1
|
Areia M, Dias LP, Matos P, Figueiredo D, Neves AL, da Costa ED, Loureiro CC, Boechat JL, Reis AB, Simões P, Taborda‐Barata L, Fonseca JA, Sá‐Sousa A, Jácome C. Public involvement in chronic respiratory diseases research: A qualitative study of patients', carers' and citizens' perspectives. Health Expect 2024; 27:e13917. [PMID: 38375962 PMCID: PMC10768873 DOI: 10.1111/hex.13917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 09/06/2023] [Accepted: 11/06/2023] [Indexed: 02/21/2024] Open
Abstract
INTRODUCTION Patient and public involvement (PPI) initiatives involving patients with chronic respiratory disease (CRD) are rare. Therefore, this study aimed to explore the perspectives of patients with CRD, carers and interested citizens regarding the relevance and need for a PPI network and suggestions for its implementation. METHODS A qualitative study based on focus groups was conducted. Recruitment occurred through invitations on social media platforms and to patients who have participated in previous asthma studies of the team. Three focus groups were conducted, via video conference, using a semi-structured guide. Thematic analysis was performed by two independent researchers and discussed with the extended team. RESULTS Fifteen patients with CRD, one carer and one interested citizen (13 females, median 36 (range: 18-72) years) participated. All participants acknowledged the importance of implementing a collaborative network and demonstrated interest in being integrated. Participants acknowledged the importance of their involvement in several phases of the research cycle. The main aim identified for this network was to facilitate communication between patients and researchers. Participants regarded the integration of patients, carers, researchers and healthcare professionals from different scientific areas as relevant. The use of digital platforms to attract members and support the work, together with group dynamics and regular meetings, were some of the most relevant practical considerations for implementing the network. The identified facilitators for their engagement were sharing experiences, researchers' and healthcare professionals' support and feedback and schedule flexibility. The identified barriers included the amount of time dedicated, low health/digital literacy and the potential detachment of nondiagnosed patients or those with low symptom impact in daily life. CONCLUSION Patients, carers and citizens acknowledged the relevance of implementing a collaborative network and demonstrated interest in active participation in every stage of the health research cycle. A deeper knowledge of the barriers and facilitators identified in this study could support implementing these initiatives in Portugal. PATIENT OR PUBLIC CONTRIBUTION This study was designed by a research team that included one patient with asthma and one carer. They were specifically involved in building the study protocol and the interview guide. They also gave feedback regarding the electronic consent form and the short sociodemographic questionnaire created, namely by removing noncontributing words or phrases and rewording expressions. The lay summary was written by another patient with asthma. All participants of this study were invited to implement and integrate the ConectAR network-a collaborative network of research in respiratory health. PUBLIC SUMMARY In Portugal, chronic respiratory patients do not have an active role as 'coinvestigators'. This study aimed to acknowledge if patients and citizens considered a patient and public involvement network useful, whose main purpose would be to facilitate communication between patients and researchers. A study based on online group interviews was carried out with patients with chronic respiratory diseases and interested citizens, both recruited on social media platforms. Participants considered that bringing together patients, carers, researchers and healthcare professionals is valuable because sharing different experiences and perspectives may help patients to improve their daily lives and increase research quality. In conclusion, patients agree that implementing a collaborative network with researchers and healthcare professionals and participating in the health research cycle is quite preponderant. Acknowledging what can help and deter this network may be beneficial to implementing this type of initiative in Portugal.
Collapse
Affiliation(s)
- Margarida Areia
- Allergy and Clinical Immunology UnitCentro Hospitalar Vila Nova de Gaia/EspinhoVila Nova de GaiaPortugal
| | - Liliana P. Dias
- Allergy and Clinical Immunology UnitCentro Hospitalar Vila Nova de Gaia/EspinhoVila Nova de GaiaPortugal
| | - Paula Matos
- CINTESIS@RISE, Health Research Network, Faculty of MedicineUniversity of PortoPortoPortugal
| | - Daniela Figueiredo
- CINTESIS@RISE, School of Health SciencesUniversity of AveiroAveiroPortugal
| | - Ana L. Neves
- CINTESIS@RISE, Health Research Network, Faculty of MedicineUniversity of PortoPortoPortugal
- MEDCIDS–Department of Community Medicine, Information and Health Decision SciencesFaculty of Medicine, University of PortoPortoPortugal
- Department of Primary Care and Public HealthImperial College LondonLondonUK
| | | | - Cláudia C. Loureiro
- Pneumology UnitHospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de CoimbraCoimbraPortugal
| | - José L. Boechat
- CINTESIS@RISE, Health Research Network, Faculty of MedicineUniversity of PortoPortoPortugal
- Department of PathologyBasic and Clinical Immunology, Faculty of Medicine of the University of PortoPortoPortugal
- Allergy UnitInstituto CUF Porto e Hospital CUF PortoPortoPortugal
| | - António B. Reis
- Utopia Academy, Utopia, Innovation on Digital Media LabUniversidad Carlos III de MadridMadridSpain
| | - Pedro Simões
- CICS‐UBI Health Sciences Research Centre, CACB‐Clinical Academic Centre of BeirasUniversity of Beira InteriorCovilhãPortugal
- UBIAir—Clinical and Experimental Lung Centre, CACB‐Clinical Academic Centre of BeirasUniversity of Beira InteriorCovilhãPortugal
- UCSP Fundão, ACeS Cova da BeiraCovilhãPortugal
| | - Luís Taborda‐Barata
- CICS‐UBI Health Sciences Research Centre, CACB‐Clinical Academic Centre of BeirasUniversity of Beira InteriorCovilhãPortugal
- UBIAir—Clinical and Experimental Lung Centre, CACB‐Clinical Academic Centre of BeirasUniversity of Beira InteriorCovilhãPortugal
- Department of ImmunoallergologyCovada Beira University Hospital Centre, CACB‐Clinical Academic Centre of BeirasCovilhãPortugal
| | - João A. Fonseca
- CINTESIS@RISE, Health Research Network, Faculty of MedicineUniversity of PortoPortoPortugal
- MEDCIDS–Department of Community Medicine, Information and Health Decision SciencesFaculty of Medicine, University of PortoPortoPortugal
- Allergy UnitInstituto CUF Porto e Hospital CUF PortoPortoPortugal
| | - Ana Sá‐Sousa
- CINTESIS@RISE, Health Research Network, Faculty of MedicineUniversity of PortoPortoPortugal
- MEDCIDS–Department of Community Medicine, Information and Health Decision SciencesFaculty of Medicine, University of PortoPortoPortugal
| | - Cristina Jácome
- CINTESIS@RISE, Health Research Network, Faculty of MedicineUniversity of PortoPortoPortugal
- MEDCIDS–Department of Community Medicine, Information and Health Decision SciencesFaculty of Medicine, University of PortoPortoPortugal
| |
Collapse
|
2
|
Abstract
BACKGROUND AND OBJECTIVES People living with dementia have historically been excluded from qualitative research and their voices ignored due to the perception that a person with dementia is not able to express their opinions, preferences and feelings. Research institutions and organizations have contributed by adopting a paternalistic posture of overprotection. Furthermore, traditional research methods have proven to be exclusionary towards this group. The objective of this paper is to address the issue of inclusion of people with dementia in research and provide an evidence-based framework for dementia researchers based on the five principles of human rights: Participation, Accountability, Non-discrimination and equality, Empowerment and Legality (PANEL). DESIGN This paper adapts the PANEL principles to the research context, and uses evidence from the literature to create a framework for qualitative research in people with dementia. This new framework aims to guide dementia researchers in designing studies around the needs of people with dementia, to improve involvement and participation, facilitate research development and maximize research outcomes. RESULTS A checklist is presented with questions related to the five PANEL principles. These questions cover ethical, methodological and legal issues that researchers may need to consider while developing qualitative research for people with dementia. CONCLUSIONS The proposed checklist offers a series of questions and considerations to facilitate the development of qualitative research in patients with dementia. It is inspired by current human rights work of recognized dementia researchers and organizations who have been directly involved in policy development. Future studies need to explore its utility in improving participation, facilitating ethics approvals and ensuring that outcomes are relevant to people with dementia.
Collapse
|
3
|
Ziebuhr B, Zanasi M, Bueno Aguado Y, Losada Durán R, Dening T, Tournier I, Niedderer K, Diaz A, Druschke D, Almeida R, Holthoff-Detto V. Living Well with Dementia: Feeling Empowered through Interaction with Their Social Environment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6080. [PMID: 37372667 DOI: 10.3390/ijerph20126080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 05/26/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023]
Abstract
This study was designed to advance our understanding of how feelings of empowerment in people living with dementia still residing at home can be promoted. We conducted qualitative interviews with 12 participants with mild-to-moderate stages of dementia in Germany and Spain as part of a European study on mindful design for dementia. A qualitative thematic content analysis was performed to elicit the key features of the experience reported by the interviewees. Three overarching categories were identified: the first category 'experiencing changes in personal life and coping with changes in life' covered losses and coping strategies; the second category 'retaining a sense of usefulness' included social participation and the need for activities with others; the third category 'feeling empowered' covered reflections on lifetime achievements, accomplishments in the present life, being in control and self-worth. Participants placed a strong emphasis on continuity and on the importance of making active decisions and meaningful social contributions. Empowerment within the person living with dementia was achieved through their interactions with their social environment, including the significance of communication about their needs and wishes and enabling shared decision-making and interactions with others in reciprocity.
Collapse
Affiliation(s)
- Berit Ziebuhr
- St. Hedwig Kliniken Berlin, Alexianer Krankenhaus Hedwigshoehe, Berlin 12526, Germany
| | - Michele Zanasi
- St. Hedwig Kliniken Berlin, Alexianer Krankenhaus Hedwigshoehe, Berlin 12526, Germany
| | | | | | - Tom Dening
- Mental Health & Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham NG7 2TU, UK
| | - Isabelle Tournier
- Department of Design, Manchester School of Art, Manchester Metropolitan University, Manchester M15 6BR, UK
- Department of Psychology, Laboratoire Cliniques Pathologique et Interculturelle, Université Toulouse 2 Jean Jaurès, 31058 Toulouse, France
| | - Kristina Niedderer
- Department of Design, Manchester School of Art, Manchester Metropolitan University, Manchester M15 6BR, UK
| | - Ana Diaz
- Alzheimer Europe, 1417 Luxembourg, Luxembourg
| | - Diana Druschke
- Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus, Carl Gustav Carus Faculty of Medicine, University of Technology Dresden, 01307 Dresden, Germany
| | - Rosa Almeida
- Fundación INTRAS, RDi Projects Department, 47016 Valladolid, Spain
| | - Vjera Holthoff-Detto
- St. Hedwig Kliniken Berlin, Alexianer Krankenhaus Hedwigshoehe, Berlin 12526, Germany
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus Faculty of Medicine, University of Technology Dresden, Alexianer Krankenhaus Hedwigshoehe, 12526 Berlin, Germany
| |
Collapse
|
4
|
Löbe C, AboJabel H. Empowering people with dementia via using intelligent assistive technology: A scoping review. Arch Gerontol Geriatr 2022; 101:104699. [DOI: 10.1016/j.archger.2022.104699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/28/2022] [Accepted: 03/24/2022] [Indexed: 11/16/2022]
|
5
|
West J, Birt L, Wilson D, Mathie E, Poland F. A Case Study of Co-production Within a Mental Health Recovery College Dementia Course: Perspectives of A Person With Dementia, Their Family Supporter and Mental Health Staff. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:920496. [PMID: 36188994 PMCID: PMC9397742 DOI: 10.3389/fresc.2022.920496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 05/30/2022] [Indexed: 12/04/2022]
Abstract
Background Undertaking co-production as a power-sharing way to improve mental health dementia services remains uncommon, suggesting opportunities to apply knowledge from lived experience of people with dementia, may often be missed. One barrier is stigma, assuming people with progressive cognitive impairment cannot manage this level of participation, support peers nor offer a “valid” perspective. Purpose This paper shares knowledge gained from a service evaluation that explored various experiences of a person with dementia, their family supporter and mental health staff, involved in co-producing a course about “living well” with dementia, within a mental health Recovery College. Design A qualitative, case study approach used semi-structured interviewing and inductive thematic analysis. Findings Co-production activities generated a shared sense of positivity, pride and privilege, highlighting positive effects in breaking down the “them and us” barriers common in traditional healthcare professional-service user relationships. Each individual had both something to offer and something to gain during the process. Staff identified challenges in the co-production process; in that balancing all the voices during meetings could be complex at times, and the process overall required considerable time commitment. Conclusion Taking part in co-production at an appropriate level and with peer support is a relational activity seen to be valuable in powerfully, yet gently, challenging stigma and assumptions around dementia. Findings show that while the process of co-production requires time and dedication, there is overall value in involving people living with dementia both in co-production and in peer support. This provided a straightforward and beneficial means to inclusively improve post-diagnosis support and care quality within a memory service.
Collapse
Affiliation(s)
- Juniper West
- Research Development Programme, Research and Development Department, Older People's Services, Norfolk and Suffolk NHS Foundation Trust, Norwich, United Kingdom
- *Correspondence: Juniper West
| | - Linda Birt
- Faculty of Medicine and Health Sciences, School of Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Danielle Wilson
- Research Development Programme, Research and Development Department, Older People's Services, Norfolk and Suffolk NHS Foundation Trust, Norwich, United Kingdom
| | - Elspeth Mathie
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, United Kingdom
| | - Fiona Poland
- Faculty of Medicine and Health Sciences, School of Health Sciences, University of East Anglia, Norwich, United Kingdom
| |
Collapse
|
6
|
Technological Solutions for Diagnosis, Management and Treatment of Alzheimer's Disease-Related Symptoms: A Structured Review of the Recent Scientific Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19053122. [PMID: 35270811 PMCID: PMC8910738 DOI: 10.3390/ijerph19053122] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/03/2022] [Accepted: 03/04/2022] [Indexed: 02/04/2023]
Abstract
In people with Alzheimer's disease (PwAD), there is a need for specific tools for the timely diagnosis, management, and treatment of symptoms. New technological solutions, including digital devices, application programs (apps), sensors and virtual reality, represent promising possibilities for objective and reliable assessment, monitoring and intervention strategies in this field. Our structured review presents an up-to-date summary of the technological solutions for the (i) diagnosis, (ii) management and (iii) treatment of AD-related symptoms. To this end, we searched electronic databases (i.e., PubMed, Web of Science, and Cochrane Library) for studies published over the last 10 years. Two authors of the review extracted data of interest. A total of eight manuscripts were included. In the last decade, a series of technological solutions across AD stages have been proposed. These include: (i) innovative strategies for the early detection of deficits in finger dexterity, visuo-spatial abilities (including spatial navigation), divided attention and instrumental autonomy; (ii) tools to activate the patient's responsiveness in terms of alertness and mood improvement; and (iii) useful interventions for retrieving memories, increasing body movements and improving spatial cognition. Methodological limitations, mainly pertaining to the paucity of randomized controlled trials and comprehensive assessments, were observed. Advances in technology currently provide the potential for designing innovative methods for evaluating, controlling and handling AD-related symptoms. The co-creation of technological solutions with all stakeholders represents the best way to design effective strategies for PwAD.
Collapse
|
7
|
Mamun MR, Hirakawa Y, Saif-Ur-Rahman KM, Sakaguchi T, Chiang C, Yatsuya H. Everyday wishes of older people living with dementia in care planning: a qualitative study. BMC Health Serv Res 2022; 22:184. [PMID: 35151313 PMCID: PMC8840703 DOI: 10.1186/s12913-022-07606-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 02/04/2022] [Indexed: 11/22/2022] Open
Abstract
Background The dementia care policy in Japan emphasizes the views of people living with dementia in care planning. An exploration of the everyday wishes of older people living with dementia can help clarify their priorities and assist in improving dementia care. This study aimed to explore the everyday wishes of older people living with dementia in Japan. Methods This qualitative study was conducted in Aichi prefecture in Japan. Older people with mild to moderate dementia were considered for inclusion. Participants were recruited from a dementia outpatient clinic. In-depth interviews were conducted with 36 participants in the same dementia outpatient clinic from January to October 2019. Audio-recorded interviews were transcribed verbatim. Inductive content analysis was carried out to analyze the data. Findings Participants expressed their everyday wishes within five themes (desire of being connected, freedom to decide, involvement in activities, status quo, and self-reliance). Older people living with dementia loved the connection with their family and wanted to have an enjoyable life by engaging in several activities without others’ interference. They desired to maintain the status quo and not be a burden to others. Conclusions This study provides evidence on the everyday wishes of people living with dementia. Identified wishes are mostly on emotional aspects of their daily lives. The findings of our study might help provide care for the people living with dementia considering their wishes. Further exploration, including people with severe dementia, is needed. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07606-1.
Collapse
|
8
|
Lynn JD, Ryan A, McCormack B, Martin S. A Qualitative Exploration of Living with Dementia in Supported Living Environments using a Peer Researcher Approach. AGING AND HEALTH RESEARCH 2022. [DOI: 10.1016/j.ahr.2022.100055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
9
|
van Corven CTM, Bielderman A, Wijnen M, Leontjevas R, Lucassen PLBJ, Graff MJL, Gerritsen DL. Empowerment for people living with dementia: An integrative literature review. Int J Nurs Stud 2021; 124:104098. [PMID: 34706313 DOI: 10.1016/j.ijnurstu.2021.104098] [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: 04/09/2021] [Revised: 09/20/2021] [Accepted: 09/24/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND OBJECTIVES Although the concept of empowerment seems useful for good care and support for people living with dementia, there is a lack of understanding of the process of empowerment. Therefore, more insight is needed into the concept of empowerment, and the environment's role in the empowerment process. RESEARCH DESIGN AND METHODS We performed an integrative literature review (PubMed, CINAHL, PsychINFO), including studies that addressed empowerment for people living with dementia in their title or abstract. Using qualitative data analysis software ATLAS.ti, we applied open codes to describe all relevant aspects of included articles. Common themes and categories were identified using inductive reasoning and constant comparison. RESULTS Sixty-nine articles were included. We identified four themes: (1) description of the state of being empowered, (2) the process of empowerment, (3) contribution of the environment to the empowerment process, and (4) effects on other variables. We combined these results with the conceptual framework of our previous qualitative study on the definition of empowerment for people living with dementia based on stakeholders' perspectives. Subsequently, the combined information of both studies was visualized in a revised conceptual framework. DISCUSSION AND IMPLICATIONS This literature review provides more details as to the role of the environment for empowerment of people living with dementia and suggests that empowerment can be considered a dynamic process, taking place through interaction between the person living with dementia and their environment. Our revised conceptual framework of empowerment can serve as a basis for future studies on empowerment for people living with dementia, and to support (in)formal caregivers in the empowerment process.
Collapse
Affiliation(s)
- Charlotte T M van Corven
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Radboud Alzheimer Center, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Annemiek Bielderman
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Radboud Alzheimer Center, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Mandy Wijnen
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Ruslan Leontjevas
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Radboud Alzheimer Center, Radboud University Medical Center, Nijmegen, the Netherlands; Faculty of Psychology, Open University of the Netherlands, Heerlen, The Netherlands.
| | - Peter L B J Lucassen
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Maud J L Graff
- Radboud Alzheimer Center, Radboud University Medical Center, Nijmegen, the Netherlands; Scientific Institute for Quality of Healthcare and Department of Rehabilitation, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Debby L Gerritsen
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Radboud Alzheimer Center, Radboud University Medical Center, Nijmegen, the Netherlands.
| |
Collapse
|
10
|
Schicktanz S, Schweda M. Aging 4.0? Rethinking the ethical framing of technology-assisted eldercare. HISTORY AND PHILOSOPHY OF THE LIFE SCIENCES 2021; 43:93. [PMID: 34342739 PMCID: PMC8332600 DOI: 10.1007/s40656-021-00447-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 07/04/2021] [Indexed: 05/31/2023]
Abstract
Technological approaches are increasingly discussed as a solution for the provision of support in activities of daily living as well as in medical and nursing care for older people. The development and implementation of such assistive technologies for eldercare raise manifold ethical, legal, and social questions. The discussion of these questions is influenced by theoretical perspectives and approaches from medical and nursing ethics, especially the principlist framework of autonomy, non-maleficence, beneficence, and justice. Tying in with previous criticism, the present contribution is taking these principles as a starting point and as a frame of reference to be critically re-examined. It thus aims to outline how existing ethical frameworks need to be extended or reconsidered to capture the ethical issues posed by technological developments regarding care for older people. In a first step, we provide a brief overview of assistive technologies in eldercare according to their purposes and functions. In the next step, we discuss how the questions and problems raised by new technologies in eldercare call for an expansion, re-interpretation, and revision of the principlist framework. We underline that the inclusion of ethical perspectives from engineering and computer science as well as a closer consideration of socio-political dimensions and fundamental anthropological and praxeological questions are needed.
Collapse
Affiliation(s)
- Silke Schicktanz
- Department of Medical Ethics and History of Medicine, University Medical Center Göttingen, Humboldt Allee 36, 37073, Göttingen, Germany.
| | - Mark Schweda
- Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University of Oldenburg, Ammerländer Heerstr. 114-118, 26111, Oldenburg, Germany
| |
Collapse
|
11
|
Koster L, Nies H. It takes three to tango: An ethnography of triadic involvement of residents, families and nurses in long-term dementia care. Health Expect 2021; 25:80-90. [PMID: 34288293 PMCID: PMC8849257 DOI: 10.1111/hex.13224] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 02/10/2021] [Accepted: 02/13/2021] [Indexed: 11/28/2022] Open
Abstract
Background Researchers often stress the necessity and challenge of integrating the positionings of residents, family members and nurses in order to realize each actor's involvement in long‐term dementia care. Yet most studies approach user and family involvement separately. Aim To explain how productive involvement in care provision is accomplished in triadic relationships between residents, family members and nurses. Methods An ethnographic study of identity work, conducted between 2014 and 2016 in a Dutch nursing home. Findings We identify four ideal‐typical identity positionings performed by nurses through daily activities. The findings reveal how their identity positionings were inseparable from those of the residents and family members as they formed triads. Congruent, or ‘matching’, identity positionings set the stage for productive involvement. Our systematic analysis of participants' identity work shows how—through embedded rights and responsibilities—their positionings inherently shaped and formed the triadic types and degrees of involvement observed within these relationships. Discussion and conclusion This study both unravels and juxtaposes the interrelatedness of, and differences between, the concepts of user and family involvement. Accordingly, our findings display how residents, family members and nurses—while continuously entangled in triadic relationships—can use their identity positionings to accomplish a variety of involvement activities. To mirror and optimize the implementation of user and family involvement, we propose a rights‐based and relational framework based on our findings. Patient or public contribution Conversations with and observations of residents; feedback session with the Clients' Council.
Collapse
Affiliation(s)
- Luzan Koster
- Department of Organization Sciences, Faculty of Social Sciences, VU University, Amsterdam, The Netherlands.,City of Amsterdam, Dep. Mobility & Public Space, Amsterdam, The Netherlands
| | - Henk Nies
- Department of Organization Sciences, Faculty of Social Sciences, VU University, Amsterdam, The Netherlands.,Vilans, National Centre of Expertise for Long-term Care, Utrecht, The Netherlands
| |
Collapse
|
12
|
Lang C, Roessler M, Schmitt J, Bergmann A, Holthoff-Detto V. Health-related quality of life in elderly, multimorbid individuals with and without depression and/or mild cognitive impairment using a telemonitoring application. Qual Life Res 2021; 30:2829-2841. [PMID: 33983617 PMCID: PMC8481145 DOI: 10.1007/s11136-021-02848-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE Multimorbidity leads to decreasing health-related quality of life (HRQoL). Telemedicine may help to improve HRQoL. The present study was conducted to show (I) differences in HRQoL and changes in HRQoL over time in elderly, multimorbid individuals with and without depression and/or mild cognitive impairment (MCI) using a telemonitoring application (TMA) and (II) associations between engagement with measurements by study participants using a TMA and changes in their HRQoL. METHODS The present feasibility study was part of a longitudinal intervention study. Recruited general practitioners (GPs) enrolled individuals and assigned them to risk groups according to absence/presence of depression and/or MCI. Depression was assessed using the Geriatric Depression Scale (GDS-15), MCI using the Mini-Mental State Examination (MMSE), and HRQoL using the SF-12. The TMA consisted of tablets, software, and measuring devices. Measured vital data were transferred to a care and case manager for monitoring and possible intervention. RESULTS Nine GPs recruited 177 individuals, 97 of whom were included in the HRQoL analysis. Significantly lower physical and mental component summary (PCS/MCS) scores were revealed in study participants with depression, and with both depression and MCI, compared to participants with no mental disorders. PCS scores did not differ between study dates, but MCS scores had significantly increased over time. Participants' engagement with measurements was significantly associated with an increased MCS score, but not with the PCS score. DISCUSSION Depression and/or MCI are negatively associated with the HRQoL of elderly, multimorbid people using a TMA. Engagement of individuals with vital data measurements via a TMA may increase their mental HRQoL. Mentally impaired people should be closely involved as co-designers and experts in development processes of TMAs to benefit from tailored solutions. An individual's increased mental HRQoL can be a decisive factor in their engagement with a GP treatment regimen and telemonitoring processes.
Collapse
Affiliation(s)
- Caroline Lang
- Center for Evidence-Based Healthcare, University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
| | - Martin Roessler
- Center for Evidence-Based Healthcare, University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Jochen Schmitt
- Center for Evidence-Based Healthcare, University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Antje Bergmann
- Department of General Practice, Medical Clinic III, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Vjera Holthoff-Detto
- Department of Psychiatry, Psychotherapy and Psychosomatics, Alexianer Hospital Hedwigshöhe, St. Hedwig Hospital Berlin, Berlin, Germany
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| |
Collapse
|
13
|
van Corven CTM, Bielderman A, Wijnen M, Leontjevas R, Lucassen PLBJ, Graff MJL, Gerritsen DL. Defining empowerment for older people living with dementia from multiple perspectives: A qualitative study. Int J Nurs Stud 2020; 114:103823. [PMID: 33253930 DOI: 10.1016/j.ijnurstu.2020.103823] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/20/2020] [Accepted: 10/27/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND OBJECTIVES The concept of empowerment seems promising for people living with dementia to live their life as they want to for as long as possible. Therefore, this study aimed to explore what the concept of empowerment means and includes for people living with dementia from the perspectives of people living with dementia themselves, their informal caregivers, and healthcare professionals. RESEARCH DESIGN AND METHODS Qualitative research using focus group discussions and individual interviews with people living with dementia (n = 15), informal caregivers (n = 16) and healthcare professionals (n = 46) to explore perspectives on empowerment. Audio-recordings were transcribed verbatim, and separately analyzed by two researchers using inductive thematic analysis. RESULTS Four themes were identified as important aspects of empowerment: (1) having a sense of personal identity, (2) having a sense of choice and control, (3) having a sense of usefulness and being needed, and (4) retaining a sense of worth. Based on these themes, a conceptual framework of empowerment for older people living with dementia was developed. Empowerment takes place within the person living with dementia, but is achieved through interaction with their environment. The four themes seem to be important both at home and in nursing homes, and in different stages of dementia. However, practical detailing of support differed. DISCUSSION AND IMPLICATIONS Our empowerment framework may provide a basis for developing interventions to empower people living with dementia and to strengthen (in)formal caregivers in this empowerment process. Support for people living with dementia must be adjusted to their personal situation and individual capabilities.
Collapse
Affiliation(s)
- Charlotte T M van Corven
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, the Netherlands; Radboud Alzheimer center, Nijmegen, The Netherlands.
| | - Annemiek Bielderman
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, the Netherlands; Radboud Alzheimer center, Nijmegen, The Netherlands.
| | - Mandy Wijnen
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, the Netherlands.
| | - Ruslan Leontjevas
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, the Netherlands; Open University of The Netherlands, Faculty of Psychology and Educational Sciences, Heerlen, the Netherlands; Open University of The Netherlands, Faculty of Psychology and Educational Sciences, Heerlen, the Netherlands.
| | - Peter L B J Lucassen
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, the Netherlands.
| | - Maud J L Graff
- Radboud Alzheimer center, Nijmegen, The Netherlands; Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare and Department of Rehabilitation, Nijmegen, the Netherlands.
| | - Debby L Gerritsen
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, the Netherlands; Radboud Alzheimer center, Nijmegen, The Netherlands.
| |
Collapse
|
14
|
Ibsen TL, Eriksen S. The experience of attending a farm-based day care service from the perspective of people with dementia: A qualitative study. DEMENTIA 2020; 20:1356-1374. [PMID: 32722922 DOI: 10.1177/1471301220940107] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
People with dementia have different needs, and it is important to have variation in the services that are offered for this population. Farm-based day care aims to meet this diversity in need, but research on such services is lacking. The present study provides knowledge about how people with dementia experience attending farm-based day care services in Norway. Ten semi-structured interviews were conducted for five different services, while the participants were at the farm. The interviews were analysed in accordance with the content analysis of Graneheim, U., & Lundman, B. (2004) [Nurse Education Today, 24(2), 105-112] and revealed three main categories that included (1) social relations, (2) being occupied at the farm, and (3) individually tailored service. The findings were summarised in the overall theme that attending day care at a farm makes me feel like a real participant. Our findings indicate that the farm-based day cares in the present study provide person-centred care. The farm setting facilitates services that are tailored to the individual, where the participants get to use their remaining resources and spend time outdoors. Further, farm-based day care was described as being suitable for people with or without farm experience and must be seen as an important supplement to regular day care for those who could benefit from a more active service.
Collapse
Affiliation(s)
- Tanja L Ibsen
- Norwegian National Advisory Unit on Ageing and Health (Ageing and Health), 60512Vestfold Hospital Trust, Norway; Faculty of Medicine, University of Oslo, Norway
| | - Siren Eriksen
- Norwegian National Advisory Unit on Ageing and Health (Ageing and Health), 60512Vestfold Hospital Trust, Norway; Lovisenberg Diaconal University College, Norway
| |
Collapse
|
15
|
Husebo BS, Allore H, Achterberg W, Angeles RC, Ballard C, Bruvik FK, Fæø SE, Gedde MH, Hillestad E, Jacobsen FF, Kirkevold Ø, Kjerstad E, Kjome RLS, Mannseth J, Naik M, Nouchi R, Puaschitz N, Samdal R, Tranvåg O, Tzoulis C, Vahia IV, Vislapuu M, Berge LI. LIVE@Home.Path-innovating the clinical pathway for home-dwelling people with dementia and their caregivers: study protocol for a mixed-method, stepped-wedge, randomized controlled trial. Trials 2020; 21:510. [PMID: 32517727 PMCID: PMC7281688 DOI: 10.1186/s13063-020-04414-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 05/14/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The global health challenge of dementia is exceptional in size, cost and impact. It is the only top ten cause of death that cannot be prevented, cured or substantially slowed, leaving disease management, caregiver support and service innovation as the main targets for reduction of disease burden. Institutionalization of persons with dementia is common in western countries, despite patients preferring to live longer at home, supported by caregivers. Such complex health challenges warrant multicomponent interventions thoroughly implemented in daily clinical practice. This article describes the rationale, development, feasibility testing and implementation process of the LIVE@Home.Path trial. METHODS The LIVE@Home.Path trial is a 2-year, multicenter, mixed-method, stepped-wedge randomized controlled trial, aiming to include 315 dyads of home-dwelling people with dementia and their caregivers, recruited from 3 municipalities in Norway. The stepped-wedge randomization implies that all dyads receive the intervention, but the timing is determined by randomization. The control group constitutes the dyads waiting for the intervention. The multicomponent intervention was developed in collaboration with user-representatives, researchers and stakeholders to meet the requirements from the national Dementia Plan 2020. During the 6-month intervention period, the participants will be allocated to a municipal coordinator, the core feature of the intervention, responsible for regular contact with the dyads to facilitate L: Learning, I: Innovation, V: Volunteering and E: Empowerment (LIVE). The primary outcome is resource utilization. This is measured by the Resource Utilization in Dementia (RUD) instrument and the Relative Stress Scale (RSS), reflecting that resource utilization is more than the actual time required for caring but also how burdensome the task is experienced by the caregiver. DISCUSSION We expect the implementation of LIVE to lead to a pathway for dementia treatment and care which is cost-effective, compared to treatment as usual, and will support high-quality independent living, at home. TRIAL REGISTRATION ClinicalTrials.gov: NCT04043364. Registered on 15 March 2019.
Collapse
Affiliation(s)
- Bettina Sandgathe Husebo
- Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway.,Department of Nursing Home Medicine, Municipality of Bergen, Bergen, Norway
| | - Heather Allore
- Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, New Haven, CT, USA.,Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | - Wilco Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Clive Ballard
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Frøydis Kristine Bruvik
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Stein Erik Fæø
- Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway.,Vid Specialized University, Bergen, Norway
| | - Marie Hidle Gedde
- Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway.,Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Eirin Hillestad
- Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway.,The Dignity Centre, Bergen, Norway
| | - Frode Fadnes Jacobsen
- Vid Specialized University, Bergen, Norway.,Centre for Care Research, Western Norway University of Applied Sciences, Bergen, Norway
| | - Øyvind Kirkevold
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Lillehamner, Norway.,Centre of Old Age Psychiatry Research, Innlandet Hospital Trust, Gjøvik, Norway.,Department of Health Sciences in Gjøvik, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway
| | | | - Reidun Lisbeth Skeide Kjome
- Centre for Pharmacy, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Janne Mannseth
- Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Mala Naik
- Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Rui Nouchi
- Department of Cognitive Health Science, Institute of Development, Aging and Cancer, Tohoku University, Tohoku, Japan
| | - Nathalie Puaschitz
- Centre for Care Research, Western Norway University of Applied Sciences, Bergen, Norway
| | - Rune Samdal
- Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Oscar Tranvåg
- Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway.,Norwegian National Advisory Unit on Women's Health, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Charalampos Tzoulis
- Neuro-SysMed, Department of Neurology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Ipsit Vihang Vahia
- McLean Hospital, Belmont, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Maarja Vislapuu
- Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Line Iden Berge
- Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway. .,NKS Olaviken Gerontopsychiatric Hospital, Bergen, Norway.
| |
Collapse
|
16
|
Lang C, Voigt K, Neumann R, Bergmann A, Holthoff-Detto V. Adherence and acceptance of a home-based telemonitoring application used by multi-morbid patients aged 65 years and older. J Telemed Telecare 2020; 28:37-51. [PMID: 32009577 PMCID: PMC8721554 DOI: 10.1177/1357633x20901400] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Currently, there are only a small number of comprehensive study results on adherence and acceptance of telemonitoring applications (TMAs) regarding multi-morbid older patients. The ATMoSPHAERE study aimed to develop an information and communication platform for an intersectoral networking of, for example, general practitioners, therapists, social services and the multi-morbid older patient. Methods The study presented was designed as a longitudinal bicentric intervention study which focused on multi-morbid patients aged ≥65 years using home-based telemedical measurement and input devices. The development and testing of this TMA aimed to optimise patients’ health care through intersectoral networking of all treating actors. Quantitative methods of data collection and analysis were used. Results Patients who completed the study were significantly younger than drop-outs and non-participants. The mental health of study patients significantly improved between the beginning and end of TMA use. The main reason for non-participation in the study was the high time expenditure when participating in the study. No perceived (information) benefits for health and insufficient content variety were the main reasons for drop-out. Appropriateness and handling of TMAs must be aligned with the needs of the heterogeneous user group of multi-morbid patients in order to increase acceptance and the added value of TMAs. Telemonitoring hardware should be oriented on functional capabilities of the older target group. Telemonitoring software content requires an individual, disease-specific approach for patients. The TMA should be unobtrusively integrated into usual daily life and be used to an appropriate extent according to the underlying disease in order to avoid stressing patients. With regard to adherence concerning TMAs, it is crucial to provide a contact person who is always available for patients having problems handling TMAs. Health concerns and questions can thus be addressed early, providing a feeling of safety in the care process. Discussion User acceptance of TMAs is an essential indicator and driver for use and for future implementation efforts in health care. In order to achieve maximum user centricity in development processes, patients must be involved as experts, co-designers and future users, considering their needs and perceptions.
Collapse
Affiliation(s)
- Caroline Lang
- Department of General Practice, Medical Clinic III, Medical Faculty, Technische Universität Dresden, Germany.,Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Germany
| | - Karen Voigt
- Department of General Practice, Medical Clinic III, Medical Faculty, Technische Universität Dresden, Germany
| | - Robert Neumann
- Institute of Sociology, Philosophical Faculty, Technische Universität Dresden, Germany
| | - Antje Bergmann
- Department of General Practice, Medical Clinic III, Medical Faculty, Technische Universität Dresden, Germany
| | - Vjera Holthoff-Detto
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Germany.,Department of Psychiatry, Psychotherapy and Psychosomatics, Alexianer Hospital Hedwigshöhe, St. Hedwig Hospital Berlin, Germany
| |
Collapse
|