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Weiner JD, Leff B, Ritchie CS. A Scoping Review of Dementia Interventions in Home-Based Primary Care. J Am Med Dir Assoc 2024; 25:105001. [PMID: 38663452 DOI: 10.1016/j.jamda.2024.03.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 02/29/2024] [Accepted: 03/18/2024] [Indexed: 07/01/2024]
Abstract
OBJECTIVES Home-based primary care (HBPC) provides interdisciplinary, longitudinal, comprehensive care at home to homebound older adults. The prevalence of dementia among HBPC recipients is approximately 50%. To date, little research has been performed to determine whether dementia-specific interventions have been conducted in HBPC or their efficacy. We performed a scoping review to assess the landscape of dementia interventions in HBPC. DESIGN Systematic scoping review. SETTING AND PARTICIPANTS Care delivery programs for patients or caregivers of patients with dementia for the purpose of improving the management of dementia in the setting of HBPC. METHODS The PRISMA-ScR protocol was followed. Literature searches were performed using PubMed, Embase, and Scopus for articles on dementia-focused interventions implemented in HBPC. Articles were excluded if they consisted of abstracts only, were not in English, or were not dementia interventions in HBPC. RESULTS A total of 1657 unique titles and abstracts were screened. Overall, 1584 titles and abstracts were excluded, resulting in 73 full-text studies to assess for eligibility. Of these 73 full-text studies, 1 study met criteria for inclusion, an observational study assessing the implementation of the Resources for Enhancing Alzheimer's Caregiver Health (REACH) intervention in Veterans Affairs HBPC. That study found the intervention to be effective in reducing caregiver burden, with a decrease of 2 hours on duty per day, trending toward significance. Among the excluded 72 full-text studies, some studies included potentially relevant interventions that could be translated into HBPC care, including dementia interventions that targeted long-term services and supports, office-based primary care and other nonhome settings such as nursing homes, and home-based palliative care. CONCLUSIONS AND IMPLICATIONS Despite high prevalence of dementia among homebound older adults receiving HBPC, there are a dearth of studies on HBPC-specific dementia interventions. Future studies should consider adapting and testing interventions found to be effective in other settings to HBPC.
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Affiliation(s)
- Jeffrey D Weiner
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Bruce Leff
- Division of Geriatric Medicine, Center for Transformative Geriatric Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christine S Ritchie
- Division of Palliative Care and Geriatric Medicine, Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Khemai C, Leão DLL, Janssen DJA, Schols JMGA, Meijers JMM. Interprofessional collaboration in palliative dementia care. J Interprof Care 2024; 38:675-694. [PMID: 38757957 DOI: 10.1080/13561820.2024.2345828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 04/16/2024] [Indexed: 05/18/2024]
Abstract
Interprofessional collaboration (IPC) is essential for high-quality palliative care (PC) for persons with dementia. The aim of this scoping review was to identify IPC approaches in palliative dementia care and explore the elements constituting these approaches. We performed a search in PubMed, CINAHL, and PsychINFO using the Joanna Briggs Institute Reviewers' manual and PRISMA guidelines, and conducted content analysis of the included articles. In total, 28 articles were included, which described 16 IPC approaches in palliative dementia care. The content analysis revealed three overall elements of these approaches: 1) collaborative themes, 2) collaborative processes, and 3) resources facilitating collaboration. Frequently reported collaborative themes embraced pain management and providing care in the dying phase. These themes were addressed through intertwined collaborative processes including communication, coordination, assessing and monitoring, and reflecting and evaluating. To ensure optimal IPC in palliative dementia care, various resources were required, such as PC knowledge, skills to manage symptoms, skills to communicate with collaborators, and a facilitating environment. In conclusion, the identified IPC approaches in palliative dementia care involve diverse collaborating professionals who mainly manage symptoms, prepare for the dying phase and require material and immaterial resources to enable optimal IPC in palliative dementia care.
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Affiliation(s)
- C Khemai
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
| | - D L L Leão
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
| | - D J A Janssen
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
- Department of Research and Development, Ciro, Horn, the Netherlands
| | - J M G A Schols
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
| | - J M M Meijers
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
- Zuyderland Care, Zuyderland Medical Centre, Sittard-Geleen, the Netherlands
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3
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Estrada LV, Barcelona V, Dhingra L, Luchsinger JA, Dick AW, Glance LG, Stone PW. Potentially Avoidable Hospitalizations Among Historically Marginalized Nursing Home Residents. JAMA Netw Open 2024; 7:e249312. [PMID: 38696169 PMCID: PMC11066698 DOI: 10.1001/jamanetworkopen.2024.9312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 03/04/2024] [Indexed: 05/04/2024] Open
Abstract
Importance Nursing home (NH) transfers to hospitals are common and have been associated with cognitive decline; approximately 45% of NH hospital transfers are potentially avoidable hospitalizations (PAHs). Objective To determine PAH incidence for historically marginalized NH residents with severe cognitive impairment compared with non-Hispanic White residents. Design, Setting, and Participants This cross-sectional study merged 2018 Centers for Medicaid & Medicare Services datasets and LTCFocus, a public dataset on US NH care, for US NH residents aged 65 years and older who had a hospitalization. Analyses were performed from January to May 2022. Exposure Race and ethnicity of NH residents. Main Outcomes and Measures Racial and ethnic differences in resident-level annual rates of PAHs were estimated for residents with and without severe cognitive impairment (measured using the Cognitive Function Scale), controlling for resident characteristics, comorbidities, dual eligibility, and time at risk. PAHs were defined as NH hospital transfers that resulted from neglectful NH care or for which NH treatment would have been appropriate. Results Of 2 098 385 NH residents nationwide included in the study, 7151 (0.3%) were American Indian or Alaska Native, 39 873 (1.9%) were Asian, 229 112 (10.9%) were Black or African American, 99 304 (4.7%) were Hispanic, 2785 (0.1%) were Native Hawaiian or Pacific Islander, 1 713 670 (81.7%) were White, and 6490 (0.3%) were multiracial; 1 355 143 (64.6%) were female; 128 997 (6.2%) were severely cognitively impaired; and the mean (SD) age was 81.8 (8.7) years. PAH incidence rate ratios (IRRs) were significantly greater for residents with severe cognitive impairment compared with those without. In unadjusted analyses comparing historically marginalized residents with severe cognitive impairment vs non-Hispanic White residents with severe cognitive impairment, American Indian or Alaska Native residents had a 49% higher PAH incidence (IRR, 1.49 [95% CI, 1.10-2.01]), Black or African American residents had a 64% higher incidence (IRR, 1.64 [95% CI, 1.48-1.81]), and Hispanic residents had a 45% higher incidence (IRR, 1.45 [95% CI, 1.29-1.62]). Higher incidences persisted for historically marginalized residents with severe cognitive impairment vs non-Hispanic White residents with severe cognitive impairment in adjusted analyses. Asian residents had a 24% higher PAH incidence (IRR, 1.24 [95% CI, 1.06-1.45]), Black or African American residents had a 48% higher incidence (IRR, 1.48 [95% CI, 1.36-1.60]), and Hispanic residents had a 27% higher incidence (IRR, 1.27 [95% CI, 1.16-1.39]). Conclusions and Relevance In this cross-sectional study of PAHs, compared with non-Hispanic White NH residents, historically marginalized residents had increased PAH incidence. In the presence of severe cognitive impairment, incidence rates increased significantly compared with rates for residents without severe cognitive impairment. These results suggest that identification of residents with severe cognitive impairment and proper NH care may help prevent further cognitive decline by avoiding PAHs.
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Affiliation(s)
- Leah V. Estrada
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Lara Dhingra
- MJHS Institute for Innovation in Palliative Care, New York, New York
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - José A. Luchsinger
- Departments of Medicine and Epidemiology, Columbia University Irving Medical Center
| | | | - Laurent G. Glance
- RAND Corporation, Boston, Massachusetts
- Department of Anesthesiology and Perioperative Medicine, University of Rochester Medical Center, Rochester, New York
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Punchik B, Kolushev-Ivshin I, Kagan E, Lerner E, Velikiy N, Marciano S, Freud T, Golan R, Cohn-Schwartz E, Press Y. The outcomes of treatment for homebound adults with complex medical conditions in a hospital-at-home unit in the southern district of Israel. Isr J Health Policy Res 2024; 13:8. [PMID: 38355553 PMCID: PMC10865532 DOI: 10.1186/s13584-024-00595-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 02/08/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND A model of hospital-at-home services called the Home Care Unit ("the unit") has been implemented in the southern region of the Clalit Healthcare Services in Israel. The aim of the present study was to characterize this service model. METHODS A retrospective cross-over study. included homebound patients 65 years of age and above who were treated for at least one month in the framework of the unit, between 2013 and 2020. We compared the hospitalization rate, the number of hospital days, the number of emergency room visits, and the cost of hospitalization for the six-month period prior to admission to the unit, the period of treatment in the unit, and the six-month period following discharge from the unit. RESULTS The study included 623 patients with a mean age of 83.7 ± 9.2 years with a mean Mini-mental State Examination (MMSE) score of 12.0 ± 10.2, a mean Charlson Comorbidity Index (CCI) of 3.7 ± 2.2 and a Barthel Index score of 23.9 ± 25.1. The main indications for admission to the unit were various geriatric syndromes (56.7%), acute functional decline (21.2%), and heart failure (12%). 22.8% died during the treatment period and 63.4% were discharged to ongoing treatment by their family doctor after their condition stabilized. Compared to the six months prior to admission to the unit there was a significant decrease (per patient per month) in the treatment period in the number of days of hospitalization (2.84 ± 4.35 vs. 1.7 ± 3.8 days, p < 0.001) and in the cost of hospitalization (1606 ± 2170 vs. 1066 ± 2082 USD, p < 0.001). CONCLUSIONS Treatment of homebound adults with a high disease burden in the setting of a hospital-at-home unit can significantly reduce the number of hospital days and the cost of hospitalization. This model of service for homebound patients with multiple medical problems maintained a high level of care while reducing costs. The results support the widespread adoption of this service in the community to enable the healthcare system to respond to the growing population of elderly patients with medical complexity.
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Affiliation(s)
- Boris Punchik
- Geriatric Unit, The Haim Doron Division of Community Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, PO Box 653, 84105, Beer-Sheva, Israel.
- Home Care Unit, Clalit Health Services, South District, Beer-Sheva, Israel.
- Siaal Research Center for Family Medicine and Primary Care, The Haim Doron Division of Community Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Ilona Kolushev-Ivshin
- Siaal Research Center for Family Medicine and Primary Care, The Haim Doron Division of Community Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Department of Epidemiology, Biostatistics and Community Health Science, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ella Kagan
- Geriatric Unit, The Haim Doron Division of Community Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, PO Box 653, 84105, Beer-Sheva, Israel
- Home Care Unit, Clalit Health Services, South District, Beer-Sheva, Israel
| | - Ella Lerner
- Geriatric Unit, The Haim Doron Division of Community Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, PO Box 653, 84105, Beer-Sheva, Israel
- Home Care Unit, Clalit Health Services, South District, Beer-Sheva, Israel
| | - Natalia Velikiy
- Home Care Unit, Clalit Health Services, South District, Beer-Sheva, Israel
- Department of Geriatrics, Soroka Medical Center, Beer-Sheva, Israel
| | - Suzann Marciano
- Home Care Unit, Clalit Health Services, South District, Beer-Sheva, Israel
| | - Tamar Freud
- Siaal Research Center for Family Medicine and Primary Care, The Haim Doron Division of Community Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Rachel Golan
- Department of Epidemiology, Biostatistics and Community Health Science, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ella Cohn-Schwartz
- Department of Epidemiology, Biostatistics and Community Health Science, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yan Press
- Geriatric Unit, The Haim Doron Division of Community Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, PO Box 653, 84105, Beer-Sheva, Israel
- Siaal Research Center for Family Medicine and Primary Care, The Haim Doron Division of Community Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Department of Geriatrics, Soroka Medical Center, Beer-Sheva, Israel
- Center for Multidisciplinary Research in Aging, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Alshakhs S, Park T, McDarby M, Reid MC, Czaja S, Adelman R, Sweet E, Jedlicka CM, Delgado D, Phongtankuel V. Interventions for Family Caregivers of Patients Receiving Palliative/Hospice Care at Home: A Scoping Review. J Palliat Med 2024; 27:112-127. [PMID: 37582194 PMCID: PMC10790551 DOI: 10.1089/jpm.2023.0160] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2023] [Indexed: 08/17/2023] Open
Abstract
There is a need for understanding the breadth of interventions for caregivers of individuals receiving hospice care at home, given the important role caregivers play in caring and the negative outcomes (e.g., depression) associated with their caregiving. Previous reviews were limited in scope to certain types of interventions or patient populations. The objective of this scoping review was to broadly examine the interventions targeting caregivers who provide care to terminally ill patients in home, with the purpose of (1) describing the characteristics of these interventions, (2) discussing key outcomes, limitations, and knowledge gaps, (3) highlighting intervention strengths, and (4) proposing future research directions. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Intervention studies that met the inclusion criteria and that were published up until October 2022 were obtained from the following databases: Ovid MEDLINE, Ovid EMBASE, CINAHL (EBSCO), and The Cochrane Library (Wiley). We analyzed 76 studies describing 55 unique interventions that took place in 14 countries. Interventions were largely delivered by nurses (n = 18, 24%), followed by an interdisciplinary team (n = 16, 21%), a health care provider (n = 10, 13%), research staff (n = 10, 13%), social worker (n = 5, 7%), and others (n = 11, 15%). Six interventions (8%) were self-administered. The most measured outcome was caregiver quality of life (n = 20, 26%), followed by anxiety (n = 18, 24%) and burden (n = 15, 20%). Missing data on patient and caregiver characteristics (i.e., age, gender) were common, and less than half of studies (n = 32, 42%) reported race/ethnicity data. Our review highlighted the current state of interventions for caregivers of patients receiving hospice care at home. Many of the interventions were in the early phases of development, raising the need for future studies to look at efficacy, effectiveness, and the ability to implement interventions in real-world settings.
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Affiliation(s)
| | | | - Meghan McDarby
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - M. Cary Reid
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Sara Czaja
- Center on Aging and Behavioral Research, Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
| | | | | | - Caroline M. Jedlicka
- Weill Cornell Medical College, New York, New York, USA
- Robert J. Kibbee Library, Kingsborough Community College, CUNY (City University of New York), New York, New York, USA
| | - Diana Delgado
- Samuel J. Wood Library and C.V. Starr Biomedical Information Center, Weill Cornell Medicine, New York, New York, USA
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Khemai C, Meijers JM, Bolt SR, Pieters S, Janssen DJA, Schols JMGA. I want to be seen as myself: needs and perspectives of persons with dementia concerning collaboration and a possible future move to the nursing home in palliative dementia care. Aging Ment Health 2023; 27:2410-2419. [PMID: 37354050 DOI: 10.1080/13607863.2023.2226079] [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] [Received: 08/08/2022] [Accepted: 05/11/2023] [Indexed: 06/26/2023]
Abstract
Introduction: Interprofessional collaboration (IPC) within and during movements between care settings is crucial for optimal palliative dementia care. The objective of this study was to explore the experiences of persons with dementia regarding collaboration with and between healthcare professionals (HCPs) and their perceptions of a possible future move to the nursing home (NH) in palliative dementia care. Method: We conducted a cross-sectional qualitative study and performed semi-structured interviews with a purposive sample of persons with dementia living at home (N = 18). Data analysis involved content analysis. Results: Our study demonstrated that even though most persons with dementia find it difficult to perceive the collaboration amongst HCPs, they could describe their perceived continuity of care (Theme 1. My perception of collaboration among HCPs). Their core needs in collaboration with HCPs were receiving information, support from informal caregivers, personal attention and tailored care (Theme 2. My needs in IPC). Regarding a possible future move to the NH, persons with dementia cope with their current decline, future decline and a possible future move to the NH (Theme 3. My coping strategies for a possible future move to the NH). They also prefer to choose the NH, and continue social life and activities in their future NH (Theme 4. My preferences when a NH becomes my possible future home). Conclusion: Persons with dementia are collaborative partners who could express their needs and preferences, if they are willing and able to communicate, in the collaboration with HCPs and a possible future move to the NH.
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Affiliation(s)
- Chandni Khemai
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Judith M Meijers
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
- Zuyderland Care, Zuyderland Medical Centre, Sittard-Geleen, the Netherlands
| | - Sascha R Bolt
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Sabine Pieters
- Zuyd University of Applied Sciences, Heerlen, the Netherlands
| | - Daisy J A Janssen
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
- Department of Research and Education, CIRO, Horn, The Netherlands
| | - Jos M G A Schols
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
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Fox S, Drennan J, Guerin S, Kernohan WG, Murphy A, O'Connor N, Rukundo A, Timmons S. A comparison of four dementia palliative care services using the RE-AIM framework. BMC Geriatr 2023; 23:677. [PMID: 37858076 PMCID: PMC10585827 DOI: 10.1186/s12877-023-04343-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/22/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Living with a life-limiting illness, people with dementia benefit from palliative care which considers the holistic needs of the person and their family. However, little is known about how palliative care may be best provided to people living with dementia at home in the community. We examined four exemplary dementia palliative care services for people with dementia in the community, to see what activities they were providing, what were the commonalities and differences, and what lessons could be learned. METHODS A long-list of dementia palliative care services in Ireland, Northern Ireland, England, Scotland, and Wales, was identified through a survey, and four exemplar services were chosen based on criteria including: in operation >six months; provides identifiable activities; availability of routinely collected service data; not exclusively for people with dementia in final hours or days of life. Mixed-methods of data collection included interviews, focus-groups and surveys with service staff, surveys of service users, and routinely collected service data. The RE-AIM framework was used to describe and understand the sample of dementia palliative care services. RESULTS The four services had varied organisational structures and were led by different disciplines. However, they all provided common core activities including holistic and person-centred care, early advance care planning with service user involvement, carer support, integrated healthcare services, continuity of care, 24/7 support, bereavement support. All had needs-based referral criteria, accepting any age or dementia sub-type. All supported people with dementia to remain living at home and to have a comfortable, dignified death in their preferred place. CONCLUSIONS An effective dementia palliative care service may take different forms. Whether the service is dementia-led or Specialist Palliative Care-led, efficacy is associated with providing a range of key activities and implementing them effectively. The data collected strongly suggests the benefits of the dementia palliative care services to a person with dementia and their families and offers valuable insight into the key factors for the establishment and successful running of such services.
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Affiliation(s)
- Siobhan Fox
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland.
| | - Jonathan Drennan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Suzanne Guerin
- School of Psychology, University College Dublin, Dublin, Ireland
| | - W George Kernohan
- Institute of Nursing and Health Research, County Antrim, Ulster University, Shore Road, Newtownabbey, Northern Ireland
| | - Aileen Murphy
- Department of Economics, University College Cork, Cork, Ireland
| | - Niamh O'Connor
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland
| | - Aphie Rukundo
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland
| | - Suzanne Timmons
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland
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8
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Timmons S, Fox S. Palliative care for people with dementia. HANDBOOK OF CLINICAL NEUROLOGY 2023; 191:81-105. [PMID: 36599517 DOI: 10.1016/b978-0-12-824535-4.00013-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Dementia is the most common neurologic disease, affecting approximately 55 million people worldwide. Dementia is a terminal illness, although not always recognized as such. This chapter discusses the key issues in providing palliative care for people with living with dementia and their families. Common palliative care needs and symptoms are presented, including psychosocial, physical, emotional, and spiritual, and the need to actively anticipate and seek symptoms according to the dementia type and stage is emphasized. Families are hugely impacted by a dementia diagnosis, and throughout this chapter, they are considered in the unit of care, and also as a member of the care team. Multiple challenges particular to dementia palliative care are highlighted throughout, such as the lack of timely dementia diagnoses, difficulty with symptom prognostication, the person's inability to verbally express their symptoms and care preferences, and a low threshold for medication side effects. Finally, service models for dementia palliative care in community, residential, and acute hospital settings are discussed, along with the evidence for each. Overall, this chapter reinforces that the individual needs of the person living with dementia and their family must be considered to provide person-centered and comprehensive palliative care, enabling them to live well until death.
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Affiliation(s)
- Suzanne Timmons
- Centre for Gerontology and Rehabilitation, School of Medicine, College of Medicine and Health, University College Cork, Cork, Ireland; Department of Geriatric Medicine, Mercy University Hospital & St. Finbarr's Hospital, Cork, Ireland.
| | - Siobhan Fox
- Centre for Gerontology and Rehabilitation, School of Medicine, College of Medicine and Health, University College Cork, Cork, Ireland
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Green G, Halevi Hochwald I, Radomyslsky Z, Nissanholtz-Gannot R. Family Caregiver's Depression, Confidence, Satisfaction, and Burden Regarding End-of-Life Home Care for People With End-Stage Dementia. OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221147961. [PMID: 36573833 DOI: 10.1177/00302228221147961] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
To detect differences between two care services units: regarding family-caregiver (FC) depression, perceived-burden and confidence in the provision of care to people with end-stage dementia (PWESD); examine predictors such as FC age, depression, confidence in the provision of care to PWESD and satisfaction with the community-home-care service to burden; and explore a mediation model.The participants were 139 FC, caring for PWESD living at home. The questionnaire was composed of FC background characteristics, perceived-burden, satisfaction with the community-home-care services, depression, and confidence in the provision of care to the PWESD. HCUs' FC felt significantly more burdened than HHUs' FC. Furthermore, satisfaction with the community-home-care services mediated the relationship between FC confidence in the provision of care to the PWESD and FC burden. The study results may affect the development of end-of-life care policies and services which meet the needs of PWESD and their FC.
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Affiliation(s)
- Gizell Green
- School of Nursing, Ariel University, Ariel, Israel
| | | | - Zorian Radomyslsky
- Maccabi Healthcare Services, Tel-Aviv, Israel
- School of Health Sciences, Ariel University, Ariel, Israel
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10
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O'Connor N, Fox S, Kernohan WG, Drennan J, Guerin S, Murphy A, Timmons S. A scoping review of the evidence for community-based dementia palliative care services and their related service activities. BMC Palliat Care 2022; 21:32. [PMID: 35264118 PMCID: PMC8905782 DOI: 10.1186/s12904-022-00922-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 02/16/2022] [Indexed: 11/15/2022] Open
Abstract
Background Palliative care is identified internationally as a priority for efficacious dementia care. Research into “effective models” of palliative care for people with dementia has been recommended by several European countries. To build an effective service-delivery model we must gain an understanding of existing models used in similar settings. The study aim is to identify core components of extant models of palliative care for people with dementia, and their families, who are living at home in the community. Methods A scoping review was employed. The search strategy was devised to identify all peer-reviewed research papers relating to the above aim. This process was iterative, and the search strategy was refined as evidence emerged and was reviewed. All types of study designs and both quantitative and qualitative studies of non-pharmacological interventions were considered for inclusion. Results The search identified 2,754 unique citations, of which 18 papers were deemed eligible for inclusion. Although a palliative care approach is recommended from early in the disease process, most evidence involves end-of-life care or advanced dementia and pertains to residential care. The majority of the research reviewed focused on the effects of advance care planning, and end-of-life care; specialist palliative care input, and/or generalist palliative care provided by dementia services to enable people to remain at home and to reduce costs of care. Community staff training in palliative care appeared to improve engagement with Specialist Palliative Care teams. Integration of dementia and palliative care services was found to improve care received for people with dementia and their carers. Conclusions While the evidence for integration of dementia and palliative care services is promising, further high-quality research is necessary particularly to identify the key components of palliative care for people living with dementia. This is imperative to enable people with dementia to inform their own care, to stay living at home for as long as possible, and, where appropriate, to die at home. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-022-00922-7.
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Affiliation(s)
- Niamh O'Connor
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland
| | - Siobhan Fox
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland. .,Centre for Gerontology and Rehabilitation, The Bungalow, St Finbarr's Hospital, Block 13, Douglas road, T12XH60, Cork, Republic of Ireland.
| | - W George Kernohan
- Institute of Nursing and Health Research, Ulster University, Newtownabbey, Northern Ireland
| | - Jonathan Drennan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Suzanne Guerin
- School of Psychology, University College Dublin, Dublin, Ireland
| | - Aileen Murphy
- Department of Economics, University College Cork, Cork, Ireland
| | - Suzanne Timmons
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland
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11
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Halevi Hochwald I, Arieli D, Radomyslsky Z, Danon Y, Nissanholtz-Gannot R. Emotion work and feeling rules: Coping strategies of family caregivers of people with end stage dementia in Israel-A qualitative study. DEMENTIA 2022; 21:1154-1172. [PMID: 35130758 PMCID: PMC9189436 DOI: 10.1177/14713012211069732] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background End stage dementia is an inevitable phase following a prolonged deterioration. Family
caregivers for people with end stage dementia who live in their home can experience an
emotional burden. Emotion work and “feeling-rules” refers to socially shared norms and
self-management of feelings, as well as projecting emotions appropriate for the
situation, aiming at achieving a positive environment as a resource for supporting
others’ wellbeing. Objectives Exploring and describing the experience of family caregivers of people with end stage
dementia at home, in Israel, unpacking their emotional coping and the
emotional-strategies they use, and placing family caregivers' emotion work in a cultural
context. Method We conducted fifty qualitative interviews using semi structured interviews analyzed
through a thematic content analysis approach. Findings Four characteristics of emotion work were identified: (1) sliding between detachment
and engagement, (2) separating the person from their condition (3), adoption of
caregiving as a social role and a type of social reinforcement, and (4) using the
caregiving role in coping with loneliness and emptiness. The emotional coping strategies
are culturally contextualized, since they are influenced by the participants’ cultural
background. Discussion This article’s focus is transparent family caregivers' emotion work, a topic which has
rarely been discussed in the literature is the context of caring for a family member
with dementia at home. In our study, emotion work appears as a twofold concept: the
emotion work by itself contributed to the burden, since family caregivers' burden
experience can evolve from the dissonance between their “true” feelings of anger and
frustration and their expected “acceptable” feelings (“feeling-rules”) formed by
cultural norms. However, emotion work was also a major source of coping and finding
strength and self-meaning. Understanding and recognizing the emotion work and the
cultural and religious influence in this coping mechanism can help professionals who
treat people with end stage dementia to better support family-caregivers.
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Affiliation(s)
- Inbal Halevi Hochwald
- Department of health systems management, Ariel University, Ariel, Israel; School of Nursing, Max Stern Yezreel Valley College, Israel
| | - Daniella Arieli
- School of Nursing, Max Stern Yezreel Valley, Israel; Department of Sociology and Anthropology, Max Stern Yezreel Valley College, Israel
| | - Zorian Radomyslsky
- Department of health systems management, Ariel University, Ariel, Israel; Maccabi Healthcare Services, Tel-Aviv, Israel
| | - Yehuda Danon
- Department of health systems management, 42732Ariel University, Ariel, Israel
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12
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Integration of a Palliative Approach in the Care of Older Adults with Dementia in Primary Care Settings: A Scoping Review. Can J Aging 2021; 41:404-420. [PMID: 34743774 DOI: 10.1017/s0714980821000349] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
A palliative approach to care aims to meet the needs of patients and caregivers throughout a chronic disease trajectory and can be delivered by non-palliative specialists. There is an important gap in understanding the perspectives and experiences of primary care providers on an integrated palliative approach in dementia care and the impact of existing programs and models to this end. To address these, we undertook a scoping review. We searched five databases; and used descriptive numerical summary and narrative synthesizing approaches for data analysis. We found that: (1) difficulty with prognostication and a lack of interdisciplinary and intersectoral collaboration are obstacles to using a palliative approach in primary care; and (2) a palliative approach results in statistically and clinically significant impacts on community-dwelling individuals, specifically those with later stages of dementia. There is a need for high-quality research studies examining the integrated palliative approach models and initiation of these models sooner in the care trajectory for persons living with mild and moderate stages of dementia in the community.
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13
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Hochwald IH, Yakov G, Radomyslsky Z, Danon Y, Nissanholtz-Gannot R. Ethical challenges in end-stage dementia: Perspectives of professionals and family care-givers. Nurs Ethics 2021; 28:1228-1243. [PMID: 34112013 PMCID: PMC8637375 DOI: 10.1177/0969733021999748] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND In Israel, caring for people with end-stage dementia confined to home is mainly done by home care units, and in some cases by home hospice units, an alternative palliative-care service. Because life expectancy is relatively unknown, and the patient's decision-making ability is poor, caring for this unique population raises ethical dilemmas regarding when to define the disease as having reached a terminal stage, as well as choosing between palliative and life-prolonging-oriented care. OBJECTIVES Exploring and describing differences and similarities of professional staff members' (PSMs') and family caregivers' perceptions of caring for people with end-stage dementia in two different settings. DESIGN Qualitative research, using semi-structured interviews analyzed through a thematic content-analysis approach. PARTICIPANTS Sixty-four interviews were conducted (24 PSMs and 40 family caregivers) in two care-settings-home hospice unit and home care unit. ETHICAL CONSIDERATIONS The study was approved by the Ethics Committee (BBL00118-17). FINDINGS We found dilemmas regarding palliative care to be the main theme, including definition of the disease as terminal, choosing "comfort" over "life-prolonging," clarifying patients' wishes and deciding whether or not to use artificial feeding. DISCUSSION Both PSMs and family caregivers deal with ethical dilemmas and have reached different conclusions, both legitimate. Comprehending dementia as a terminal disease influenced participants' perceptions of the relevancy of palliative care for people with end-stage dementia. Discrepancies between PSMs and family caregivers in caring for people with end-stage dementia were found in both home hospice unit and home care unit environments, raising potential conflicts regarding decisions for end-of-life care. CONCLUSIONS Communication between PSMs and family caregivers is crucial for the discussion about the discrepancies regarding the unique dilemmas of caring for people with end-stage dementia and bridging the gap between them. Lack of communication and resources can hamper the provision of an acceptable solution for quality and equality of care in the best interest of people with end-stage dementia.
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Affiliation(s)
| | - Gila Yakov
- Max Stern Yezreel Valley College, Israel
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14
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Jaul E, Meiron O. Advanced Dementia: Brain-State Characteristics and Clinical Indicators of Early Mortality. J Alzheimers Dis 2021; 81:933-941. [PMID: 33843676 DOI: 10.3233/jad-201563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There is an urgent need in advanced dementia for evidence-based clinical prognostic predictors that could positively influence ethical decisions allowing health provider and family preparation for early mortality. Accordingly, the authors review and discuss the prognostic utility of clinical assessments and objective measures of pathological brain states in advanced dementia patients associated with accelerated mortality. Overall, due to the paucity of brain-activity and clinical-comorbidity predictors of survival in advanced dementia, authors outline the potential prognostic value of brain-state electroencephalography (EEG) measures and reliable clinical indicators for forecasting early mortality in advanced dementia patients. In conclusion, two consistent risk-factors for predicting accelerated mortality in terminal-stage patients with advanced dementia were identified: pressure ulcers and paroxysmal slow-wave EEG parameters associated with cognitive impairment severity and organic disease progression. In parallel, immobility, malnutrition, and co-morbid systemic diseases are highly associated with the risk for early mortality in advanced dementia patients. Importantly, the authors' conclusions suggest utilizing reliable quantitative-parameters of disease progression for estimating accelerated mortality in dementia patients entering the terminal disease-stages characterized by severe intellectual deficits and functional disability.
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Affiliation(s)
- Efraim Jaul
- Geriatric Skilled Nursing Department, Herzog Medical Center, Hebrew University, Jerusalem, Israel
| | - Oded Meiron
- Clinical Research Center for Brain Sciences, Herzog Medical Center, Jerusalem, Israel
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15
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Sternberg SA, Shinan-Altman S, Volicer L, Casarett DJ, van der Steen JT. Palliative Care in Advanced Dementia: Comparison of Strategies in Three Countries. Geriatrics (Basel) 2021; 6:44. [PMID: 33922208 PMCID: PMC8167764 DOI: 10.3390/geriatrics6020044] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/09/2021] [Accepted: 04/16/2021] [Indexed: 11/18/2022] Open
Abstract
Palliative care including hospice care is appropriate for advanced dementia, but policy initiatives and implementation have lagged, while treatment may vary. We compare care for people with advanced dementia in the United States (US), The Netherlands, and Israel. We conducted a narrative literature review and expert physician consultation around a case scenario focusing on three domains in the care of people with advanced dementia: (1) place of residence, (2) access to palliative care, and (3) treatment. We found that most people with advanced dementia live in nursing homes in the US and The Netherlands, and in the community in Israel. Access to specialist palliative and hospice care is improving in the US but is limited in The Netherlands and Israel. The two data sources consistently showed that treatment varies considerably between countries with, for example, artificial nutrition and hydration differing by state in the US, strongly discouraged in The Netherlands, and widely used in Israel. We conclude that care in each country has positive elements: hospice availability in the US, the general palliative approach in The Netherlands, and home care in Israel. National Dementia Plans should include policy regarding palliative care, and public and professional awareness must be increased.
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Affiliation(s)
| | - Shiri Shinan-Altman
- The Louis and Gabi Weisfeld School of Social Work, Faculty of Social Sciences, Bar Ilan University, Ramat Gan 5290002, Israel;
| | - Ladislav Volicer
- School of Aging Studies, University of South Florida, Tampa, FL 33620, USA;
- Third Faculty of Medicine, Charles University, 100 00 Prague, Czech Republic
| | | | - Jenny T. van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands
- Department of Primary and Community Care, Radboud university medical center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
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16
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Halevi Hochwald I, Radomyslsky Z, Danon Y, Nissanholtz-Gannot R. Challenges in home care at the end stage of dementia: Hospice units vs. home care units. A qualitative study. DEATH STUDIES 2020; 46:1667-1677. [PMID: 33040716 DOI: 10.1080/07481187.2020.1829748] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Home hospice units specializing in palliative end-of-life care are uncommon despite the theoretical benefit for people with end stage dementia (PWESD). We described the challenges of caring for PWESD and their families using 24 semi-structured in-depth interviews with professional staff members from two care settings-home hospice units and home care units-in Israel. Staff described end-of-life care for PWESD in four sub-themes: dementia as an end-stage disease; appropriateness of palliative care for PWESD; a family member at the center of care; and "dying-in-place" versus hospitalization. Our findings may enable better services and quality of care for PWESD living at home.
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Affiliation(s)
- Inbal Halevi Hochwald
- School of Nursing, Max Stern Yezreel Valley College, Emek Yezreel, Israel
- School of Health Sciences, Ariel University, Ariel, Israel
| | | | - Yehuda Danon
- School of Health Sciences, Ariel University, Ariel, Israel
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17
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Harrison J, Mor V, Mitchell S, McCarthy EP. Reflections on the IJHPR's article collection on dementia. Isr J Health Policy Res 2020; 9:50. [PMID: 33023673 PMCID: PMC7537951 DOI: 10.1186/s13584-020-00411-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 09/30/2020] [Indexed: 11/10/2022] Open
Abstract
Alzheimer's disease and Alzheimer's disease-related dementias (AD/ADRD) constitute a worldwide public health crisis. In light of the AD/ADRD epidemic now existing within the global COVID-19 pandemic, the need for global action to improve dementia care is greater than ever. The article collection "Dementia- an Interdisciplinary Approach," in the Israeli Journal of Health Policy and Research (IJHPR) highlights the need for interprofessional approaches to improving outcomes for people living with dementia and their care partners, as well as the complexities of conducting dementia care research.
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Affiliation(s)
- Jill Harrison
- Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Box G-S121 (6), Providence, RI, 02912, USA.
| | - Vincent Mor
- Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Box G-S121 (6), Providence, RI, 02912, USA
- Providence Veterans Administration Medical Center, Center of Innovation in Health Services Research and Development Service, Providence, RI, USA
| | - Susan Mitchell
- Hebrew SeniorLife Hinda and Arthur Marcus Institute for Aging Research, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Department of Medicine, Boston, MA, USA
| | - Ellen P McCarthy
- Hebrew SeniorLife Hinda and Arthur Marcus Institute for Aging Research, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Department of Medicine, Boston, MA, USA
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18
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Quinn KL, Grossman DL. At the crossroads of religion and palliative care in patients with dementia. Isr J Health Policy Res 2020; 9:43. [PMID: 32831132 PMCID: PMC7446053 DOI: 10.1186/s13584-020-00401-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 08/19/2020] [Indexed: 11/10/2022] Open
Abstract
The timing of palliative care initiation may be more appropriately directed using a needs-based approach, instead of a prognostically driven one. Jewish Law or Halachah (“the way”) upholds a strong commitment to the sanctity of life and teaches that the duty to prolong life supersedes the duty to end suffering prematurely, unless one is expected to imminently die. This intersection of palliative care and a reliance on prognostic triggers with an individual’s observance of religious traditions complicates matters nearing the end-of-life. A recent pilot study by Sternberg et al. of 20 patients with advanced dementia in Israel found that home hospice care significantly reduced distressing symptoms, caregiver burden and hospitalization and teaches us important lessons about some of the essential elements to providing excellent palliative care at home, including the 24/7 availability of healthcare providers outside of the emergency department. In light of specific religious practices, palliative care should strive to incorporate a patient’s specific religious observance as part of high-quality end-of-life care.
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Affiliation(s)
- Kieran L Quinn
- Department of Medicine, Divisions of General Internal Medicine and Palliative Care, University of Toronto, Toronto, Canada. .,Department of Medicine, Sinai Health System and University Health Network, 60 Murray Street, 2nd Floor Room 404, Toronto, Ontario, M5T 3L9, Canada. .,Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Canada.
| | - Daphna L Grossman
- Department of Family and Community Medicine, North York General Hospital, Toronto, Canada.,Department of Family and Community Medicine, Division of Palliative Care, University of Toronto, Toronto, Canada
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19
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Sternberg SA, Sabar R, Katz G, Segal R, Fux-Zach L, Grofman V, Roth G, Cohen N, Radomyslaski Z, Bentur N. Correction to: home hospice for older people with advanced dementia: a pilot project. Isr J Health Policy Res 2019; 8:56. [PMID: 31262354 PMCID: PMC6600898 DOI: 10.1186/s13584-019-0329-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 06/17/2019] [Indexed: 11/10/2022] Open
Affiliation(s)
- Shelley A Sternberg
- Israel Ministry of Health, Division of Geriatrics, 39 Yirmiyahu St, Jerusalem, Israel.
| | - Ron Sabar
- Sabar Health, Home Hospital and Hospice, Jerusalem, Israel
| | - Glynis Katz
- Sabar Health, Home Hospital and Hospice, Jerusalem, Israel
| | - Ronit Segal
- Maccabi Healthcare Services, Tel Aviv, Israel
| | | | - Valeria Grofman
- EMDA - the Alzheimer's Association of Israel, Jerusalem, Israel
| | - Gery Roth
- EMDA - the Alzheimer's Association of Israel, Jerusalem, Israel
| | - Netta Cohen
- JDC-ESHEL - the Association for the Planning and Development of Services for the Aged, Jerusalem, Israel
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