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Backhouse T, Killett A, Bratches RWR, Mioshi E. Reducing refusals of care through improved personal care interactions between caregivers and people with dementia: protocol for a realist synthesis. BMJ Open 2024; 14:e088149. [PMID: 39209500 PMCID: PMC11367303 DOI: 10.1136/bmjopen-2024-088149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 08/02/2024] [Indexed: 09/04/2024] Open
Abstract
INTRODUCTION People with dementia develop progressive difficulties conducting basic activities of daily living, often requiring considerable assistance from caregivers. Many people with dementia, particularly in the advanced stages, can refuse assistance with care leading to difficult interactions. The ways in which refusals of care can be best reduced are unknown. Using a realist approach, this study aims to develop and refine evidence-based programme theories showing which mechanisms of interventions contribute to reducing refusals of care between caregivers and people with dementia, in which contexts, how and why. METHODS AND ANALYSIS The realist synthesis will be conducted in three iterative stages.Stage 1 will develop initial programme theories through secondary analysis of caregivers and persons with dementia interviews and observations, a preliminary exploratory literature review and team discussions. After initial programme theory development, the focus of the synthesis will be decided by the study team.Stage 2 will involve conducting focused, iterative and targeted literature searches to test and refine our initial programme theories considering the evidence for each setting: hospital, care home, home care and family. Data synthesis will use a realist lens to examine what works for whom in what circumstances and how, and organise related evidence to context-mechanism-outcome configurations whenever possible.Stage 3 will use stakeholder interviews to explore reactions to the programme theories and enhance validity after integration of these findings, recommendations and conclusions will be developed. ETHICS AND DISSEMINATION The NHS Social Care Research Ethics Committee has approved the interview stage of this study (REC reference: 24/IEC08/0007; IRAS project ID: 338274). Informed consent will be obtained from all interviewees prior to data collection. Findings will be disseminated via peer-reviewed publications, conference presentations and accessible information for key stakeholders. PROPSPERO REGISTRATION NUMBER CRD42024496072.
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Affiliation(s)
- Tamara Backhouse
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Anne Killett
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Reed WR Bratches
- School of Nursing - Nursing Acute, Chronic & Continuing Care, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Eneida Mioshi
- School of Health Sciences, University of East Anglia, Norwich, UK
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Yous ML, Coker E, Hunter PV, Fisher KA, Sue JL, Nicula M, Kazmie N, Orsini T, Sussman T, Thompson G, Kaasalainen S. Acceptability and preliminary effects of the volunteer-supported Meaningful Moments program to engage older adults with advanced dementia on a hospital-based specialized dementia care unit: a mixed methods study. BMC Geriatr 2024; 24:593. [PMID: 38992599 PMCID: PMC11238390 DOI: 10.1186/s12877-024-05194-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 07/02/2024] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND Namaste Care offers practical skills for healthcare providers, volunteers, and families to meaningfully engage individuals with dementia in activities (e.g., music, massage, reminiscing, socialization, aromatherapy, snacks). A hospital-based specialized dementia care unit for patients with mid- to late-stage dementia offered an adapted version of the Namaste Care program, which was called Meaningful Moments. The aim of this study was to assess the acceptability and preliminary effects of this novel approach using trained volunteers for older adults with mid- to late-stage dementia. METHODS A mixed methods multiphase design was used. Qualitative description was used to explore acceptability of the Meaningful Moments program delivered over 6 months through focus groups (e.g., charge nurses, therapeutic recreationists, nurses, social workers) and individual interviews with one volunteer and two family members. A prospective pre-post-test study design was used to evaluate the preliminary effects of the program for patients with dementia and family members. Outcomes included quality of life, neuropsychiatric symptoms, and pain for patients with dementia and family carer role stress and the quality of visits for families. Data were collected from June 2018 to April 2019. Descriptive analyses of participants' characteristics were expressed as a mean (standard deviation [SD]) for continuous variables and count (percent) for categorical variables. Focus group and individual interview data were analyzed using thematic analysis. The generalized estimating equations (GEE) method was used to assess change in the repeated measures outcome data. RESULTS A total of 15 patients received the Meaningful Moments interventions. Families, staff, and volunteers perceived that patients experienced benefits from Meaningful Moments. Staff, volunteers, and families felt fulfilled in their role of engaging patients in the Meaningful Moments program. Individualized activities provided by volunteers were perceived as necessary for the patient population. There were no statistically significant improvements in patient outcomes. There was a statistically significant decline in family carer role stress. CONCLUSIONS Using a one-on-one approach by volunteers, patients experienced perceived benefits such as improved mood and opportunities for social interactions. There is a need for tailored activities for older adults with advanced dementia through practical strategies that can offer benefit to patients.
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Affiliation(s)
- Marie-Lee Yous
- School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
| | - Esther Coker
- School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Paulette V Hunter
- Department of Psychology, St. Thomas More College, University of Saskatchewan, 1437 College Drive, Saskatoon, SK, S7N 0W6, Canada
| | - Kathryn A Fisher
- School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Joanna L Sue
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Maria Nicula
- Health Research Methodology, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Nadia Kazmie
- School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Theresa Orsini
- School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Tamara Sussman
- School of Social Work, McGill University, 3506 University St, Montreal, QC, H3A 2A7, Canada
| | - Genevieve Thompson
- College of Nursing, University of Manitoba, 89 Curry Place (Fort Garry Campus), Winnipeg, MB, R3T 2N2, Canada
| | - Sharon Kaasalainen
- School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
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Helbling M, Grandjean ML, Srinivasan M. Effects of multisensory environment/stimulation therapy on adults with cognitive impairment and/or special needs: A systematic review and meta-analysis. SPECIAL CARE IN DENTISTRY 2024; 44:381-420. [PMID: 37515496 DOI: 10.1111/scd.12906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 06/30/2023] [Accepted: 07/12/2023] [Indexed: 07/31/2023]
Abstract
AIM This review aimed to evaluate the effects of multisensory environments/stimulation (MSE/MSS) therapy, on the behavior and psychological symptoms in adults with cognitive impairment and/or special needs. METHODS Online database searches were performed to identify studies reporting on the effects of MSS/MSE therapy in adults (>18 years). Data were extracted for the following investigated outcomes including anxiety, depression, mood, behavioral attributes, biomedical parameters, cognition, motor skills, quality of life (QoL), pain, and end of life quality. Two reciprocally blinded investigators extracted the data. Inter-investigator reliability (𝝹) was calculated. A meta-analysis and a qualitative analysis were performed on the information extracted. RESULTS Thirty-six studies were included for data extraction and analysis. Meta-analysis of the included studies revealed a significant improvement with the MSE/MSS therapy, for agitation (p = .018), anxiety (p = .023), cognition (p < .001), and depression (p < .001). MSS/MSE therapy demonstrated a tendency for the improvement of the QoL in adults (p = .05). CONCLUSION MSE/MSS therapies are beneficial in cognitively impaired adults and improve their anxiety, depression, cognitive and other behavioral attributes such as agitative behaviors. Promoting these therapies in geriatric care may help to improve/reduce the challenging/care-resistant behaviors in adults and facilitate effective provision of the necessary care.
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Affiliation(s)
- Meret Helbling
- Clinic of General-, Special Care- and Geriatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Marie-Laure Grandjean
- Clinic of General-, Special Care- and Geriatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Murali Srinivasan
- Clinic of General-, Special Care- and Geriatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
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Haunch K, Downs M, Oyebode J. 'Making the most of time during personal care': nursing home staff experiences of meaningful engagement with residents with advanced dementia. Aging Ment Health 2023; 27:2346-2354. [PMID: 36786726 DOI: 10.1080/13607863.2023.2177254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 01/24/2023] [Indexed: 02/15/2023]
Abstract
OBJECTIVES Dementia progressively affects cognitive functioning, including the ability to communicate. Those who struggle to communicate are often considered unable to relate to other people. Frontline care workers are in a position to connect with residents. However, we know little about their perspectives. The aim of this study was to understand how and when nursing home staff meaningfully engaged with residents with advanced dementia. METHODS Semi-structured interviews, supplemented by informal conversations, were conducted with 21 staff from seven nursing homes. Inductive thematic analysis identified themes in the accounts. RESULTS Four themes related to how staff engaged with residents with advanced dementia (initiating meaningful engagement, recognising subtle reactions, practising caring behaviours, patience and perseverance). Two themes related to when meaningful engagement occurred (lacking time to connect, making the most of time during personal care). CONCLUSION A key barrier to implementing formal interventions to improve care is lack of staff time. Staff overcome this by using personal care time for meaningful engagement with residents. Their approach, developed through experience, is consonant with person-centred dementia care. Building on this, future research should use participatory approaches building on practice wisdom to further develop and evaluate meaningful engagement with residents with advanced dementia.
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Affiliation(s)
- Kirsty Haunch
- School of Healthcare, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Murna Downs
- Centre for Applied Dementia, University of Bradford, Bradford, UK
| | - Jan Oyebode
- Centre for Applied Dementia, University of Bradford, Bradford, UK
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Li DHY, Yous ML, Hunter PV, Coker E, Just D, Bello-Haas VD, McAiney C, Wickson-Griffiths A, Kaasalainen S. Supporting the "hallway residents": a qualitative descriptive study of staff perspectives on implementing the Namaste Care intervention in long-term care. BMC Geriatr 2023; 23:661. [PMID: 37845662 PMCID: PMC10580502 DOI: 10.1186/s12877-023-04360-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 09/27/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Long-term care (LTC) settings are becoming home to an increasing number of people living with advanced or late-stage dementia. Residents living with advanced dementia represent some of society's most vulnerable and socially excluded populations and are thus at an increased risk of social isolation. A multisensory intervention tailored to this population, Namaste Care, has been developed to improve quality of life for residents living with advanced dementia in LTC homes. To date, limited research has explored the perspectives of staff in implementing the Namaste Care program with an emphasis on social inclusion of residents in Canadian LTC homes. This study aimed to describe the perspectives of LTC staff on the implementation facilitators and barriers of Namaste Care as a program to support the social inclusion of residents living with advanced dementia. METHODS Using a qualitative descriptive design, semi-structured interviews (n = 12) and focus groups (n = 6) were conducted in two LTC homes in Southern Ontario, Canada, over a 6-month period. Convenience sampling was used to recruit LTC home staff from the two participating sites. Thematic analysis was used to analyze data. RESULTS LTC staff (n = 46) emphasized the program's ability to recognize the unique needs of residents with advanced dementia, and also stated its potential to facilitate meaningful connections between families and residents, as well as foster care partnerships between staff and families. Findings indicated staff also perceived numerous facilitators and barriers to Namaste Care. In particular, providing staff with dedicated time for Namaste Care and implementing volunteer and family participation in the program were seen as facilitators, whereas the initial perception of the need for extra staff to deliver Namaste Care and identifying times in the day where Namaste Care was feasible for residents, families, and staff, were seen as barriers. CONCLUSIONS LTC staff recognized the need for formalized programs like Namaste Care to address the biopsychosocial needs of residents with advanced dementia and offer positive care partnership opportunities between staff and family members. Although staffing constraints remain the largest barrier to effective implementation, staff valued the program and made suggestions to build LTC home capacity for Namaste Care.
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Affiliation(s)
- Donny H Y Li
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
- Michael G. DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
| | - Marie-Lee Yous
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Paulette V Hunter
- Department of Psychology, St. Thomas More College, University of Saskatchewan, Saskatoon, SK, Canada
| | - Esther Coker
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- St. Peter's Hospital, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Danielle Just
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Vanina Dal Bello-Haas
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Carrie McAiney
- School of Public Health Sciences, University of Waterloo and Schlegel-UW Research Institute for Aging, Waterloo, ON, Canada
| | | | - Sharon Kaasalainen
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
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Smaling HJA, Francke AL, Achterberg WP, Joling KJ, van der Steen JT. The Perceived Impact of the Namaste Care Family Program on Nursing Home Residents with Dementia, Staff, and Family Caregivers: A Qualitative Study. J Palliat Care 2023; 38:143-151. [PMID: 36200165 PMCID: PMC10026161 DOI: 10.1177/08258597221129739] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective(s): To examine the perspectives of staff, and family caregivers (i.e., family, friends, and volunteers) on the impact of the Namaste Care Family program on all involved. The Namaste Care Family program is a structured program for people with advanced dementia based on a palliative care approach in which family caregivers provide daily sessions together with staff with the aim to increase residents' quality of life. Methods: In this descriptive qualitative study, we interviewed 12 family caregivers, and 31 staff members from 10 nursing homes. Data was analyzed thematically. Results: A perceived impact of the program was identified for the residents, staff, and family caregivers. For residents, this included well-being, more engagement, enhanced interactions, changes in energy level, and weight gain. The impact on family caregivers included a more positive view of people with dementia, changes in family visits, mixed feelings during sessions, and mixed changes in relations with all involved. For staff, this included diverse work experiences, shift to more person-centered care (more time and attention for residents, and more awareness), and developing relationships with residents and colleagues. Conclusions: The Namaste Care Family program was valued for its observed benefits and shift towards a person-centered care culture.
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Affiliation(s)
- Hanneke J A Smaling
- Department of Public Health and Primary Care, 4501Leiden University Medical Center, Leiden, the Netherlands
- University Network for the Care sector Zuid-Holland, 4501Leiden University Medical Center, Leiden, the Netherlands
| | - Anneke L Francke
- Department of Public and Occupational Health, Amsterdam University Medical Centers, Location VU University Medical Center, Amsterdam, the Netherlands
- 8123Netherlands Institute for Health Services Research (NIVEL), Utrecht, the Netherlands
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, 4501Leiden University Medical Center, Leiden, the Netherlands
- University Network for the Care sector Zuid-Holland, 4501Leiden University Medical Center, Leiden, the Netherlands
| | - Karlijn J Joling
- Department of General Practice and Elderly Care Medicine, Amsterdam University Medical Centers, Location VU University Medical Center, Amsterdam, the Netherlands
| | - Jenny T van der Steen
- Department of Public Health and Primary Care, 4501Leiden University Medical Center, Leiden, the Netherlands
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
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Yous ML, Boamah SA, Hunter PV, Coker E, Hadjistavropoulos T, Sussman T, Kaasalainen S. Exploring the factors influencing meaningful engagement of persons living with advanced dementia through the Namaste Care Program: a qualitative descriptive study. Palliat Care Soc Pract 2023; 17:26323524231165319. [PMID: 37025503 PMCID: PMC10071147 DOI: 10.1177/26323524231165319] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 03/07/2023] [Indexed: 04/04/2023] Open
Abstract
Background: Meaningful engagement has been described as active participation based on a person’s interests, preferences, personhood, or perceived value. It has many benefits for persons living with dementia in long-term care (LTC) homes, including improvement in physical and cognitive function, and mental health. People with advanced dementia continue to need and benefit from inclusion and social contact in LTC, yet there is not a well-developed understanding of how to support this. A tailored intervention called Namaste Care has been shown to be an effective approach to meaningfully engage residents in LTC, decrease behavioral symptoms, and improve their comfort and quality of life. There is a need to consider how best to deliver this intervention. Objective: The aim of this study was to describe environmental, social, and sensory factors influencing meaningful engagement of persons with advanced dementia during Namaste Care implementation in LTC. Methods: In this qualitative descriptive study, focus groups and interviews were conducted with families, volunteers, staff, and managers at two LTC homes. Directed content analysis was conducted. The Comprehensive Process Model of Engagement was used as a coding framework. Results: With respect to environmental attributes, participants emphasized that a designated quiet space and a small group format were helpful for engagement. In terms of social attributes, participants emphasized Namaste Care staff capacity to deliver individualized care. Regarding sensorial factors, familiarity with the activities delivered in the program was emphasized. Conclusion: Findings reveal the need to offer small group programs that include adapted recreational and stimulating activities, such as Namaste Care, for residents at the end of life in LTC. Such programs facilitate meaningful engagement for persons with dementia as they focus on individual preferences, comfort, and inclusion while recognizing changing needs and abilities of residents.
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Affiliation(s)
- Marie-Lee Yous
- School of Nursing, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada
| | - Sheila A. Boamah
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Paulette V. Hunter
- Department of Psychology, St. Thomas More College, University of Saskatchewan, Saskatoon, SK, Canada
| | - Esther Coker
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- St. Peter’s Hospital, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Thomas Hadjistavropoulos
- Department of Psychology and Centre on Aging and Health, University of Regina, Regina, SK, Canada
| | - Tamara Sussman
- School of Social Work, McGill University, Montreal, QC, Canada
| | - Sharon Kaasalainen
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
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Haaksma ML, O'Driscoll C, Joling KJ, Achterberg WP, Francke AL, van der Steen JT, Smaling HJA. Evaluating the feasibility, experiences, facilitators of and barriers to carers and volunteers delivering Namaste Care to people with dementia in their own home: a qualitative interview study in the UK and the Netherlands. BMJ Open 2022; 12:e063422. [PMID: 36375973 PMCID: PMC9664309 DOI: 10.1136/bmjopen-2022-063422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To evaluate the feasibility, facilitators of and barriers to delivering Namaste Care by volunteers and family carers to community-dwelling people with dementia, and to map family carers and volunteers' experiences with the programme. DESIGN Qualitative interview study with two phases: (1) preparation phase; (2) pilot phase. SETTING Private residences of community-dwelling people with dementia in the UK and the Netherlands. PARTICIPANTS Family carers and volunteers of community-dwelling people with dementia (phase 1: 36 Dutch interviews, phase 2: 9 Dutch and 16 UK interviews). INTERVENTION Namaste Care is a multicomponent psychosocial programme, originally developed for people with dementia residing in long-term care facilities. Meaningful activities were offered by carers and volunteers. Each person with dementia was offered 10 one-hour sessions. RESULTS Phase 1: Namaste Care was deemed feasible for community-dwelling people with dementia and no major adaptations to the programme were considered necessary. Phase 2: perceived effects of Namaste Care on people with dementia included improved mood and increased interaction. The programme appeared enriching for both family carers and volunteers, providing joy, respite from care and new insights for coping with challenging behaviour. A flexible attitude of the Namaste provider facilitated its delivery. High caregiver burden and a strained relationship between the family carer and person with dementia were considered barriers. Experiences of family carers and volunteers with Namaste Care were very positive (mean satisfaction rating: 8.7 out of 10, SD=0.9, range 7-10). CONCLUSION We recommend offering Namaste Care delivered by volunteers, preferably multiple sessions per week of 1.5-2 hours to optimise quality of life of community-dwelling people with dementia. Working with well-matched, flexible Namaste providers is pivotal. Family involvement should be encouraged, although the extent should be adapted depending on preference, caregiver burden and the relationship between the family carer and the person with dementia. TRIAL REGISTRATION NUMBER NL5570.
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Affiliation(s)
- Miriam L Haaksma
- University Network for the Care Sector South Holland, Leiden University Medical Center, Leiden, Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | | | - Karlijn J Joling
- Amsterdam Public Health research Institute, Department of Medicine for Older People, Amsterdam UMC, VUmc site, Amsterdam, Netherlands
| | - Wilco P Achterberg
- University Network for the Care Sector South Holland, Leiden University Medical Center, Leiden, Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Anneke L Francke
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, Netherlands
- Amsterdam Public Health research institute, Department of Public and Occupational Health, Amsterdam UMC, VUmc site, Amsterdam, Netherlands
- Expertise Center Palliative Care, Amsterdam UMC, VUmc site, Amsterdam, Netherlands
| | - Jenny T van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- Department of Primary and Community Care, Radboud university medical center, Nijmegen, Netherlands
| | - Hanneke J A Smaling
- University Network for the Care Sector South Holland, Leiden University Medical Center, Leiden, Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
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Yous ML, Ploeg J, Kaasalainen S, McAiney C. Experiences of caregivers of community-dwelling older persons with moderate to advanced dementia in adapting the Namaste Care program: a qualitative descriptive study. RESEARCH INVOLVEMENT AND ENGAGEMENT 2022; 8:61. [PMID: 36371288 PMCID: PMC9655803 DOI: 10.1186/s40900-022-00401-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 11/04/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Globally many older persons with dementia are living at home to maintain independence within the community. As older persons with dementia transition from early to moderate or advanced stages of dementia they require more support from family members and friends to complete their daily activities. Family and friend caregivers, however, often report a lack of preparation for their caregiving role. There are few psychosocial programs that can be delivered by caregivers of community-dwelling older persons with moderate to advanced dementia. Namaste Care is a psychosocial intervention, predominantly used in long-term care, to improve the quality of life of persons with advanced dementia. Namaste Care provides multisensory stimulation for persons with dementia through meaningful activities such as music, massage, aromatherapy, and nutrition. There have been limited attempts at adapting Namaste Care for use by caregivers in the community.There is a need to involve caregivers in adapting programs and understanding their experiences in research involvement so that strategies can be put in place for a positive experience. The purpose of this study is to explore the experiences of caregivers who participated in workshop sessions to adapt Namaste Care for community-dwelling older persons with moderate to advanced dementia. METHODS A qualitative descriptive design was used. Six caregivers residing in Ontario, Canada attended virtual workshop sessions (i.e., by phone or videoconference) that were guided by the Strategy for Patient-Oriented Research (SPOR) Patient Engagement Framework. Caregivers completed individual post-workshop interviews. Experiential thematic analysis was used to analyze interviews and post-interview researcher notes. RESULTS Key findings were that caregivers had a positive experience in adapting Namaste Care by learning how to improve their caregiving skills and being supported to engage in research through multiple facilitators such as flexible scheduling and an inclusive and respectful environment. Having designated time for discussions between caregivers was perceived as important to forming partnerships within the group to support co-creation of knowledge. CONCLUSION Findings support the need to improve caregiver research engagement processes by ensuring that caregivers can benefit through learning opportunities and discussions and empowering caregivers to value their contributions in adapting interventions.
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Affiliation(s)
- Marie-Lee Yous
- School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
| | - Jenny Ploeg
- School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
| | - Sharon Kaasalainen
- School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
| | - Carrie McAiney
- Schlegel-UW Research Institute for Aging, School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1 Canada
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Adapting the Namaste Care Program for Use with Caregivers of Community-Dwelling Older Adults with Moderate to Advanced Dementia: A Qualitative Descriptive Study. Can J Aging 2022; 42:271-283. [PMID: 35722973 DOI: 10.1017/s0714980822000174] [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: 11/07/2022] Open
Abstract
Family/friend caregivers are highly involved in supporting older adults with dementia who are 65 years of age or older with daily activities, especially when these older adults with dementia are living at home. There is a need for psychosocial interventions for caregivers of older adults with moderate to advanced dementia, as most interventions focus on persons at earlier stages. Namaste Care is a psychosocial, multisensory program intended to enhance quality of life for people with advanced dementia and their caregivers; however, it has not yet been adapted for use in a home setting. In this study, caregivers collaborated in adapting Namaste Care during workshops so that it could be delivered by caregivers of older adults with moderate to advanced dementia at home. Key findings were that Namaste Care resonated with the daily activities of caregivers, but that the intervention required modifications to ensure that it could be tailored to the needs and realities of caregivers and persons with dementia.
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Handley M, Bunn F, Dunn V, Hill C, Goodman C. Effectiveness and sustainability of volunteering with older people living in care homes: A mixed methods systematic review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:836-855. [PMID: 34558761 DOI: 10.1111/hsc.13576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 08/14/2021] [Accepted: 09/10/2021] [Indexed: 06/13/2023]
Abstract
Older people living in care homes should be considered part of the wider local community; however, little is known about what enables them to connect with people not paid to look after them or family members. Volunteering can complement paid and familial support. While volunteering is common in community settings, care home residents are less likely to benefit from their input. We conducted a mixed methods systematic review and stakeholder consultation that aimed to identify volunteer activities in care homes and evidence for their effectiveness and sustainability. Databases were searched from 2000 to July 2021. Studies of all designs reporting volunteer-led activities with care home residents 65-years or over were included. Data on interventions, study population, study context, outcomes and implementation issues were extracted and synthesised. We identified 36 studies on the use, effectiveness and implementation of volunteering in care homes, although the overall strength of evidence was weak. Resident engagement and mood appeared to improve during volunteer-led activities, but there was little research examining the longer-term impact. Qualitative and stakeholder data suggest considerable investment is needed to initiate and maintain volunteering initiatives, but there are positive benefits for volunteers, residents and staff if an intervention is sustained. Financial cost for care home facilities is unclear. Interventions that address inequalities in accessing volunteer support within the resident population and between facilities should be considered.
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Hayden L, Passarelli C, Shepley SE, Tigno W. A scoping review: Sensory interventions for older adults living with dementia. DEMENTIA 2022; 21:1416-1448. [PMID: 35230906 DOI: 10.1177/14713012211067027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This scoping review focused on the existing scholarly literature exploring sensory interventions and immersive environments developed for, and used by, older adults living with dementia. The purpose of the scoping review is 1) to understand the various sensory interventions that have been developed, used, and have provided data to show how such interventions are expected to impact the lives of individuals living with dementia; and 2) to understand how the field is moving forward. We chose to map the literature to understand the types of interventions, the types of outcomes measured, and the contexts of their implementation. Our search was constrained to references from 1990 to 1 June 2019 in the following databases: Academic Search Complete, CINAHL Complete, MEDLINE, PsycINFO databases, and Summon Search discovery layer. We screened 2305 articles based on their titles and abstracts, and 465 were sent to full text review, of which 170 were included in our full text extraction. Once the data were extracted, we created emic categories, which emerged from the data, for data that were amenable to categorization (e.g., study setting, intervention type, and outcome type). We developed ten different categories of interventions: art, aromatics, light, multi-component interventions, multisensory rooms, multisensory, music, nature, touch, and taste. Sensory interventions are a standard psychosocial approach to managing the personal expressions commonly experienced by people living with dementia. Our findings can help providers, caregivers, and researchers better design interventions for those living with dementia, to help them selectively choose interventions for particular outcomes and settings. Two areas emerging in the field are nature interventions (replacing traditional "multisensory rooms" with natural environments that are inherently multisensory and engaging) and multi-component interventions (where cognitive training programs are enhanced by adding sensory components).
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Handley M, Parker D, Bunn F, Goodman C. A qualitative comparison of care home staff and palliative care specialists' experiences of providing end of life care to people living and dying with dementia in care homes in two countries: A focus group study. Palliat Med 2022; 36:114-123. [PMID: 34479468 PMCID: PMC8793290 DOI: 10.1177/02692163211043374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Palliative care for people with dementia dying in care homes is an important aspect of long-term care. Whilst there is consensus about the principles of palliative care, less is known about how care home staff negotiate and influence decisions around end of life and how organisational context shapes that process. AIM To explore the views and experiences of care home staff and palliative care specialists on end of life care in care homes and understand how care home settings affected palliative care provision in England and Australia. DESIGN/PARTICIPANTS Eight focus groups in Australia and England with care home staff and palliative care specialists (n = 49). Reflexive thematic analysis was undertaken. FINDINGS Australian participants reported collaboration between care home staff, visiting professions and family members though case conferences. English participants discussed resident-focussed involvement from specialists that was less formally organised. Negotiating roles and responsibilities in end of life care; the importance of relationships to overcome deficiencies in formal processes; and the legitimacy and authority of advance care planning at times of crisis were recurring themes. The organisation and embedding of end of life care in processes and practices of care homes differed; this closely linked to care home procedures in Australia but was less apparent in England. CONCLUSION In both countries, partnership working was recognised and valued as key to effective palliative care. Work that enables care home staff to identify challenges with visiting professionals, such as agreeing priorities for care and negotiating their shared responsibilities, may lead to context-sensitive, sustainable solutions.
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Affiliation(s)
- Melanie Handley
- University of Hertfordshire, Hatfield, Hertfordshire, England, UK
| | | | - Frances Bunn
- University of Hertfordshire, Hatfield, Hertfordshire, England, UK
| | - Claire Goodman
- University of Hertfordshire, Hatfield, Hertfordshire, England, UK
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Lorusso L, Bosch S, Park NK, Shorr R, Conroy M, Ahrentzen S, Freytes M. Investigating the Feasibility of Multisensory Environments to Improve the Assisted Bathing Experience for Veterans With Dementia: A Clinical Trial. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2021; 15:180-195. [PMID: 34763558 DOI: 10.1177/19375867211053861] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This evidence-based design clinical trial assessed the feasibility of a multisensory environment (MSE) using aromatherapy, color-changing lights, and music as a behavioral intervention to calm Veterans with dementia during assisted bathing to improve the patient experience. BACKGROUND The number of Veterans with dementia is growing rapidly, along with the associated debilitating behavior challenges. The severity of these distressed behaviors that predominantly occur at bath time often necessitates costly, dangerous sedatives. Feasibility studies of nonpharmacological behavioral interventions during bathing for people with dementia are urgently needed, and research supports MSE as a viable solution. METHOD Using an A-B, multiple baselines across participants design, this study tracked operational behaviors of four Veterans with dementia during bathing without and with an MSE intervention. Sessions were provided and recorded by a dedicated team of five nurses, so the study team could analyze the Veterans' operational behaviors to understand the impact of individualized MSE during both baseline and intervention phases. RESULTS The results support the feasibility of MSE as a helpful, nonpharmacological behavioral intervention for Veterans with dementia during bathing. All participants experienced an overall increase in duration of positive operational behaviors and an overall decrease in duration of negative operational behaviors. CONCLUSIONS Healthcare environments are integral components in dementia care and the use of MSE within the bathing setting appears to improve not only operational behaviors but the overall bathing experience.
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Affiliation(s)
| | | | | | - Ronald Shorr
- Geriatric Research Education and Clinical Center, University of Florida, Gainesville, FL, USA
| | | | | | - Magaly Freytes
- Center of Innovation on Disability & Rehabilitation Research, Gainesville, FL, USA
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Kaasalainen S, Mccleary L, Vellani S, Pereira J. Improving End-of-Life Care for People with Dementia in LTC Homes During the COVID-19 Pandemic and Beyond. Can Geriatr J 2021; 24:164-169. [PMID: 34484498 PMCID: PMC8390320 DOI: 10.5770/cgj.24.493] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
COVID-19 pandemic has resulted in a significant increase in deaths in long-term care homes (LTCH). People with dementia living in LTCHs represent one of the most frail and marginalized populations in Canada. The surge of COVID-19 cases in LTCHs and rationing of health-care resources during the pandemic have amplified the pre-existing need for improvements in palliative and end-of-life care in LTCHs. This position statement, created by a task force commissioned by the Alzheimer Society of Canada, provides recommendations for a multipronged coordinated approach to improving palliative and end-of-life care of people with dementia living in LTCHs during the COVID-19 pandemic and beyond.
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Affiliation(s)
| | - Lynn Mccleary
- Faculty of Applied Health Sciences, Nursing, Brock University, St. Catharines, ON
| | - Shirin Vellani
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON
| | - Jose Pereira
- Division of Palliative Care, Department of Family Medicine, McMaster University, Hamilton, ON.,Pallium Canada, Ottawa, ON
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Amrollah Majdabadi Kohne Z, Nikpeyma N, Bayat F, Salsali M, Hunter PV, Kaasalainen S, Khavasi M, Keyvanloo Shahrestanaki S, Rezaei M. The effects of a Namaste care program on quality of life: A pilot study in Iranian women with late-stage Alzheimer's disease. Geriatr Nurs 2020; 42:78-82. [PMID: 33302002 DOI: 10.1016/j.gerinurse.2020.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 11/13/2020] [Accepted: 11/17/2020] [Indexed: 01/09/2023]
Abstract
The current study aimed to investigate the effects of a Namaste care program on the quality of life of 25 women with late-stage Alzheimer's disease. The program was implemented two hours daily and four days per week for six months in a nursing facility, Tehran, Iran. Women's quality of life was measured using the Persian version of the Quality of Life in Late-Stage Dementia scale before and after the program implementation. After a six-month intervention with the Namaste care program, the total score of quality of life significantly decreased (17.79 ± 1.10 at the end of trial compared with 24.67 ± 1.62 at baseline, P = 0.01), indicating improved quality of life. This effect was obtained after controlling for demographic variables and comorbidities. Hence, it seems that the Namaste care program might be an effective supportive method to improve the quality of life of women with late-stage Alzheimer's disease in Iranian culture. However, further large-sample studies are needed to investigate the generalizability of the findings.
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Affiliation(s)
- Zahra Amrollah Majdabadi Kohne
- Nursing and Midwifery Care Research Center, Tehran University of Medical Sciences, Tehran, Iran; Phd student, Nursing Care Research Center, Midwifery and Reproductive Health Department, School of Nursing and Midwifery, Iran University of Medical Science, Tehran, Iran.
| | - Nasrin Nikpeyma
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Firoozeh Bayat
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahvash Salsali
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Mohammed Khavasi
- School of Nursing and Midwifery, Dezful University of Mesical Sciences, Dezful, Iran.
| | - Sahar Keyvanloo Shahrestanaki
- Phd student, Nursing Care Research Center, Midwifery and Reproductive Health Department, School of Nursing and Midwifery, Iran University of Medical Science, Tehran, Iran.
| | - Masoud Rezaei
- Phd student, Nursing Care Research Center, Midwifery and Reproductive Health Department, School of Nursing and Midwifery, Iran University of Medical Science, Tehran, Iran.
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The Impact of Implementing a Namaste Care Intervention in UK Care Homes for People Living with Advanced Dementia, Staff and Families. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17166004. [PMID: 32824847 PMCID: PMC7459821 DOI: 10.3390/ijerph17166004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/14/2020] [Accepted: 08/14/2020] [Indexed: 11/16/2022]
Abstract
Care homes can struggle to provide optimal care for residents with advanced dementia. Namaste Care provides a structured daily programme of physical, sensory and emotional care delivered by regular care workers. A three-year, mixed method process study of implementation and impact created a manualised Namaste Care Intervention for UK care homes (NCI-UK). This article reports on the impact of NCI-UK delivered consistently in five care homes for 12–24 weeks. Impact for residents was assessed using, pre-post data, showing significant positive effects for QUALID (t = 2.92, p = 0.01, n = 31) and CMAI (t = 3.31, p = 0.002, n = 32), alongside many qualitative examples of positive impacts on wellbeing, responsiveness and communication. Pre-post staff questionnaire data (n = 20) were not significant. Qualitative data indicated that NCI-UK is a positive staff experience, providing sense of purpose, improved wellbeing and relationships. The care homes reported benefiting from implementing NCI-UK in terms of reputation and quality improvement. Family interviews were also positive, relating to seeing the difference, improving relationships and being involved. NCI-UK can therefore be recommended as an impactful intervention for residents, staff and families.
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Kochovska S, Garcia MV, Bunn F, Goodman C, Luckett T, Parker D, Phillips JL, Sampson EL, van der Steen JT, Agar MR. Components of palliative care interventions addressing the needs of people with dementia living in long-term care: A systematic review. Palliat Med 2020; 34:454-492. [PMID: 32013780 DOI: 10.1177/0269216319900141] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND People with dementia requiring palliative care have multiple needs, which are amplified in long-term care settings. The European Association for Palliative Care White Paper offers recommendations for optimal palliative care in dementia integral for this population, providing useful guidance to inform interventions addressing their specific needs. AIM The aim of this study is to describe the components of palliative care interventions for people with dementia in long-term care focusing on shared decision-making and examine their alignment to the European Association for Palliative Care domains of care. DESIGN Systematic review with narrative synthesis (PROSPERO ID: CRD42018095649). DATA SOURCES Four databases (MEDLINE, CINAHL, PsycINFO and CENTRAL) were searched (earliest records - July 2019) for peer-reviewed articles and protocols in English, reporting on palliative care interventions for people with dementia in long-term care, addressing European Association for Palliative Care Domains 2 (person-centred) or 3 (setting care goals) and ⩾1 other domain. RESULTS Fifty-one papers were included, reporting on 32 studies. For each domain (1-10), there were interventions found aiming to address its goal, although no single intervention addressed all domains. Domain 7 (symptom management; n = 19), 6 (avoiding overly aggressive treatment; n = 18) and 10 (education; n = 17) were the most commonly addressed; Domain 5 (prognostication; n = 7) and 4 (continuity of care; n = 2) were the least addressed. CONCLUSION Almost all domains were addressed across all interventions currently offered for this population to various degrees, but not within a singular intervention. Future research optimally needs to be theory driven when developing dementia-specific interventions at the end of life, with the European Association for Palliative Care domains serving as a foundation to inform the best care for this population.
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Affiliation(s)
- Slavica Kochovska
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Maja V Garcia
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Frances Bunn
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hertfordshire, UK
| | - Claire Goodman
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hertfordshire, UK
| | - Tim Luckett
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Deborah Parker
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Jane L Phillips
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Elizabeth L Sampson
- Centre for Dementia Palliative Care Research, Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Jenny T van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Meera R Agar
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
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Kaasalainen S, Hunter PV, Dal Bello-Haas V, Dolovich L, Froggatt K, Hadjistavropoulos T, Markle-Reid M, Ploeg J, Simard J, Thabane L, van der Steen JT, Volicer L. Evaluating the feasibility and acceptability of the Namaste Care program in long-term care settings in Canada. Pilot Feasibility Stud 2020; 6:34. [PMID: 32161658 PMCID: PMC7053118 DOI: 10.1186/s40814-020-00575-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 02/17/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Residents living and dying in long-term care (LTC) homes represent one of society's most frail and marginalized populations of older adults, particularly those residents with advanced dementia who are often excluded from activities that promote quality of life in their last months of life. The purpose of this study is to evaluate the feasibility, acceptability, and effects of Namaste Care: an innovative program to improve end-of-life care for people with advanced dementia. METHODS This study used a mixed-method survey design to evaluate the Namaste Care program in two LTC homes in Canada. Pain, quality of life, and medication costs were assessed for 31 residents before and 6 months after they participated in Namaste Care. The program consisted of two 2-h sessions per day for 5 days per week. Namaste Care staff provided high sensory care to residents in a calm, therapeutic environment in a small group setting. Feasibility was assessed in terms of recruitment rate, number of sessions attended, retention rate, and any adverse events. Acceptability was assessed using qualitative interviews with staff and family. RESULTS The feasibility of Namaste Care was acceptable with a participation rate of 89%. However, participants received only 72% of the sessions delivered and only 78% stayed in the program for at least 3 months due to mortality. After attending Namaste Care, participants' pain and quality of life improved and medication costs decreased. Family members and staff perceived the program to be beneficial, noting positive changes in residents. The majority of participants were very satisfied with the program, providing suggestions for ongoing engagement throughout the implementation process. CONCLUSIONS These study findings support the implementation of the Namaste Care program in Canadian LTC homes to improve the quality of life for residents. However, further testing is needed on a larger scale.
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Affiliation(s)
- Sharon Kaasalainen
- School of Nursing, McMaster University, 1280 Main Street West, HSC 3H48C, Hamilton, ON L8S 3Z1 Canada
- Department of Family Medicine, McMaster University, 1280 Main Street West, 3H48C, Hamilton, ON L8N 3Z5 Canada
| | | | | | - Lisa Dolovich
- Department of Family Medicine, McMaster University, 1280 Main Street West, 3H48C, Hamilton, ON L8N 3Z5 Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON Canada
| | | | | | - Maureen Markle-Reid
- Aging, Community and Health Research Unit, School of Nursing, McMaster Institute for Research on Aging/Collaborative for Health and Aging, McMaster University, 1280 Main Street West, HSc 3N25B, Hamilton, ON L8S 4K1 Canada
| | - Jenny Ploeg
- Aging, Community and Health Research Unit, School of Nursing, McMaster University, 1280 Main Street West, HSc 3N25C, Hamilton, ON L8S 4K1 Canada
| | | | - Lehana Thabane
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON Canada
| | - Jenny T. van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Ladislav Volicer
- School of Aging Studies, University of South Florida, Tampa, FL USA
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Dalkin SM, Lhussier M, Kendall N, Atkinson J, Tolman S. Namaste care in the home setting: developing initial realist explanatory theories and uncovering unintended outcomes. BMJ Open 2020; 10:e033046. [PMID: 31974087 PMCID: PMC7045233 DOI: 10.1136/bmjopen-2019-033046] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION The End-of-Life Namaste Care Program for People with Dementia, challenges the misconception that people with dementia are a 'shell'; it provides a holistic approach using the five senses, which can provide positive ways of communicating and emotional responses. It is proposed Namaste Care can improve communication and the relationships families and friends have with the person with dementia. Previously used in care homes, this study is the first to explore the pioneering use of Namaste Care in people's own homes. OBJECTIVE To develop initial programme theories detailing if, how and under which circumstances Namaste Care works when implemented at home. DESIGN A qualitative realist approach following the RAMESES II guidelines was employed to understand not only whether Namaste Care has positive outcomes, but also how these are generated, for whom they happen and in which circumstances. SETTING A hospice in the North East of England, operating in the community, through volunteers. PARTICIPANTS Programme theories were developed from three focus groups with volunteers implementing Namaste Care (n=8; n=8; n=11) and eight interviews with family carers (n=8). RESULTS Four refined explanatory theories are presented: increasing engagement, respite for family carers, importance of matched volunteers and increasing social interaction. It was identified that while Namaste Care achieved some of the same goals in the home setting as it does in the care home setting, it could also function in a different way that promoted socialisation. CONCLUSIONS Namaste Care provides holistic and personalised care to people with both moderate and advanced dementia, improving engagement and reducing social isolation. In the present study carers often chose to use Namaste Care sessions as respite. This was often linked to their frustration of the unavoidable dominance of task-focussed care in daily life. Individualised Namaste Care activities thus led to positive outcomes for both those with dementia and their carers.
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Affiliation(s)
- Sonia Michelle Dalkin
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, Tyne and Wear, UK
- Fuse (The Centre for Translational Research in Public Health), Newcastle Upon Tyne, UK
| | - Monique Lhussier
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, Tyne and Wear, UK
- Fuse (The Centre for Translational Research in Public Health), Newcastle Upon Tyne, UK
| | | | - Joanne Atkinson
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, Tyne and Wear, UK
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Froggatt K, Best A, Bunn F, Burnside G, Coast J, Dunleavy L, Goodman C, Hardwick B, Jackson C, Kinley J, Davidson Lund A, Lynch J, Mitchell P, Myring G, Patel S, Algorta GP, Preston N, Scott D, Silvera K, Walshe C. A group intervention to improve quality of life for people with advanced dementia living in care homes: the Namaste feasibility cluster RCT. Health Technol Assess 2020; 24:1-140. [PMID: 31971506 PMCID: PMC7008353 DOI: 10.3310/hta24060] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND People with advanced dementia who live and die in nursing homes experience variable quality of life, care and dying. There is a need to identify appropriate, cost-effective interventions that facilitate high-quality end-of-life care provision. OBJECTIVES To establish the feasibility and acceptability to staff and family of conducting a cluster randomised controlled trial of the Namaste Care intervention for people with advanced dementia in nursing homes. DESIGN The study had three phases: (1) realist review and (2) intervention refinement to inform the design of (3) a feasibility cluster randomised controlled trial with a process evaluation and economic analysis. Clusters (nursing homes) were randomised in a 3 : 1 ratio to intervention or control (usual care). The nature of the intervention meant that blinding was not possible. SETTING Nursing homes in England providing care for people with dementia. PARTICIPANTS Residents with advanced dementia (assessed as having a Functional Assessment Staging Test score of 6 or 7), their informal carers and nursing home staff. INTERVENTION Namaste Care is a complex group intervention that provides structured personalised care in a dedicated space, focusing on enhancements to the physical environment, comfort management and sensory engagement. MAIN OUTCOME MEASURES The two contender primary outcome measures were Comfort Assessment in Dying - End of Life Care in Dementia for quality of dying (dementia) and Quality of Life in Late Stage Dementia for quality of life. The secondary outcomes were as follows: person with dementia, sleep/activity (actigraphy), neuropsychiatric symptoms, agitation and pain; informal carers, satisfaction with care at the end of life; staff members, person-centred care assessment, satisfaction with care at the end of life and readiness for change; and other data - health economic outcomes, medication/service use and intervention activity. RESULTS Phase 1 (realist review; 86 papers) identified that a key intervention component was the activities enabling the development of moments of connection. In phase 2, refinement of the intervention enabled the production of a user-friendly 16-page A4 booklet. In phase 3, eight nursing homes were recruited. Two homes withdrew before the intervention commenced; four intervention and two control homes completed the study. Residents with advanced dementia (n = 32) were recruited in intervention (n = 18) and control (n = 14) homes. Informal carers (total, n = 12: intervention, n = 5; control, n = 7) and 97 staff from eight sites (intervention, n = 75; control, n = 22) were recruited over a 6-month period. Recruitment is feasible. Completion rates of the primary outcome questionnaires were high at baseline (100%) and at 4 weeks (96.8%). The Quality of Life in Late Stage Dementia was more responsive to change over 24 weeks. Even where economic data were missing, these could be collected in a full trial. The intervention was acceptable; the dose varied depending on the staffing and physical environment of each care home. Staff and informal carers reported changes for the person with dementia in two ways: increased social engagement and greater calm. No adverse events related to the intervention were reported. CONCLUSIONS A subsequent definitive trial is feasible if there are amendments to the recruitment process, outcome measure choice and intervention specification. FUTURE WORK In a full trial, consideration is needed of the appropriate outcome measure that is sensitive to different participant responses, and of clear implementation principles for this person-centred intervention in a nursing home context. TRIAL REGISTRATION Current Controlled Trials ISRCTN14948133. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 6. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Katherine Froggatt
- International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Ashley Best
- Clinical Trials Research Centre, University of Liverpool, Liverpool, UK
| | - Frances Bunn
- Department of Health and Human Sciences, University of Hertfordshire, Hatfield, UK
| | - Girvan Burnside
- Clinical Trials Research Centre, University of Liverpool, Liverpool, UK
| | - Joanna Coast
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Lesley Dunleavy
- International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Claire Goodman
- Department of Health and Human Sciences, University of Hertfordshire, Hatfield, UK
| | - Ben Hardwick
- Clinical Trials Research Centre, University of Liverpool, Liverpool, UK
| | - Clare Jackson
- Clinical Trials Research Centre, University of Liverpool, Liverpool, UK
| | | | | | - Jennifer Lynch
- Department of Health and Human Sciences, University of Hertfordshire, Hatfield, UK
| | - Paul Mitchell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Gareth Myring
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Shakil Patel
- Lancashire Clinical Trials Unit, University of Central Lancashire, Preston, UK
| | - Guillermo Perez Algorta
- International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Nancy Preston
- International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | | | - Kate Silvera
- Clinical Trials Research Centre, University of Liverpool, Liverpool, UK
| | - Catherine Walshe
- International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
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Kupeli N, Sampson EL, Leavey G, Harrington J, Davis S, Candy B, King M, Nazareth I, Jones L, Moore K. Context, mechanisms and outcomes in end-of-life care for people with advanced dementia: family carers perspective. BMC Palliat Care 2019; 18:87. [PMID: 31651310 PMCID: PMC6813066 DOI: 10.1186/s12904-019-0467-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 09/20/2019] [Indexed: 12/17/2022] Open
Abstract
Background Keeping people living with advanced dementia in their usual place of residence is becoming a key governmental goal but to achieve this, family carers and health care professionals must negotiate how to provide optimal care. Previously, we reported a realist analysis of the health care professional perspective. Here, we report on family carer perspectives. We aimed to understand the similarities and differences between the two perspectives, gain insights into how the interdependent roles of family carers and HCPs can be optimised, and make recommendations for policy and practice. Method Qualitative study using a realist approach in which we used the criteria from guidance on optimal palliative care in advanced dementia to examine key contexts, mechanisms and outcomes highlighted by family carers. Results The themes and views of family caregivers resonate with those of health care professionals. Their overlapping anxieties related to business-driven care homes, uncertainty of families when making EOL decisions and the importance of symptom management referring to contexts, mechanisms and outcomes, respectively. Contexts specific to family carers were ad hoc information about services, dementia progression and access to funding. Not all family carers identified dementia as terminal, but many recognised the importance of continuity of care and knowing the wishes of the person with dementia. New mechanisms included specific resources for improving EOL care and barriers to discussing and planning for future care. Family carers identified the importance of comfort, being present, the meeting of basic care needs and feeling the right decisions have been made as good outcomes of care. Conclusions Family carers and health care professionals share similar concerns about the challenges to good EOL dementia care. Better understanding of the effects of dementia at the advanced stages would improve confidence in EOL care and reduce uncertainty in decision making for family carers and health care professionals.
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Affiliation(s)
- Nuriye Kupeli
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
| | - Elizabeth L Sampson
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.,Barnet Enfield and Haringey Mental Health Trust Liaison Psychiatry Team, North Middlesex University Hospital, London, UK
| | - Gerard Leavey
- Bamford Centre for Mental Health & Wellbeing, University of Ulster, Londonderry, UK
| | - Jane Harrington
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Sarah Davis
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Bridget Candy
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Michael King
- Division of Psychiatry, University College London, London, UK
| | - Irwin Nazareth
- Department of Primary Care & Population Health, University College London, London, UK
| | - Louise Jones
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Kirsten Moore
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
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23
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Walshe C, Kinley J, Patel S, Goodman C, Bunn F, Lynch J, Scott D, Lund AD, Stacpoole M, Preston N, Froggatt K. A four-stage process for intervention description and guide development of a practice-based intervention: refining the Namaste Care intervention implementation specification for people with advanced dementia prior to a feasibility cluster randomised trial. BMC Geriatr 2019; 19:275. [PMID: 31638902 PMCID: PMC6802319 DOI: 10.1186/s12877-019-1275-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 09/10/2019] [Indexed: 02/03/2023] Open
Abstract
Background Some interventions are developed from practice, and implemented before evidence of effect is determined, or the intervention is fully specified. An example is Namaste Care, a multi-component intervention for people with advanced dementia, delivered in care home, community, hospital and hospice settings. This paper describes the development of an intervention description, guide and training package to support implementation of Namaste Care within the context of a feasibility trial. This allows fidelity to be determined within the trial, and for intervention users to understand how similar their implementation is to that which was studied. Methods A four-stage approach: a) Collating existing intervention materials and drawing from programme theory developed from a realist review to draft an intervention description. b) Exploring readability, comprehensibility and utility with staff who had not experienced Namaste Care. c) Using modified nominal group techniques with those with Namaste Care experience to refine and prioritise the intervention implementation materials. d) Final refinement with a patient and public involvement panel. Results Eighteen nursing care home staff, one carer, one volunteer and five members of our public involvement panel were involved across the study steps. A 16-page A4 booklet was designed, with flow charts, graphics and colour coded information to ease navigation through the document. This was supplemented by infographics, and a training package. The guide describes the boundaries of the intervention and how to implement it, whilst retaining the flexible spirit of the Namaste Care intervention. Conclusions There is little attention paid to how best to specify complex interventions that have already been organically implemented in practice. This four-stage process may have utility for context specific adaptation or description of existing, but untested, interventions. A robust, agreed, intervention and implementation description should enable a high-quality future trial. If an effect is determined, flexible practice implementation should be enabled through having a clear, evidence-based guide.
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Affiliation(s)
- Catherine Walshe
- International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4YG, UK.
| | - Julie Kinley
- St Christopher's Hospice, 51-59 Lawrie Park Road, Sydenham, London, SE26 6DZ, UK
| | - Shakil Patel
- International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4YG, UK.,Lancashire Clinical Trials Unit, University of Central Lancashire, Preston, Lancashire, PR1 2HE, UK
| | - Claire Goodman
- Centre for Research in Public Health and Community Care, University of Hertfordshire, College Lane, Hatfield, Hertfordshire, AL10 9AB, UK
| | - Frances Bunn
- Centre for Research in Public Health and Community Care, University of Hertfordshire, College Lane, Hatfield, Hertfordshire, AL10 9AB, UK
| | - Jennifer Lynch
- Centre for Research in Public Health and Community Care, University of Hertfordshire, College Lane, Hatfield, Hertfordshire, AL10 9AB, UK
| | - David Scott
- Patient Representative c/o The Alzheimer's Society, London, UK
| | | | - Min Stacpoole
- St Christopher's Hospice, 51-59 Lawrie Park Road, Sydenham, London, SE26 6DZ, UK
| | - Nancy Preston
- International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4YG, UK
| | - Katherine Froggatt
- International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4YG, UK
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24
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Bray J, Brooker DJ, Garabedian C. What is the evidence for the activities of Namaste Care? A rapid assessment review. DEMENTIA 2019; 20:247-272. [DOI: 10.1177/1471301219878299] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objectives To assess the quality of research evidence for the different activity components for the psycho-social Namaste Care intervention for care home residents with advanced dementia. Design Namaste Care is a multi-component intervention delivered on a daily basis to people living with advanced dementia or people at end of life with dementia. A significant part of its operationalisation within care homes is the delivery of a number of activities delivered by trained in-house Namaste Care workers to a group of residents with similar high dependency needs. The Namaste Care workers focus on touch, music, nature, sensory experience, aromas and interactions with objects delivered in a way to enhance feelings of enjoyment and wellbeing. This review evaluated the evidence for using these activities with people living with advanced dementia. A systematic search of peer-reviewed research articles was conducted between November 2016 and September 2018 using search terms of activities used in Namaste Care. The quality of each accepted article was rated using the Rapid Evidence Assessment scale. Results The initial literature search returned 1341 results: 127 articles including 42 reviews were included. The majority of activity interventions yielded between 10 and 20 peer-reviewed papers. The use of smells and aromas, interacting with animals and dolls, the use of various forms of music (e.g. background music, singing, personalised music), nature, lighting, various forms of touch/massage and sensory interventions (including Snoezelen) all appear to have proven efficacy with people living with advanced dementia. Conclusions There is generally a limited number of research papers and reviews in this area, but overall there is a good evidence base for including these activities within Namaste Care for people living with advanced dementia.
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Affiliation(s)
- Jennifer Bray
- Association for Dementia Studies, University of Worcester, UK
| | - Dawn J Brooker
- Association for Dementia Studies, University of Worcester, UK
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25
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Reducing agitation in care home residents with dementia. Lancet Psychiatry 2019; 6:274-275. [PMID: 30872011 DOI: 10.1016/s2215-0366(19)30080-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 02/27/2019] [Indexed: 11/20/2022]
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