)
- Sam Nightingale
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, Cape Town, South Africa.
| | - Beau Ances
- Department of Neurology, Washington University School of Medicine, St Louis, MO, USA
| | - Paola Cinque
- Unit of Infectious Diseases, San Raffaele Institute, Milan, Italy
| | - Ameet Dravid
- Department of Medicine, Poona Hospital and Research Centre and Noble Hospital, Pune, India
| | - Anna J Dreyer
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Magnus Gisslén
- Institute of Biomedicine, Department of Infectious Diseases, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Infectious Diseases, Gothenburg, Sweden
| | - John A Joska
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Judith Kwasa
- Department of Clinical Medicine and Therapeutics, Faculty of Health Science, University of Nairobi, Nairobi, Kenya
| | - Ana-Claire Meyer
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | | | - Noeline Nakasujja
- Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Anton Pozniak
- Department of HIV Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Richard W Price
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | | | - Deanna Saylor
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
- University Teaching Hospital, Lusaka, Zambia
| | - Kevin G F Thomas
- Applied Cognitive Science and Experimental Neuropsychology Team (ACSENT), Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - Jonathan Underwood
- Division of Infection and Immunity, Cardiff University, Cardiff, UK
- Department of Infectious Diseases, Cardiff and Vale University Health Board, Cardiff, UK
| | - Jaime H Vera
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK
| | - Alan Winston
- Department of Infectious Disease, Imperial College London, London, UK
- HIV Clinical Trials, Winston Churchill Wing, St Mary's Hospital, London, UK
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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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Abstract
BACKGROUND With the growing population of older adults in Nigeria comes a simultaneous rise in the incidence of dementia in the country. Adequate knowledge of dementia is needed to effectively administer interventions for persons living with dementia. Physiotherapy is one of the professions providing care for people with dementia. The aim of this study was to evaluate the knowledge of dementia among physiotherapists in Nigeria. METHODS An online survey method was used to collect data from the sample population of practicing physiotherapists in Nigeria. Data was collected using the 21-item Dementia Knowledge Assessment Tool Version Two (DKAT2) and the respondents also provided some demographic information. Mann Whitney test, Kruskal Wallis test and Spearman's rho correlation were used to test for association between the DKAT2 scores and the demographic variables and this association was further explored with multiple linear regression analysis. RESULTS A total number of 223 physiotherapists participated in this study. The findings of the study show that there is limited knowledge of dementia among the physiotherapists. Number of years of professional experience and specialty groups predicted significantly higher knowledge scores. CONCLUSION The knowledge deficits found among physiotherapists in Nigeria indicate that older adults living with dementia might not be receiving the best evidence-based physiotherapy treatments for their condition. This research therefore advocates for an educational intervention to be carried out within the physiotherapy profession in order to improve the quality of services rendered to their patients.
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Affiliation(s)
- Chisom I Onyekwuluje
- Chisom I Onyekwuluje, Department of
Gerontology, University of Southampton, 24 Akinyemi street, Southampton SO17
1BJ, UK.
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Mwendwa P, Lawlor B, Kroll T, De Brún A. A systematic review and narrative synthesis of the experiences with caring for older people living with dementia in Sub-Saharan Africa. BMC Geriatr 2022; 22:961. [PMID: 36514016 PMCID: PMC9749146 DOI: 10.1186/s12877-022-03668-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/30/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND In low- and middle-income countries, including sub-Saharan Africa little is known about the experiences with caring for people living with dementia. The purpose of this systematic review and narrative synthesis was to examine the experiences with caring for older people living with dementia at home. RESULTS In total, 366 abstracts were identified and following screening, 19 studies were included in the synthesis. Six themes were identified: conceptualising dementia, caregiving arrangements, the impact of caregiving, caregiver identity and role, managing caregiving, unmet caregiver needs. CONCLUSION There is a dearth of research in relation to caregiving for older people living with dementia in sub-Saharan Africa. There is need for better information campaigns and support programs directed at family and professional caregivers in this context.
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Affiliation(s)
- Purity Mwendwa
- UCD Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - Brian Lawlor
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Thilo Kroll
- UCD Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - Aoife De Brún
- UCD Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
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Mfene XP, Pillay BJ. Knowledge of dementia and dementia care in a cross-sectional sample of individuals living in rural and urban areas in KwaZulu-Natal, South Africa. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2022. [DOI: 10.1177/00812463221139651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Knowledge of dementia is considered one of the facilitators of dementia risk reduction because it has been linked to early detection, diagnosis, and help-seeking in people with dementia. This study explored knowledge of dementia symptoms, causes, and care in a community sample of individuals living in rural and urban areas in KwaZulu-Natal, South Africa. A cross-sectional household study of 300 participants, ⩾ 18 years old, using semi-structured individual interviews was conducted. Of the 300 participants, 94% recognised the presence of the cognitive decline symptoms, and 12.4% identified the symptoms as dementia. Participants emphasised biological and medical risk factors over socio-cultural factors. Although the participants primarily adopted a biomedical understanding of dementia, with a small number acknowledging a traditional understanding, they preferred a multi-disciplinary approach to care. Participants advocated for a multidisciplinary care approach that included medical, family, social work, mental health services, and spiritual and traditional care for people with dementia and their families. Therefore, policy and care services for African people with dementia and their families need to holistically integrate multiple care approaches. This will maximise the benefit of public health interventions while also building capacity in our understaffed and burdened healthcare systems.
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Affiliation(s)
| | - Basil Joseph Pillay
- Department of Behavioural Medicine, University of KwaZulu Natal, South Africa
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Onohuean H, Akiyode AO, Akiyode O, Igbinoba SI, Alagbonsi AI. Epidemiology of neurodegenerative diseases in the East African region: A meta-analysis. Front Neurol 2022; 13:1024004. [PMID: 36468051 PMCID: PMC9718573 DOI: 10.3389/fneur.2022.1024004] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 10/18/2022] [Indexed: 07/30/2023] Open
Abstract
INTRODUCTION There is a scarcity of epidemiological data on neurodegenerative diseases (NDs) in East Africa. This meta-analysis provides the regional prevalence of NDs, their contributing factors, and evidence of change over time concerning gender per age or year. METHODS Articles were retrieved from electronic databases following the PRISMA standard. RESULTS Forty-two studies were reviewed, and 25 were meta-analyzed with a random-effects model. The pool estimate proportion of 15.27%, 95% CI (0.09-0.23) (I2 = 98.25%), (Q = 1,369.15, p < 0.0001) among a population of 15,813 male/female and 1,257 with NDs. Epidemiological characteristics associated with NDs include Dyskinesias prevalence 55.4%, 95% CI (13.5; 90.9), I2 (96%) and subsistence farming prevalence 11.3%, 95% CI (5.8; 20.9), I2 (99%). Publication bias by Egger test was (z = 4.1913, p < 0.0001), while rank correlation test using Kendall's model was (tau = 0.1237, p = 0.3873). Heterogeneity (R2 design = 5.23%, p design < 0.0001; R2 size = 52.163%, p size < 0.001; and R2 period = 48.13, p period < 0.0001. Covariates (R2 design + size + period = 48.41%, p < 0.001). CONCLUSION There is a high prevalence of NDs in the East African region, which could impact life expectancy, morbidity, and quality of life. Thus, early screening and regular surveillance could assist in management strategies.
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Affiliation(s)
- Hope Onohuean
- Biopharmaceutics Unit, Department of Pharmacology and Toxicology, Kampala International University Western Campus, Ishaka, Uganda
- Biomolecules, Metagenomics, Endocrine and Tropical Disease Research Group (BMETDREG), Kampala International University Western Campus, Ishaka, Uganda
| | - Abraham Olutumininu Akiyode
- Department of Biology, College of Arts and Sciences, University of Texas of the Permian Odessa, TX, United States
| | - Oluwole Akiyode
- Biomolecules, Metagenomics, Endocrine and Tropical Disease Research Group (BMETDREG), Kampala International University Western Campus, Ishaka, Uganda
- Biological and Environmental Sciences Department, Kampala International University, Kampala, Uganda
| | - Sharon Iyobor Igbinoba
- Biopharmaceutics Unit, Department of Pharmacology and Toxicology, Kampala International University Western Campus, Ishaka, Uganda
- Biomolecules, Metagenomics, Endocrine and Tropical Disease Research Group (BMETDREG), Kampala International University Western Campus, Ishaka, Uganda
- Department of Clinical Pharmacy and Pharmacy Administration, Faculty of Pharmacy, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - Abdullateef Isiaka Alagbonsi
- Department of Clinical Biology (Physiology Unit), School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Huye, Rwanda
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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. [PMID: 35968611 PMCID: PMC9606014 DOI: 10.1177/14713012221118441] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2024]
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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Mussie KM, Setchell J, Elger BS, Kaba M, Memirie ST, Wangmo T. Care of Older Persons in Eastern Africa: A Scoping Review of Ethical Issues. Front Public Health 2022; 10:923097. [PMID: 35874990 PMCID: PMC9298985 DOI: 10.3389/fpubh.2022.923097] [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] [Received: 04/18/2022] [Accepted: 06/16/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction The aging population is rapidly increasing globally, with 80% of the older population living in low- and middle-income countries. In Eastern African countries, there exists an incongruence between readiness-economically, structurally, politically, and culturally-to create a conducive environment for healthy aging, which implies public health as well as ethical concerns. The aim of this scoping review was to explore existing evidence addressing the various ethical issues in connection with elder care in the region of Eastern Africa. Methods We searched six databases (Africa-Wide Information, AgeLine, CINHAL, MEDLINE, APA PsycInfo, and SocINDEX) to identify peer-reviewed journal articles that could meet some eligibility criteria such as being a peer-reviewed journal article written in English, having been published in any year until July 2020, and focusing on ethical issues in the care of older people aged 60 years and older from Eastern Africa. We also searched for additional evidence in the references of included papers and web-based platforms. We included 24 journal articles and analyzed them using the inductive content analysis approach. Results The included articles represent seven (38.9%) of the 18 countries in the Eastern African region. The articles covered six ethical concerns: lack of government attention to older persons (n = 14, 58.3%), inaccessibility of health care services (n = 13, 54.2%), loneliness and isolation (n = 11, 45.8%), gender inequalities in old age (n = 9, 37.5%), mistreatment and victimization (n = 8, 33.3%), and medical errors (n = 2, 8.3%). Conclusion This scoping review summarized ethical issues arising in relation to providing care for older persons in the Eastern African context. In light of the rapid increase in the number of older persons in this region, it is critical for governments and responsible bodies to implement and accelerate efforts promptly to generate more evidence to inform programs and policies that improve the health and wellbeing of older persons. Further research is needed to inform global health efforts that aim at improving the lives of older persons, particularly in low- and middle-income countries. Clinical Trial Registration https://osf.io/sb8gw, identifier: 10.17605/OSF.IO/SB8GW.
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Affiliation(s)
| | - Jenny Setchell
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Bernice Simone Elger
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland.,Center for Legal Medicine, University of Geneva, Geneva, Switzerland
| | - Mirgissa Kaba
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Solomon Tessema Memirie
- Addis Centre for Ethics and Priority Setting, Addis Ababa University, Addis Ababa, Ethiopia.,Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States
| | - Tenzin Wangmo
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
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Stigma and its implications for dementia in South Africa: a multi-stakeholder exploratory study. AGEING & SOCIETY 2022. [DOI: 10.1017/s0144686x2200040x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Stigma and discrimination in relation to dementia has a range of implications for people living with dementia and their families worldwide, including help-seeking, quality of life, social rejection and isolation. Few studies consider the perceptions and stigma towards dementia from multiple perspectives, such as people living with dementia, carers, general public and health-care workers. South Africa has limited evidence on the stigmatisation of people living with dementia, with responses to people living with dementia being driven by poor understanding of the condition, cultural beliefs about causes and social interaction problems associated with memory and cognitive impairment. This study explored the experiences of stigma among people living with dementia and their carers through understanding their own knowledge, attitudes and beliefs as well as those of the public and health-care workers. Qualitative data (N = 52) were collected across two provinces and in four languages (English, Afrikaans, Sesotho and isiZulu), with semi-structured interviews and focus groups with the following stakeholder groups: people living with dementia and their carers, the general public and health-care workers. Inductive thematic analysis generated themes across stakeholder groups. The study shows that people living with dementia and carers experienced high levels of internalised stigma, related to negative public attitudes, which were associated with high levels of isolation, health system unpreparedness and limited access to support. The study contributes to the evidence base needed in South Africa but also extends its relevance by contributing to a growing global evidence base on stigma and dementia in low- and middle-income contexts.
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Lay Health Workers in Community-Based Care and Management of Dementia: A Qualitative ‘Pre’ and ‘Post’ Intervention Study in Southwestern Uganda. BIOMED RESEARCH INTERNATIONAL 2022; 2022:9443229. [PMID: 35372572 PMCID: PMC8967551 DOI: 10.1155/2022/9443229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 03/03/2022] [Indexed: 11/17/2022]
Abstract
Background The global need for efficient and cost-effective use of healthcare resources in low-income countries has led to the introduction of lay health workers (LHWs) as a link of the community to healthcare services. As such, the LHWs perform a variety of tasks such as education, support for care delivery, and social support across all disease types. However, little is known about their ability to support dementia care and management in the community. Purpose The goal of the pilot intervention was to evaluate the 5-day training intervention for LHWs in rural southwestern Uganda in community-based care and management of people with dementia, and implementation of the knowledge and skills gained. Methods This was a “pre” and “post” pilot intervention study which involved a qualitative assessment of LHWs' knowledge on community-based management and care for people with dementia. We focused on four core competency domains in the WHO dementia toolkit. The intervention included a five-day training of the LHWs on dementia care, eight weeks of implementation, and an evaluation of the experiences. Analysis focused on the needs assessment, early detection and management, community engagement, support for people with dementia; and evaluation of the eight weeks implementation. Results Before the training, the LHWs did not know much about what dementia-related support to provide in the community. Activities were limited to general support, including nutrition, and health education. After the training, LHWs had a basic understanding of dementia and began sensitizing the communities. They felt more comfortable working with people with dementia and reported a notable change in the attitude of family members. However, they reported challenges in differentiating the signs of early dementia from superstitious beliefs. Conclusion With enhanced capacity, LHWs may be able to support community-based management for people with dementia. A larger study is needed to explore potential roles for LHWs and further assess effectiveness of the LHWs' skills.
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Adedeji IA, Ogunniyi A, Henderson DC, Sam-Agudu NA. Experiences and practices of caregiving for older persons living with dementia in African countries: A qualitative scoping review. DEMENTIA 2022; 21:995-1011. [PMID: 34978956 DOI: 10.1177/14713012211065398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The increasing awareness and diagnosis of dementia in Africa necessitate documentation of caregiving practices to understand local patterns and improve the quality of care. Caregiving in African communities is rooted in informal-communal social organization. This scoping review analyses caregiver characteristics and experiences, and practices of caregiving for persons living with dementia in Africa. METHODS A total of 152 references were retrieved, with 64 references obtained from PubMed, 85 from AJOL, and three from Scopus. Based on the relevance of titles, 83 references were further retained from PubMed (64), AJOL (16), and Scopus (3). A rapid review of abstracts was done in Distiller SR, and finally, six relevant articles were content-analyzed using Atlas ti 8.4 qualitative analysis software. RESULTS All six included studies were published between 2003 and 2018. Four themes were identified: article characteristics, caregiver characteristics, caregiver in context, and caregiver potentialities (challenges and opportunities). Studies reported findings from research conducted in four African countries: three from Nigeria, and one each from South Africa, Egypt, and Tanzania. Caregivers of persons living with dementia typically had eight years or less of formal education, were unpaid, and spent a daily average of 13 hours in caregiving. Cultural thresholds and individual caregiver differences underlie the interpretation of stressors across cultures. Caregivers lack the right training and information as well as support systems to improve their role performance and reduce accumulated stress. CONCLUSION In African countries, informational and educational platforms are essential for improved individual dementia caregiving, vis-à-vis strengthened roles of governments, and religious/traditional leaders and organizations.
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Affiliation(s)
- Isaac A Adedeji
- Department of Sociology, 107991Olabisi Onabanjo University, Ago-Iwoye, Nigeria
| | - Adesola Ogunniyi
- Department of Medicine, 58987University College Hospital, Ibadan, Nigeria
| | - David C Henderson
- Department of Psychiatry, 1846Boston University School of Medicine, USA
| | - Nadia A Sam-Agudu
- International Research Center of Excellence, 12264Institute of Human Virology Nigeria, Abuja, Nigeria.,Department of Paediatrics and Child Health, University of Cape Coast School of Medical Sciences, Cape Coast, Ghana.,Division of Epidemiology and Prevention, Institute of Human Virology, 12264University of Maryland School of Medicine, Baltimore, USA
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14
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Paddick SM, Yoseph M, Gray WK, Andrea D, Barber R, Colgan A, Dotchin C, Urasa S, Kissima J, Haule I, Kisoli A, Rogathi J, Safic S, Mushi D, Robinson L, Walker RW. Effectiveness of App-Based Cognitive Screening for Dementia by Lay Health Workers in Low Resource Settings. A Validation and Feasibility Study in Rural Tanzania. J Geriatr Psychiatry Neurol 2021; 34:613-621. [PMID: 32964799 PMCID: PMC8600584 DOI: 10.1177/0891988720957105] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The majority of people with dementia live in low-and middle-income countries (LMICs). In sub-Saharan Africa (SSA) human-resource shortages in mental health and geriatric medicine are well recognized. Use of technological solutions may improve access to diagnosis. We aimed to assess the diagnostic accuracy of a brief dementia screening mobile application (app) for non-specialist workers in rural Tanzania against blinded gold-standard diagnosis of DSM-5 dementia. The app includes 2 previously-validated culturally appropriate low-literacy screening tools for cognitive (IDEA cognitive screen) and functional impairment (abbreviated IDEA-IADL questionnaire). METHODS This was a 2-stage community-based door-to-door study. In Stage1, rural primary health workers approached all individuals aged ≥60 years for app-based dementia screening in 12 villages in Hai district, Kilimanjaro Tanzania.In Stage 2, a stratified sub-sample were clinically-assessed for dementia blind to app screening score. Assessment included clinical history, neurological and bedside cognitive assessment and collateral history. RESULTS 3011 (of 3122 eligible) older people consented to screening. Of these, 610 were evaluated in Stage 2. For the IDEA cognitive screen, the area under the receiver operating characteristic (AUROC) curve was 0.79 (95% CI 0.74-0.83) for DSM-5 dementia diagnosis (sensitivity 84.8%, specificity 58.4%). For those 358 (44%) completing the full app, AUROC was 0.78 for combined cognitive and informant-reported functional assessment. CONCLUSIONS The pilot dementia screening app had good sensitivity but lacked specificity for dementia when administered by non-specialist rural community workers. This technological approach may be a promising way forward in low-resource settings, specialist onward referral may be prioritized.
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Affiliation(s)
- Stella-Maria Paddick
- Newcastle University, Newcastle upon
Tyne, United Kingdom,Stella-Maria Paddick, Campus for Ageing and
Vitality Newcastle University, Westgate Road, Newcastle upon Tyne NE4 6BE,
Tanzania.
| | - Marcella Yoseph
- Kilimanjaro Christian Medical University
College, Moshi, Tanzania
| | - William K. Gray
- Northumbria Healthcare NHS Foundation
Trust, North Tyneside General Hospital, North Shields, United Kingdom
| | | | - Robyn Barber
- Newcastle University, Newcastle upon
Tyne, United Kingdom
| | - Aofie Colgan
- Newcastle University, Newcastle upon
Tyne, United Kingdom
| | - Catherine Dotchin
- Newcastle University, Newcastle upon
Tyne, United Kingdom,Northumbria Healthcare NHS Foundation
Trust, North Tyneside General Hospital, North Shields, United Kingdom
| | - Sarah Urasa
- Kilimanjaro Christian Medical University
College, Moshi, Tanzania
| | - John Kissima
- Hai District Hospital, Boman’gombe,
Kilimanjaro, Tanzania
| | - Irene Haule
- Hai District Hospital, Boman’gombe,
Kilimanjaro, Tanzania
| | - Aloyce Kisoli
- Kilimanjaro Christian Medical University
College, Moshi, Tanzania
| | - Jane Rogathi
- Kilimanjaro Christian Medical University
College, Moshi, Tanzania
| | | | - Declare Mushi
- Kilimanjaro Christian Medical University
College, Moshi, Tanzania
| | | | - Richard W. Walker
- Newcastle University, Newcastle upon
Tyne, United Kingdom,Northumbria Healthcare NHS Foundation
Trust, North Tyneside General Hospital, North Shields, United Kingdom
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15
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Kalu ME, Ojembe BU, Akinrolie O, Okoh AC, Adandom II, Nwankwo HC, Ajulo MS, Omeje CA, Okeke CO, Uduonu EM, Ezulike JC, Anieto EM, Emofe D, Nwachukwu EC, Ibekaku MC, Obi PC. Setting priorities for ageing research in Africa: A systematic mapping review of 512 studies from sub-Saharan Africa. J Glob Health 2021. [PMID: 34327003 PMCID: PMC8284542 DOI: 10.7189/11.15002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background In 2040, the older population's growth rate in sub-Saharan Africa (SSA) will be faster than those experienced by developed nations since 1950. In preparation for this growth, the National Institute on Aging commissioned the National Academies' Committee on Population to organize a workshop on advancing aging research in Africa. This meeting provided a platform for discussing some areas requiring improvement in aging research in SSA regions. We believed that conducting a systematic review of peer-reviewed articles to set priorities for aging research in SSA is warranted. Therefore, this article is the first in a Four-Part series that summaries the types and trends of peer-reviewed studies in SSA. Methods This systematic mapping review followed the Search-Appraisal-Synthesis-Analysis Framework. We systematically searched multiple databases from inception till February 2021 and included peer-reviewed articles conducted with/for older adults residing in SSA. Conventional content analysis was employed to categorize studies into subject-related areas. Results We included 512 studies (quantitative = 426, qualitative = 71 and mixed-method = 15). Studies were conducted in 32 countries. Quantitative studies included were observational studies: cross-sectional (n = 250, 59%), longitudinal (n = 126, 30%), and case-control (n = 12, 3%); and experimental studies: pre-post design (n = 4, 1%), randomized control trial (RCT, n = 12, 3%); and not reported (n = 21, 5%). Fifteen qualitative studies did not state their study design; where stated, study design ranged from descriptive (n = 14, 20%), ethnography (n = 12, 17%), grounded theory (n = 7, 10%), narrative (n = 5, 7%), phenomenology (n = 10, 14%), interpretative exploratory (n = 4, 6%), case studies (n = 4, 6%). Of the 15 mixed-method studies, seven did not state their mixed-method design. Where stated, design includes concurrent (n = 1), convergent (n = 1), cross-sectional (n = 3), informative (n = 1), sequential exploratory (n = 1) and retrospective (n = 2). Studies were classified into 30 (for quantitative studies) and seven (for qualitative and mixed-method) subject-related areas. HIV/AIDs-related and non-communicable diseases-related studies were the most predominant subject-related areas. No studies explored the transdisciplinary co-production of interventions. Conclusions There are glaring gaps in ageing research in SSA, especially mixed-methods and RCTs. A large number of studies focused on HIV/AIDs and non-communicable disease-related studies. National and international funding agencies should set up priority funding competitions for transdisciplinary collaborations in ageing research.
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Affiliation(s)
- Michael E Kalu
- Emerging Researchers & Professionals in Ageing - African Network, Nigeria (www.erpaan.org).,School of Rehabilitation Science, McMaster University, Hamilton Ontario Canada
| | - Blessing U Ojembe
- Emerging Researchers & Professionals in Ageing - African Network, Nigeria (www.erpaan.org).,Department of Health, Ageing & Society, McMaster University, Hamilton Ontario Canada
| | - Olayinka Akinrolie
- Emerging Researchers & Professionals in Ageing - African Network, Nigeria (www.erpaan.org).,Applied Health Science Program, University of Manitoba, Winnipeg, Canada
| | - Augustine C Okoh
- Emerging Researchers & Professionals in Ageing - African Network, Nigeria (www.erpaan.org)
| | - Israel I Adandom
- Emerging Researchers & Professionals in Ageing - African Network, Nigeria (www.erpaan.org).,Physiotherapy Department, Cedacrest Hospitals, Abuja, Nigeria
| | - Henrietta C Nwankwo
- Emerging Researchers & Professionals in Ageing - African Network, Nigeria (www.erpaan.org).,Faculty of Health Science, University of Lethbridge, Lethbridge, Alberta, Canada
| | - Michael S Ajulo
- Emerging Researchers & Professionals in Ageing - African Network, Nigeria (www.erpaan.org)
| | - Chidinma A Omeje
- Emerging Researchers & Professionals in Ageing - African Network, Nigeria (www.erpaan.org).,Department of Medical Rehabilitation, College of Medicine, University of Nigeria, Nigeria
| | - Chukwuebuka O Okeke
- Emerging Researchers & Professionals in Ageing - African Network, Nigeria (www.erpaan.org).,Department of Medical Rehabilitation, Nnamdi Azikiwe University, Awka, Nigeria
| | - Ekezie M Uduonu
- Emerging Researchers & Professionals in Ageing - African Network, Nigeria (www.erpaan.org).,Department of Medical Rehabilitation, College of Medicine, University of Nigeria, Nigeria
| | - Juliet C Ezulike
- Emerging Researchers & Professionals in Ageing - African Network, Nigeria (www.erpaan.org).,Department of Social Work, University of Nigeria, Nsukka, Nigeria.,Department of Social and Behavioural Sciences, City University of Hong Kong, Kowloon, Hong Kong
| | - Ebuka M Anieto
- Emerging Researchers & Professionals in Ageing - African Network, Nigeria (www.erpaan.org).,Department of Health and Rehabilitation Sciences, University of Cape Town, Cape Town, South Africa
| | - Diameta Emofe
- Emerging Researchers & Professionals in Ageing - African Network, Nigeria (www.erpaan.org).,Physiotherapy Department, Humanity Hospital Effurun, Delta State, Nigeria
| | - Ernest C Nwachukwu
- Emerging Researchers & Professionals in Ageing - African Network, Nigeria (www.erpaan.org).,Physiotherapy Department, Enugu State University of Science and Technology Teaching Hospital-Parklane, Enugu, Nigeria
| | - Michael C Ibekaku
- Emerging Researchers & Professionals in Ageing - African Network, Nigeria (www.erpaan.org).,Department of Physiotherapy, University of Benin Teaching Hospital, Benin city, Nigeria
| | - Perpetual C Obi
- Emerging Researchers & Professionals in Ageing - African Network, Nigeria (www.erpaan.org).,Physiotherapy Unit, Peak Wellness Centre, Abuja, Nigeria
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16
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Kalu ME, Ojembe BU, Akinrolie O, Okoh AC, Adandom II, Nwankwo HC, Ajulo MS, Omeje CA, Okeke CO, Uduonu EM, Ezulike JC, Anieto EM, Emofe D, Nwachukwu EC, Ibekaku MC, Obi PC. Setting priorities for ageing research in Africa: A systematic mapping review of 512 studies from sub-Saharan Africa. J Glob Health 2021; 11:15002. [PMID: 34327003 PMCID: PMC8284542 DOI: 10.7189/jogh.11.15002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023] Open
Abstract
BACKGROUND In 2040, the older population's growth rate in sub-Saharan Africa (SSA) will be faster than those experienced by developed nations since 1950. In preparation for this growth, the National Institute on Aging commissioned the National Academies' Committee on Population to organize a workshop on advancing aging research in Africa. This meeting provided a platform for discussing some areas requiring improvement in aging research in SSA regions. We believed that conducting a systematic review of peer-reviewed articles to set priorities for aging research in SSA is warranted. Therefore, this article is the first in a Four-Part series that summaries the types and trends of peer-reviewed studies in SSA. METHODS This systematic mapping review followed the Search-Appraisal-Synthesis-Analysis Framework. We systematically searched multiple databases from inception till February 2021 and included peer-reviewed articles conducted with/for older adults residing in SSA. Conventional content analysis was employed to categorize studies into subject-related areas. RESULTS We included 512 studies (quantitative = 426, qualitative = 71 and mixed-method = 15). Studies were conducted in 32 countries. Quantitative studies included were observational studies: cross-sectional (n = 250, 59%), longitudinal (n = 126, 30%), and case-control (n = 12, 3%); and experimental studies: pre-post design (n = 4, 1%), randomized control trial (RCT, n = 12, 3%); and not reported (n = 21, 5%). Fifteen qualitative studies did not state their study design; where stated, study design ranged from descriptive (n = 14, 20%), ethnography (n = 12, 17%), grounded theory (n = 7, 10%), narrative (n = 5, 7%), phenomenology (n = 10, 14%), interpretative exploratory (n = 4, 6%), case studies (n = 4, 6%). Of the 15 mixed-method studies, seven did not state their mixed-method design. Where stated, design includes concurrent (n = 1), convergent (n = 1), cross-sectional (n = 3), informative (n = 1), sequential exploratory (n = 1) and retrospective (n = 2). Studies were classified into 30 (for quantitative studies) and seven (for qualitative and mixed-method) subject-related areas. HIV/AIDs-related and non-communicable diseases-related studies were the most predominant subject-related areas. No studies explored the transdisciplinary co-production of interventions. CONCLUSIONS There are glaring gaps in ageing research in SSA, especially mixed-methods and RCTs. A large number of studies focused on HIV/AIDs and non-communicable disease-related studies. National and international funding agencies should set up priority funding competitions for transdisciplinary collaborations in ageing research.
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Affiliation(s)
- Michael E Kalu
- Emerging Researchers & Professionals in Ageing – African Network, Nigeria (www.erpaan.org)
- School of Rehabilitation Science, McMaster University, Hamilton Ontario Canada
| | - Blessing U Ojembe
- Emerging Researchers & Professionals in Ageing – African Network, Nigeria (www.erpaan.org)
- Department of Health, Ageing & Society, McMaster University, Hamilton Ontario Canada
| | - Olayinka Akinrolie
- Emerging Researchers & Professionals in Ageing – African Network, Nigeria (www.erpaan.org)
- Applied Health Science Program, University of Manitoba, Winnipeg, Canada
| | - Augustine C Okoh
- Emerging Researchers & Professionals in Ageing – African Network, Nigeria (www.erpaan.org)
| | - Israel I Adandom
- Emerging Researchers & Professionals in Ageing – African Network, Nigeria (www.erpaan.org)
- Physiotherapy Department, Cedacrest Hospitals, Abuja, Nigeria
| | - Henrietta C Nwankwo
- Emerging Researchers & Professionals in Ageing – African Network, Nigeria (www.erpaan.org)
- Faculty of Health Science, University of Lethbridge, Lethbridge, Alberta, Canada
| | - Michael S Ajulo
- Emerging Researchers & Professionals in Ageing – African Network, Nigeria (www.erpaan.org)
| | - Chidinma A Omeje
- Emerging Researchers & Professionals in Ageing – African Network, Nigeria (www.erpaan.org)
- Department of Medical Rehabilitation, College of Medicine, University of Nigeria, Nigeria
| | - Chukwuebuka O Okeke
- Emerging Researchers & Professionals in Ageing – African Network, Nigeria (www.erpaan.org)
- Department of Medical Rehabilitation, Nnamdi Azikiwe University, Awka, Nigeria
| | - Ekezie M Uduonu
- Emerging Researchers & Professionals in Ageing – African Network, Nigeria (www.erpaan.org)
- Department of Medical Rehabilitation, College of Medicine, University of Nigeria, Nigeria
| | - Juliet C Ezulike
- Emerging Researchers & Professionals in Ageing – African Network, Nigeria (www.erpaan.org)
- Department of Social Work, University of Nigeria, Nsukka, Nigeria
- Department of Social and Behavioural Sciences, City University of Hong Kong, Kowloon, Hong Kong
| | - Ebuka M Anieto
- Emerging Researchers & Professionals in Ageing – African Network, Nigeria (www.erpaan.org)
- Department of Health and Rehabilitation Sciences, University of Cape Town, Cape Town, South Africa
| | - Diameta Emofe
- Emerging Researchers & Professionals in Ageing – African Network, Nigeria (www.erpaan.org)
- Physiotherapy Department, Humanity Hospital Effurun, Delta State, Nigeria
| | - Ernest C Nwachukwu
- Emerging Researchers & Professionals in Ageing – African Network, Nigeria (www.erpaan.org)
- Physiotherapy Department, Enugu State University of Science and Technology Teaching Hospital-Parklane, Enugu, Nigeria
| | - Michael C Ibekaku
- Emerging Researchers & Professionals in Ageing – African Network, Nigeria (www.erpaan.org)
- Department of Physiotherapy, University of Benin Teaching Hospital, Benin city, Nigeria
| | - Perpetual C Obi
- Emerging Researchers & Professionals in Ageing – African Network, Nigeria (www.erpaan.org)
- Physiotherapy Unit, Peak Wellness Centre, Abuja, Nigeria
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17
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Mwendwa P, Mutunga E, Kroll T, De Brún A. 'It is stressful, almost every hour…': Experiences of caring for people living with dementia in Kenya-An interpretive phenomenological approach. DEMENTIA 2021; 20:2916-2932. [PMID: 34053227 PMCID: PMC8671649 DOI: 10.1177/14713012211022989] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction As chronic conditions such as dementia become increasingly prevalent, the role of caregivers will become ever more critical. In the East African region, little is known about the experiences of caring for people living with dementia. This study aims to describe the views of being a caregiver, including day-to-day responsibilities and duties, determine the impact of caregiving and understand participants’ experiences of supports available or required to facilitate caring for a person living with dementia in Kenya. Methods This was a qualitative study that employed an interpretative phenomenological analysis (IPA) approach. We used convenience sampling to identify study participants in three counties in Kenya. Participants were main caregivers for the family and hence included both families and paid caregivers. We recruited 10 caregivers to participate in the study (9 females and 1 male). Data were analysed manually following the IPA approach. Results Three main themes emerged from the analysis: the personal experience of caregiving, supports to assist with caregiving and the perceived unmet care needs. The challenges experienced varied based on the support available to the caregiver, the number of years in the caregiving role and knowledge and skills related to providing care. Conclusion Our study shows that caring for a person living with dementia is an arduous experience, requiring significant mental and physical effort. The study highlights a general lack of knowledge and awareness of dementia among families, healthcare professionals and the general public. Training programmes for caregivers, including dementia care skills, educating healthcare practitioners and organising public awareness programmes to understand and accept dementia are urgently needed.
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Affiliation(s)
- Purity Mwendwa
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery & Health Systems, 8797University College Dublin, Dublin, Ireland
| | | | - Thilo Kroll
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery & Health Systems, 8797University College Dublin, Dublin, Ireland
| | - Aoife De Brún
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery & Health Systems, 8797University College Dublin, Dublin, Ireland
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18
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Farina N, Suemoto CK, Burton JK, Oliveira D, Frost R. Perceptions of dementia amongst the general public across Latin America: a systematic review. Aging Ment Health 2021; 25:787-796. [PMID: 32048522 DOI: 10.1080/13607863.2020.1725738] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: Perceptions of dementia are important determinants of support, treatment and care received in the dementia community. Understanding these perceptions are vital for regions such as Latin America, where there is a rapid increase in people living with dementia. The aim of this study is to review and synthesise the general public's perceptions of dementia in Latin America, what factors are associated with these perceptions, and how they differ between countries in the region.Methods: Searches were completed across five databases (Medline, SCOPUS, PsychINFO, SciELO, and WoS). Studies were required to capture attitudes or knowledge of dementia in the general public residing within Latin America. English, Spanish and Portuguese search terms were used. Results were synthesised narratively.Results: About 1574 unique records were identified. Following lateral searches, de-duplication and screening, six articles (four studies) met the inclusion criteria for this review. All the studies were quantitative research from Brazil (median, n = 722). There was evidence of a limited to moderate knowledge of dementia, though a significant minority had negative or stigmatising attitudes. Only higher levels of education were consistently associated with better attitudes and knowledge of dementia in the region.Conclusion: There is a need for more in-depth research about attitudes of the general public across Latin America, particularly outside of São Paulo state, Brazil. There appears to be a greater need to raise awareness of dementia amongst less educated Latin American groups.
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Affiliation(s)
- Nicolas Farina
- Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, UK
| | - Claudia K Suemoto
- Brazilian Aging Brain Study Group, University of São Paulo Medical School, São Paulo, Brazil
| | - Jenni K Burton
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK
| | - Déborah Oliveira
- Department of Psychiatry, School of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Rachael Frost
- Department of Primary Care and Population Health, University College London, London, UK
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19
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Musyimi CW, Ndetei DM, Evans-Lacko S, Oliveira D, Mutunga E, Farina N. Perceptions and experiences of dementia and its care in rural Kenya. DEMENTIA 2021; 20:2802-2819. [PMID: 33928810 DOI: 10.1177/14713012211014800] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES We aimed to explore the perceptions towards dementia and related care across three stakeholder groups in rural Kenya. METHODS A total of 38 key stakeholders (carers of persons with dementia, health care providers and the general public) participated in focus group discussions. Additional five individual interviews were held with carers. Thematic analysis was used to analyse the data. FINDINGS Across the three participant groups, a total of four themes were identified: (i) negative stereotypes of dementia, (ii) limited knowledge about dementia, (iii) diagnostic pathway and (iv) neglect and abuse. CONCLUSIONS We found a general lack of knowledge of dementia amongst family carers, healthcare professionals and the general public. The combination of poor awareness and ill-equipped healthcare systems leads to stigma manifested in the form of patchy diagnostic pathways, neglect and abuse. Local governments could take advantage of the existing family- and community-based systems to improve understanding of dementia nationally.
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Affiliation(s)
| | - David M Ndetei
- Africa Mental Health Research and Training Foundation, 107854University of Nairobi, Nairobi, Kenya
| | - Sara Evans-Lacko
- 4905Care Policy and Evaluation Centre, London School of Economics and Political Science, UK
| | | | | | - Nicolas Farina
- Centre for Dementia Studies, 12190Brighton and Sussex Medical School, Brighton, UK
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20
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Spittel S, Kraus E, Maier A. Dementia Awareness Challenges in Sub-Saharan Africa: A Cross-Sectional Survey Conducted Among School Students in Ghana. Am J Alzheimers Dis Other Demen 2021; 36:15333175211055315. [PMID: 34985361 PMCID: PMC10581119 DOI: 10.1177/15333175211055315] [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] [Indexed: 01/15/2023]
Abstract
The survey focuses on identifying dementia awareness challenges among Ghanaian school students. Data were generated in a cross-sectional survey (n = 1137). 9.3% of school students showed dementia awareness whilst the community respondents, representing both higher age and level of education, showed greater awareness (32.2%, P < .001). 45% of respondents believed in witchcraft and 57% were afraid of potentially being harmed by witchcraft. Age and education did not influence people's belief in witchcraft. Moreover, dementia symptoms were often mistaken for witchcraft, especially by those who had encountered a person accused of witchcraft: "swearing at others" (24%), displaying "memory loss" and "confused speech" (22%), "forgetfulness" and who was seen "roaming around" (19%). Lack of dementia awareness was particularly evident among school students whereas belief in witchcraft was similar in both respondent groups. There was a correlation between low dementia awareness rates and misinterpretation of dementia symptoms with attribution to witchcraft.
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Affiliation(s)
- Susanne Spittel
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Neurology, Berlin, Germany
- Universität Bremen, Department of Health Care Research, Institute for Public Health and Nursing Research, Bremen, Germany
| | - Elke Kraus
- Alice-Salomon University of Applied Sciences, Berlin, Germany
| | - André Maier
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Neurology, Berlin, Germany
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21
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McLoughlin A, Bennett K, Cahir C. Developing a model of the determinants of medication nonadherence in older community-dwelling patients. Ann Behav Med 2020; 53:942-954. [PMID: 30870558 DOI: 10.1093/abm/kaz004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Medication nonadherence is associated with adverse health outcomes in older populations. The aim of this study was to develop a model that describes the relationship between the determinants of nonadherence, per the World Health Organization (WHO) model of nonadherence and the necessity-concerns framework (NCF) and nonadherence in a cohort of older community-dwelling patients. A retrospective cohort study of 855 community-dwelling patients aged ≥70 years from 15 practices. Medication nonadherence was assessed by (i) medication possession ratio (MPR < 80%) and (ii) the median MPR across all drugs dispensed. Patient questionnaires, interviews, and medical records measured the determinants of nonadherence per the WHO and NCF frameworks. Confirmatory factor analysis (CFA) was undertaken to generate the model of best fit. Two structural equation models (SEM) were developed to evaluate the relationship between the WHO factors, the NCF, and nonadherence (Model 1: MPR < 80%, Model 2: median MPR). The CFA produced a reasonable fit (χ2(113) = 203, p < .001; root mean square error of approximation = 0.03; comparative fit index = 0.98, and weighted root mean square residual = 0.97) and adequate internal consistency (r = .26-.40). SEM analysis (Model 1) showed a significant direct relationship between patient-related (β = 0.45, p < .01), socioeconomic (β = 0.20, p < .01), and therapy-related factors (β = -0.27, p < .01) and nonadherence (MPR < 80%). Similar results were found for Model 2 (median MPR). There was a significant direct relationship between medication concerns (β = -0.13, p < .01) and nonadherence. Therapy-related (β = -0.04, p < .05) and patient-related factors (β = -0.06, p < .05) also had a significant mediating effect on nonadherence through medication concerns. Health care professionals need to address medication concerns and management of adverse effects in older populations to improve adherence and clinical outcomes.
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Affiliation(s)
- Affraic McLoughlin
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Kathleen Bennett
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Caitriona Cahir
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin 2, Ireland
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Johnston K, Preston R, Strivens E, Qaloewai S, Larkins S. Understandings of dementia in low and middle income countries and amongst indigenous peoples: a systematic review and qualitative meta-synthesis. Aging Ment Health 2020; 24:1183-1195. [PMID: 31074290 DOI: 10.1080/13607863.2019.1606891] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives: Dementia is a growing health priority, particularly in less resourced countries and amongst indigenous populations. Understanding cultural meanings ascribed to dementia is an important aspect of policy development and the provision of culturally congruent care and support for people with dementia, their families and the caring professions. This review investigates conceptualizations of dementia amongst indigenous peoples and populations living in low and middle income countries (LMIC), who experience limited diagnosis and formal care for dementia, and how these shape responses to dementia.Methods: A systematic search was conducted for qualitative studies, reported in English, that investigated the perceptions, attitudes or understandings of dementia in LMIC and amongst indigenous populations. A qualitative analysis and meta-synthesis was carried out.Findings: Nineteen articles were included in the review following quality assessment. Dementia was rarely conceptualized as a defined, pathological condition characterized by progressive cognitive decline. Rather, notions of dementia existed within conceptualizations of aging, mental illness, traditional cultural beliefs and the trauma of colonization. Responses to dementia were influenced and perpetuated by community and health providers, and cultural norms for caregiving.Conclusions: There is a need to understand conceptualizations of dementia from the perspective of all stakeholders within a setting, and the dynamic responses that exist between key stakeholders. Community knowledge systems could facilitate understanding about appropriate and acceptable health and community care responses to dementia, and approaches to stigma reduction. Inclusive discussions about dementia are essential if awareness campaigns are to improve the wellbeing of people with dementia and caregivers.
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Affiliation(s)
- Karen Johnston
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.,Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, Townsville, Queensland, Australia
| | - Robyn Preston
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.,Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, Townsville, Queensland, Australia
| | - Edward Strivens
- Sub-acute and Rehabilitation Services, Cairns and Hinterland Hospital Health Service, Cairns, Queensland, Australia
| | - Sefanaia Qaloewai
- College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji
| | - Sarah Larkins
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.,Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, Townsville, Queensland, Australia
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Kakongi N, Rukundo GZ, Gelaye B, Wakida EK, Obua C, Okello ES. Exploring pathways to Hospital Care for Patients with Alzheimer's disease and related dementias in rural South Western Uganda. BMC Health Serv Res 2020; 20:498. [PMID: 32493309 PMCID: PMC7268702 DOI: 10.1186/s12913-020-05365-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 05/25/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND In order to analyze use of health services and identify sources of delays in accessing the right care for patients with Alzheimer's disease and related dementias (AD/ADRD), understanding of care seeking pathways is needed. The objectives of this study were: (i) to explore pathways to hospital care for patients with AD/ADRD and (ii) to describe challenges experienced by the patients and their families while seeking health care. METHODS Using purposive sampling, 30-in-depth, semi-structured interviews were conducted among caregivers of older adults diagnosed with dementia from rural Southwestern, Uganda. Data was analyzed using ATLAS. Ti software. RESULTS There was variability in pathways to care from individual to individual. There was one broader theme captured: points of care choice with four broader categories: hospitals, clinics, places of religious worship and traditional healers' shrines, each with its facilitating factors, outcomes and challenges encountered. Most of the respondents reported use of hospitals at first and second visit to the health care point but places of religious worship became more common from third to sixth health care encounter. Major improvements (58.1%) were observed on hospital use but little or no help with prayers, clinics and traditional healers. The challenges experienced with formal points of care focused on lack and cost of prescribed drugs, weakening effect of the drugs, lack of skills to manage the condition, and lack of improvement in quality of life. These challenges together with knowledge gap about the disease and belief in spiritual healing facilitated the shift from formal to informal health care pathways, more particularly the places of religious worship. CONCLUSIONS Our study findings indicate that caregivers/families of patients with dementia went to different places both formal and informal care settings while seeking health care. However, hospital point of care was more frequent at initial health care visits while places of worship took the lead at subsequent visits. Although no specific pathway reported, most of them begin with hospital (formal) and end with non-formal. We recommend that health systems carry out public awareness on dementia.
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Affiliation(s)
- Nathan Kakongi
- Department of Biochemistry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Godfrey Zari Rukundo
- Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Bizu Gelaye
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA USA
- The Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA USA
| | - Edith K. Wakida
- Office of Research Administration, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Celestino Obua
- Department of Pharmacology and Therapeutics and Vice Chancellor, Mbarara University of Science and Technology, Mbarara, Uganda
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Owokuhaisa J, Rukundo GZ, Wakida E, Obua C, Buss SS. Community perceptions about dementia in southwestern Uganda. BMC Geriatr 2020; 20:135. [PMID: 32293301 PMCID: PMC7158106 DOI: 10.1186/s12877-020-01543-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 03/31/2020] [Indexed: 11/24/2022] Open
Abstract
Background With the increasing number of people surviving into older age in Africa, dementia is becoming a public health concern. Understanding the social dynamics of dementia in resource-limited settings is critical for developing effective interventions. We explored community perceptions about people with dementia in southwestern Uganda. Methods Fifty-nine individuals (aged 19–85 years, 56% female) participated in seven focus group discussions. In addition, 22 individual in-depth interviews were conducted among individuals (aged 22–84 years, 36% female). Both interviews and focus group discussions were audio recorded, transcribed verbatim, and evaluated using a quantitative content analysis approach. Results Five themes were generated during content analysis: i) Labeling of the illness, ii) Presentation of the person with dementia, iii) Causation, iv) Impact of the disease on people with dementia and their caregivers and v) Views on how to address unmet needs in dementia care. Dementia was commonly referred to as “okuhuga”or “okwebwayebwa” (also, oruhuzyo/ empugye / akahuriko) which translates as “mental disorientation”. The participants reported that most people with dementia presented with forgetfulness, defecating and urinating on themselves, wandering away from home, going out naked, and picking up garbage. Some participants perceived memory problems as a normal part of the aging process, while others attributed the cause of dementia to syphilis, cancer, allergy, old age, satanic powers, witchcraft, poor nutrition, or life stress. Participants reported multiple sources of stress for caregivers of people with dementia, including financial, social, and emotional burdens. Finally, participants suggested that community and governmental organizations should be involved in meeting the needs of people with dementia and their caregivers. Conclusions Community members in southwestern Uganda largely identified dementia as a problem that comes with older age, and can identify key features of dementia presentation. Participants identified significant stressors affecting people with dementia and their caregivers, and reported that families and caregivers would benefit from education on the management of symptoms of dementia, and assistance in overcoming associated financial, social, and emotional burdens related to caretaking.
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Affiliation(s)
- Judith Owokuhaisa
- Department of Internal Medicine, Faculty of Medicine, Mbarara University of Science and Technology, P. O. Box 1410, Mbarara, Uganda.
| | - Godfrey Zari Rukundo
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Edith Wakida
- Office of Research Administration, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Celestino Obua
- Department of Pharmacology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Stephanie S Buss
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Caregiving burden and mental health problems among family caregivers of people with dementia in rural Uganda. Glob Ment Health (Camb) 2020; 7:e13. [PMID: 32742671 PMCID: PMC7379317 DOI: 10.1017/gmh.2020.7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 04/07/2020] [Accepted: 04/26/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Alzheimer's disease and related dementias are associated with increasing health burden in low- and middle-income countries. Less well-recognized is the potential health burden experienced by other affected individuals, such as family caregivers. In this study, we sought to profile the burden of care and its association with symptoms of depression and anxiety among informal caregivers of people living with dementia in rural southwestern Uganda. METHOD We conducted a cross-sectional study of 232 family caregivers of people with dementia. The key measured variables of interest were caregiving burden (Zarit Burden Index) and symptoms of depression and anxiety (Depression Anxiety Stress Scales). We fitted multivariable regression models specifying depression and anxiety symptoms as the primary outcomes of interest and caregiving burden as the primary explanatory variable of interest. RESULTS Family caregivers of people with dementia experience significant caregiving burden, with each item on the Zarit Burden Index endorsed by more than 70% of study participants. Nearly half [108 (47%)] of caregivers had Zarit Burden Interview scores >60, suggestive of severe caregiving burden. In multivariable regression models, we estimated a statistically significant positive association between caregiving burden and symptoms of both depression [b = 0.42; 95% confidence interval (CI) 0.34-0.49] and anxiety (b = 0.37; 95% CI 0.30-0.45). CONCLUSION Family caregivers of people with dementia in rural Uganda experience a high caregiving burden, which is associated with symptoms of depression and anxiety. Interventions aimed at reducing caregiving burden may have important collateral mental health benefits.
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Spittel S, Maier A, Kraus E. Awareness challenges of mental health disorder and dementia facing stigmatisation and discrimination: a systematic literature review from Sub-Sahara Africa. J Glob Health 2019; 9:020419. [PMID: 31656607 PMCID: PMC6790232 DOI: 10.7189/jogh.09.020419] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background Mental health disorders (MHD) are leading causes of disabilities. Awareness of MHD in Sub-Saharan Africa (SSA) is crucial to both health care professionals and general community if those affected by MHD are to be allowed to live in dignity and be socially included, rather than being treated as outcasts or witches, as is presently the case. Therefore, this review aims to map and summarise the extent to which awareness of MHD and dementia in SSA challenges stigmatisation issues. Methods A systematic review was conducted using electronic databases (PubMed, CINAHL, PsycINFO). A content analysis of selected studies was performed. Findings on awareness challenges and stigmatisation were identified and categorised. Results A total of 230 publications were screened, 25 were selected for this review. The results demonstrate strong supernatural beliefs influencing peoples’ perceptions of diseases. These perceptions promote stigmatising attitudes towards people with MHD and dementia. The education level correlated with stigmatising attitudes, whereby higher educated people were less likely to distance themselves socially from people with MHD and from people living with dementia (PwD). Astonishingly, even people educated in health issues (eg, nurses, medical practitioners) tended to have strong beliefs in supernatural causations of diseases, like witchcraft, and hold negative attitudes towards MHD and PwD. Conclusions This review provides some evidence on the influence of traditional beliefs on MHDs in SSA. Those beliefs are powerful and exist in all segments in SSA-communities, promoting superstitious perceptions on diseases and stigmatisation. Awareness and education campaigns on MHD are absolutely mandatory to reduce stigmatisation.
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Affiliation(s)
- Susanne Spittel
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Neurology, Berlin, Germany.,University of Bremen, Health Science Bremen - Institute for Public Health and Nursing Research (IPP), Bremen, Germany
| | - André Maier
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Neurology, Berlin, Germany
| | - Elke Kraus
- Alice Salomon University of Applied Sciences Berlin, Berlin, Germany
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Bjørkløf GH, Helvik AS, Ibsen TL, Telenius EW, Grov EK, Eriksen S. Balancing the struggle to live with dementia: a systematic meta-synthesis of coping. BMC Geriatr 2019; 19:295. [PMID: 31666020 PMCID: PMC6822397 DOI: 10.1186/s12877-019-1306-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 10/07/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND People with dementia describe experiences of loss that threaten their autonomy and ability to contribute to society. They often have difficulties with orientation, loss of roll function, and fear about the future, and need help from others. An increasing body of literature also focuses on how people with dementia search for meaning and maintaining of quality to life, and how they find strategies to live with dementia. A review of the scientific literature on coping and dementia is warranted and can help to advice and inform healthcare personnel and decision makers on how they can support and plan for appropriate healthcare services for people with dementia. The aim of this systematic meta-synthesis was therefore to interpret and synthesize knowledge regarding people with dementia's experience of coping. METHODS We conducted a systematic, computerised search of Medline, Embase, Cinahl Complete, PsycINFO and Age Line combining MeSH terms and text words for different types of dementia with different descriptions of experience. Studies comprised 1) a sample of people with dementia, 2) a qualitative interview as a research method and 3) a description of experiences of coping were included. The search resulted in 7129 articles, of which 163 were read in full text, 80 were excluded due to the exclusion criteria or low quality according. The analysis was conducted in line with qualitative content analyses. RESULTS This interpretative qualitative meta-synthesis included 74 articles of good quality encompassing interviews with 955 persons with dementia. The material revealed two main resources of coping: (1) Humour and (2) Practical and emotional support, and four overall strategies in which people with dementia cope with the challenges they experience: (1) Keep going and holding on to life as usual; (2) Adapting and adjusting to the demands from the situation; (3) Accepting the situation; and (4) Avoiding the situation A comprehensive understanding of the categories led to the latent theme: Balancing the struggle of living with dementia. CONCLUSION This meta-synthesis indicates that people with dementia cope in different ways and using several parallel strategies. This insight is essential in dementia care to facilitate a supportive environment.
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Affiliation(s)
- Guro Hanevold Bjørkløf
- Norwegian National Advisory Unit on Ageing and Health (Ageing and Health), Postbox 2136, N-3103 Tønsberg, Norway
| | - Anne-Sofie Helvik
- Norwegian National Advisory Unit on Ageing and Health (Ageing and Health), Postbox 2136, N-3103 Tønsberg, Norway
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
| | - Tanja Louise Ibsen
- Norwegian National Advisory Unit on Ageing and Health (Ageing and Health), Postbox 2136, N-3103 Tønsberg, Norway
| | - Elisabeth Wiken Telenius
- Norwegian National Advisory Unit on Ageing and Health (Ageing and Health), Postbox 2136, N-3103 Tønsberg, Norway
| | - Ellen Karine Grov
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Siren Eriksen
- Norwegian National Advisory Unit on Ageing and Health (Ageing and Health), Postbox 2136, N-3103 Tønsberg, Norway
- VID Spesialized University, Faculty of Health Studies, Oslo, Norway
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Braun A, Trivedi DP, Dickinson A, Hamilton L, Goodman C, Gage H, Ashaye K, Iliffe S, Manthorpe J. Managing behavioural and psychological symptoms in community dwelling older people with dementia: 2. A systematic review of qualitative studies. DEMENTIA 2019; 18:2950-2970. [PMID: 29557193 DOI: 10.1177/1471301218762856] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
Background People living with dementia often develop distressing behavioural and psychological symptoms (BPSD) that can affect their quality of life and the capacity of family carers and staff providing support at home. This systematic review of qualitative studies considers the views and experiences of people living with dementia and care providers about these symptoms and what helps to reduce their impact. Methods The two-stage review involved (a) An initial mapping of the literature to understand the range of BPSD, and how it is operationalised by different groups, to develop a search strategy; (b) A search of electronic databases from January 2000 to March 2015, updated in October 2016. Included studies focused on people living in their own homes. Data extraction and thematic analysis were structured to provide a narrative synthesis of the evidence. Results We retrieved 17, 871 records and included relevant qualitative papers (n = 58) targeting community-dwelling people with dementia and family carers around the management of BPSD. Five key themes were identified: (1) Helpful interventions/support for BPSD management, (2) Barriers to support services for BPSD management, (3) Challenges around recognition/diagnosis of BPSD, (4) Difficulties in responding to aggression and other BPSD, and (5) Impact of BPSD on family carers and people living with dementia. Conclusions Family carers sometimes feel that their experiences of BPSD may not be evident to professionals until a crisis point is reached. Some helpful services exist but access to support, lack of knowledge and skills, and limited information are consistently identified as barriers to their uptake. The lack of common terminology to identify and monitor the range of BPSD that people with dementia living at home may experience means that closer attention should be paid to family carer accounts. Future research should include qualitative studies to evaluate the relevance of interventions.
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Affiliation(s)
| | | | | | | | - Claire Goodman
- Centre for Research in Primary and Community Care, University of Hertfordshire, UK
| | | | - Kunle Ashaye
- Mental Health Unit, Hertfordshire Partnership University NHS Foundation Trust, UK
| | - Steve Iliffe
- Department of Primary Care and Population Health, University College London, UK
| | - Jill Manthorpe
- Social Care Workforce Research Unit, King's College London, UK
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Brooke J, Ojo O. Contemporary views on dementia as witchcraft in sub‐Saharan Africa: A systematic literature review. J Clin Nurs 2019; 29:20-30. [DOI: 10.1111/jocn.15066] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 08/12/2019] [Accepted: 08/24/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Joanne Brooke
- Faculty of Health, Education and Life Sciences Birmingham City University Birmingham UK
| | - Omorogieva Ojo
- Faculty of Education and Health University of Greenwich London UK
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Agyeman N, Guerchet M, Nyame S, Tawiah C, Owusu-Agyei S, Prince MJ, Mayston R. "When someone becomes old then every part of the body too becomes old": Experiences of living with dementia in Kintampo, rural Ghana. Transcult Psychiatry 2019; 56:895-917. [PMID: 31046632 DOI: 10.1177/1363461519847054] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Studies have suggested that in African countries, symptoms of cognitive decline are commonly seen as part of "normal ageing" or attributed to supernatural causes. The impact of folk beliefs about causality upon help-seeking is unclear. Likewise, there is a lack of evidence relating to how families cope with living with an older resident with dementia. Our study's aim was to explore the sociocultural beliefs, understandings, perceptions and behaviours relating to living with dementia in Kintampo, Ghana. We conducted in-depth interviews with a total of 28 people, using a series of case studies among 10 older people living with dementia and their families. Results revealed that symptoms of cognitive impairment were generally linked to inexorable bodily decline understood to be characteristic of "normal" ageing. Stigma was therefore perceived to be non-existent. Whilst managing the costs of care was often a challenge, care-giving was largely accepted as a filial duty, commonly shared among female residents of large compound households. Families experimented with biomedical and traditional medicine for chronic conditions they perceived to be treatable. Our findings suggest that whilst families offer a holistic approach to the needs of older people living with chronic conditions including dementia, health and social policies offer inadequate scaffolding to support this work. In the future, it will be important to develop policy frameworks that acknowledge the continued social and economic potential of older people and strengthen the existing approach of families, optimising the management of non-communicable diseases within primary care.
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Affiliation(s)
| | | | - Solomon Nyame
- Kintampo Health Research Centre, Ghana Health Service
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Attitudes, knowledge and beliefs about dementia: focus group discussions with Pakistani adults in Karachi and Lahore. AGEING & SOCIETY 2019. [DOI: 10.1017/s0144686x19000862] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractPakistan is a lower middle-income country, which to date has had very little research and policy making to address the challenge of dementia. This study aims to explore the perceptions of dementia in a group of Pakistani adults. A series of focus group discussions were completed during 2017 with men and women in two metropolitan centres in Pakistan (Lahore and Karachi) (N = 40). Two vignettes, depicting someone with mild dementia and someone with severe dementia, were used to facilitate discussions. An induction-led thematic analysis was completed. Five themes were identified, reflecting (a) dementia awareness, (b) responsibility, (c) barriers to health care, (d) identified support needs, and (e) religion. Most participants had little awareness and knowledge about dementia, commonly understood to be a disease of forgetting or just normal ageing. Thus, there is an urgent need of a nation-wide campaign to raise dementia awareness in Pakistan, though this needs to be accompanied by improved, accessible health and social care services.
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Abstract
Background An ageing global population will bring a significant increase in the prevalence of dementia, with the need for a collaborative international effort to combat this public health challenge being increasingly recognised. To be successful, this cooperation must be sensitive to the different cultural environments in which dementia is positioned, which shape the variety of clinical, political and social approaches to the condition worldwide. The aim of this project is to examine the social representations of dementia among people from three countries with different health care systems. More specifically, to investigate the internal structure of the social representations of dementia within the framework of the structural approach among British, American and Chinese lay-people. Methods A sample of 194 participants completed a free association task and a justification task in response to the stimulus word ‘dementia’. The data was subsequently analysed within the framework of the structural approach to social representations, using prototypical analysis. Results The American group’s unique elements were nearly exclusively concerned with physical and cognitive decline, and elements referring to care were focused on external support, namely nursing homes. In the Chinese group, there were several elements referring to behaviour, but a much greater emphasis on cognition than predicted by the literature. Elements concerning care were, as expected, focused on the family. In the British group, there was also a cognitive focus, but this was accompanied by elements which portrayed the experience of the condition from the perspective of those affected, and a reference to relative well-being in the context of care. Conclusions Social representation theory proved to be a viable method in gathering data on cross-cultural differences in how dementia is understood and approached. The current study demonstrated how the conceptualisation of the condition’s relationship with the cognitive, behavioural and affective dimensions might have an impact on the structure and form of care for those living with dementia in each culture.
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Affiliation(s)
- Clara Calia
- Department of Clinical Psychology, School of Health in Social Science, Medical School, The University of Edinburgh, UK
| | - Harry Johnson
- Department of Clinical Psychology, School of Health in Social Science, Medical School, The University of Edinburgh, UK
| | - Mioara Cristea
- Department of Psychology, School of Social Sciences, Heriot Watt University, Edinburgh, UK
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Kehoua G, Dubreuil CM, Ndamba-Bandzouzi B, Guerchet M, Mbelesso P, Dartigues JF, Preux PM. People with Dementia in Sub-Saharan Africa: From Support to Abuse by Caregivers: Results of EPIDEMCA-FU Program in Congo. Dement Geriatr Cogn Dis Extra 2019; 9:163-175. [PMID: 31097954 PMCID: PMC6489057 DOI: 10.1159/000489846] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 05/04/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND/AIMS Dementia is an emerging public health problem in sub-Saharan Africa (SSA). In SSA, the stigma suffered by people with dementia (PWD) can be strongly linked to pejorative social representations, interfering in social relationships with informal caregivers. The objective of the study was to analyze the consequences of social representations of PWD in social interactions with informal caregivers. METHODS A qualitative study was conducted in Republic of Congo among 93 interviewees. Nondirectional interviews were conducted in local languages and complemented by participating observations. The collected data were transcribed literally, synthesized, and then coded to allow extraction and organization of text segments. RESULTS Informal caregivers, daughters-in-laws, were considered as abusers and granddaughters as benevolent. The leaders of syncretic churches and traditional healers were the first therapeutic itineraries of PWD, due to pejorative social representations of disease. Of these, some PWD have appeared at front of a customary jurisdiction for accusations of witchcraft. Dementia, perceived as a mysterious disease by informal caregivers, wasn't medicalized by leaders of syncretic churches, traditional healers, nurses, or general practitioners. Conclusion: Stigma, generated by social representations, can change the patient's behavior and the one of informal caregivers, leading to time delay in the search for appropriate help.
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Affiliation(s)
- Gilles Kehoua
- INSERM, U1094, Tropical Neuroepidemiology, Limoges, France
- Université Limoges, UMR-S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, Limoges, France
| | - Catherine-Marie Dubreuil
- INSERM, U1094, Tropical Neuroepidemiology, Limoges, France
- Université Limoges, UMR-S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, Limoges, France
| | - Bébène Ndamba-Bandzouzi
- INSERM, U1094, Tropical Neuroepidemiology, Limoges, France
- Université Limoges, UMR-S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, Limoges, France
- Department of Neurology, University Hospital of Brazzaville, Brazzaville, Congo
| | - Maëlenn Guerchet
- INSERM, U1094, Tropical Neuroepidemiology, Limoges, France
- Université Limoges, UMR-S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, Limoges, France
- King's College London, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neurosciences, Health Services and Population Research Department, London, United Kingdom
| | - Pascal Mbelesso
- INSERM, U1094, Tropical Neuroepidemiology, Limoges, France
- Université Limoges, UMR-S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, Limoges, France
- Department of Neurology, Hôpital de l'Amitié de Bangui, Bangui, Central African Republic
| | | | - Pierre-Marie Preux
- INSERM, U1094, Tropical Neuroepidemiology, Limoges, France
- Université Limoges, UMR-S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, Limoges, France
- University Hospital, CEBIMER, Limoges, France
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Stone L, Heward J, Paddick SM, Dotchin CL, Walker RW, Collingwood C, Thornton J, Yarwood V, McCartney J, Irwin C, Mkenda S, Kissima J, Swai B, Gray WK. Screening for Instrumental Activities of Daily Living in Sub-Saharan Africa: A Balance Between Task Shifting, Simplicity, Brevity, and Training. J Geriatr Psychiatry Neurol 2018; 31:248-255. [PMID: 30049234 DOI: 10.1177/0891988718790400] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Task shifting has been suggested as one way to help manage the increasing burden of dementia in sub-Saharan Africa (SSA). However, brief, easy-to-use and valid screening tools are needed to support this approach. Our team has developed an 11-item questionnaire to assess instrumental activities of daily living (IADLs) in SSA, the Identification and Intervention for Dementia in Elderly Africans (IDEA)-IADL questionnaire. We aimed to externally validate the questionnaire and develop a shorter, more efficient version. METHODS A community-based sample of 329 older adults in 4 rural villages was screened for dementia using the validated IDEA cognitive screen and the 11-item IDEA-IADL questionnaire. A stratified sample was assessed for Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) dementia by a United Kingdom-based doctor, who was blinded to the results of screening. Area under the receiver operating characteristic (AUROC) curve analysis was used to assess validity, and factor analysis and regression modeling were used to develop a shorter version of the questionnaire. RESULTS A 3-item IDEA-IADL questionnaire was developed and externally validated in the study sample. The questionnaire was deemed to be valid and enhanced screening performance in 2 villages (AUROC: 0.857 and 0.895) but detracted from the accuracy of the IDEA cognitive screen in the other 2 villages (AUROC: 0.591 and 0.639). These differences appeared to be due to differences in interpretation of responses to questions by the assessors. CONCLUSIONS A brief IDEA-IADLs scale was developed and worked well in some villages. However, our study highlights a training need if brief screening tools to assess IADLs are to be effectively used by nonspecialists in low-resource settings.
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Affiliation(s)
- Lydia Stone
- 1 The Medical School, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Jessica Heward
- 1 The Medical School, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Stella-Maria Paddick
- 2 Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom.,3 Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Catherine L Dotchin
- 2 Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom.,4 Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Richard W Walker
- 2 Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom.,4 Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Cecilia Collingwood
- 1 The Medical School, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Jessica Thornton
- 2 Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom
| | - Vanessa Yarwood
- 2 Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom
| | - Judith McCartney
- 2 Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom
| | - Charlotte Irwin
- 2 Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom
| | - Sarah Mkenda
- 5 Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - John Kissima
- 6 Hai District Medical Centre, Boman'gombe, Kilimanjaro Region, Tanzania
| | - Bernadette Swai
- 6 Hai District Medical Centre, Boman'gombe, Kilimanjaro Region, Tanzania
| | - William K Gray
- 2 Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom
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Førsund LH, Grov EK, Helvik AS, Juvet LK, Skovdahl K, Eriksen S. The experience of lived space in persons with dementia: a systematic meta-synthesis. BMC Geriatr 2018; 18:33. [PMID: 29390970 PMCID: PMC5795848 DOI: 10.1186/s12877-018-0728-0] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 01/23/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Identifying how persons with dementia experience lived space is important for enabling supportive living environments and creating communities that compensate for the fading capabilities of these persons. Several single studies have explored this topic; however, few studies have attempted to explicitly review and synthesize this research literature. The aim of this systematic meta-synthesis was therefore to interpret and synthesize knowledge regarding persons with dementia's experience of space. METHODS A systematic, computerized search of AgeLine, CINAHL Complete, Embase, Medline and PsycINFO was conducted using a search strategy that combined MeSH terms and text words for different types of dementia with different descriptions of experience. Studies with 1) a sample of persons with dementia, 2) qualitative interviews as a research method and 3) a description of experiences of lived space were included. The search resulted in 1386 articles, of which 136 were identified as eligible and were read and assessed using the CASP criteria. The analysis was inspired by qualitative content analyses. RESULTS This interpretative qualitative meta-synthesis included 45 articles encompassing interviews with 672 persons with dementia. The analysis showed that living in one's own home and living in long-term care established different settings and posed diverse challenges for the experience of lived space in persons with dementia. The material revealed four main categories that described the experience of lived space: (1) belonging; (2) meaningfulness; (3) safety and security; and (4) autonomy. It showed how persons with dementia experienced a reduction in their lived space due to the progression of dementia. A comprehensive understanding of the categories led to the latent theme: "Living with dementia is like living in a space where the walls keep closing in". CONCLUSION This meta-synthesis reveals a process whereby lived space gradually becomes smaller for persons with dementia. This underscores the importance of being aware of the experiences of persons with dementia and the spatial dimensions of their life-world. To sustain person-centred care and support the preservation of continuity and identity, one must acknowledge not only the physical and social environment but also space as an existential experience for persons with dementia.
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Affiliation(s)
- Linn Hege Førsund
- Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University College of Southeast Norway, Postbox 7053, N- 3007 Drammen, Norway
| | - Ellen Karine Grov
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Anne-Sofie Helvik
- Norwegian National Advisory Unit on Ageing and Health, Tønsberg, Norway
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lene Kristine Juvet
- Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University College of Southeast Norway, Postbox 7053, N- 3007 Drammen, Norway
- The National Institute of Public Health, Oslo, Norway
| | - Kirsti Skovdahl
- Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University College of Southeast Norway, Postbox 7053, N- 3007 Drammen, Norway
| | - Siren Eriksen
- Norwegian National Advisory Unit on Ageing and Health, Tønsberg, Norway
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Eriksen S, Helvik AS, Juvet LK, Skovdahl K, Førsund LH, Grov EK. The Experience of Relations in Persons with Dementia: A Systematic Meta-Synthesis. Dement Geriatr Cogn Disord 2018; 42:342-368. [PMID: 27866199 DOI: 10.1159/000452404] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/10/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Dementia influences a person's experience of social relationships, as described in several studies. In this systematic meta-synthesis of qualitative studies, we aim to interpret and synthesize the experiences of persons with dementias and their relations with others. SUMMARY Living with dementia changes life, leading to new social roles and different social statuses. Persons with dementia experience being disconnected and dependent on others, feeling like being a burden, and being a person who is treated in paternalistic ways. Family, friends and others with dementia might play significant roles in their ability to maintain a meaningful life. Key Messages: Three categories emerged from the data, change in life, change in relations, and maintenance of meaningful aspects in life; these categories are intertwined and essential in sustaining a lifeline for persons with dementia. The comprehensive meaning of the material is understood as the expression: Living a meaningful life in relational changes.
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Affiliation(s)
- Siren Eriksen
- Norwegian National Advisory Unit on Ageing and Health, Tønsberg, Norway
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Mkhonto F, Hanssen I. When people with dementia are perceived as witches. Consequences for patients and nurse education in South Africa. J Clin Nurs 2017; 27:e169-e176. [DOI: 10.1111/jocn.13909] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Flora Mkhonto
- Sefako Makgatha Health Service University; Pretoria South Africa
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38
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Mokaya J, Gray WK, Carr J. Beliefs, knowledge and attitudes towards Parkinson's disease among a Xhosa speaking black population in South Africa: A cross-sectional study. Parkinsonism Relat Disord 2017; 41:51-57. [DOI: 10.1016/j.parkreldis.2017.05.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 04/17/2017] [Accepted: 05/10/2017] [Indexed: 01/26/2023]
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Cognitive stimulation therapy as a sustainable intervention for dementia in sub-Saharan Africa: feasibility and clinical efficacy using a stepped-wedge design. Int Psychogeriatr 2017; 29:979-989. [PMID: 28222815 DOI: 10.1017/s1041610217000163] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Cognitive stimulation therapy (CST) is a psychosocial group-based intervention for dementia shown to improve cognition and quality of life with a similar efficacy to cholinesterase inhibitors. Since CST can be delivered by non-specialist healthcare workers, it has potential for use in low-resource environments, such as sub-Saharan Africa (SSA). We aimed to assess the feasibility and clinical effectiveness of CST in rural Tanzania using a stepped-wedge design. METHODS Participants and their carers were recruited through a community dementia screening program. Inclusion criteria were DSM-IV diagnosis of dementia of mild/moderate severity following detailed assessment. No participant had a previous diagnosis of dementia and none were taking a cholinesterase inhibitor. Primary outcomes related to the feasibility of conducting CST in this setting. Key clinical outcomes were changes in quality of life and cognition. The assessing team was blind to treatment group membership. RESULTS Thirty four participants with mild/moderate dementia were allocated to four CST groups. Attendance rates were high (85%) and we were able to complete all 14 sessions for each group within the seven week timeframe. Substantial improvements in cognition, anxiety, and behavioral symptoms were noted following CST, with smaller improvements in quality of life measures. The number needed to treat was two for a four-point cognitive (adapted Alzheimer's Disease Assessment Scale-Cognitive) improvement. CONCLUSIONS This intervention has the potential to be low-cost, sustainable, and adaptable to other settings across SSA, particularly if it can be delivered by non-specialist health workers.
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40
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Hindley G, Kissima J, L Oates L, Paddick SM, Kisoli A, Brandsma C, K Gray W, Walker RW, Mushi D, Dotchin CL. The role of traditional and faith healers in the treatment of dementia in Tanzania and the potential for collaboration with allopathic healthcare services. Age Ageing 2017; 46:130-137. [PMID: 28181644 DOI: 10.1093/ageing/afw167] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 07/06/2016] [Indexed: 12/13/2022] Open
Abstract
Background Low diagnostic rates are a barrier to improving care for the growing number of people with dementia in sub-Saharan Africa. Many people with dementia are thought to visit traditional healers (THs) and Christian faith healers (FHs) and these groups may have a role in identifying people with dementia. We aimed to explore the practice and attitudes of these healers regarding dementia in rural Tanzania and investigate attitudes of their patients and their patients’ carers. Methods This was a qualitative study conducted in Hai district, Tanzania. Semi-structured interviews were conducted with a convenience sample of THs and FHs and a purposive-stratified sample of people with dementia and their carers. Interview guides were devised which included case vignettes. Transcripts of interviews were subject to thematic analysis. Findings Eleven THs, 10 FHs, 18 people with dementia and 17 carers were recruited. Three themes emerged: (i) conceptualisation of dementia by healers as a normal part of the ageing process and no recognition of dementia as a specific condition; (ii) people with dementia and carer reasons for seeking help and experiences of treatment and the role of prayers, plants and witchcraft in diagnosis and treatment; (iii) willingness to collaborate with allopathic healthcare services. FHs and people with dementia expressed concerns about any collaboration with THs. Conclusions Although THs and FHs do not appear to view dementia as a specific disease, they may provide a means of identifying people with dementia in this setting.
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Affiliation(s)
- Guy Hindley
- The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - John Kissima
- Hai District Hospital, Boman'gombe, Kilimanjaro Region, United Republic of Tanzania
| | - Lloyd L Oates
- Research & Development, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Stella-Maria Paddick
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
- Department of Medicine, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Aloyce Kisoli
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro Region, United Republic of Tanzania
| | - Christine Brandsma
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro Region, United Republic of Tanzania
| | - William K Gray
- Research & Development, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Richard W Walker
- Department of Medicine, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Declare Mushi
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro Region, United Republic of Tanzania
| | - Catherine L Dotchin
- Department of Medicine, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
- Institute for Ageing, Newcastle University, Newcastle upon Tyne, UK
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Kehoua G, Dubreuil CM, Ndamba-Bandzouzi B, Guerchet M, Mbelesso P, Dartigues JF, Preux PM. From the social representation of the people with dementia by the family carers in Republic of Congo towards their conviction by a customary jurisdiction, preliminary report from the EPIDEMCA-FU study. Int J Geriatr Psychiatry 2016; 31:1254-1255. [PMID: 27018503 DOI: 10.1002/gps.4474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 02/18/2016] [Indexed: 11/07/2022]
Affiliation(s)
- G Kehoua
- INSERM, U1094, Tropical Neuroepidemiology, Limoges, France. .,University of Limoges, UMR-S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, Limoges, France.
| | - C M Dubreuil
- INSERM, U1094, Tropical Neuroepidemiology, Limoges, France.,University of Limoges, UMR-S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, Limoges, France
| | - B Ndamba-Bandzouzi
- INSERM, U1094, Tropical Neuroepidemiology, Limoges, France.,University of Limoges, UMR-S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, Limoges, France.,Department of Neurology, University Hospital of Brazzaville, Brazzaville, Republic of Congo
| | - M Guerchet
- INSERM, U1094, Tropical Neuroepidemiology, Limoges, France.,University of Limoges, UMR-S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, Limoges, France.,Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - P Mbelesso
- INSERM, U1094, Tropical Neuroepidemiology, Limoges, France.,University of Limoges, UMR-S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, Limoges, France.,Department of Neurology, Hôpital de l'Amitié de Bangui, Bangui, Central African Republic
| | - J F Dartigues
- INSERM U1219, University of Bordeaux, Bordeaux, France
| | - P M Preux
- INSERM, U1094, Tropical Neuroepidemiology, Limoges, France.,University of Limoges, UMR-S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, Limoges, France.,University Hospital, CEBIMER, Limoges, France
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Adebiyi AO, Fagbola MA, Olakehinde O, Ogunniyi A. Enacted and implied stigma for dementia in a community in south-west Nigeria. Psychogeriatrics 2016; 16:268-73. [PMID: 26551624 DOI: 10.1111/psyg.12156] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Revised: 07/30/2015] [Accepted: 08/12/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Dementia is a chronic progressive disease that mostly affects the elderly. There is often a stigma surrounding dementia patients because of poor awareness about the disease. In Nigeria, this stigma and related attitudes have not been fully explored. In this study, we assessed the attitude of people towards demented individuals in a transitional community in Nigeria. METHODS The study used a mixed methods approach. Focused group discussions exploring the concept of dementia were conducted among six community groups, and quantitative data was obtained from an interviewer-administered questionnaire. A total of 313 respondents were selected with a cluster sampling technique. RESULTS Only 212 respondents (67.7%) were aware of dementia. 'Memory loss disease', 'ageing disease', 'disease of insanity', 'brain disorder', 'disease of forgetfulness', and 'dull brain' are the common names used to describe dementia in the community. Enacted stigma was evident as 36% of respondents felt dementia was associated with shame and embarrassment in the community. Implied stigma was evident in another third that opined that demented individuals would prefer not to know or let others know that they have the disease. Also, 28% were of the opinion that people do not take those with dementia seriously. Of the 22 (10.4%) that reported having received structured information about dementia, 16 (72.7%) got the information from health facilities. Qualitative data revealed the presence of enacted stigma in the community as some referred to affected individuals by derogatory names such as 'madman'. Some statements from the focus group discussion participants also gave useful insights into the scorn with which demented individuals are sometimes treated. CONCLUSION The presence of enacted and implied stigma related to dementia within the community calls for concern. More research efforts are needed to unravel the burden of stigma within communities and best practice for stigma-reducing interventions.
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Affiliation(s)
- Akindele O Adebiyi
- Department of Preventive Medicine and Primary Care, University of Ibadan, Ibadan, Nigeria
| | - Motunrayo A Fagbola
- Department of Community Medicine, University College Hospital, Ibadan, Nigeria
| | - Olaide Olakehinde
- IDEA Project, Institute of Advanced Medical Research, University of Ibadan, Ibadan, Nigeria
| | - Adesola Ogunniyi
- Department of Internal Medicine, University of Ibadan, Ibadan, Nigeria
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Khanassov V, Vedel I. Family Physician-Case Manager Collaboration and Needs of Patients With Dementia and Their Caregivers: A Systematic Mixed Studies Review. Ann Fam Med 2016; 14:166-77. [PMID: 26951593 PMCID: PMC4781521 DOI: 10.1370/afm.1898] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Revised: 10/15/2015] [Accepted: 11/08/2015] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Dementia case management (CM) in primary care is a complex intervention aimed at identifying the various needs of patients with dementia and their caregivers, as well as the organization and coordination of care. A key element of CM is the collaboration of family physicians with case managers. We conducted a systematic mixed-studies review to identify the needs of the patient-caregiver dyad and the effects of CM. METHODS We searched MEDLINE, PsycINFO, and EMBASE up to October 2014, regardless of the study design. Our main outcomes were needs of patients and their caregivers and the effects of CM on these needs. We used narrative syntheses to develop a taxonomy of needs and to describe the effects of CM on those needs. We used meta-analysis to calculate the prevalence of needs and the standardized mean differences to evaluate the effects of CM on the needs identified. RESULTS Fifty-four studies were included. We identified needs of the patient-caregiver dyad and needs of the patient and caregiver individually. CM addressed the majority of the identified needs. Still, some very common needs (eg, early diagnosis) are overlooked while other needs (eg, education on the disease) are well addressed. Fully establishing the value of CM is difficult given the small number of studies of CM in primary care. CONCLUSIONS There is good evidence that case managers, in collaboration with family physicians, have a pivotal role in addressing the needs of the patient-caregiver dyad.
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Affiliation(s)
| | - Isabelle Vedel
- Department of Family Medicine, McGill University, Montreal, Canada
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44
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Paddick SM, Kisoli A, Longdon A, Dotchin C, Gray WK, Chaote P, Teodorczuk A, Walker R. The prevalence and burden of behavioural and psychological symptoms of dementia in rural Tanzania. Int J Geriatr Psychiatry 2015; 30:815-23. [PMID: 25351844 DOI: 10.1002/gps.4218] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 08/26/2014] [Accepted: 09/04/2014] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Behavioural and psychological symptoms (BPS) in dementia are common in high-income countries, but there are few data from sub-Saharan Africa. Our aim was to estimate the prevalence and pattern of BPS and associated caregiver distress in rural Tanzania. METHODS Prevalent cases of dementia (aged 70 and over) were identified during a community-based door-to-door study in six rural villages in Tanzania. Following cognitive screening, a stratified sample (over-sampled for people with dementia) of cases underwent a detailed clinical assessment including the brief 12 item neuropsychiatric inventory (NPI-Q), which assesses BPS and associated caregiver distress over the preceding 30 days. RESULTS Of 78 people with dementia, at least one current BPS was reported by 69 (88.4%), with 40 (51.3%) reporting 3 or more symptoms. In 172 people with no cognitive impairment, 110 (64.0%) reported at least one symptom and 48 (27.9%) reported 3 or more. In dementia cases, the most frequent symptoms reported were anxiety (47.4%), agitation/aggression (38.5%), night-time behavioural disturbance (34.6%), irritability (33.3%) and depression (33.3%). CONCLUSION The frequency of BPS in dementia in this rural Tanzanian population is high and comparable to that reported in prevalence studies from high income countries. Symptoms were also common, although to a lesser degree, amongst cognitively intact subjects. BPS are likely to have a significant impact on quality of life for elderly persons and their carers in low-income settings. Low-cost interventions, such as community-based therapy and education, are needed.
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Affiliation(s)
- S-M Paddick
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, Tyne and Wear, North Shields, UK.,Institute of Neuroscience, Newcastle University, Newcastle Upon Tyne, UK
| | - A Kisoli
- Hai District Hospital, Boma'ngombe, Tanzania
| | - A Longdon
- South Devon Healthcare Trust, Torquay, UK
| | - C Dotchin
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, Tyne and Wear, North Shields, UK.,Institute for Ageing, Newcastle University, Newcastle upon Tyne, UK
| | - W K Gray
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, Tyne and Wear, North Shields, UK
| | - P Chaote
- Hai District Hospital, Boma'ngombe, Tanzania
| | - A Teodorczuk
- Institute of Neuroscience, Newcastle University, Newcastle Upon Tyne, UK.,Northumberland, Tyne and Wear NHS Trust, Newcastle Upon Tyne, UK
| | - R Walker
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, Tyne and Wear, North Shields, UK.,Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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45
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Levels of functional disability in elderly people in Tanzania with dementia, stroke and Parkinson's disease. Acta Neuropsychiatr 2015; 27:206-12. [PMID: 25777617 DOI: 10.1017/neu.2015.9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Disability is associated with increasing age and poverty, yet there are few reliable data regarding disability amongst the elderly in low-income countries. The aim of this study was to compare disability levels for three of the most common neurological, non-communicable diseases: dementia, stroke and Parkinson's disease (PD). METHODS We performed a community-based study of people aged 70 years and over in 12 randomly selected villages in the rural Hai district of Tanzania. Participants underwent disability assessment using the Barthel Index, and clinical assessment for dementia, stroke and PD. RESULTS In a representative cohort of 2232 people aged 70 years and over, there were 54 cases of stroke, 12 cases of PD and estimated (by extrapolation from a sub-sample of 1198 people) to be 112 cases of dementia. People with stroke were the most disabled, with 62.9% having moderate or severe disability. Levels of moderate or severe disability were 41.2% in people with dementia and 50.0% in people with PD. However, the higher prevalence of dementia meant that, at a population level, it was associated with similar levels of disability as stroke, with 18.5% of 249 people identified as having moderate or severe disability having dementia, compared to 13.7% for stroke and 2.4% for PD. CONCLUSIONS Levels of disability from these conditions is high and is likely to increase with demographic ageing. Innovative, community-based strategies to reduce disability levels should be investigated.
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The association between disability and cognitive impairment in an elderly Tanzanian population. J Epidemiol Glob Health 2014; 5:57-64. [PMID: 25700924 PMCID: PMC7320352 DOI: 10.1016/j.jegh.2014.09.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 09/12/2014] [Accepted: 09/13/2014] [Indexed: 11/29/2022] Open
Abstract
Cognitive impairment is thought to be a major cause of disability worldwide, though data from sub-Saharan Africa (SSA) are sparse. This study aimed to investigate the association between cognitive impairment and disability in a cohort of community-dwelling older adults living in Tanzania. The study cohort of 296 people aged 70 years and over was recruited as part of a dementia prevalence study. Subjects were diagnosed as having dementia or mild cognitive impairment according to the DSM-IV criteria. Disability level was assessed according to the WHO Disability Assessment Schedule, version 2.0 (WHODAS). A higher WHODAS score indicates greater disability. The median WHODAS in the background population was 25.0; in those with dementia and in those with mild cognitive impairment, 72 of 78 (92.3%) and 41 of 46 (89.1%), respectively, had a WHODAS score above this level. The presence of dementia, mild cognitive impairment, hearing impairment, being unable to walk without an aid and not having attended school were independent predictors of having a WHODAS score above 25.0, though age and gender were not. In summary, cognitive impairment is a significant predictor of disability in elderly Tanzanians. Screening for early signs of cognitive decline would allow management strategies to be put in place that may reduce the associated disability burden.
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