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Fox S, Faherty M, Drennan J, Guerin S, Kernohan WG, Murphy A, Timmons S. People with dementia and family carers are welcoming of a model of dementia palliative care, but sceptical of its implementation. DEMENTIA 2024:14713012241270777. [PMID: 39121236 DOI: 10.1177/14713012241270777] [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: 08/11/2024]
Abstract
INTRODUCTION A palliative care approach can improve quality-of-life for people with dementia. It is the preference of many people with dementia to remain living at home until death, with the appropriate care. To develop a successful model for dementia palliative care in the community, it is essential to assimilate the perspectives and experiences of those affected. The guiding research question for this study was: What are people with dementia and family carers' views on a model for dementia palliative care?. METHODS Focus groups (n = 3) were conducted with bereaved or current family carers (n = 11), and people with dementia (n = 2). Discussions centred around a proposed model of dementia palliative care. These were transcribed and analysed using thematic analysis. RESULTS Three main themes were identified: living and dying well with dementia; reducing carer burden to fulfil the wish for home care; and lack of faith in the healthcare system. One statement which summarised the analysis was: "Dementia palliative care is a dream, but not a reality." This reflected participants' repeated "wish" for this "ideal" model of care, but simultaneous scepticism regarding its implementation, based on their prior experiences of healthcare services. CONCLUSION All participants were welcoming of the proposed model for dementia palliative care and were generally positive about palliative care as a concept relating to dementia. There was consensus that the model would allow people to live and die well with dementia, and reducing the carer burden would fulfil the wish to remain at home. However systemic changes in the healthcare system will be needed to facilitate a truly person-centred, holistic, individualised and flexible model of care.
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Affiliation(s)
- Siobhan Fox
- Centre for Gerontology and Rehabilitation, University College Cork, Ireland
| | - Mary Faherty
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Ireland
| | - Jonathan Drennan
- School of Nursing and Midwifery, University College Cork, University College Dublin, Ireland
| | - Suzanne Guerin
- School of Psychology, University College Dublin, Ireland
| | - W George Kernohan
- Institute of Nursing and Health Research, Ulster University, Ireland
| | - Aileen Murphy
- Department of Economics, University College Cork, Ireland
| | - Suzanne Timmons
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Ireland
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McLaughlin D, Hasson F, Reid J, Brazil K, Rutherford L, Stone C, van der Steen JT, Ballentine J. Evaluating a partnership model of hospice enabled dementia care: A three-phased monitoring, focus group and interview study. Palliat Med 2022; 36:1351-1363. [PMID: 36065098 PMCID: PMC9606481 DOI: 10.1177/02692163221116763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND People with dementia and their caregivers often lack equitable access to hospice care which is a concern internationally. Domains of best practice in palliative care for this population exist and hospices are urged to become dementia friendly. AIM This study aimed to evaluate the model of 'Hospice Enabled Dementia Partnership' mapped to international domains of best practice. DESIGN Three-phased monitoring, group interview and individual interview study using a formative evaluation framework. SETTINGPARTICIPANTS The partnership model was a collaboration between a large specialist palliative care hospice, a dementia charity and a Health Care Trust in the United Kingdom. Service documents were subjected to documentary review of monitoring activity and key indicators of service success. Group interviews and individual interviews took place with family carers (n = 12), health care professionals involved in delivering the service (n = 32) and senior professionals (n = 5) responsible for service commissioning in palliative or dementia care. RESULTS One hundred people with dementia were referred to the service between May 2016 and December 2017. Thirty-eight of the 42 people who died, achieved their preferred place of care and died at home. Four themes were derived from the data 'Impact of Dementia', 'Value of the Service', 'Information and Learning Needs' and 'Working in Partnership'. CONCLUSIONS Positive outcomes resulted from this best practice model; achievement of preferred place of care and death at home, dual benefits of therapies for patients and families and partnership in cross working and learning between services. Replication of this model should be considered internationally.
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Affiliation(s)
- Dorry McLaughlin
- School of Nursing and Midwifery & Centre for Evidence and Social Innovation, Queen's University, Belfast, Northern Ireland
| | - Felicity Hasson
- Institute of Nursing and Health Research, Ulster University, Shore Road, Newtownabbey, Northern Ireland
| | - Joanne Reid
- School of Nursing and Midwifery & Centre for Evidence and Social Innovation, Queen's University, Belfast, Northern Ireland
| | - Kevin Brazil
- School of Nursing and Midwifery & Centre for Evidence and Social Innovation, Queen's University, Belfast, Northern Ireland
| | - Lesley Rutherford
- School of Nursing and Midwifery & Centre for Evidence and Social Innovation, Queen's University, Belfast, Northern Ireland.,Belfast Health and Social Care Trust, Marie Curie Hospice, Belfast, Northern Ireland
| | - Carol Stone
- Belfast Health and Social Care Trust, Marie Curie Hospice, Belfast, Northern Ireland
| | - Jenny T van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.,Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
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Rukundo A, Fox S, Guerin S, Kernohan G, Drennan J, O'Connor N, Timmons S. How blogs support the transfer of knowledge into practice in the field of dementia palliative care: a survey of facilitators and barriers. BMC Palliat Care 2022; 21:117. [PMID: 35778712 PMCID: PMC9248102 DOI: 10.1186/s12904-022-01001-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/31/2022] [Indexed: 12/01/2022] Open
Abstract
Background Blogging can help to maximise the impact of one’s work in academia and beyond by making research findings accessible for multiple knowledge users, such as healthcare professionals and the public, as well as other researchers. As part of the knowledge exchange and dissemination activities of the Model for Dementia Palliative Care Project, this study explored stakeholders’ views of blogs as a means to translate research findings. Methods A web-based survey was developed, piloted, and revised. It was distributed electronically via key dementia and palliative care organisations websites, newsletters, social media platforms, and within the staff mailing lists of five Universities in Ireland. Data were analysed using descriptive statistics and content analysis. Results Complete responses were received from 128 participants. The majority of respondents were healthcare researchers (n = 53), followed by healthcare providers (n = 46). The preferred methods of reviewing research findings were scientific papers, websites and news articles. Respondents read healthcare blogs “sometimes” (39.1%), with < 19% reading them “often” or “very often”. Receiving an email notification might increase the likelihood of reading a new blog post for 83% of respondents. Barriers to engaging with blogs included lack of time, preference for other media, lack of awareness regarding available blogs, and concerns about the credibility and source of information. An appropriate length and the author of the blog were key features that encouraged engagement with a blog. Conclusions Despite respondents choosing a scientific paper as their preferred method to consume research findings, many indicated an openness to reading blogs on their area of interest. Creating concise, relevant, and credible blogs, and suitably promoting them, could increase the impact and reach of healthcare research, such as in the emerging field of dementia palliative care, and thus promote translation of research findings into practice. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-022-01001-7.
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Affiliation(s)
- Aphie Rukundo
- 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
| | - Suzanne Guerin
- School of Psychology, University College Dublin, Dublin, Ireland
| | - George Kernohan
- School of Nursing and Paramedic Science, Ulster University, Belfast, Northern Ireland
| | - Jonathan Drennan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Niamh O'Connor
- 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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Nasu K, Fukahori H, Miyashita M. Long-term care nurses' perceptions of a good death for people with dementia: A qualitative descriptive study. Int J Older People Nurs 2021; 17:e12443. [PMID: 34957680 DOI: 10.1111/opn.12443] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 11/26/2021] [Accepted: 12/04/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The number of people with dementia (PwD) dying in long-term care (LTC) settings is expected to increase. However, effective care strategies to promote a good death for PwD remain unclear. This study aimed to explore nurses' perceptions of a good death for PwD in LTC settings for older adults. METHODS Interviews were conducted with 19 nurses providing end-of-life care in LTC settings for older adults in Japan. The transcribed texts were analysed using inductive content analysis. RESULTS We identified two themes: (1) ambiguity and (2) preparedness. Participants perceived that there was ambiguity regarding a good death for PwD and emphasised the need for preparedness of those around PwD for a good death. Five categories represented preparedness: (a) reaffirming the original personality before dementia; (b) respecting that PwD change; (c) interpreting and fulfilling obscure desires, feelings, and sensations; (d) providing care consistent with an agreed-upon natural death process; and (e) maintaining relationships. CONCLUSION Long-term care nurses should encourage families and multidisciplinary team members, including the nurses themselves, to prepare for a good death of the PwD. Future research should focus on healthcare professionals' perspectives on advance care planning in the early stages of dementia, as well as the perceptions of PwD, their family members and other healthcare professionals regarding the natural death process.
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Affiliation(s)
- Katsumi Nasu
- Yasuda Women's University, Hiroshima, Japan.,Keio Research Institute at SFC, Kanagawa, Japan
| | - Hiroki Fukahori
- Faculty of Nursing and Medical Care, Keio University, Kanagawa, Japan
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Timmons S, O'Loughlin C, Buckley C, Cornally N, Hartigan I, Lehane E, Finn C, Coffey A. Dementia palliative care: A multi-site survey of long term care STAFF'S education needs and readiness to change. Nurse Educ Pract 2021; 52:103006. [PMID: 33690020 DOI: 10.1016/j.nepr.2021.103006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 02/05/2021] [Accepted: 02/20/2021] [Indexed: 11/26/2022]
Abstract
Many people with dementia reside in long-term care, where limited staff knowledge of dementia palliative care has been identified, along with poor awareness that a palliative approach can assist in identifying unmet care needs. Evidence-based guidance in palliative care for people with dementia is available however, implementing this guidance requires staff engagement and a tailored educational approach. This pre-implementation situational analysis informed a tailored staff education intervention to support the implementation of national guidance on dementia palliative care in long term care. Using a cross-sectional study design, underpinned by the Consolidated Framework for Implementation Research, survey data were collected on site profile, staff demographics, learning needs, and readiness-to change at three residential care sites for older people in Ireland. In total, 69 staff (predominantly nurses and healthcare attendants) completed the surveys. Medication management and management of pain were the most frequently identified learning needs. Staff were confident in their ability to implement change but de-motivation and powerlessness were substantial factors as only one-third of staff were "ready for change". Staffing levels, managing risk during change and perceived reluctance in others were common barriers. These results informed an educational intervention to address the specific care context, staff learning needs and barriers to change prior to implementation.
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Affiliation(s)
- S Timmons
- University College Cork, College Road, Cork, T12 K8AF, Ireland
| | - C O'Loughlin
- University of Limerick, Limerick, V94 X5K6, Ireland
| | - C Buckley
- University College Cork, College Road, Cork, T12 K8AF, Ireland
| | - N Cornally
- University College Cork, College Road, Cork, T12 K8AF, Ireland
| | - I Hartigan
- University College Cork, College Road, Cork, T12 K8AF, Ireland
| | - E Lehane
- University College Cork, College Road, Cork, T12 K8AF, Ireland
| | - C Finn
- University College Cork, College Road, Cork, T12 K8AF, Ireland
| | - A Coffey
- University of Limerick, Limerick, V94 X5K6, Ireland.
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Takahashi Z, Yamakawa M, Nakanishi M, Fukahori H, Igarashi N, Aoyama M, Sato K, Sakai S, Nagae H, Miyashita M. Defining a good death for people with dementia: A scoping review. Jpn J Nurs Sci 2021; 18:e12402. [PMID: 33442939 DOI: 10.1111/jjns.12402] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 11/20/2020] [Accepted: 11/22/2020] [Indexed: 12/01/2022]
Abstract
AIM End-of-life care for people with dementia is becoming increasingly important as the global population ages. However, there is no agreed definition of a good death for people with dementia. The current review examined previous literature to establish the current state of knowledge on this issue. METHODS We conducted a scoping review using a standard methodological framework. Relevant studies were identified from four databases. Studies were included if they were in English, discussed palliative or end-of-life care for dementia, and defined or explained a good death. The definitions or explanations of a good death were categorized into subthemes, and grouped into broader themes. RESULTS We identified 11 articles discussing or explaining a good death in dementia, which were published between 2009 and 2017. Most of these studies drew on the views of healthcare professionals and/or family members of people with dementia, and only one considered the views of people with dementia themselves. Ten themes were identified, including pain-free status, peaceful/comfort, dignity, family presence, surrounded by familiar things and people, person-centered communication, spirituality, life completion, treatment preferences, and other. CONCLUSIONS The characteristics of a good death in dementia showed similarities with those identified more generally. However, there were some themes that were specific to end-of-life care in dementia, notably "surrounded by familiar things and people" and "person-centered communication". To obtain a fuller picture of the nature of a good death in dementia, researchers need to examine the views of people living with dementia.
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Affiliation(s)
- Zaiya Takahashi
- Department of Medical Education, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Miyae Yamakawa
- Division of Health Sciences, Department of Evidence-Based Clinical Nursing, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Miharu Nakanishi
- Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Japan
| | - Hiroki Fukahori
- Faculty of Nursing and Medical Care, Keio University, Minato-ku, Japan
| | - Naoko Igarashi
- Department of Palliative Nursing, Health Sciences, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Maho Aoyama
- Department of Palliative Nursing, Health Sciences, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Kazuki Sato
- Nursing for Advanced Practice, Division of Integrated Health Sciences, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Shima Sakai
- Faculty of Health Sciences, Kyorin University, Hachioji, Japan
| | - Hiroko Nagae
- Gerontological Nursing/End of Life Care in Nursing, School of Nursing, Tokyo Women's Medical University, Shinjuku-ku, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Graduate School of Medicine, Tohoku University, Sendai, Japan
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Pennbrant S, Hjorton C, Nilsson C, Karlsson M. "The challenge of joining all the pieces together" - Nurses' experience of palliative care for older people with advanced dementia living in residential aged care units. J Clin Nurs 2020; 29:3835-3846. [PMID: 32671912 DOI: 10.1111/jocn.15415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 06/25/2020] [Accepted: 07/03/2020] [Indexed: 12/22/2022]
Abstract
AIMS AND OBJECTIVES To describe nurses' experiences of palliative care for older people with advanced dementia living in residential aged care units. BACKGROUND Dementia is a global health problem and the number of older people with dementia who need palliative care is increasing. Previous research has revealed that care for older people with dementia in the final stage of life is usually complex. However, little is known about how nurses experience palliative care for older people with advanced dementia living in residential aged care units. METHOD Nine individual, semi-structured face-to-face interviews with nurses working in residential aged care units for older people with advanced dementia in palliative care in Western Sweden were analysed using qualitative inductive content analysis. The COREQ checklist was followed. RESULTS The nurses considered that palliative care for older people with advanced dementia is a complex and challenging form of care. In particular, they identified three challenges that must be met: developing specialised knowledge and skills, developing teamwork as a working method and creating a caring relationship. CONCLUSIONS The results of our analysis indicate that if nurses are aware of and understand that the challenges are essential for "joining all the pieces together," the palliative care for older people with advanced dementia may become a positive experience for nurses and may increase their sense of satisfaction and security in their professional role. RELEVANCE TO CLINICAL PRACTICE For the palliative care to be successful, the nurses need to "join all the pieces together," that is succeed in developing specialised knowledge and skills, developing teamwork as a working method and creating a caring relationship to establish a person-centred care with the older person with advanced dementia and with his or her relatives.
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Affiliation(s)
- Sandra Pennbrant
- Department of Health Sciences, University West, Trollhättan, Sweden
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Abstract
PurposeThe Model for Dementia Palliative Care Project will develop a service-delivery model for community-based dementia palliative care. Many countries provide dementia palliative care services, albeit with considerable variability within these. However, little is known about what service providers consider to be the most important components of a dementia palliative care model. This study aimed to address this knowledge gap.Design/methodology/approachAn exploratory design using a survey method was used as an initial phase of the wider project. A web-based survey was developed, piloted (n = 5), revised, and distributed within five healthcare jurisdictions: the Republic of Ireland, Northern Ireland, England, Scotland, and Wales. The target population was health and social care professionals, policymakers, and academics interested in dementia and palliative care. Content analysis of open-ended questions identified common themes; descriptive statistics were applied to the closed-ended questions.FindingsOverall, N = 112 complete surveys were received. Key care principles incorporated the philosophies of palliative care and dementia care; many described “holistic” and “person-centred care” as the core. Important individual service components were the support for carers, advanced care planning, information, education and training, activities for “meaningful living”, comprehensive disease management, coordinated case management, and linking with community health services and social activities. Barriers included poor availability and organisation of healthcare services, stigma, misconceptions around dementia prognosis, insufficiently advanced care planning, and dementia-related challenges to care. Facilitators included education, carer support, and therapeutic relationships.Originality/valueThis study, as part of the larger project, will directly inform the development of a novel service delivery Model of Dementia Palliative Care for Ireland. The results can also inform service planning and design in other countries.
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Mileski M, Lee K, Bourquard C, Cavazos B, Dusek K, Kimbrough K, Sweeney L, McClay R. Preventing The Abuse Of Residents With Dementia Or Alzheimer's Disease In The Long-Term Care Setting: A Systematic Review. Clin Interv Aging 2019; 14:1797-1815. [PMID: 31695349 PMCID: PMC6816079 DOI: 10.2147/cia.s216678] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 08/20/2019] [Indexed: 01/21/2023] Open
Abstract
Purpose The main objective of this study was to investigate abuse of residents with either dementia or Alzheimer’s disease in long-term care settings, to identify facilitators and barriers surrounding implementation of systems to prevent such occurrences, and to draw conclusions on combating the issue of abuse. Patients and methods A systematic review was conducted using the Medline, CINAHL, and Academic Search Ultimate databases. With the use of key terms via Boolean search, 30 articles were obtained which were determined to be germane to research objectives. The review was conducted and structured based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results Residents with dementia or Alzheimer’s disease are at greater risk of abuse. The growing population could increase this problem exponentially. The most common facilitators were the introduction of policies/programs in the facility, education, and working conditions. The most cited barriers were poor training, lack of research, and working conditions in the long-term care setting. Conclusion The examples given would be useful in minimizing the potential for abuse in the long-term care setting. Leadership can take an active role in the prevention of abuse of the elderly through their actions, education of employees, and changes in the work environment.
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Affiliation(s)
- Michael Mileski
- School of Health Administration, Texas State University, San Marcos, TX, USA
| | - Kimberly Lee
- School of Health Administration, Texas State University, San Marcos, TX, USA
| | - Curtis Bourquard
- School of Health Administration, Texas State University, San Marcos, TX, USA
| | - Belinda Cavazos
- School of Health Administration, Texas State University, San Marcos, TX, USA
| | - Kristopher Dusek
- School of Health Administration, Texas State University, San Marcos, TX, USA
| | | | - Linda Sweeney
- School of Health Administration, Texas State University, San Marcos, TX, USA
| | - Rebecca McClay
- School of Science, Technology, Engineering, and Math, American Public University System, Charles Town, WV, USA
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10
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Bolt S, van der Steen J, Schols J, Zwakhalen S, Meijers J. What do relatives value most in end-of-life care for people with dementia? Int J Palliat Nurs 2019; 25:432-442. [DOI: 10.12968/ijpn.2019.25.9.432] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background:End-of-life care for older people with dementia is often sub-optimal. Understanding the experiences of the relatives involved in the care of the person with dementia may help to improve care practice.Aims:To investigate relatives' experiences with end-of-life care for people with dementia, comparing the nursing home and home setting.Methods:In-depth interviews were conducted with 32 individuals who were bereaved of someone with dementia. Thematic analysis was performed to identify main themes from the data.Findings:Experiences translated into four themes: acknowledging human dignity; being recognised as an important caregiver; (not) talking about death and dying and making decisions together. A lack of person-centered care was mainly evident in nursing homes. Relatives took on a more prominent role in the care of the older person with dementia when the relative was cared for in a home setting and this involvement in the care of the older person was something that the relatives valued. Surrogate decision-making induced similar challenges in both settings.Conclusion:It is important that healthcare professionals inform and support relatives to help them make decision about end-of-life care and preferences. Nursing homes should learn to offer the same standard of person-centred care as a home care setting, and ensure that relatives are still involved in the care of the person with dementia.
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Affiliation(s)
- Sascha Bolt
- PhD candidate, Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health Medicine and Lifesciences, Maastricht University, Maastricht, the Netherlands
| | - Jenny van der Steen
- Associate Professor, Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands, Department of Primary and Community Care, Radboud university medical center, Nijmegen, the Netherlands
| | - Jos Schols
- Professor, Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health Medicine and Lifesciences, Maastricht University, Maastricht, the Netherlands
| | - Sandra Zwakhalen
- Professor, Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health Medicine and Lifesciences, Maastricht University, Maastricht, the Netherlands
| | - Judith Meijers
- Assistant Professor, Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health Medicine and Lifesciences, Maastricht University, Maastricht, the Netherlands, Zuyderland Care, Zuyderland Medical Center, Sittard-Geleen, the Netherlands
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11
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Miranda R, Bunn F, Lynch J, Van den Block L, Goodman C. Palliative care for people with dementia living at home: A systematic review of interventions. Palliat Med 2019; 33:726-742. [PMID: 31057088 PMCID: PMC6620864 DOI: 10.1177/0269216319847092] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
BACKGROUND The European Association for Palliative Care White Paper defined optimal palliative care in dementia based on evidence and expert consensus. Yet, we know little on how to achieve this for people with dementia living and dying at home. AIMS To examine evidence on home palliative care interventions in dementia, in terms of their effectiveness on end-of-life care outcomes, factors influencing implementation, the extent to which they address the European Association for Palliative Care palliative care domains and evidence gaps. DESIGN A systematic review of home palliative care interventions in dementia. DATA SOURCES The review adhered to the PRISMA guidelines and the protocol was registered with PROSPERO (CRD42018093607). We searched four electronic databases up to April 2018 (PubMed, Scopus, Cochrane library and CINAHL) and conducted lateral searches. RESULTS We retrieved eight relevant studies, none of which was of high quality. The evidence, albeit of generally weak quality, showed the potential benefits of the interventions in improving end-of-life care outcomes, for example, behavioural disturbances. The interventions most commonly focused on optimal symptom management, continuity of care and psychosocial support. Other European Association for Palliative Care domains identified as important in palliative care for people with dementia, for example, prognostication of dying or avoidance of burdensome interventions were under-reported. No direct evidence on facilitators and barriers to implementation was found. CONCLUSIONS The review highlights the paucity of high-quality dementia-specific research in this area and recommends key areas for future work, for example, the need for process evaluation to identify facilitators and barriers to implementing interventions.
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Affiliation(s)
- Rose Miranda
- 1 End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Brussels, Belgium.,2 Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussels, Belgium
| | - Frances Bunn
- 3 Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, United Kingdom
| | - Jennifer Lynch
- 3 Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, United Kingdom
| | - Lieve Van den Block
- 1 End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Brussels, Belgium.,2 Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussels, Belgium
| | - Claire Goodman
- 3 Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, United Kingdom
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12
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McCleary L, Thompson GN, Venturato L, Wickson-Griffiths A, Hunter P, Sussman T, Kaasalainen S. Meaningful connections in dementia end of life care in long term care homes. BMC Psychiatry 2018; 18:307. [PMID: 30249213 PMCID: PMC6154884 DOI: 10.1186/s12888-018-1882-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 09/11/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Most persons with dementia die in long term care (LTC) homes, where palliative approaches are appropriate. However, palliative approaches have not been widely implemented and there is limited understanding of staff and family experiences of dying and bereavement in this context. METHOD This descriptive qualitative study explored family and staff experiences of end of life and end of life care for persons with dementia in LTC homes. Eighteen focus groups were conducted with 77 staff members and 19 relatives of persons with dementia at four LTC homes in four Canadian provinces. RESULTS Three themes emerged: knowing the resident, the understanding that they are all human beings, and the long slow decline and death of residents with dementia. DISCUSSION Intimate knowledge of the person with dementia, obtained through longstanding relationships, was foundational for person-centred end of life care. Health care aides need to be included in end of life care planning to take advantage of their knowledge of residents with dementia. There were unmet bereavement support needs among staff, particularly health care aides. Persons with dementia were affected by death around them and existing rituals for marking deaths in LTC homes may not fit their needs. Staff were uncomfortable answering relatives' questions about end of life. CONCLUSIONS Longstanding intimate relationships enhanced end of life care but left health care aides with unmet bereavement support needs. Staff in LTC homes should be supported to answer questions about the trajectory of decline of dementia and death. Further research about residents' experiences of deaths of other residents is needed.
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Affiliation(s)
- Lynn McCleary
- Department of Nursing, Brock University, St. Catharines, Canada.
| | - Genevieve N Thompson
- 0000 0004 1936 9609grid.21613.37College of Nursing, University of Manitoba, Winnipeg, Canada
| | - Lorraine Venturato
- 0000 0004 1936 7697grid.22072.35Faculty of Nursing, University of Calgary, Calgary, Canada
| | | | - Paulette Hunter
- 0000 0001 2154 235Xgrid.25152.31Department of Psychology, St. Thomas More College, University of Saskatchewan, Saskatoon, Canada
| | - Tamara Sussman
- 0000 0004 1936 8649grid.14709.3bSchool of Social Work, McGill University, Montreal, Canada
| | - Sharon Kaasalainen
- 0000 0004 1936 8227grid.25073.33School of Nursing, McMaster University, Hamilton, Canada
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13
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Perri GA, Liao P. A palliative care perspective on deprescribing cholinesterase inhibitors in Alzheimer's disease. Curr Med Res Opin 2018; 34:1695-1697. [PMID: 29912576 DOI: 10.1080/03007995.2018.1490255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Giulia-Anna Perri
- a Baycrest Health Sciences - Division of Palliative Care, Department of Family and Community Medicine , Toronto , Ontario , Canada
| | - Pamela Liao
- b Trillium Health Partners - Palliative Care , Mississauga , Ontario , Canada
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14
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Zhou Y, Slachevasky A, Calvo E. Health conditions and unmet needs for assistance to perform activities of daily living among older adults with dementia in Chile. Int J Geriatr Psychiatry 2018; 33:964-971. [PMID: 29570856 DOI: 10.1002/gps.4879] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 01/23/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study aims to address gaps in health conditions and unmet needs in daily activities between people with dementia (PWD) and without dementia in a developing country and to identify the variables associated with unmet needs among PWD to guide practitioners and policymakers in dealing with an increased burden of dementia. METHODS Nationally representative data on 4655 Chileans age 60 and over were used to compare health conditions and unmet needs in daily life activities between individuals with (N = 455, 9.6%) and without dementia. Regression analysis was conducted to identify the variables associated with unmet needs among PWD. RESULTS Overall, PWD had worse health and needed greater assistance in performing daily activities than people without dementia. Among PWD, being male was associated with more unmet needs, in both activities of daily living (ADL) and instrumental ADL. Lower educational level and fewer caregivers were associated with more unmet needs for ADL, while inferior functional ability was associated with more unmet needs for instrumental ADL. CONCLUSIONS The results from this study call for action by practitioners and policymakers to foster caregiver training, increase supportive services, and advance care planning for PWD.
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Affiliation(s)
- Yi Zhou
- Environment and Health Group, Cambridge, MA, USA.,Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Andrea Slachevasky
- Geroscience Center for Brain Health and Metabolism (GERO), Santiago, Chile.,Laboratory of Neuropsychology and Clinical Neuroscience (LANNEC), Physiopathology Program-ICBM, East Neurologic and Neurosciences Departments, Faculty of Medicine, University of Chile, Santiago, Chile.,Neuropsychiatry and Memory Disorders clinic (CMYN), Neurology Department, Hospital del Salvador and Faculty of Medicine, University of Chile, Santiago, Chile.,Centre for Advanced Research in Education, Santiago, Chile.,Servicio de Neurología, Departamento de Medicina, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
| | - Esteban Calvo
- Department of Epidemiology and Robert N. Butler Columbia Aging Center, Columbia University, New York, NY, USA.,Center for Public Policy Research and Laboratory on Aging and Social Epidemiology, Universidad Mayor, Santiago, Chile
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15
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Palliative and end-of-life care for adults with advanced chronic obstructive pulmonary disease: a rapid review focusing on patient and family caregiver perspectives. Curr Opin Support Palliat Care 2018; 11:315-327. [PMID: 28957884 DOI: 10.1097/spc.0000000000000303] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW The aim of the review was to explore patient and family caregiver perspectives on key issues for ensuring quality of end-of-life care for people with chronic obstructive pulmonary disease (COPD). The growing evidence on the value of specialist palliative care services demonstrates significant improvements in treatments and provisions; however, much of the literature is generic in nature or centred on people with a cancer diagnosis. In this review, we examine the literature to ascertain the views and needs of patients and carers affected by advanced COPD, a highly debilitating condition that can have a profoundly negative impact on the quality of end-of-life experience. RECENT FINDINGS A total of 19 papers were included in the review. The main themes in the literature were Holistic Care, Illness Trajectory and Technology. SUMMARY Areas of unmet need emphasized across physical, psychosocial and spiritual domains were identified, particularly in relation to appropriate and timely conversations. Positive developments in the care and treatment of advanced COPD include the use of the STIOLTO Respimat inhaler, a brief educative and psychosocial intervention based on cognitive-behavioural therapy, and high-intensity exercise training. There is some evidence regarding the use of technology in end-stage COPD.
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16
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Faes K, Cohen J, Annemans L. Resource Use During the Last 6 Months of Life of Individuals Dying with and of Alzheimer's Disease. J Am Geriatr Soc 2018; 66:879-885. [DOI: 10.1111/jgs.15287] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 12/27/2017] [Accepted: 12/27/2017] [Indexed: 12/19/2022]
Affiliation(s)
- Kristof Faes
- Department of Public HealthInteruniversity Center for Health Economic Research, Ghent UniversityGhent Belgium
- Department of Family Medicine and Chronic CareEnd‐of‐Life Care Research Group, Vrije Universiteit Brussel and Ghent UniversityBrussels Belgium
| | - Joachim Cohen
- Department of Family Medicine and Chronic CareEnd‐of‐Life Care Research Group, Vrije Universiteit Brussel and Ghent UniversityBrussels Belgium
| | - Lieven Annemans
- Department of Public HealthInteruniversity Center for Health Economic Research, Ghent UniversityGhent Belgium
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17
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Affiliation(s)
- Fran McInerney
- Wicking Dementia Research and Education Centre, University of Tasmania
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18
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Seiger Cronfalk B, Ternestedt BM, Norberg A. Being a close family member of a person with dementia living in a nursing home. J Clin Nurs 2017; 26:3519-3528. [DOI: 10.1111/jocn.13718] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/25/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Berit Seiger Cronfalk
- Department of Health Care Sciences and Palliative Research Centre; Ersta Sköndal Bräcke University College; Stockholm Sweden
- Division of Nursing; Department of Neurobiology, Care Sciences and Society; Karolinska Institutet; Stockholm Sweden
- Stord Haugesund University College; Department of Nursing Science; Haugesund Norway
| | - Britt-Marie Ternestedt
- Department of Health Care Sciences and Palliative Research Centre; Ersta Sköndal Bräcke University College; Stockholm Sweden
| | - Astrid Norberg
- Department of Health Care Sciences and Palliative Research Centre; Ersta Sköndal Bräcke University College; Stockholm Sweden
- Department of Nursing; Umeå University; Umeå Sweden
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19
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Dempsey L, Dowling M, Larkin P, Murphy K. Sensitive Interviewing in Qualitative Research. Res Nurs Health 2016; 39:480-490. [DOI: 10.1002/nur.21743] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Laura Dempsey
- Lecturer, School of Nursing & Midwifery; National University of Ireland; Galway Ireland
| | - Maura Dowling
- Lecturer, School of Nursing & Midwifery; National University of Ireland; Galway Ireland
| | - Philip Larkin
- Associate Professor, School of Nursing, Midwifery & Health Systems; Health Sciences Centre; Belfield, Dublin 4 Ireland
| | - Kathy Murphy
- Professor, School of Nursing & Midwifery; National University of Ireland; Galway Ireland
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20
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Toye C, Jiwa M, Holloway K, Horner BJ, Andrews S, McInerney F, Robinson AL. Can a community of practice enhance a palliative approach for people drawing close to death with dementia? Int J Palliat Nurs 2015; 21:548-56. [PMID: 26619239 DOI: 10.12968/ijpn.2015.21.11.548] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This action research study was conducted to trial a strategy intended to support a consistent, high-quality, palliative approach for people with dementia drawing close to death-the implementation of a community of practice. Professionals from community/residential care and hospitals formed this community of practice, which took on the role of an action research group. The group was supported to identify and address practice problems. Four action plans were implemented; outcomes from two are reported. When actioning the plan 'providing education and information for the staff', the staff's ratings of sessions and resources were positive but impacts upon knowledge, views, or confidence were small. When actioning 'supporting families', families providing care in non-hospital settings received information about severe dementia from suitably prepared staff, plus contact details to access support. Family feedback was primarily positive. Reference to additional practice change frameworks and inclusion of specialist palliative care professionals are recommendations for future initiatives; also focusing on targeted, achievable goals over longer timeframes.
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Andrews S, McInerney F, Toye C, Parkinson CA, Robinson A. Knowledge of Dementia: Do family members understand dementia as a terminal condition? DEMENTIA 2015; 16:556-575. [PMID: 26394629 DOI: 10.1177/1471301215605630] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Current research identifies advanced dementia to be the terminal phase of this progressive and incurable condition. However, there has been relatively little investigation into how family members of people with advanced dementia understand their relative's condition. In this article, we report on semi-structured interviews with 10 family members of people with advanced dementia, in a residential aged care facility. Using a qualitative, descriptive design, we explored family members' understandings of dementia, whether they were aware that it was a terminal condition, and the ways they developed their understandings. Findings revealed that the majority of family members could not recognize the terminal nature of dementia. Relying on predominantly lay understandings, they had little access to formal information and most failed to conceptualize a connection between dementia and death. Moreover, family members engaged in limited dialogue with aged care staff about such issues, despite their relatives being in an advanced stage of the disease. Findings from our study suggest that how family members understand their relative's condition requires greater attention. The development of staff/family partnerships that promote shared communication about dementia and dying may enhance family members' understandings of the dementia trajectory and the types of decisions they may be faced with during the more advanced stages of the disease.
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Affiliation(s)
- Sharon Andrews
- School of Nursing & Midwifery, Australian Catholic University/Mercy Health, Victoria, Australia
| | - Fran McInerney
- School of Nursing & Midwifery, Australian Catholic University/Mercy Health, Victoria, Australia
| | - Christine Toye
- Curtin Health Innovation Research Institute, Curtin University, Western Australia, Australia
| | | | - Andrew Robinson
- Wicking Dementia Research and Education Centre, University of Tasmania-Hobart, Tasmania, Australia
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22
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McLaughlin D, Brazil K, Carter G. Dementia in palliative care: a new era for the hospice. Int J Palliat Nurs 2015; 21:369-70. [DOI: 10.12968/ijpn.2015.21.8.369] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Dorry McLaughlin
- Lecturer in Palliative Care and Chronic Illness, at the School of Nursing and Midwifery, Queen's University, Belfast, UK
| | - Kevin Brazil
- Professor of Palliative Care, at the School of Nursing and Midwifery, Queen's University, Belfast, UK
| | - Gillian Carter
- Research Fellow in Palliative Care, at the School of Nursing and Midwifery, Queen's University, Belfast, UK
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