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Yu Y, Xiao L, Cheng A, Wang I, Chiu K, Chan E, Xie C, Zhou Y, Zhuang Z, Wang J. Chinese-Australian carers' perceived needs and preferences in planning to embed an iSupport for Dementia program in aged care services. Australas J Ageing 2024. [PMID: 38415371 DOI: 10.1111/ajag.13287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 10/24/2023] [Accepted: 01/16/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVE To assess Chinese-Australian carers' needs and preferences through co-design strategies with stakeholders to embed an evidence-based iSupport for Dementia program into routine community aged care services in Chinese ethno-specific aged care organisations. METHODS A cross-sectional survey was conducted from July to August 2022 in three Chinese ethno-specific aged care organisations in Australia. We applied a univariate analysis to test variables associated with carers' needs and preferences when embedding the iSupport for Dementia program into routine practice among community aged care services. RESULTS A total of 101 carers completed the survey. Most carers in our study preferred the iSupport program to be provided in their first language, have a program facilitator to lead the program and would like to interact with peers in the program. Most carers indicated that they are willing to pay for the iSupport program using the budget allocated to their home care package. Younger carers (younger than 65 years), and adult children's carers are more likely to use the web-based iSupport manual and invite their family members to the program compared to those older than 65 years. Other demographic characteristics had no significant association with their needs and preferences. CONCLUSIONS Chinese-Australian carers' perceived needs and preferences in this study will inform the implementation of a culturally tailored iSupport program to be embedded in community aged care services provided by Chinese ethno-specific aged care organisations. Findings will also inform culturally and linguistically congruent iSupport programs for carers from other culturally and linguistically diverse communities in Australia.
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Affiliation(s)
- Ying Yu
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Caring Future Institutes, Flinders University, Adelaide, South Australia, Australia
| | - Lily Xiao
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Caring Future Institutes, Flinders University, Adelaide, South Australia, Australia
| | - Ada Cheng
- Australian Nursing Home Foundation Limited (ANHF), New South Wales, Australia
| | - Ivan Wang
- Home Ageing Services, Chinese Australian Services Society (CASS), New South Wales, Australia
| | - Kam Chiu
- Chinese Welfare Services of SA Inc. (CWS), New South Wales, Australia
| | - Eliza Chan
- Australian Nursing Home Foundation Limited (ANHF), New South Wales, Australia
| | - Candy Xie
- Home Ageing Services, Chinese Australian Services Society (CASS), New South Wales, Australia
| | - Yunrui Zhou
- Chinese Welfare Services of SA Inc. (CWS), New South Wales, Australia
| | - Zoey Zhuang
- Home Ageing Services, Chinese Australian Services Society (CASS), New South Wales, Australia
| | - Jing Wang
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Faculty of Nursing, Health Science Center, Xi'an Jiaotong University, Xi'an, China
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Huggins M, Pesut B, Puurveen G. Interventions for Caregivers of Older Adults with Dementia Living in the Community: A Rapid Review of Reviews. Can J Aging 2023; 42:425-433. [PMID: 36799030 DOI: 10.1017/s0714980823000016] [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: 02/18/2023] Open
Abstract
This rapid review of systematic reviews examines non-professional interventions that have been implemented to support family caregivers of older adults with dementia who are living in the community. There is a robust body of empirical literature examining such interventions for family caregivers; therefore, this rapid review includes only systematic reviews. MEDLINE, CINAHL, and EMBASE databases were searched from September 2020 to December 2020, and 19 systematic reviews were selected for a full review. Psychosocial, psychoeducational, social support, and multicomponent interventions consistently show positive impacts on a variety of outcomes. The evidence suggests that multicomponent interventions that are tailored to the needs of individual caregivers are the most impactful interventions and should be utilized in future program development. The most effective combination of interventions is unknown and warrants further investigation. However, the repeated success of psychoeducational, psychosocial, and social support interventions suggests that when used together, they may be a successful combination that contributes to positive impacts on caregivers. This multicomponent intervention should be flexible, as interventions are most effective when they are tailored to the individual needs of caregivers and adapted over time as the needs of the caregiver and person living with dementia change with disease progression.
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Affiliation(s)
- Madison Huggins
- Health Ethics and Diversity Lab, University of British Columbia Okanagan, School of Nursing Asc, Kelowna, BC, Canada
| | - Barbara Pesut
- Palliative and End of Life Care, University of British Columbia Okanagan, School of Nursing Asc, Kelowna, BC, Canada
| | - Gloria Puurveen
- Health Ethics and Diversity Lab, University of British Columbia Okanagan, School of Nursing Asc, Kelowna, BC, Canada
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Kirvalidze M, Abbadi A, Dahlberg L, Sacco LB, Morin L, Calderón-Larrañaga A. Effectiveness of interventions designed to mitigate the negative health outcomes of informal caregiving to older adults: an umbrella review of systematic reviews and meta-analyses. BMJ Open 2023; 13:e068646. [PMID: 37085312 PMCID: PMC10124259 DOI: 10.1136/bmjopen-2022-068646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/23/2023] Open
Abstract
OBJECTIVES This umbrella review aimed to evaluate whether certain interventions can mitigate the negative health consequences of caregiving, which interventions are more effective than others depending on the circumstances, and how these interventions are experienced by caregivers themselves. DESIGN An umbrella review of systematic reviews was conducted. DATA SOURCES Quantitative (with or without meta-analyses), qualitative and mixed-methods systematic reviews were included. ELIGIBILITY CRITERIA Reviews were considered eligible if they met the following criteria: included primary studies targeting informal (ie, unpaid) caregivers of older people or persons presenting with ageing-related diseases; focused on support interventions and assessed their effectiveness (quantitative reviews) or their implementation and/or lived experience of the target population (qualitative reviews); included physical or mental health-related outcomes of informal caregivers. DATA EXTRACTION AND SYNTHESIS A total of 47 reviews were included, covering 619 distinct primary studies. Each potentially eligible review underwent critical appraisal and citation overlap assessment. Data were extracted independently by two reviewers and cross-checked. Quantitative review results were synthesised narratively and presented in tabular format, while qualitative findings were compiled using the mega-aggregation framework synthesis method. RESULTS The evidence regarding the effectiveness of interventions on physical and mental health outcomes was inconclusive. Quantitative reviews were highly discordant, whereas qualitative reviews only reported practical, emotional and relational benefits. Multicomponent and person-centred interventions seemed to yield highest effectiveness and acceptability. Heterogeneity among caregivers, care receivers and care contexts was often overlooked. Important issues related to the low quality of evidence and futile overproduction of similar reviews were identified. CONCLUSIONS Lack of robust evidence calls for better intervention research and evaluation practices. It may be warranted to avoid one-size-fits-all approaches to intervention design. Primary care and other existing resources should be leveraged to support interventions, possibly with increasing contributions from the non-profit sector. PROSPERO REGISTRATION NUMBER CRD42021252841; BMJ Open: doi:10.1136/bmjopen-2021-053117.
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Affiliation(s)
- Mariam Kirvalidze
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden
| | - Ahmad Abbadi
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden
| | - Lena Dahlberg
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Lawrence B Sacco
- Stress Research Institute, Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Lucas Morin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
- Inserm CIC 1431, University Hospital of Besançon, Besançon, France
| | - Amaia Calderón-Larrañaga
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
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4
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Xiao L, Yu Y, Ratcliffe J, Milte R, Meyer C, Chapman M, Chen L, Ullah S, Kitson A, De Andrade AQ, Beattie E, Brodaty H, McKechnie S, Low LF, Nguyen TA, Whitehead C, Brijnath B, Sinclair R, Voss D. Creating 'Partnership in iSupport program' to optimise family carers' impact on dementia care: a randomised controlled trial protocol. BMC Health Serv Res 2022; 22:762. [PMID: 35689281 PMCID: PMC9185883 DOI: 10.1186/s12913-022-08148-2] [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: 05/12/2022] [Accepted: 06/01/2022] [Indexed: 12/03/2022] Open
Abstract
Background The majority of people with dementia are cared for by their family members. However, family carers are often unprepared for their caring roles, receiving less education and support compared with professional carers. The consequences are their reduced mental and physical health and wellbeing, and that of care recipients. This study protocol introduces the ‘Partnership in iSupport program’ that includes five interventional components: managing transitions, managing dementia progression, psychoeducation, carer support group and feedback on services. This health services research is built on family carer and dementia care service provider partnerships. The aims of the study are to evaluate the effectiveness, cost-effectiveness and family carers’ experiences in the program. Methods A multicentre randomised controlled trial will be conducted with family carers of people living with dementia from two tertiary hospitals and two community aged care providers across three Australian states. The estimated sample size is 185 family carers. They will be randomly assigned to either the intervention group or the usual care group. Outcomes are measurable improvements in quality of life for carers and people with dementia, caregiving self-efficacy, social support, dementia related symptoms, and health service use for carers and their care recipients. Data will be collected at three time points: baseline, 6 months and 12 months post-initiation of the intervention. Discussion This is the first large randomised controlled trial of a complex intervention on health and social care services with carers of people living with dementia in real-world practice across hospital and community aged care settings in three Australian states to ascertain the effectiveness, cost-effectiveness and carers’ experiences of the innovative program. We expect that this study will address gaps in supporting dementia carers in health and social care systems while generating new knowledge of the mechanisms of change in the systems. Findings will strengthen proactive health management for both people living with dementia and their carers by embedding, scaling up and sustaining the ‘Partnership in iSupport program’ in the health and social care systems. Trial registration The Australian New Zealand Clinical Trials Registry (ANZCTR). ACTRN12622000199718. Registered February 4th, 2022. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08148-2.
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Affiliation(s)
- Lily Xiao
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, 5042, Australia.
| | - Ying Yu
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, 5042, Australia
| | - Julie Ratcliffe
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, 5042, Australia
| | - Rachel Milte
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, 5042, Australia
| | - Claudia Meyer
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, 5042, Australia.,Bolton Clarke Research Institute, Melbourne, VIC, Australia.,Adjunct Research Fellow; Rehabilitation, Ageing and Independent Living Research Centre, Monash University, Melbourne, Australia.,Honorary Associate, Centre for Health Communication and Participation, La Trobe University, Melbourne, Australia
| | | | - Langduo Chen
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, 5042, Australia.,Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Shahid Ullah
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Alison Kitson
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, 5042, Australia
| | - Andre Queiroz De Andrade
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Medical Sciences, University of South Australia, Adelaide, Australia
| | - Elizabeth Beattie
- Queensland Dementia Training Study Centre, School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Sue McKechnie
- Community Services, Resthaven Incorporated, Wayville, South Australia, Australia
| | - Lee-Fay Low
- Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Tuan Anh Nguyen
- Social Gerontology Division, National Ageing Research Institute, Melbourne, Australia
| | - Craig Whitehead
- Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Bianca Brijnath
- Social Gerontology Division, National Ageing Research Institute, Melbourne, Australia.,School of Allied Health, Curtin University, Bentley, West Australia, Australia
| | - Ronald Sinclair
- Faculty of Sciences, University of Adelaide, Adelaide, Australia
| | - Diana Voss
- Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
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5
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Gridley K, Parker G. Specialist nursing case management support for carers of people with dementia: A qualitative study comparing experiences of carers with and without Admiral Nursing. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e668-e676. [PMID: 34028916 DOI: 10.1111/hsc.13437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/24/2021] [Accepted: 04/28/2021] [Indexed: 06/12/2023]
Abstract
Carers of people with dementia can experience reduced health and well-being, but little is known about how best to support them. There is some evidence to suggest that case management may improve outcomes for carers but less evidence about the features of case management services that can effectively support carers of people with dementia. Admiral Nursing operates a case management approach staffed by specialist nurses and is the only service of its kind in the United Kingdom dedicated to helping people with dementia and their carers. This paper reports qualitative findings from a mixed methods study of Admiral Nursing. For the qualitative strand of the project, data were collected in focus groups and in-depth interviews with carers of people with dementia (n = 35) and analysed thematically using the framework approach. The aim of this analysis was to understand differences between the experiences of the carers in our sample with and without Admiral Nursing, applying Freeman's model of continuity of care (Freeman et al., Continuity of care, 2000). Participants who had received Admiral Nursing were recruited from two geographical locations and carers without experience of this service were recruited from two different areas. We found that carers in our sample felt 'supported' in circumstances where they received an ongoing service from an Admiral Nurse or other professional with expertise in dementia who was able to develop a meaningful relationship with them over time. We conclude that ongoing support, expertise in dementia and a meaningful relationship are key features of relationship continuity common in carers' reports of feeling supported. Specialist nurses are well placed to provide this continuity.
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Affiliation(s)
- Kate Gridley
- Social Policy Research Unit, University of York, York, UK
| | - Gillian Parker
- Social Policy Research Unit, University of York, York, UK
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6
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Brooks D, Beattie E, Fielding E, Wyles K, Edwards H. Long-term care placement: The transitional support needs and preferences of spousal dementia caregivers. DEMENTIA 2021; 21:794-809. [PMID: 34870490 DOI: 10.1177/14713012211056461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVES Many spousal caregivers experience stress, depression, loneliness, guilt and grief when placing a partner with dementia into long-term care. However, there is little research about their transitional support experiences, needs and preferences. This study aimed to gain a deeper understanding of these issues from spousal caregiver and long-term care facility staff perspectives, to inform subsequent support and intervention development. RESEARCH DESIGN AND METHODS Semi-structured interviews and small group discussions were held separately with spousal caregivers (n = 9) and care facility staff (n = 11). Criterion and variation sampling aimed to ensure a range of experiences and perspectives. The 'Framework' approach was utilised for data analysis. Interpretation was with respect to underpinning models of stress-grief process in dementia caregiving. FINDINGS A range of informational, psychoeducational and psychosocial supports were identified to help spousal caregivers cope better with the stressors and losses experienced throughout the transition from home to long-term care. Improved education about disease progression, information relating to long-term care provision, peer support and dementia-specific grief counselling were deemed important. Opportunities for better support within care facilities were also identified. Support should be tailored to individual needs and preferences. DISCUSSION AND IMPLICATIONS The findings suggest a supportive care framework be developed, encompassing the trajectory from assessment for and admission into long-term care to end-of-life and post-bereavement support. Spousal caregivers should have their support needs assessed by trained health or social care professionals and be offered a range of support options as appropriate.
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Affiliation(s)
- Deborah Brooks
- Dementia Centre for Research Collaboration, 1969Queensland University of Technology, Brisbane, Queensland, Australia
| | - Elizabeth Beattie
- Dementia Centre for Research Collaboration, 1969Queensland University of Technology, Brisbane, Queensland, Australia
| | - Elaine Fielding
- Dementia Centre for Research Collaboration, 1969Queensland University of Technology, Brisbane, Queensland, Australia
| | - Katy Wyles
- Dementia Centre for Research Collaboration, 1969Queensland University of Technology, Brisbane, Queensland, Australia
| | - Helen Edwards
- Faculty of Health, 1969Queensland University of Technology, Brisbane, Queensland, Australia
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7
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Nielsen TR, Nielsen DS, Waldemar G. A personalized dementia care intervention for family carers from minority ethnic groups in Denmark: A pilot study. DEMENTIA 2021; 21:477-488. [PMID: 34605285 PMCID: PMC8811331 DOI: 10.1177/14713012211046597] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is a growing number of people with dementia in minority ethnic groups in Denmark. Support for the increasing number of family carers from minority ethnic groups is crucial, as caring for a relative with dementia may negatively affect the carer's health and quality of life. The aim of this study was to determine the feasibility of a personalized intervention for family carers from minority ethnic groups. The intervention was a modified version of a culturally sensitive case-management program developed in Australia which had been shown to improve carers' sense of competence in managing dementia and their mental well-being. METHODS A small pilot trial was used to examine the feasibility and preliminary efficacy of the intervention. Feasibility indicators included data on recruitment, retention, adherence, and fidelity. Acceptability and suitability of the intervention was explored in post-intervention interviews with family carers, and baseline and follow-up scores for outcome measures were examined. RESULTS Ten (30%) of 33 eligible family carers consented to participate in the study, but three were lost to follow-up and seven (70%) family carers completed the trial. Intervention fidelity, acceptance, and satisfaction were high. Results for outcome measures indicated that the intervention may improve family carers' sense of competence by helping them cope better with challenges relating to caring and managing dementia and improved their satisfaction with primary care services. CONCLUSIONS The results suggest that the intervention is feasible and worth exploring for family carers of people with dementia from minority ethnic groups in Denmark.
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Affiliation(s)
- T Rune Nielsen
- Danish Dementia Research Centre, Copenhagen University Hospital, 53146Rigshospitalet, Copenhagen, Denmark
| | - Dorthe S Nielsen
- Migrant Health Clinic, Odense University Hospital, Odense, Denmark.,Centre for Global Health, 6174University of Southern Denmark, Odense, Denmark.,Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
| | - Gunhild Waldemar
- Danish Dementia Research Centre, Copenhagen University Hospital, 53146Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Fekonja Z, Kmetec S, Novak B, McCormack B, Mlinar Reljić N. A qualitative study of family members' experiences of their loved one developing dementia and their subsequent placement in a nursing home. J Nurs Manag 2021; 29:1284-1292. [PMID: 33484604 DOI: 10.1111/jonm.13267] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/30/2020] [Accepted: 01/19/2021] [Indexed: 01/03/2023]
Abstract
AIM To investigate the family members' experiences with receiving help and support while their loved one develops dementia and their subsequent placement in nursing homes. BACKGROUND As the dementia disease progresses, some family members will struggle with the option of nursing home placement. This situation can precipitate feelings of anger, disappointment and guilt, all of which can be overwhelming. METHODS A qualitative descriptive study with in-depth interviews (n = 19) was carried out in several nursing homes of Slovenia's North Eastern Region. RESULTS Inductive thematic analysis identified two main themes: (i) developing the diagnosis and (ii) accommodation process. Family members noticed the progressive behavioural changes in their loved ones. While they were searching for help at the primary health care level, they experienced a lack of help and support. CONCLUSIONS When family members detect behavioural changes in their loved ones, the primary health care team should establish an early diagnosis of dementia and provide adequate decision-making support. IMPLICATIONS FOR NURSING MANAGEMENT The findings are useful to prepare guidance for a family member to inform them of the types of support available and from which associations and organisations. To achieve adequate management support, primary health care teams need to be aware of family member experiences.
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Affiliation(s)
- Zvonka Fekonja
- Faculty of Health Science, University of Maribor, Maribor, Slovenia
| | - Sergej Kmetec
- Faculty of Health Science, University of Maribor, Maribor, Slovenia
| | | | - Brendan McCormack
- Division of Nursing, Queen Margaret University Edinburgh, Edinburgh, UK
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9
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Cunningham N. Understanding the training and education needs of homecare workers supporting people with dementia and cancer: A systematic review of reviews. DEMENTIA 2020; 19:2780-2803. [PMID: 31271044 PMCID: PMC7925442 DOI: 10.1177/1471301219859781] [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] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Many people with dementia, supported by family carers, prefer to live at home and may rely on homecare support services. People with dementia are also often living with multimorbidities, including cancer. The main risk factor for both cancer and dementia is age and the number of people living with dementia and cancer likely to rise. Upskilling the social care workforce to facilitate more complex care is central to national workforce strategies and challenges. Training and education development must also respond to the key requirements of a homecare workforce experiencing financial, recruitment and retention difficulties. This systematic review of reviews provides an overview of dementia and cancer training and education accessible to the homecare workforce. Findings reveal there is a diverse range of training and education available, with mixed evidence of effectiveness. Key barriers and facilitators to effective training and education are identified in order to inform future training, education and learning development for the homecare workforce supporting people with dementia and cancer.
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10
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Satisfaction with Health Care Interventions among Community Dwelling People with Cognitive Disorders and Their Informal Caregivers-A Systematic Review. Healthcare (Basel) 2020; 8:healthcare8030240. [PMID: 32751259 PMCID: PMC7551121 DOI: 10.3390/healthcare8030240] [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: 06/29/2020] [Revised: 07/24/2020] [Accepted: 07/27/2020] [Indexed: 11/16/2022] Open
Abstract
Informal caregivers have a leading role when implementing health care services for people with cognitive disorders living at home. This study aims to examine the current evidence for interventions with dual satisfaction with health care services for people with cognitive disorders and their caregivers. Original papers with quantitative and mixed method designs were extracted from two databases, covering years 2009-2018. Thirty-five original papers reported on satisfaction with health care services. The International Classification of Health Interventions (ICHI) was used to classify the interventions. Most interventions had a home-based approach (80%). Reduction in caregiver depression was the outcome measure with the highest level of satisfaction. Interventions to reduce depression or increase cognitive performance in persons with cognitive disorders gave the least satisfaction. Satisfaction of both caregivers and persons with cognitive disorders increased their use of services. In the ICHI, nearly 50% of the interventions were classified as activities and participation. A limited number of interventions have a positive effect on satisfaction of both the persons with cognitive disorders and the caregiver. It is important to focus on interventions that will benefit both simultaneously. More research is needed with a clear definition of satisfaction and the use of the ICHI guidelines.
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Gibson C, Goeman D, Pond D. What is the role of the practice nurse in the care of people living with dementia, or cognitive impairment, and their support person(s)?: a systematic review. BMC FAMILY PRACTICE 2020; 21:141. [PMID: 32660419 PMCID: PMC7359614 DOI: 10.1186/s12875-020-01177-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 05/28/2020] [Indexed: 01/09/2023]
Abstract
Background The potential value of expanding the Practice Nurse role to include the recognition and management of dementia has been acknowledged. Practice Nurses are well-positioned to provide comprehensive dementia information and support so that people living with dementia are better equipped to self-manage their health and live well with dementia. The purpose of this review was to systematically examine published literature to identify existing and potential roles of Practice Nurse’s in the delivery of care to people affected by dementia and to describe the characteristics and effectiveness of nurse interventions in dementia models of care. Methods The PRISMA statement guided the systematic review of the quantitative and qualitative evidence for roles and characteristics of the Practice Nurse in the delivery of dementia care. A comprehensive literature search of seven electronic databases and Google scholar identified relevant original research published in English between January 2000 and January 2019. Thirteen articles met the inclusion criteria and were extracted into the Covidence software for analysis. Results The heterogeneity of the included studies purpose, design and outcomes measures and the diversity in health systems and primary care nurses scope of practice made it difficult to synthesise the findings and draw conclusions. The heterogeneity did, however, provide important insights into the characteristics of roles undertaken by nurses working in the general practice setting, which were potentially beneficial to people living with dementia and their support person. These included patient accessibility to the Practice Nurse, early recognition and management of cognitive changes, care management and collaboration with the General Practitioner. Limitations of the provision of dementia care by Practice Nurses included a lack of definition of the role, inadequate dementia specific training, time constraints and poor communication with General Practitioners. Conclusions Embedding an evidence-based model that describes the role of the Practice Nurse in dementia care provision has the potential to increase early recognition of cognitive impairment and more appropriate primary care management of dementia. Systematic review registration PROSPERO 2018 CRD42018088191.
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Affiliation(s)
- Caroline Gibson
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.
| | - Dianne Goeman
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Central Clinical School, Monash University; Kolling Institute, the University of Sydney, Sydney, Australia
| | - Dimity Pond
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
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12
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Abstract
PurposeThe Model for Dementia Palliative Care Project will develop a service-delivery model for community-based dementia palliative care. Many countries provide dementia palliative care services, albeit with considerable variability within these. However, little is known about what service providers consider to be the most important components of a dementia palliative care model. This study aimed to address this knowledge gap.Design/methodology/approachAn exploratory design using a survey method was used as an initial phase of the wider project. A web-based survey was developed, piloted (n = 5), revised, and distributed within five healthcare jurisdictions: the Republic of Ireland, Northern Ireland, England, Scotland, and Wales. The target population was health and social care professionals, policymakers, and academics interested in dementia and palliative care. Content analysis of open-ended questions identified common themes; descriptive statistics were applied to the closed-ended questions.FindingsOverall, N = 112 complete surveys were received. Key care principles incorporated the philosophies of palliative care and dementia care; many described “holistic” and “person-centred care” as the core. Important individual service components were the support for carers, advanced care planning, information, education and training, activities for “meaningful living”, comprehensive disease management, coordinated case management, and linking with community health services and social activities. Barriers included poor availability and organisation of healthcare services, stigma, misconceptions around dementia prognosis, insufficiently advanced care planning, and dementia-related challenges to care. Facilitators included education, carer support, and therapeutic relationships.Originality/valueThis study, as part of the larger project, will directly inform the development of a novel service delivery Model of Dementia Palliative Care for Ireland. The results can also inform service planning and design in other countries.
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13
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Bayer A. Next steps after diagnosing dementia: interventions to help patients and families. Pract Neurol 2020; 20:294-303. [PMID: 32444477 DOI: 10.1136/practneurol-2019-002416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2020] [Indexed: 11/03/2022]
Abstract
The way that a diagnosis of dementia is delivered to patients, what information is provided and what practical advice and support is arranged has a lasting impact and deserves at least as much attention as the process of assessment and investigation. Individuals and their families require an honest yet sensitive discussion about the nature and cause of their problems, using non-technical language and tailored to their priorities and needs. This should lead on to the provision of good-quality information in an accessible format. Priorities for intervention include medication review, attention to sensory deficits, appropriate pharmacological and nonpharmacological treatment, best use of memory aids and strategies and discussion of driving eligibility, financial entitlement and legal advice. Referral onwards should be made to an appropriate individual or service to provide ongoing emotional and practical support and signposting.
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Affiliation(s)
- Antony Bayer
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
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14
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Leslie M, Gray RP, Khayatzadeh-Mahani A. What is 'care quality' and can it be improved by information and communication technology? A typology of family caregivers' perspectives. Scand J Caring Sci 2020; 35:220-232. [PMID: 32168399 DOI: 10.1111/scs.12837] [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] [Received: 08/16/2019] [Accepted: 02/11/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION With governments worldwide reducing their involvement in the provision of institutional long-term elder care, community-based family caregivers (FCs) have become a key element in policies aimed at improving the quality of healthcare systems and maintaining their financial sustainability. This paper uses data from focus groups with FCs providing care to older adults to describe their approaches to and priorities for achieving care quality and sustainability as they work with formal health and social care systems. It describes FCs' views on information and communications technology (ICT) as potential supports for achieving these care quality and sustainability goals. METHODS We held 10 focus groups from May 2017 to August 2018 and recruited 25 FCs through a mix of convenience and snowball sampling strategies. We employed an inductive approach and used qualitative thematic content analysis methods to examine and interpret the resulting data. We used NVIVO 12 software for data analysis. RESULTS Quality of care - as delivered by both FCs themselves, and formal health and social care systems - was a major preoccupation for our participants. They saw communications quality as a key aspect of the broader concept of care quality. Our data analysis produced a typology of communications quality from the FC perspective. Analysis of our data also revealed ICT development opportunities and available products in key areas. CONCLUSIONS Our findings suggest that the formal care system providers could be more caregiver-oriented in their communications by engaging FCs in the decision-making process and allowing them to express their own concerns and goals. The implication of our findings for those seeking to develop policies and ICT products in support of FCs is that these should focus on human relationships and seek to expand facilitative communications.
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Affiliation(s)
- Myles Leslie
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,School of Public Policy, University of Calgary, Calgary, AB, Canada
| | | | - Akram Khayatzadeh-Mahani
- School of Public Policy, University of Calgary, Calgary, AB, Canada.,Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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15
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Goeman DP, Corlis M, Swaffer K, Jenner V, Thompson JF, Renehan E, Koch S. Partnering with people with dementia and their care partners, aged care service experts, policymakers and academics: A co-design process. Australas J Ageing 2020; 38 Suppl 2:53-58. [PMID: 31496067 DOI: 10.1111/ajag.12635] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 01/11/2019] [Accepted: 01/30/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe the co-design process in a project that "evaluated how the key worker role can best support people living with dementia in the community setting." METHODS People with dementia, care-partners, aged-care service experts, policymakers and academics utilised a co-design process to undertake a systematic literature review and a qualitative evaluation study. RESULTS The development of a successful co-design process that includes people living with dementia and their care-partners ("consumers") at all stages of the research process and addresses their individual needs. CONCLUSIONS The co-design approach utilised in this project provided support, for consumers living in the community to be fully involved in the research design, conduct and plans for dissemination and implementation of the findings. Consequently, the research outcomes are based on solid evidence and consumer need. Additionally, a successful model for supporting consumers to facilitate their involvement in all aspects of the research process, was developed.
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Affiliation(s)
- Dianne P Goeman
- CPDC Partnership Centre, University of Sydney, Sydney, New South Wales, Australia.,Department of Public Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Megan Corlis
- CPDC Partnership Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Kate Swaffer
- CPDC Partnership Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Valerie Jenner
- CPDC Partnership Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Jennifer F Thompson
- CPDC Partnership Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Emma Renehan
- CPDC Partnership Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Susan Koch
- CPDC Partnership Centre, University of Sydney, Sydney, New South Wales, Australia
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16
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Hopkinson JB, King A, Mullins J, Young L, Kumar S, Hydon K, Muthukrishnan S, Elliott F, Hopkinson M. What happens before, during and after crisis for someone with dementia living at home: A systematic review. DEMENTIA 2020; 20:570-612. [PMID: 32013558 DOI: 10.1177/1471301220901634] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND People living with dementia often experience crisis. Home treatment of crisis is an alternative to hospital admission that can have better outcomes. This systematic review is about people with dementia living at home and in crisis. It identifies modifiable factors in the crisis process that may facilitate crisis resolution. METHODS The protocol is registered on PROSPERO. A systematic search of MEDLINE, EMBASE, CINAHL, AHMED, PsycINFO, Cochrane Library and references of retrieved publications, identified empirical research in English language and date range January 2000 to February 2019. Two researchers independently screened abstracts, selected publications and extracted data using a framework based on published guidelines. This is a report of the analysis and narrative synthesis. RESULTS The search identified 2755 titles and abstracts, 76 were selected for full-text examination and 13 agreed for inclusion. The included studies evidence that: for a person with dementia, crisis is a process that begins with a problem judged to put them or others at risk of harm. It leads to decision and action to treat this risk, thus resolve the crisis. Such crisis can be predicted or unpredicted and progress quickly or slowly. Medical treatment, community resources and psychosocial support of personal resources, decision making, relationships and social networks, are all modifiable factors that can treat the risk of harm during crisis. Carers' and professionals' knowledge and skills in dementia care are likely to play a key role in crisis resolution in the home. CONCLUSION There has been limited investigation of the process and management of crisis at home for people living with dementia. The results of this review provide a foundation for future research. There is no consensus on critical components of home treatment to facilitate crisis resolution. However, education in dementia care for carers and professionals is likely to prove essential to successful home treatment.
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Affiliation(s)
| | | | - Jane Mullins
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Wales
| | | | - Sugandha Kumar
- Mental Health Services for Older People, Cardiff & Vale University Health Board, Wales
| | | | | | - Fiona Elliott
- Sparkle, Serennu Children's Centre, Aneurin Bevin University Health Board, Wales
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17
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Alves GS, Casali ME, Veras AB, Carrilho CG, Bruno Costa E, Rodrigues VM, Dourado MCN. A Systematic Review of Home-Setting Psychoeducation Interventions for Behavioral Changes in Dementia: Some Lessons for the COVID-19 Pandemic and Post-Pandemic Assistance. Front Psychiatry 2020; 11:577871. [PMID: 33132937 PMCID: PMC7550734 DOI: 10.3389/fpsyt.2020.577871] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/07/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Impacts of social isolation measures imposed by COVID-19 Pandemic on mental health and quality of life of older adults living with dementia and their caregivers remain unexplored. Studies have shown that psychoeducational and psychosocial interventions can manage behavioral and psychological symptoms in dementia (BPSD) and reduce the emotional burden on family members when applied in home-setting scenarios. METHOD a comprehensive systematic review of useful interventions for easing the BPSD burden in patients with dementia (PwD) and their caregivers in the context of COVID-19 quarantine was performed from January 2010 to March 2020. RESULTS From a total of 187 articles retrieved from electronic databases (MEDLINE, LILACS, Cochrane and SCOPUS), 43 studies were eligible for this review. Most of the psychosocial and psychoeducational interventions described were person-centered strategies based on the cognitive-behavioral approach or informational tools to enhance care providers' knowledge of dementia. Most studies achieved successful results in handling BPSD and mood-anxiety symptoms of care providers, contributing to an overall improvement in dyad life quality. CONCLUSION Evidence from the last few years suggest that low-cost techniques, tailored to the dyad well-being, with increasing use of technology through friendly online platforms and application robots, can be an alternative to conventional assistance during COVID-19 Pandemic. Nevertheless, the world's current experience regarding the duration of the COVID-19 Pandemic and its effects on the cognition, behavior, and life quality of PwD will demand research on preventive and protective factors of dementia and the pursue of efficient interventions in different scenarios.
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Affiliation(s)
- Gilberto Sousa Alves
- Translational Psychiatry Research Group, Federal University of Maranhão, São Luís, Brazil.,Post Graduation in Psychiatry and Mental Health (PROPSAM), Institute of Psychiatry, UFRJ, Rio de Janeiro, Brazil
| | | | | | | | - Eriko Bruno Costa
- Translational Psychiatry Research Group, Federal University of Maranhão, São Luís, Brazil
| | - Valeska Marinho Rodrigues
- Post Graduation in Psychiatry and Mental Health (PROPSAM), Institute of Psychiatry, UFRJ, Rio de Janeiro, Brazil.,Center for Alzheimer's Disease, Institute of Psychiatry, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Marcia Cristina Nascimento Dourado
- Post Graduation in Psychiatry and Mental Health (PROPSAM), Institute of Psychiatry, UFRJ, Rio de Janeiro, Brazil.,Center for Alzheimer's Disease, Institute of Psychiatry, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
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18
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Lord K, Beresford-Dent J, Rapaport P, Burton A, Leverton M, Walters K, Lang I, Downs M, Manthorpe J, Boex S, Jackson J, Ogden M, Cooper C. Developing the New Interventions for independence in Dementia Study (NIDUS) theoretical model for supporting people to live well with dementia at home for longer: a systematic review of theoretical models and Randomised Controlled Trial evidence. Soc Psychiatry Psychiatr Epidemiol 2020; 55:1-14. [PMID: 31679047 DOI: 10.1007/s00127-019-01784-w] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 10/09/2019] [Indexed: 01/14/2023]
Abstract
PURPOSE To build an evidence-informed theoretical model describing how to support people with dementia to live well or for longer at home. METHODS We searched electronic databases to August 2018 for papers meeting predetermined inclusion criteria in two reviews that informed our model. We scoped literature for theoretical models of how to enable people with dementia to live at home independently, with good life quality or for longer. We systematically reviewed Randomised Controlled Trials (RCTs) reporting psychosocial intervention effects on time lived with dementia at home. Two researchers independently rated risk of bias. We developed our theoretical model through discussions with experts by personal, clinical and academic experiences, informed by this evidence base. RESULTS Our scoping review included 52 studies. We divided models identified into: values and approaches (relational and recovery models; optimising environment and activities; family carer skills and support); care strategies (family carer-focused; needs and goal-based; self-management); and service models (case management; integrated; consumer-directed). The 11 RCTs included in our systematic review, all judged at low risk of bias, described only two interventions that increased time people with dementia lived in their own homes. These collectively encompassed all these components except for consumer-directed and integrated care. We developed and revised our model, using review evidence and expert consultation to define the final model. CONCLUSIONS Our theoretical model describes values, care strategies and service models that can be used in the design of interventions to enable people with dementia to live well and for longer at home. TRIAL REGISTRATION PROSPERO 2018 registration number: CRD42018099693 (scoping review). PROSPERO 2018 registration number: CRD42018099200 (RCT systematic review).
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Affiliation(s)
- Kathryn Lord
- Faculty of Health Studies, Centre for Applied Dementia Studies, Horton A Building, Richmond Road, Bradford, BD7 1DP, UK
| | - Jules Beresford-Dent
- Faculty of Health Studies, Centre for Applied Dementia Studies, Horton A Building, Richmond Road, Bradford, BD7 1DP, UK
| | - Penny Rapaport
- Division of Psychiatry, University College London, 6th Floor Maple House, Tottenham Court Road, London, W1T 7NF, UK
| | - Alex Burton
- Division of Psychiatry, University College London, 6th Floor Maple House, Tottenham Court Road, London, W1T 7NF, UK
| | - Monica Leverton
- Division of Psychiatry, University College London, 6th Floor Maple House, Tottenham Court Road, London, W1T 7NF, UK
| | - Kate Walters
- Department of Primary Care and Population Health, University College London, Rowland Hill Street, London, NW3 2PF, UK
| | - Iain Lang
- South Cloisters, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Murna Downs
- Faculty of Health Studies, Centre for Applied Dementia Studies, Horton A Building, Richmond Road, Bradford, BD7 1DP, UK
| | - Jill Manthorpe
- Social Care Workforce Research Unit, King's College London, London, WC2R 2LS, UK
| | - Sue Boex
- Alzheimer's Society Research Network Volunteer, London, UK
| | - Joy Jackson
- Alzheimer's Society Research Network Volunteer, London, UK
| | - Margaret Ogden
- Alzheimer's Society Research Network Volunteer, London, UK
| | - Claudia Cooper
- Division of Psychiatry, University College London, 6th Floor Maple House, Tottenham Court Road, London, W1T 7NF, UK.
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19
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Tjia J. A Telephone-Based Dementia Care Management Intervention-Finding the Time to Listen. JAMA Intern Med 2019; 179:1667-1668. [PMID: 31566650 DOI: 10.1001/jamainternmed.2019.4111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Jennifer Tjia
- University of Massachusetts Medical School, Worcester, Massachusetts
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20
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Sela-Katz P, Werner P. The Alzheimer's Disease Home Hospice Knowledge Scale: development, validity and reliability. Int J Palliat Nurs 2019; 24:108-114. [PMID: 29608380 DOI: 10.12968/ijpn.2018.24.3.108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Several instruments are available to assess knowledge about hospice care, but none specifically address knowledge about home hospice for persons with Alzheimer's disease (AD). AIM To develop and validate the Alzheimer's Disease Home Hospice Knowledge Scale (AD-HHK-S). METHODS A total of 107 Israeli family caregivers of persons with dementia (mean age=71.2; 73% female) participated in the study. RESULTS The AD-HHK-S included 28 true/false items assessing 3 areas of knowledge: knowledge about hospice, knowledge about home hospice, and knowledge about home hospice for AD. Good internal reliability was found, with Cronbach alpha ranging from 0.72 to 0.85. Good face, construct and predictive validity were found. CONCLUSIONS The AD-HHK-S proved to be a valid and reliable tool to assess knowledge about hospice care in the area of AD. It might provide an effective tool for palliative care nurses to communicate with family caregivers of persons with AD at the end of life.
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Affiliation(s)
- Pnina Sela-Katz
- Registered Nurse, Department of Gerontology, University of Haifa, Israel
| | - Perla Werner
- Department of Community Mental Health, University of Haifa, Israel
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21
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Guterman EL, Allen IE, Josephson SA, Merrilees JJ, Dulaney S, Chiong W, Lee K, Bonasera SJ, Miller BL, Possin KL. Association Between Caregiver Depression and Emergency Department Use Among Patients With Dementia. JAMA Neurol 2019; 76:1166-1173. [PMID: 31282955 DOI: 10.1001/jamaneurol.2019.1820] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance Current attempts to gauge the acute care needs of patients with dementia have not effectively addressed the role of caregivers, despite their extensive involvement in decisions about acute care management. Objective To determine whether caregiver depression is associated with increased use of the emergency department (ED) among patients with dementia. Design, Setting, and Participants This longitudinal cohort study used data from the Care Ecosystem study, a randomized clinical trial examining telephone-based supportive care for patients with dementia and their caregivers. Patients were 45 years or older with any type of dementia. A total of 780 caregiver-patient dyads were enrolled from March 20, 2015, until February 28, 2017, and 663 dyads contributed baseline and 6-month data and were included in the analysis. Exposures Caregiver depression (9-item Patient Health Questionnaire score of ≥10). Secondary analyses examined caregiver burden and self-efficacy. Main Outcomes and Measures The primary outcome was the number of ED visits in a 6-month period. Results Among the 663 caregivers (467 women and 196 men; mean [SD] age, 64.9 [11.8] years), 84 caregivers (12.7%) had depression at baseline. The mean incidence rate of ED visits was 0.9 per person-year. Rates of ED presentation were higher among dyads whose caregiver did vs did not have depression (1.5 vs 0.8 ED visits per person-year). In a Poisson regression model adjusting for patient age, sex, severity of dementia, number of comorbidities, and baseline ED use, as well as caregiver age and sex, caregiver depression continued to be associated with ED use, with a 73% increase in rates of ED use among dyads with caregivers with depression (adjusted incident rate ratio, 1.73; 95% CI, 1.30-2.30). Caregiver burden was associated with higher ED use in the unadjusted model, but this association did not reach statistical significance after adjustment (incident rate ratio, 1.19; 95% CI, 0.93-1.52). Caregiver self-efficacy was inversely proportional to the number of ED visits in the unadjusted and adjusted models (adjusted incident rate ratio, 0.96; 95% CI, 0.92-0.99). Conclusions and Relevance Among patients with dementia, caregiver depression appears to be significantly associated with increased ED use, revealing a key caregiver vulnerability, which, if addressed with patient- and caregiver-centered dementia care, could improve health outcomes and lower costs for this high-risk population.
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Affiliation(s)
- Elan L Guterman
- Department of Neurology, University of California, San Francisco.,Weill Institute for Neurosciences, University of California, San Francisco
| | - I Elaine Allen
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - S Andrew Josephson
- Department of Neurology, University of California, San Francisco.,Weill Institute for Neurosciences, University of California, San Francisco.,Editor, JAMA Neurology
| | - Jennifer J Merrilees
- Department of Neurology, University of California, San Francisco.,Weill Institute for Neurosciences, University of California, San Francisco
| | - Sarah Dulaney
- Department of Neurology, University of California, San Francisco.,Weill Institute for Neurosciences, University of California, San Francisco
| | - Winston Chiong
- Department of Neurology, University of California, San Francisco.,Weill Institute for Neurosciences, University of California, San Francisco
| | - Kirby Lee
- Department of Clinical Pharmacy, University of California, San Francisco
| | - Stephen J Bonasera
- Department of Geriatrics, Gerontology, and Palliative Medicine, University of Nebraska Medical Center, Omaha.,Department of Internal Medicine, University of Nebraska Medical Center, Omaha
| | - Bruce L Miller
- Department of Neurology, University of California, San Francisco.,Weill Institute for Neurosciences, University of California, San Francisco
| | - Katherine L Possin
- Department of Neurology, University of California, San Francisco.,Weill Institute for Neurosciences, University of California, San Francisco
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22
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Gridley K, Aspinal F, Parker G, Weatherly H, Faria R, Longo F, van den Berg B. Specialist nursing support for unpaid carers of people with dementia: a mixed-methods feasibility study. HEALTH SERVICES AND DELIVERY RESEARCH 2019. [DOI: 10.3310/hsdr07120] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Unpaid carers are the mainstay of support for people with dementia. Admiral Nursing (AN) is the only specialist nursing service that specifically focuses on supporting such carers, but evidence of its effectiveness, costs and relationships with other health and social care services is limited. This project aimed to address this gap and explore the feasibility of a full-scale formal evaluation.
Objectives
To explore the relationships between characteristics of carers and people with dementia, service type and input and outcomes; to develop and test data collection methods for subsequent economic evaluation; to explore the effect of AN on outcomes and costs, compared with usual care; to explore the perceived system-wide impact of specialist support for carers of people with dementia, compared with usual care; and to implement new data collection methods in AN, which could also be used by other services, to facilitate evaluation.
Design
A mixed-methods study, using secondary analysis of an administrative data set, and primary (cross-sectional) quantitative and qualitative data collection.
Setting
Qualitative research with carers in four areas of England; a survey of carers in 32 local authority areas (16 with and 16 without AN); and qualitative interviews with professionals in four areas.
Participants
Thirty-five carers of people with dementia and 20 professionals were interviewed qualitatively; 346 carers completed in-scope questionnaires (46% through AN services and 54% from matched non-AN areas).
Interventions
Specialist nursing support for carers of people with dementia (with AN as an exemplar) compared with usual care.
Main outcome measures
The Adult Social Care Outcomes Toolkit for Carers; the EuroQol-5 Dimensions, five-level version; and the Caregiver Self-Efficacy for Managing Dementia Scale.
Data sources
Dementia UK’s AN administrative data set.
Results
Admiral Nurses are successfully targeting the most complex cases. They work predominantly with older carers who have the main responsibility for the person with dementia, who are heavily involved in caring activity and who may be at risk. Three outcome areas that are important to carers of people with dementia and are potentially affected by receiving support are (1) carer self-efficacy, (2) carer quality of life (3) and carer mental and physical health. The carers in the survey receiving support from AN were older, were more heavily involved in caring and had poorer outcomes than carers not in receipt of such support. When these differences were controlled for, carers supported by AN had better outcomes, although the differences did not reach statistical significance. Health and social care costs were similar in both groups. The perceived system-wide impact of services, such as AN, is not well understood by professional stakeholders.
Limitations
Challenges were experienced in identifying similar carers in areas with or without an AN service and in the cross-sectional nature of the work.
Conclusions
Specialist nursing support to carers of people with dementia may enable them to continue providing care to the end or very close to the end of the dementia journey. The outcomes for such carers may be no different from, or even slightly better than, those of similar carers without this support, although the costs to health and social care services are the same in each case.
Future work
Future research could investigate the impact of specialist support for carers on admission to long-term care. There is also a need for more work to encourage routine use of the selected outcome measures in dementia service delivery.
Funding
The National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Kate Gridley
- Social Policy Research Unit, University of York, York, UK
| | - Fiona Aspinal
- Social Policy Research Unit, University of York, York, UK
| | - Gillian Parker
- Social Policy Research Unit, University of York, York, UK
| | | | - Rita Faria
- Centre for Health Economics, University of York, York, UK
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23
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Phillipson L, Johnson K, Cridland E, Hall D, Neville C, Fielding E, Hasan H. Knowledge, help-seeking and efficacy to find respite services: an exploratory study in help-seeking carers of people with dementia in the context of aged care reforms. BMC Geriatr 2019; 19:2. [PMID: 30616592 PMCID: PMC6322308 DOI: 10.1186/s12877-018-1009-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 12/10/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Research highlights the need for carers of people with dementia to acquire relevant and timely information to assist them to access appropriate respite services. Unfortunately, negative experiences of information-seeking can create additional stress for carers and contribute to delays in up-take, or not using respite services at all. METHODS Cross-sectional survey data was collected from a convenience sample of n = 84 carers of older people with dementia living in the Illawarra-Shoalhaven region of NSW, Australia. We assessed knowledge, attitudes, information seeking behaviours, and unmet need for respite services in 2016, following national aged care reforms. RESULTS Over the previous 12 months, 86% of carers sought respite service information. The majority (73%) of all carers reported an unmet need for respite services, and were relying on personal networks to provide support for respite information. Few utilised the new government gateway 'My Aged Care' phone line (11%) or website (25%). However, 35% used a pre-existing helpline to access short term or emergency respite. We found a preference for interpersonal information sources, including local doctor (65%), professionally and volunteer led carer support groups (49%), and family and friends (46%). Those using four or more information sources showed higher capacity to name local respite services. Respite service information seekers were more likely to be caring for someone with behavioural problems, to have received assistance to access services, and to have used respite services in the past 3 to 6 months. CONCLUSIONS New reforms in the Australian aged care sector have not adequately responded to the needs of carers of people with dementia for respite service information and support. Wider, community-based messaging promoting positive service options and the provision of active personal support is required to address the unmet need for respite in carers of people with dementia.
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Affiliation(s)
- L. Phillipson
- School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, Australia
- Australian Health Services Research Institute, University of Wollongong, Wollongong, Australia
| | - K. Johnson
- Australian Health Services Research Institute, University of Wollongong, Wollongong, Australia
| | - E. Cridland
- Australian Health Services Research Institute, University of Wollongong, Wollongong, Australia
| | - D. Hall
- Australian Health Services Research Institute, University of Wollongong, Wollongong, Australia
| | - C. Neville
- School of Nursing and Midwifery, Faculty of Health, Engineering and Sciences, University of Southern Queensland, Toowoomba, Australia
| | - E. Fielding
- Dementia Centre for Research Collaboration, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - H. Hasan
- Australian Health Services Research Institute, University of Wollongong, Wollongong, Australia
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24
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Stall NM, Kim SJ, Hardacre KA, Shah PS, Straus SE, Bronskill SE, Lix LM, Bell CM, Rochon PA. Association of Informal Caregiver Distress with Health Outcomes of Community‐Dwelling Dementia Care Recipients: A Systematic Review. J Am Geriatr Soc 2018; 67:609-617. [DOI: 10.1111/jgs.15690] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 10/09/2018] [Accepted: 10/17/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Nathan M. Stall
- Division of Geriatric Medicine, Department of Medicine University of Toronto Toronto Ontario Canada
- Institute of Health Policy, Management, and Evaluation University of Toronto Toronto Ontario Canada
- Women's College Research Institute Women's College Hospital Toronto Ontario Canada
| | - Sanghun J. Kim
- Women's College Research Institute Women's College Hospital Toronto Ontario Canada
| | - Kate A. Hardacre
- Women's College Research Institute Women's College Hospital Toronto Ontario Canada
| | - Prakesh S. Shah
- Institute of Health Policy, Management, and Evaluation University of Toronto Toronto Ontario Canada
- Department of Paediatrics University of Toronto Toronto Ontario Canada
| | - Sharon E. Straus
- Division of Geriatric Medicine, Department of Medicine University of Toronto Toronto Ontario Canada
- Institute of Health Policy, Management, and Evaluation University of Toronto Toronto Ontario Canada
- Knowledge Translation Program Li Ka Shing Knowledge Institute, St. Michael's Hospital Toronto Ontario Canada
| | - Susan E. Bronskill
- Institute of Health Policy, Management, and Evaluation University of Toronto Toronto Ontario Canada
- Women's College Research Institute Women's College Hospital Toronto Ontario Canada
- ICES Toronto Ontario Canada
| | - Lisa M. Lix
- Department of Community Health Sciences, Rady Faculty of Health Sciences University of Manitoba Winnipeg Manitoba Canada
| | - Chaim M. Bell
- Institute of Health Policy, Management, and Evaluation University of Toronto Toronto Ontario Canada
- ICES Toronto Ontario Canada
- Division of General Internal Medicine Sinai Health System Toronto Ontario Canada
- Department of Medicine University of Toronto Toronto Ontario Canada
| | - Paula A. Rochon
- Division of Geriatric Medicine, Department of Medicine University of Toronto Toronto Ontario Canada
- Institute of Health Policy, Management, and Evaluation University of Toronto Toronto Ontario Canada
- Women's College Research Institute Women's College Hospital Toronto Ontario Canada
- ICES Toronto Ontario Canada
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Dutton J, McCaskill K, Alton S, Levesley M, Hemingway C, Farndon L. Changing roles in community health care: Delegation of insulin injections to health care support workers. Br J Community Nurs 2018; 23:14-19. [PMID: 29281909 DOI: 10.12968/bjcn.2018.23.1.14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Diabetes is a common long-term condition affecting many people many of whom require support with their insulin injections at home. These injections are often carried out by community nurses if individuals are unable to self-manage their condition. This paper describes a pilot project where health care support workers were trained to administer insulin at home for suitable patients. Four patients took part in the pilot study and two support workers were trained to give the insulin injections. The project was evaluated well by all those who took part. It freed up 80 hours of nursing time while also providing the support workers with an extended scope of practice and associated increased in job satisfaction. No untoward medication errors were reported as a result of this initiative. This project will now be rolled out to the wider nursing teams with a staggered approach to the delivery of the training to ensure there is not a detrimental effect on patient care.
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Affiliation(s)
- Julie Dutton
- Integrated Care Team Nurse Lead, Combined Community and Acute Care Group, Sheffield Teaching Hospitals NHS Foundation Trust
| | - Kelly McCaskill
- ACP/Learning and Development Lead, Combined Community and Acute Care Group, Sheffield Teaching Hospitals NHS Foundation Trust
| | - Sarah Alton
- Head of Medicines Management, Combined Community and Acute Care Group, Sheffield Teaching Hospitals NHS Foundation Trust
| | - Maria Levesley
- Integrated Care Team Nurse Lead, Combined Community and Acute Care Group, Sheffield Teaching Hospitals NHS Foundation Trust
| | - Cath Hemingway
- Integrated Community Care Pathway Manager, Combined Community and Acute Care Group, Sheffield Teaching Hospitals NHS Foundation Trust
| | - Lisa Farndon
- Clinical Research Podiatrist/Research Lead, Combined Community and Acute Care Group, Sheffield Teaching Hospitals NHS Foundation Trust
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26
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The role of primary care in identification and ongoing management of dementia: a time of transition. Int Psychogeriatr 2017; 29:1409-1411. [PMID: 28701239 DOI: 10.1017/s1041610217001296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
In this edition of International Psychogeriatrics, Pertrazzuoli et al. (2017) address attitudes to dementia by primary care physicians (PCPs) across a range of European countries. The article focusses on diagnosis, screening instruments and drug treatment, and finds a wide range of approaches to the PCPs' role in referral for diagnosis and medication prescription. The findings include that PCPs who are allowed to prescribe dementia drugs, engage in higher levels of diagnostic work up, despite all the barriers to identification ably summarized in the paper. Perhaps, this heterogeneity is not random: it may be that roles and responsibilities for PCPs in relation to dementia are in transition.
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Dos Santos GD, Forlenza OV, Ladeira RB, Aprahamian I, Almeida JG, Lafer B, Nunes PV. Caregiver burden in older adults with bipolar disorder: relationship to functionality and neuropsychiatric symptoms. Psychogeriatrics 2017; 17:317-323. [PMID: 28130857 DOI: 10.1111/psyg.12241] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 09/04/2016] [Accepted: 11/21/2016] [Indexed: 01/18/2023]
Abstract
BACKGROUND There are few studies addressing caregivers of bipolar disorder (BD) patients, especially patients who are older adults with an increased need for care, often given by a relative. The aim of this study was to describe which factors increase caregiver burden among caregivers of elderly BD outpatients. METHODS Patients were older than 60 years and met the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, criteria for BD. They were evaluated for current mood, cognitive and other neuropsychiatric symptoms, functionality, medical comorbidities, quality of life, years since BD diagnosis, and number of psychiatric admissions. The caregiver who spent the greatest time with each patient was evaluated with the Zarit Caregiver Burden Interview. The caregivers' global health, mood symptoms, quality of life, and tasks performed for the patient were also assessed. RESULTS Thirty-six BD patients and their caregivers were assessed. The Zarit Caregiver Burden Interview was positively correlated with patients' neuropsychiatric symptoms (r = 0.508, P = 0.002) and functional impairment (r = 0.466, P = 0.004). The Zarit Caregiver Burden Interview was also correlated with caregivers' own depression (r = 0.576, P < 0.001), anxiety (r = 0.360, P = 0.031), quality of life (r = -0.406, P = 0.014), medical comorbidities (r = 0.387, P = 0.020), and number of tasks that they completed for the patient (r = 0.480, P = 0.003). CONCLUSIONS In this group of elderly BD patients, caregiver burden was more associated with symptoms frequently seen in others diseases as in dementia than with depressive, manic, or anxiety symptoms, which are often used as treatment outcomes measures goals in BD. Potential treatable and modifiable factors associated with caregiver burden could be caregivers' depression, anxiety, and medical comorbidities, as well as support for caregivers in terms of services and social relationships.
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Affiliation(s)
- Glenda D Dos Santos
- Faculty of Medicine, Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Orestes V Forlenza
- Faculty of Medicine, Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Rodolfo B Ladeira
- Faculty of Medicine, Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Ivan Aprahamian
- Faculty of Medicine, Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Jouce G Almeida
- Faculty of Medicine, Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Beny Lafer
- Faculty of Medicine, Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Paula V Nunes
- Faculty of Medicine, Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
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28
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Renehan E, Goeman D, Koch S. Development of an optimised key worker framework for people with dementia, their family and caring unit living in the community. BMC Health Serv Res 2017; 17:501. [PMID: 28728578 PMCID: PMC5520382 DOI: 10.1186/s12913-017-2448-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 07/13/2017] [Indexed: 11/17/2022] Open
Abstract
Background In Australia, dementia is a national health priority. With the rising number of people living with dementia and shortage of formal and informal carers predicted in the near future, developing approaches to coordinating services in quality-focused ways is considered an urgent priority. Key worker support models are one approach that have been used to assist people living with dementia and their caring unit coordinate services and navigate service systems; however, there is limited literature outlining comprehensive frameworks for the implementation of community dementia key worker roles in practice. In this paper an optimised key worker framework for people with dementia, their family and caring unit living in the community is developed and presented. Methods A number of processes were undertaken to inform the development of a co-designed optimised key worker framework: an expert working and reference group; a systematic review of the literature; and a qualitative evaluation of 14 dementia key worker models operating in Australia involving 14 interviews with organisation managers, 19 with key workers and 15 with people living with dementia and/or their caring unit. Data from the systematic review and evaluation of dementia key worker models were analysed by the researchers and the expert working and reference group using a constant comparative approach to define the essential components of the optimised framework. Results The developed framework consisted of four main components: overarching philosophies; organisational context; role definition; and key worker competencies. A number of more clearly defined sub-themes sat under each component. Reflected in the framework is the complexity of the dementia journey and the difficulty in trying to develop a ‘one size fits all’ approach. Conclusions This co-designed study led to the development of an evidence based framework which outlines a comprehensive synthesis of components viewed as being essential to the implementation of a dementia key worker model of care in the community. The framework was informed and endorsed by people living with dementia and their caring unit, key workers, managers, Australian industry experts, policy makers and researchers. An evaluation of its effectiveness and relevance for practice within the dementia care space is required. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2448-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Emma Renehan
- RDNS Institute, Royal District Nursing Service Ltd, 31 Alma Rd, St Kilda, Vic, 3182, Australia.
| | - Dianne Goeman
- RDNS Institute, Royal District Nursing Service Ltd, 31 Alma Rd, St Kilda, Vic, 3182, Australia.,Central Clinical School, Medicine, Nursing & Health Sciences, Monash University, Melbourne, Australia.,School of Medicine & Public Health, The University of Newcastle, Callaghan, Australia
| | - Susan Koch
- RDNS Institute, Royal District Nursing Service Ltd, 31 Alma Rd, St Kilda, Vic, 3182, Australia.,School of Medicine & Public Health, The University of Newcastle, Callaghan, Australia
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29
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Possin KL, Merrilees J, Bonasera SJ, Bernstein A, Chiong W, Lee K, Wilson L, Hooper SM, Dulaney S, Braley T, Laohavanich S, Feuer JE, Clark AM, Schaffer MW, Schenk AK, Heunis J, Ong P, Cook KM, Bowhay AD, Gearhart R, Chodos A, Naasan G, Bindman AB, Dohan D, Ritchie C, Miller BL. Development of an adaptive, personalized, and scalable dementia care program: Early findings from the Care Ecosystem. PLoS Med 2017; 14:e1002260. [PMID: 28323819 PMCID: PMC5360211 DOI: 10.1371/journal.pmed.1002260] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Katherine Possin and colleagues report on the implementation, development, and early findings of the Care Ecosystem, an adaptive, personalized, and scalable dementia care program.
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Affiliation(s)
- Katherine L. Possin
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, California, United States of America
- Global Brain Health Institute, University of California, San Francisco, San Francisco, California, United States of America
- * E-mail:
| | - Jennifer Merrilees
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, California, United States of America
| | - Stephen J. Bonasera
- Division of Geriatrics, Department of Internal Medicine, Home Instead Center for Successful Aging, Omaha, Nebraska, United States of America
| | - Alissa Bernstein
- Global Brain Health Institute, University of California, San Francisco, San Francisco, California, United States of America
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California, United States of America
| | - Winston Chiong
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, California, United States of America
| | - Kirby Lee
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, California, United States of America
| | - Leslie Wilson
- Department of Medicine and Clinical Pharmacy, University of California, San Francisco, San Francisco, California, United States of America
| | - Sarah M. Hooper
- UCSF/UC Consortium on Law, Science & Health Policy, UC Hastings College of the Law, San Francisco, California, United States of America
| | - Sarah Dulaney
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, California, United States of America
| | - Tamara Braley
- Division of Geriatrics, Department of Internal Medicine, Home Instead Center for Successful Aging, Omaha, Nebraska, United States of America
| | - Sutep Laohavanich
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, California, United States of America
| | - Julie E. Feuer
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, California, United States of America
| | - Amy M. Clark
- Division of Geriatrics, Department of Internal Medicine, Home Instead Center for Successful Aging, Omaha, Nebraska, United States of America
| | - Michael W. Schaffer
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, California, United States of America
| | - A. Katrin Schenk
- Department of Physics, Randolph College, Lynchburg, Virginia, United States of America
| | - Julia Heunis
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, California, United States of America
| | - Paulina Ong
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, California, United States of America
| | - Kristen M. Cook
- Department of Pharmacy Practice, College of Pharmacy, University of Nebraska Medical Center, Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Angela D. Bowhay
- Division of Geriatrics, Department of Internal Medicine, Home Instead Center for Successful Aging, Omaha, Nebraska, United States of America
| | - Rosalie Gearhart
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, California, United States of America
| | - Anna Chodos
- Division of General Internal Medicine, University of California, San Francisco/San Francisco General Hospital and Trauma Center, San Francisco, California, United States of America
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Georges Naasan
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, California, United States of America
| | - Andrew B. Bindman
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California, United States of America
- Division of General Internal Medicine, University of California, San Francisco/San Francisco General Hospital and Trauma Center, San Francisco, California, United States of America
| | - Daniel Dohan
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California, United States of America
| | - Christine Ritchie
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Bruce L. Miller
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, California, United States of America
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Goeman D, King J, Koch S. Development of a model of dementia support and pathway for culturally and linguistically diverse communities using co-creation and participatory action research. BMJ Open 2016; 6:e013064. [PMID: 27927662 PMCID: PMC5168626 DOI: 10.1136/bmjopen-2016-013064] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To develop an inclusive model of culturally sensitive support, using a specialist dementia nurse (SDN), to assist people with dementia from culturally and linguistically diverse (CALD) communities and their carers to overcome barriers to accessing health and social care services. DESIGN Co-creation and participatory action research, based on reflection, data collection, interaction and feedback from participants and stakeholders. SETTING An SDN support model embedded within a home nursing service in Melbourne, Australia was implemented between October 2013 and October 2015. PARTICIPANTS People experiencing memory loss or with a diagnosis of dementia from CALD backgrounds and their carers and family living in the community setting and expert stakeholders. DATA COLLECTION AND ANALYSIS Reflections from the SDN on interactions with participants and expert stakeholder opinion informed the CALD dementia support model and pathway. RESULTS Interaction with 62 people living with memory loss or dementia from CALD backgrounds, carers or family members receiving support from the SDN and feedback from 13 expert stakeholders from community aged-care services, consumer advocacy organisations and ethnic community group representatives informed the development and refinement of the CALD dementia model of care and pathway. We delineate the three components of the 'SDN' model: the organisational support; a description of the role; and the competencies needed. Additionally, we provide an accompanying pathway for use by health professionals delivering care to consumers with dementia from CALD backgrounds. CONCLUSIONS Our culturally sensitive model of dementia care and accompanying pathway allows for the tailoring of health and social support to assist people from CALD backgrounds, their carers and families to adjust to living with memory loss and remain living in the community as long as possible. The model and accompanying pathway also have the potential to be rolled out nationally for use by health professionals across a variety of health services.
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Affiliation(s)
- Dianne Goeman
- RDNS Institute, Royal District Nursing Service Ltd, St Kilda, Victoria, Australia
| | - Jordan King
- RDNS Institute, Royal District Nursing Service Ltd, St Kilda, Victoria, Australia
| | - Susan Koch
- RDNS Institute, Royal District Nursing Service Ltd, St Kilda, Victoria, Australia
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31
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Goeman D, Comans T, Enticott JC, Renehan E, Beattie E, Kurrle S, Koch S. Evaluating the Efficacy of the "Support for Life" Program for People with Dementia and Their Families and Carers' to Enable Them to Live Well: A Protocol for a Cluster Stepped Wedge Randomized Controlled Trial. Front Public Health 2016; 4:245. [PMID: 27843893 PMCID: PMC5086896 DOI: 10.3389/fpubh.2016.00245] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 10/18/2016] [Indexed: 11/13/2022] Open
Abstract
Introduction Assistance provided to support people living with dementia and carers is highly valued by them. However, current support systems in Australia are disjointed, inaccessible to all, poorly coordinated, and focus on dysfunction rather than ability. Support workers for people with dementia are in short supply, and there is little consistency in their roles. To address this large service gap and unmet need, we have developed an evidence-based optimized model of holistic support for people with dementia and their carers and families. This article describes the “Support for Life” model intervention. Methods A stepped wedge cluster randomized controlled trial will be conducted over 3 years across three Australian states. One hundred participants with dementia and/or their carers/family members will be randomly selected from community health center client lists in each state to receive either the dementia “Support for Life” intervention (Group A) or routine care (Group B). Group A participants will have access to the intervention from year 1. Group B participants will continue to receive usual care and will not be denied information on dementia or dementia services in year 1. In year 2, Group B participants will have access to the intervention. A highly trained expert dementia support worker will provide the “Support for Life” intervention, which is a flexible, individually tailored, holistic support that is relationship-centered, focused on enablement as opposed to dysfunction, and facilitate participants’ continued engagement in their community and the workforce. Additionally, dementia education, information resources, advocacy, and practical support to navigate and access dementia services and health care will be provided. The mode of support will include face to face, telephone, and internet interaction on an “as needed basis” for 12 months. The primary hypothesis is that the intervention will improve the quality of life of people with dementia and the health and well-being of carers/family through facilitating the continuation and enhancement of regular daily activities. Secondary hypotheses will examine other health and service usage outcomes. The outputs will also include a health economic analysis to investigate the costs (and savings) of any associated reduction in unnecessary health services use and delay in accessing permanent residential aged care. Trial registration number Australian and New Zealand Clinical Trials Registry: ACTRN12616000927426p.
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Affiliation(s)
- Dianne Goeman
- Royal District Nursing Service Ltd., RDNS Institute, St. Kilda, VIC, Australia; Faculty of Health and Medicine, The University of Newcastle, Newcastle, NSW, Australia
| | - Tracy Comans
- Metro North Hospital and Health Service District, Brisbane, QLD, Australia; Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia
| | | | - Emma Renehan
- Royal District Nursing Service Ltd., RDNS Institute , St. Kilda, VIC , Australia
| | - Elizabeth Beattie
- Dementia and Collaborative Research Centre (DCRC), School of Nursing, Queensland University of Technology , Brisbane, QLD , Australia
| | - Susan Kurrle
- NHMRC Cognitive Decline Partnership Centre (CDPC), Sydney Medical School - Northern, Hornsby Ku-ring-gai Hospital, The University of Sydney , Sydney, NSW , Australia
| | - Susan Koch
- Royal District Nursing Service Ltd., RDNS Institute , St. Kilda, VIC , Australia
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