Context, mechanisms and outcomes in end-of-life care for people with advanced dementia: family carers perspective

Family Caregiver's Depression, Confidence, Satisfaction, and Burden Regarding End-of-Life Home Care for People With End-Stage Dementia

To detect differences between two care services units: regarding family-caregiver (FC) depression, perceived-burden and confidence in the provision of care to people with end-stage dementia (PWESD); examine predictors such as FC age, depression, confidence in the provision of care to PWESD and satisfaction with the community-home-care service to burden; and explore a mediation model.The participants were 139 FC, caring for PWESD living at home. The questionnaire was composed of FC background characteristics, perceived-burden, satisfaction with the community-home-care services, depression, and confidence in the provision of care to the PWESD. HCUs' FC felt significantly more burdened than HHUs' FC. Furthermore, satisfaction with the community-home-care services mediated the relationship between FC confidence in the provision of care to the PWESD and FC burden. The study results may affect the development of end-of-life care policies and services which meet the needs of PWESD and their FC.

Evaluating a partnership model of hospice enabled dementia care: A three-phased monitoring, focus group and interview study

BACKGROUND

People with dementia and their caregivers often lack equitable access to hospice care which is a concern internationally. Domains of best practice in palliative care for this population exist and hospices are urged to become dementia friendly.

AIM

This study aimed to evaluate the model of 'Hospice Enabled Dementia Partnership' mapped to international domains of best practice.

DESIGN

Three-phased monitoring, group interview and individual interview study using a formative evaluation framework.

SETTINGPARTICIPANTS

The partnership model was a collaboration between a large specialist palliative care hospice, a dementia charity and a Health Care Trust in the United Kingdom. Service documents were subjected to documentary review of monitoring activity and key indicators of service success. Group interviews and individual interviews took place with family carers (n = 12), health care professionals involved in delivering the service (n = 32) and senior professionals (n = 5) responsible for service commissioning in palliative or dementia care.

RESULTS

One hundred people with dementia were referred to the service between May 2016 and December 2017. Thirty-eight of the 42 people who died, achieved their preferred place of care and died at home. Four themes were derived from the data 'Impact of Dementia', 'Value of the Service', 'Information and Learning Needs' and 'Working in Partnership'.

CONCLUSIONS

Positive outcomes resulted from this best practice model; achievement of preferred place of care and death at home, dual benefits of therapies for patients and families and partnership in cross working and learning between services. Replication of this model should be considered internationally.

The Knowledge of Palliative Care among Geriatric Home Staff in Jordan

Background

Palliative care in nursing homes (NHS) is a major challenge, because it gives the demands of the knowledge and skills of nursing staff to provide high-quality care.

Purpose

The purpose of this study was to assess the knowledge of palliative care among nursing home staff.

Methods

A descriptive study design was used, 124 nurses, aged over 30 years and most of them were male working in the nursing home in Jordan. Around 109 participants were responded to the questionnaire. All licensed nurses were included in the study, except of that will be excluded. The knowledge of palliative care was measured via the palliative care survey. knowledge scores were ranged 0-1, with higher scores indicate greater knowledge.

Results

Descriptive statistics was used. The Knowledge of palliative care issues is 0.21 in Jordan (95% confidence interval (CI) 0.19-0.24). Knowledge of physical aspects that can contribute to pain is 0.22 (95% CI 0.2-0.25), and knowledge of psychological aspects that can contribute to pain is 0.21 (95% CI 0.2-0.22).

Conclusion

Education for nursing staff needs to be enhanced to address the specific knowledge gaps. Additional studies with large sample size recommended to explore the effect of educational programs in regard of palliative care in nursing homes.

Older people, information-giving and active agency practices in health, social care and housing: theory, evidence and reflections

That older people should be consumers and active agents has dominated policy discourse across health, social care and housing that has a core care function. This discourse has some established and long-standing critics, such as Gilleard and Higgs, and yet the central question(s) a consumerist discourse raises remains surprisingly relevant today. The purpose of this forum article is to reconsider the viability of active agency amongst older people in the context of empirical research on information-giving across health, social care and housing that has been published since the paper by Gilleard and Higgs in 1998. Information-giving is the key consumer choice mechanism, and yet research is currently located in separate literatures. Giving these separate fields some coherence engages with and provides important empirical commentary. There is little or no evidence that information alone triggers active agency for older people in regard to their health, social care or housing. However, there is consistent evidence that discussion, deliberation and dialogue – or the practices associated with Habermas’ theory of communicative action – are desirable to older people in the context of active agency. More research is needed to demonstrate efficacy beyond communicative approaches being desirable.

Could negative behaviors by patients with dementia be positive communication? Seeking ways to understand and interpret their nonverbal communication

In interactions with caregivers, patients with dementia have communication challenges that are common and worrisome to families. Family and professional caregivers find it challenging to “guess” or “interpret” what their patients with dementia are trying to tell them. In this creative controversy article, we discuss how family and professional caregivers can seek to understand and correctly interpret the nonverbal communications of patients with dementia (behaviors, actions, facial expressions, and vocal sounds). Equipping family and professional caregivers with the resources to interpret the nonverbal communications of patients with dementia requires a commitment to in‐service and family education in healthcare facilities. Nurses could play a critical role in raising the awareness among the public about the potential changes and declines in verbal communications of the patients with dementia.

Educational intervention to improve palliative care knowledge among informal caregivers of cognitively impaired older adults

OBJECTIVE

Lack of palliative care knowledge among caregivers may pose an access barrier for cognitively impaired older adults, who may benefit from the specialized care. Therefore, this study aims to examine the effectiveness of an educational intervention in improving palliative care knowledge among informal caregivers of cognitively impaired older adults.

METHOD

Using a one-group, pre- and post-test intervention design, this study implemented an individual, face-to-face educational intervention with an informational brochure for 43 informal caregivers of chronically or seriously ill older adults (50+) with cognitive impairment, recruited from communities in West Alabama. Their level of knowledge about palliative care was assessed by the Palliative Care Knowledge Scale (PaCKS). The pre- and post-test scores were compared by the Wilcoxon signed-ranks test, and the racial subgroup (Whites vs. Blacks) comparison was made by the Mann-Whitney U test.

RESULTS

There was a statistically significant difference between the pre- and post-test scores (z = 5.38, p < 0.001), indicating a statistically significant effect of the educational intervention in improving palliative care knowledge among participants. There was a significant difference (U = 143, p < 0.05) between Whites and Blacks in the pre-test, which, however, disappeared in the post-test (U = 173.50, p > 0.05), suggesting that the amount of increased PaCKS scores were significantly greater for Blacks (Mdn = 9.50) than for Whites (Mdn = 4.00, U = 130.50, p < 0.05).

SIGNIFICANCE OF RESULTS

This study demonstrated that a one-time educational intervention can improve the level of palliative care knowledge among informal caregivers of chronically or seriously ill older adults with cognitive impairment, particularly among Black caregivers. Therefore, further educational efforts can be made to promote palliative care knowledge and reduce racial disparities in palliative care knowledge and its use.

Virtual Reality for Therapeutic Recreation in Dementia Hospice Care: A Feasibility Study

OBJECTIVES

To explore acceptability, tolerability, and subjective experience of virtual reality (VR) as therapeutic recreation for hospice patients living with dementia (hPLWD).

DESIGN

Descriptive study setting.

COMMUNITY HOSPICE AGENCY PARTICIPANTS

A convenience sample of n = 25 hPLWD cared for by a local hospice agency.

INTERVENTION

Participants viewed a beach scene using VR headset for ≤30 minutes.

MEASUREMENTS

Tolerability was measured with Pain Assessment IN Advanced Dementia (PAINAD)scores at baseline, every 5 minutes during VR use, and 5 minutes after headset removal. Additionally, follow-up phone calls to caregivers several hours after the intervention were performed to inquire regarding any noted adverse effect after the intervention. The subjective experience was measured with qualitative semistructured interviews with the hPLWD regarding enjoyment for the VR. Descriptive statistics were performed on all collected data.

RESULTS

The VR was stopped early in 2 of the participants due to a ≥2-point increase in PAINAD score. Baseline behavioral and psychological symptoms of dementia (BPSD) were reported to have worsened in 2 (8%) of the participants at follow-up. There was no significant difference between dementia type and usage time or dementia severity and usage time. Of the 25 participants, 14 (56%) reported enjoying VR and 12 (48%) would do it again.

CONCLUSION

Virtual reality use was generally safe and enjoyable in hPLWD. Virtual reality can provide meaningful activity and enhance quality of life for hPLWD at the end of life. In the future, VR may be a useful intervention for BPSD in hPLWD.