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de Sola-Smith K, Gilissen J, van der Steen JT, Mayan I, Van den Block L, Ritchie CS, Hunt LJ. Palliative Care in Early Dementia. J Pain Symptom Manage 2024; 68:e206-e227. [PMID: 38848792 DOI: 10.1016/j.jpainsymman.2024.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 05/14/2024] [Accepted: 05/25/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND Palliative care is recommended for all people with dementia from diagnosis through end-of-life. However, palliative care needs and effective elements of palliative care are not well-defined for the earlier stages of dementia. OBJECTIVE To systematically map current research on palliative care early in the disease trajectory of dementia. DESIGN Scoping review of scientific literature. DATA SOURCES PubMed, CINAHL, EMBASE, Cochrane, PsycINFO, Web of Science. REVIEW METHODS We included studies published in English over the last decade (through March 2022) that focused on palliative care in early stages of dementia and targeted outcomes in palliative care domains. Two authors independently screened abstracts and full texts and scored the quality of included studies using tools by the Joanna Briggs Institute. RESULTS Among the 77 papers reviewed, few addressed early stages of dementia specifically. We found that: 1) While "early" palliative care was not well-defined in the literature, evidence indicated that palliative care needs were present at or before diagnosis and across the trajectory. Notable opportunities for palliative care arise at 'tipping points' (i.e., when symptoms, functional status, or caregiving needs change). 2) Palliative care needs in early dementia include advocacy for goal-aligned care in the future, reassurance against the threat of negligence and abandonment by caregivers, planning for future scenarios of care (practical, individual, and relational needs), and establishing of long-term relationships with providers entrusted for care later in disease. 3) Elements of effective palliative care in early dementia could include dementia-specific ACP and goals of care discussions, navigation for building a network of support, provision of tools and resources for family, tailored care and knowledge of the person, and well-prepared dementia-care providers. The scarcity of palliative care studies aimed at early disease indicates a gap in the evidence in dementia care. CONCLUSION The literature on palliative care in early dementia is sparse. Future studies should focus on assessment tools for optimizing timing of palliative care in early dementia, gaining better understanding of patient and family needs during early phases of disease, and providing training for providers and families in long-term relationships and communication around goals of care and future planning.
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Affiliation(s)
- Karen de Sola-Smith
- Department of Geriatrics (K.d.S.), Palliative and Extended Care, Veterans Affairs Medical Center, San Francisco, California, USA; Department of Physiological Nursing (K.d.S., L.J.H.), University of California San Francisco, California, USA.
| | - Joni Gilissen
- Global Brain Health Institute (GBHI) (J.G., I.M., C.S.R., L.J.H.), University of California San Francisco, California, USA; Department of Family Medicine and Chronic Care (J.G., L.V.B), Vrije Universiteit Brussel (VUB) and Department of Public Health and Primary Care, End-of-Life Care Research Group, Universiteit Gent, Brussels, Belgium
| | - Jenny T van der Steen
- Department of Primary and Community Care and Radboudumc Alzheimer Center (J.T.S.), Radboud university medical center, Nijmegen, The Netherlands; Department of Public Health and Primary Care (J.T.S.), Leiden University Medical Center, Leiden, The Netherlands
| | - Inbal Mayan
- Global Brain Health Institute (GBHI) (J.G., I.M., C.S.R., L.J.H.), University of California San Francisco, California, USA
| | - Lieve Van den Block
- Department of Family Medicine and Chronic Care (J.G., L.V.B), Vrije Universiteit Brussel (VUB) and Department of Public Health and Primary Care, End-of-Life Care Research Group, Universiteit Gent, Brussels, Belgium
| | - Christine S Ritchie
- Global Brain Health Institute (GBHI) (J.G., I.M., C.S.R., L.J.H.), University of California San Francisco, California, USA; Division of Palliative Care and Geriatric Medicine and the Mongan Institute for Aging and Serious Illness (CASI) (C.S.R.), Massachusetts General Hospital (MGH), Boston, Massachusetts, USA; Harvard Medical School (C.S.R.), Harvard University, Boston, Massachusetts, USA
| | - Lauren J Hunt
- Global Brain Health Institute (GBHI) (J.G., I.M., C.S.R., L.J.H.), University of California San Francisco, California, USA; Department of Physiological Nursing (K.d.S., L.J.H.), University of California San Francisco, California, USA; Philip R. Lee Institute for Health Policy Studies (L.J.H.), University of California San Francisco, California, USA
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Tay R, Tan JY, Lim B, Hum AY, Simpson J, Preston N. Factors associated with the place of death of persons with advanced dementia: A systematic review of international literature with meta-analysis. Palliat Med 2024:2692163241265231. [PMID: 39092850 DOI: 10.1177/02692163241265231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
BACKGROUND Many individuals with advanced dementia die in hospital, despite preferring home death. Existing evidence of factors affecting their place of death is inconsistent. To inform policies/practices for meeting needs/preferences, systematically establishing the evidence is pertinent, particularly given the exponential rise in advanced dementia prevalence. AIM To identify factors influencing where people with advanced dementia die. DESIGN AND DATA SOURCES This systematic review with meta-analysis was registered on PROSPERO (CRD42022366722). Medline, CINAHL, PsycINFO, SocINDEX and a grey literature database, Overton, were searched on 21/12/2022, supplemented by hand-searching/citation tracking. Papers reporting quantitative data on factors associated with place of death in advanced dementia were included and appraised using QualSyst. Data were analysed using random effects with the certainty of evidence determined using the GRADE criteria. RESULTS Thirty-three papers involving >5 million individuals (mean age = 89.2 years) were included. Long-term care setting deaths were relatively common but hospice deaths were rarer. Marriage's association with home death underscores social networks' importance, while younger age's and male gender's associations with hospital death demonstrate patients' and families' interdependency. Pneumonia/COPD's opposing effects on hospital deaths with cancer/functional impairment highlight the challenges of advanced dementia care. Unlike hospital/nursing home bed availability's lack of effect, capitated funding (fixed-amount-per-patient-per-period) decreased hospital death likelihood. CONCLUSION This comprehensive review of place of death determinants highlight the profound challenges of advanced dementia end-of-life care. Given that bed capacity did not affect place of death, a capitation-based, integrated palliative care model would appear more likely to meet patients' needs in a resource-constrained environment.
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Affiliation(s)
- RiYin Tay
- International Observatory on End of Life Care, Lancaster University, Lancaster, UK
- The Palliative Care Centre for Excellence in Research and Education, Singapore, Singapore
- Dover Park Hospice, Singapore, Singapore
| | - Joyce Ys Tan
- The Palliative Care Centre for Excellence in Research and Education, Singapore, Singapore
| | - BinYan Lim
- The Palliative Care Centre for Excellence in Research and Education, Singapore, Singapore
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore, Singapore
| | - Allyn Ym Hum
- The Palliative Care Centre for Excellence in Research and Education, Singapore, Singapore
- Department of Palliative Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Jane Simpson
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Nancy Preston
- International Observatory on End of Life Care, Lancaster University, Lancaster, UK
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Kim H, Cho J, Shin S, Kim SS. Uncertainty in surrogate decision-making about end-of-life care for people with dementia: An integrative review. J Adv Nurs 2024; 80:3103-3118. [PMID: 38197503 DOI: 10.1111/jan.16038] [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: 09/28/2023] [Revised: 12/05/2023] [Accepted: 12/17/2023] [Indexed: 01/11/2024]
Abstract
AIM To describe uncertainty in surrogate decision-making regarding end-of-life care for people with dementia using Mishel's reconceptualized uncertainty in illness theory. DESIGN Integrative literature review using Whittemore and Knafl's approach. DATA SOURCES PubMed, CINAHL, EMBASE, Scopus and Web of Science were searched using terms such as uncertainty/unpredictability, decision-making/advance care planning/end-of-life care planning, surrogate/family/caregiver/proxy and dementia. The search was initially conducted on 28 September 2021 and updated on 31 July 2023. REVIEW METHODS Through systematic screening, 20 research articles were included in the analysis. Content related to uncertainty in surrogate decision-making regarding end-of-life care was extracted and analysed, focusing on the reconceptualized uncertainty in illness theory. RESULTS First, surrogate uncertainty exists in various areas of surrogate decision-making regarding end-of-life care. Second, antecedents of surrogate uncertainty include numerous intrinsic and extrinsic factors. Third, surrogates exhibited some negative psychological responses to uncertainty but continually processed and structured their uncertainty through certain approaches, leading them to grow as decision-makers. Finally, research-based evidence on surrogates' processing of uncertainty and shifts to new life perspectives remains limited. CONCLUSION Surrogates' uncertainty in decision-making regarding end-of-life care for people with dementia is well characterized using the reconceptualized uncertainty in illness theory. Healthcare providers should help surrogates manage their uncertainty in surrogate decision-making more constructively throughout the dementia trajectory. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE The findings highlight the importance of assessing how surrogates process uncertainty and gauging how to help them process uncertainty and transition to new life perspectives. IMPACT This review contributes to healthcare professionals' understanding of surrogates' uncertainty in end-of-life care planning for people with dementia, especially what they are uncertain about, what influences their uncertainty and how they process it. REPORTING METHOD This study adheres to the PRISMA reporting guidelines. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Hyejin Kim
- Red Cross College of Nursing, Chung-Ang University, Seoul, Korea
| | - Jeonghyun Cho
- College of Nursing, Institute of Health Science Research, Inje University, Busan, Korea
| | - Sungmin Shin
- Red Cross College of Nursing, Chung-Ang University, Seoul, Korea
| | - Sang Suk Kim
- Red Cross College of Nursing, Chung-Ang University, Seoul, Korea
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Biesmans JMA, Bolt SR, Janssen DJA, Wintjens T, Khemai C, Schols JMGA, Van Der Steen JT, Zwakhalen SMG, Meijers JMM. Desired dementia care towards end of life: Development and experiences of implementing a new approach to improve person-centred dementia care. J Adv Nurs 2024. [PMID: 38923055 DOI: 10.1111/jan.16285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 04/08/2024] [Accepted: 06/06/2024] [Indexed: 06/28/2024]
Abstract
AIMS To describe the co-creation of the 'Desired Dementia Care Towards End of Life' (DEDICATED) approach to improve person-centred palliative care for individuals with dementia and to describe the experiences of healthcare professionals during the approach's implementation. METHODS A needs assessment, comprising both qualitative and quantitative studies, informed palliative care needs of healthcare professionals, family caregivers and individuals with dementia. The approach was co-created with healthcare and education professionals, guided by the findings. Then, healthcare professionals were trained to implement the approach in their organizations. From April to June 2022, semi-structured interviews with actively engaged professionals were analysed using Conventional Content Analysis. RESULTS The needs assessment yielded six key themes: (1) raising palliative care awareness, (2) familiarization with a person with dementia, (3) communication about future care preferences, (4) managing pain and responsive behaviour, (5) enhancing interprofessional collaboration in advance care planning and (6) improving interprofessional collaboration during transitions to nursing homes. Interviews with 17 healthcare professionals revealed that active involvement in co-creating or providing feedback facilitated implementation. Overall, the DEDICATED approach was perceived as a valuable toolkit for optimizing palliative care for people with dementia and their loved ones. CONCLUSION Co-creating the DEDICATED approach with healthcare professionals facilitated implementation in daily practice. The approach was considered helpful in enhancing person-centred palliative dementia care. IMPACT STATEMENT This study underscores the importance of active involvement of healthcare professionals in the research and development of new interventions or tools for palliative care, which can influence the successful implementation, dissemination and sustained usage of the developed tools. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE The developed approach can improve person-centred palliative care for individuals with dementia, ultimately improving their quality of life and that of their loved ones. REPORTING METHOD This study used the Consolidated Criteria for Reporting Qualitative Research. PATIENT OF PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Jesper M A Biesmans
- Department of Health Services Research, Maastricht University, Care and Public Health Research Institute, Maastricht, The Netherlands
- Living Lab for Aging and Long-Term Care Limburg, Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
- Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | - Sascha R Bolt
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - Daisy J A Janssen
- Department of Health Services Research, Maastricht University, Care and Public Health Research Institute, Maastricht, The Netherlands
- Living Lab for Aging and Long-Term Care Limburg, Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
- Department of Family Medicine, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Toon Wintjens
- Department of Health Services Research, Maastricht University, Care and Public Health Research Institute, Maastricht, The Netherlands
| | - Chandni Khemai
- Department of Health Services Research, Maastricht University, Care and Public Health Research Institute, Maastricht, The Netherlands
- Living Lab for Aging and Long-Term Care Limburg, Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
| | - Jos M G A Schols
- Department of Health Services Research, Maastricht University, Care and Public Health Research Institute, Maastricht, The Netherlands
- Living Lab for Aging and Long-Term Care Limburg, Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
| | - 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
- Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sandra M G Zwakhalen
- Department of Health Services Research, Maastricht University, Care and Public Health Research Institute, Maastricht, The Netherlands
- Living Lab for Aging and Long-Term Care Limburg, Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
| | - Judith M M Meijers
- Department of Health Services Research, Maastricht University, Care and Public Health Research Institute, Maastricht, The Netherlands
- Living Lab for Aging and Long-Term Care Limburg, Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
- Zuyderland Medical Center, Sittard-Geleen, The Netherlands
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Groenvynck L, Khemai C, de Boer B, Beaulen A, Hamers JPH, van Achterberg T, van Rossum E, Meijers JMM, Verbeek H. The perspectives of older people living with dementia regarding a possible move to a nursing home. Aging Ment Health 2023; 27:2377-2385. [PMID: 37099667 DOI: 10.1080/13607863.2023.2203693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 04/04/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND/OBJECTIVES Moving into a nursing home is often an unavoidable life event for older people living with dementia. It is associated with negative emotions and outcomes. Research capturing their perspectives is scarce. This study aims to identify how older people living with dementia perceive a potential life in a nursing home and to understand their (future) care wishes. MATERIALS AND METHODS This study is part of the European TRANS-SENIOR research network. The study followed a qualitative phenomenological methodology. Semi-structured interviews with 18 community-dwelling older people living with dementia were conducted between August 2018 and October 2019 (METCZ20180085). A stepwise interpretive phenomenological analysis was performed. RESULTS The majority of community-dwelling older people feared the idea of potentially moving to a nursing home. The participants associated a possible move with negative perceptions and emotions. Additionally, this study emphasized the importance of knowledge of current and past experiences with care when identifying the participant's wishes. They wanted to remain (a) individuals, who are (b) autonomous and have (c) social contacts if they would move to a nursing home. DISCUSSION/IMPLICATIONS This study showed how past and current care experiences can educate/inform healthcare professionals on the future care wishes of older people living with dementia. The results indicated that listening to the wishes, and life stories of people living with dementia could be a way of identifying 'a suitable time' to suggest a move to a nursing home. This could improve the transitional care process and adjustment to living in a nursing home.
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Affiliation(s)
- Lindsay Groenvynck
- Maastricht University, Care and Public Health Research Institute, Department of Health Services Research, Maastricht, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
- KU Leuven, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Leuven, Belgium
| | - Chandni Khemai
- Maastricht University, Care and Public Health Research Institute, Department of Health Services Research, Maastricht, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Bram de Boer
- Maastricht University, Care and Public Health Research Institute, Department of Health Services Research, Maastricht, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Audrey Beaulen
- Maastricht University, Care and Public Health Research Institute, Department of Health Services Research, Maastricht, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Jan P H Hamers
- Maastricht University, Care and Public Health Research Institute, Department of Health Services Research, Maastricht, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Theo van Achterberg
- KU Leuven, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Leuven, Belgium
| | - Erik van Rossum
- Maastricht University, Care and Public Health Research Institute, Department of Health Services Research, Maastricht, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
- Zuyd University of Applied Sciences, Academy of Nursing, Research centre on Community Care, Heerlen, The Netherlands
| | - Judith M M Meijers
- Maastricht University, Care and Public Health Research Institute, Department of Health Services Research, Maastricht, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
- Zuyderland Care, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | - Hilde Verbeek
- Maastricht University, Care and Public Health Research Institute, Department of Health Services Research, Maastricht, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
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Mattos MK, Gibson JS, Wilson D, Jepson L, Ahn S, Williams IC. Shared decision-making in persons living with dementia: A scoping review. DEMENTIA 2023; 22:875-909. [PMID: 36802973 PMCID: PMC10866150 DOI: 10.1177/14713012231156976] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Evidence supports that older adults with cognitive impairment can reliably communicate their values and choices, even as cognition may decline. Shared decision-making, including the patient, family members, and healthcare providers, is critical to patient-centered care. The aim of this scoping review was to synthesize what is known about shared decision-making in persons living with dementia. A scoping review was completed in PubMed, CINAHL, and Web of Science. Keywords included content areas of dementia and shared decision-making. Inclusion criteria were as follows: description of shared or cooperative decision making, cognitively impaired patient population, adult patient, and original research. Review articles were excluded, as well as those for which the formal healthcare provider was the only team member involved in the decision-making (e.g., physician), and/or the patient sample was not cognitively impaired. Systematically extracted data were organized in a table, compared, and synthesized. The search yielded 263 non-duplicate articles that were screened by title and abstract. Ninety-three articles remained, and the full text was reviewed; 32 articles were eligible for this review. Studies were from across Europe (n = 23), North America (n = 7), and Australia (n = 2). The majority of the articles used a qualitative study design, and 10 used a quantitative study design. Categories of similar shared decision-making topics emerged, including health promotion, end-of-life, advanced care planning, and housing decisions. The majority of articles focused on shared decision-making regarding health promotion for the patient (n = 16). Findings illustrate that shared decision-making requires deliberate effort and is preferred among family members, healthcare providers, and patients with dementia. Future research should include more robust efficacy testing of decision-making tools, incorporation of evidence-based shared decisionmaking approaches based on cognitive status/diagnosis, and consideration of geographical/cultural differences in healthcare delivery systems.
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Affiliation(s)
| | | | - Dan Wilson
- Health Sciences Library, 2358University of Virginia, USA
| | - Laura Jepson
- School of Nursing, 2358University of Virginia, USA
| | - Soojung Ahn
- School of Nursing, Vanderbilt University, USA
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Smit KD, Bolt SR, de Boer B, Verbeek H, Meijers JMM. End-of-life care for people with dementia on a green care farm during the COVID-19 pandemic: a qualitative study. BMC Geriatr 2022; 22:956. [PMID: 36510157 PMCID: PMC9744593 DOI: 10.1186/s12877-022-03584-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 11/03/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Green care farms combine agriculture production with health-related, social and educational services. In the Netherlands, they form an alternative to traditional nursing homes for people with dementia. Green care farms that offer 24-hour care, also offers end-of-life care. To date, little is known about end-of-life care for people with dementia on green care farms. This study aimed to explore the experiences of healthcare workers and family caregivers with end-of-life care for people with dementia who died on a green care farm. DESIGN An explorative, descriptive qualitative design with a phenomenological approach. SETTING AND PARTICIPANTS A purposive sample of 15 participants - seven healthcare workers and eight family caregivers - from three green care farms in the Netherlands. METHODS Semi-structured, in-depth interviews were conducted to explore participants' experiences with end-of-life care, including topics such as advance care planning, the influence of COVID-19, and bereavement support. Transcripts were thematically analysed using Braun and Clarke's approach. RESULTS Four main themes were extracted: 1) tailored care and attention for the individual resident, 2) reciprocal care relationships between healthcare workers and family caregivers, 3) compassionate care and support in the dying phase, and 4) the influence of COVID-19 on end-of-life care. CONCLUSION AND IMPLICATIONS The overall experience of the healthcare workers and family caregivers was that end-of-life care offered on green care farms is person-centred and compassionate and is tailored to the person with dementia and their family caregivers. Despite the COVID-19 pandemic, healthcare workers and family caregivers were satisfied with end-of-life care on the green care farms. Green care farms may offer a valuable alternative care setting for people with dementia in their last phase of life. More research is needed to investigate green care farms'benefits compared to other, more traditional settings.
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Affiliation(s)
- Kirsten D. Smit
- grid.5477.10000000120346234Utrecht University, Nursing Sciences, program in Clinical Health Sciences, University Medical Center Utrecht, Utrecht, The Netherlands ,grid.5012.60000 0001 0481 6099Maastricht University, Care and Public Health Research Institute, Department of Health Services Research, Maastricht, The Netherlands
| | - Sascha R. Bolt
- grid.5012.60000 0001 0481 6099Maastricht University, Care and Public Health Research Institute, Department of Health Services Research, Maastricht, The Netherlands ,Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands ,grid.12295.3d0000 0001 0943 3265Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
| | - Bram de Boer
- grid.5012.60000 0001 0481 6099Maastricht University, Care and Public Health Research Institute, Department of Health Services Research, Maastricht, The Netherlands ,Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Hilde Verbeek
- grid.5012.60000 0001 0481 6099Maastricht University, Care and Public Health Research Institute, Department of Health Services Research, Maastricht, The Netherlands ,Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Judith M. M. Meijers
- grid.5012.60000 0001 0481 6099Maastricht University, Care and Public Health Research Institute, Department of Health Services Research, Maastricht, The Netherlands ,Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands ,Zuyderland Care, Zuyderland Medical Center, Dr. H. van der Hoffplein 1, 6162 BG Sittard-Geleen, The Netherlands
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Crowther J, Horton S, Wilson K, Lloyd-Williams M. A UK qualitative study of living and dying with dementia in the last year of life. Palliat Care Soc Pract 2022; 16:26323524221096691. [PMID: 35757158 PMCID: PMC9218895 DOI: 10.1177/26323524221096691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 04/07/2022] [Indexed: 11/25/2022] Open
Abstract
Background Dementia is a life-limiting illness, but the trajectory of dying can be difficult to establish and care at end of life can be variable and problematic. Methods This UK study was carried out to explore the end-of-life-care experiences of people with dementia from the perspective of their family carers. In-depth interviews were conducted with 40 bereaved family carers of people with dementia. Results Forty family carers (male n = 9, female n = 31) age range: 18-86 years were interviewed. Issues with poor communication were common. The hard work of caring and issues regarding unpredictability of living and dying with dementia were also commonplace within the study. Only three patients were referred for specialist palliative care support at the end of life, all of whom had a dual diagnosis of dementia and cancer. Conclusion This qualitative study has identified that there are several gaps in the end-of-life care of people with dementia, and frequently, there is poor communication during the last year of life. The need for high-quality integrated care for people dying with dementia with appropriate support during the last year of life is identified. COVID-19 has disproportionately affected people with dementia, and in the post-pandemic era, there is an urgent need to ensure every person dying with dementia is supported to die in their preferred place and that family members are supported and enabled to be treated as the 'expert' in terms of their knowledge of their relatives' care and preferences.
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Affiliation(s)
- Jacqueline Crowther
- Academic Palliative and Supportive Care Studies Group (APSCSG) and Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | | | - Kenneth Wilson
- Department of Psychiatry, University of Liverpool, Liverpool, UK
| | - Mari Lloyd-Williams
- Professor, Primary Care and Mental Health, Liverpool Health Partners and University of Liverpool, Brownlow Hill, Liverpool L69 3GB, UK
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Vandenbogaerde I, De Vleminck A, van der Heide A, Deliens L, Van den Block L, Smets T. Quality of end-of-life nursing home care in dementia: relatives' perceptions. BMJ Support Palliat Care 2022:bmjspcare-2021-003497. [PMID: 35710707 DOI: 10.1136/bmjspcare-2021-003497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 05/30/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Only a few studies have investigated the quality of end-of-life care provided to nursing home residents with dementia as perceived by their relatives. We aim to investigate the quality of end-of-life care as perceived by relatives and to investigate which characteristics of nursing home residents with dementia, their relatives and the care they received are associated with the evaluation the quality of end-of-life care as perceived by the relatives. METHODS Data used were from two cross-sectional studies performed in Flanders in 2010 and 2015. Questionnaires were sent to bereaved relatives of nursing home residents with dementia and 208 questionnaires were returned. The quality of end-of-life care as perceived by the relatives was measured with the End-of-Life with Dementia-Satisfaction With Care scale (scores ranging 10-40). RESULTS In total, 208 (response rate2010: 51.05%, response rate2015=60.65%) bereaved relatives responded to the questionnaire. The quality of end-of-life care as perceived by them was positively associated with the nursing home resident being male (b=1.78, p<0.05), relatives receiving information on palliative care (b=2.92, p<0.01) and relatives receiving information about medical care from care providers (b=2.22, p<0.01). CONCLUSION This study suggests that relatives need to be well informed about palliative and medical care. Future end-of-life care interventions in nursing homes should focus on how to increase the information exchange and communication between nursing home staff and relatives.
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Affiliation(s)
- Isabel Vandenbogaerde
- End of Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Public Health and Primary Care, Universiteit Gent, Gent, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussel, Belgium
| | - Aline De Vleminck
- End of Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Public Health and Primary Care, Universiteit Gent, Gent, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussel, Belgium
| | - Agnes van der Heide
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Luc Deliens
- End of Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Public Health and Primary Care, Universiteit Gent, Gent, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussel, Belgium
| | - Lieve Van den Block
- End of Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Public Health and Primary Care, Universiteit Gent, Gent, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussel, Belgium
| | - Tinne Smets
- End of Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Public Health and Primary Care, Universiteit Gent, Gent, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussel, Belgium
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10
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Nishimura M, Dening KH, Sampson EL, de Oliveira Vidal EI, de Abreu WC, Kaasalainen S, Eisenmann Y, Dempsey L, Moore KJ, Davies N, Bolt SR, Meijers JMM, Dekker NL, Miyashita M, Nakanishi M, Nakayama T, van der Steen JT. Cross-cultural conceptualization of a good end of life with dementia: a qualitative study. Palliat Care 2022; 21:106. [PMID: 35676673 PMCID: PMC9175529 DOI: 10.1186/s12904-022-00982-9] [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: 01/23/2022] [Accepted: 05/19/2022] [Indexed: 09/25/2023] Open
Abstract
Background Research on the nature of a “good death” has mostly focused on dying with cancer and other life-limiting diseases, but less so on dementia. Conceptualizing common cross-cultural themes regarding a good end of life in dementia will enable developing international care models. Methods We combined published qualitative studies about end of life with dementia, focus group and individual interviews with the researchers, and video-conferencing and continuous email discussions. The interviews were audio-recorded and transcribed verbatim. The data were analyzed thematically, and the researchers developed common themes referring to their original studies. Results Fourteen qualitative researchers representing 14 cross-cultural studies covering qualitative data of 121 people with dementia and 292 family caregivers. The researchers and data were from eight countries UK, The Netherlands, Japan, Portugal, Germany, Canada, Brazil, and Ireland. Three focus groups, five individual interviews, and video-conferencing were conducted and feedback on multiple iterations was gained by 190 emails between May 2019 and April 2020 until consensus was achieved. Nine cross-culturally common themes emerged from the discussions and shared interpretation of the data of persons with dementia and family caregivers. Three represent basic needs: “Pain and Symptoms Controlled,” “Being Provided Basic Care,” and “A Place like Home.” Other themes were “Having Preferences Met,” “Receiving Respect as a Person,” “Care for Caregivers,” “Identity Being Preserved,” “Being Connected,” and “Satisfaction with Life and Spiritual Well-being.” “Care for Caregivers” showed the greatest difference in emphasis across cultures. Good relationships were essential in all themes. Conclusions The common cross-cultural themes comprise a framework underpinned by value placed on personhood and dignity, emphasizing that interdependency through relationships is essential to promote a good end of life with dementia. These themes and valuing the importance of relationships as central to connecting the themes could support care planning and further development of a dementia palliative care model. Trial registration The Graduate School and Faculty of Medicine Kyoto University (R1924–1). Supplementary Information The online version contains supplementary material available at 10.1186/s12904-022-00982-9.
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Affiliation(s)
- Mayumi Nishimura
- Department of Health Informatics, School of Public Health, Graduate School of Medicine, Kyoto University, Sakyo-ku, Yoshida Konoe-cho, Kyoto, 606-8501, Japan.
| | | | - Elizabeth L Sampson
- Marie Curie Palliative Care Research Department, University College London, Gower Street, London, WC1E 6BT, UK
| | - Edison Iglesias de Oliveira Vidal
- Botucatu Medical School, Sao Paulo State University (UNESP), Av. Prof. Mario Rubens Guimaraes Montenegro, Botucatu, SP, 18618-687, Brazil
| | - Wilson Correia de Abreu
- Center for Health Technology and Services Research, University of Porto (ESEP/CINTESIS), R. Dr. Plácido da Costa, 4200-450, Porto, Portugal
| | - Sharon Kaasalainen
- School of Nursing, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada
| | - Yvonne Eisenmann
- Department of Palliative Medicine, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Laura Dempsey
- Department of Nursing and Healthcare, Technological University of the Shannon: Midlands Midwest, Dublin Road, Athlone, Co Westmeath, N37 HD68, Ireland
| | - Kirsten J Moore
- Marie Curie Palliative Care Research Department, University College London, Gower Street, London, WC1E 6BT, UK.,National Ageing Research Institute Inc., Royal Melbourne Hospital, Royal Park Campus, Gate 4, Building 8, 34-54 Poplar Rd, Parkville, VIC, 3052, Australia
| | - Nathan Davies
- Marie Curie Palliative Care Research Department, University College London, Gower Street, London, WC1E 6BT, UK.,Research Department of Primary Care and Population Health, University College London, Gower Street, London, WC1E 6BT, UK
| | - Sascha R Bolt
- Department of Health Services Research, Care and Public Health Research Institute, Living Lab in Ageing and Long-Term Care, Faculty of Health Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | - Judith M M Meijers
- Department of Health Services Research, Care and Public Health Research Institute, Living Lab in Ageing and Long-Term Care, Faculty of Health Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands.,Zuyderland Care, Zuyderland Medical Center, Dr. H. van der Hoffplein 1, 6162, BG, Sittard-Geleen, The Netherlands
| | - Natashe Lemos Dekker
- Institute of Cultural Anthropology and Development Sociology, Leiden University, Pieter de la Court Wassenaarseweg 52, 2333, AK, Leiden, The Netherlands
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Miharu Nakanishi
- Department of Psychiatric Nursing, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Takeo Nakayama
- Department of Health Informatics, School of Public Health, Graduate School of Medicine, Kyoto University, Sakyo-ku, Yoshida Konoe-cho, Kyoto, 606-8501, Japan
| | - Jenny T van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, 2333, ZD, Leiden, The Netherlands.,Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
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11
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Akunor HS, McCarthy EP, Hendricksen M, Roach A, Hendrix Rogers A, Mitchell SL, Lopez RP. Nursing Home Staff Perceptions of End-of-Life Care for Residents With Advanced Dementia: A Multisite Qualitative Study. J Hosp Palliat Nurs 2022; 24:152-158. [PMID: 35195109 PMCID: PMC9058147 DOI: 10.1097/njh.0000000000000843] [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] [Indexed: 11/26/2022]
Abstract
Nursing homes (NHs) are an important site of death for residents with advanced dementia. Few studies have explored the experiences of NH staff about providing end-of-life care for residents with advanced dementia. This study aimed to describe NH staff perceptions on where end-of-life care should be delivered, the role of Medicare hospice care, and their experiences providing end-of-life care to residents with advanced dementia. Data from the Assessment of Disparities and Variation for Alzheimer's disease Nursing home Care at End of life study were used to explore the study objectives. Semistructured interviews with 158 NH staff working in 13 NHs across the United States were analyzed. Most NH staff endorsed the NH as a better site of death for residents with advanced dementia compared with a hospital. They expressed mixed perceptions about hospice care. However, regardless of their role, the staff expressed experiencing difficult emotions while providing end-of-life care to residents with dementia because of the close attachments they had formed with them and bearing witness to their decline. The findings show that most NH staff have strong emotional attachments to their dying residents with dementia and prefer to care for them at the NH rather than transfer them to the hospital.
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12
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Which has more influence on a family's assessment of the quality of dying of their long-term care resident with dementia: Frequency of symptoms or quality of communication with healthcare team? Palliat Support Care 2022; 21:438-444. [PMID: 35346414 DOI: 10.1017/s1478951522000323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Symptoms present at the end of life and the quality of communication with the healthcare team have both been shown to impact family assessments of the quality of dying of their loved one with dementia. However, the relative contributions of these two factors to family assessments have not yet been investigated. To address this knowledge gap, we explored which of these two factors has more influence on family assessments of the quality of dying of long-term care (LTC) residents with dementia. METHOD This is a secondary analysis of a mortality follow-back study. Ninety-four family members of LTC residents who had died with dementia assessed the quality of dying (very good or not very good), the frequency of symptoms, and the quality of communication with the healthcare team using a self-administered questionnaire mailed 1 month after the resident's death. Logistic regression analyses were performed to determine the relative contributions of the two independent variables of primary interest (frequency of symptoms and quality of communication) to the families' assessments of the quality of dying. RESULTS Multivariate analyses revealed that the quality of communication with the healthcare team was closely linked to the quality of dying (p = 0.009, OR = 1.34, 95% CI = 1.09-1.65), whereas the frequency of symptoms was not (p = 0.142, OR = 1.05, 95% CI = 0.98-1.11) after controlling for potential confounders. SIGNIFICANCE OF RESULTS Our findings show that healthcare providers' ability to engage in the end-of-life conversations with families outweighs the frequency of symptoms in family assessments of the quality of dying of their relative with dementia. Enhancing healthcare providers' ability to communicate with families about the end-of-life care could improve families' perceptions of the quality of dying of their relative with dementia and, consequently, ease their grieving process.
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13
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Whitehead P. Palliative Care and Dementia: What All Advanced Practice Nurses Should Know. Crit Care Nurs Clin North Am 2022; 34:121-127. [PMID: 35210021 DOI: 10.1016/j.cnc.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Dementia is a progressive, incurable condition that causes limitations in life and should be recognized as a life-limiting condition. Health care professionals should understand its trajectory to better manage symptoms and to provide early and ongoing advance care planning. Advanced practice registered nurses are uniquely qualified to work with patients and their families to identify care preferences and then to align treatments to them. Palliative care and hospice are important interventions that should be integrated into the management of patients with dementia. Additionally, early integration of palliative medicine can better manage symptoms and lessen the strain on loved ones.
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Affiliation(s)
- Phyllis Whitehead
- Carilion Roanoke Memorial Hospital Palliative Care Service, 1906 Belleview Avenue Southeast, Roanoke, VA 24014, USA; Virginia Tech Carilion School of Medicine, 2 Riverside Circle, Roanoke, VA 24014, USA.
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14
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Klapwijk MS, Bolt SR, Boogaard JA, Ten Koppel M, Gijsberts MJH, van Leussen C, The BAM, Meijers JM, Schols JM, Pasman HRW, Onwuteaka-Philipsen BD, Deliens L, Van den Block L, Mertens B, de Vet HC, Caljouw MA, Achterberg WP, van der Steen JT. Trends in quality of care and dying perceived by family caregivers of nursing home residents with dementia 2005-2019. Palliat Med 2021; 35:1951-1960. [PMID: 34455856 PMCID: PMC8637361 DOI: 10.1177/02692163211030831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Dementia palliative care is increasingly subject of research and practice improvement initiatives. AIM To assess any changes over time in the evaluation of quality of care and quality of dying with dementia by family caregivers. DESIGN Combined analysis of eight studies with bereaved family caregivers' evaluations 2005-2019. SETTING/PARTICIPANTS Family caregivers of nursing home residents with dementia in the Netherlands (n = 1189) completed the End-of-Life in Dementia Satisfaction With Care (EOLD-SWC; quality of care) and Comfort Assessment in Dying (EOLD-CAD, four subscales; quality of dying) instruments. Changes in scores over time were analysed using mixed models with random effects for season and facility and adjustment for demographics, prospective design and urbanised region. RESULTS The mean total EOLD-SWC score was 33.40 (SD 5.08) and increased by 0.148 points per year (95% CI, 0.052-0.244; adjusted 0.170 points 95% CI, 0.055-0.258). The mean total EOLD-CAD score was 30.80 (SD 5.76) and, unadjusted, there was a trend of decreasing quality of dying over time of -0.175 points (95% CI, -0.291 to -0.058) per year increment. With adjustment, the trend was not significant (-0.070 EOLD-CAD total score points, 95% CI, -0.205 to 0.065) and only the EOLD-CAD subscale 'Well being' decreased. CONCLUSION We identified divergent trends over 14 years of increased quality of care, while quality of dying did not increase and well-being in dying decreased. Further research is needed on what well-being in dying means to family. Quality improvement requires continued efforts to treat symptoms in dying with dementia.
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Affiliation(s)
- Maartje S Klapwijk
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.,Huis op de Waard, Marente, Leiden, The Netherlands
| | - Sascha R Bolt
- Department of Health Services Research, Faculty of Health Medicine and Lifesciences, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.,Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Jannie A Boogaard
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Maud Ten Koppel
- Zorginstituut Nederland, Diemen, North Holland, The Netherlands
| | - Marie-José He Gijsberts
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | | | - B Anne-Mei The
- Tao of Care, Amsterdam, The Netherlands.,Department Sociology, Faculty of Social Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Judith Mm Meijers
- Department of Health Services Research, Faculty of Health Medicine and Lifesciences, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.,Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands.,Zuyderland Care, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | - Jos Mga Schols
- Department of Health Services Research, Faculty of Health Medicine and Lifesciences, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.,Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | | | | | - Luc Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | - Lieve Van den Block
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | - Bart Mertens
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands
| | - Henrica Cw de Vet
- Department of Epidemiology and Data Science, Amsterdam UMC, Location VU University Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Monique Aa Caljouw
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - 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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15
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Harper AE, Terhorst L, Moscirella M, Turner RL, Piersol CV, Leland NE. The experiences, priorities, and perceptions of informal caregivers of people with dementia in nursing homes: A scoping review. DEMENTIA 2021; 20:2746-2765. [PMID: 33899537 DOI: 10.1177/14713012211012606] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Person-centered care has been shown to increase desired outcomes for people with dementia, yet informal caregivers' dissatisfaction with care is often reported. For those living in a nursing home, informal caregivers are uniquely situated to provide key insights into the individual's care. However, little is known of the informal caregivers' perspective, which hinders efforts to improve their satisfaction with person-centered nursing home care. Thus, we examined the comprehensive experiences, priorities, and perceptions of informal caregivers of nursing home residents with dementia. METHODS In collaboration with stakeholders, a scoping review of Medline (Ovid), EMBASE.com, CINAHL (EBSCO), the Cochrane Library (Wiley), and PsycINFO (Ovid) databases from January 2000 to July 2020 was conducted. Data were extracted reflecting the experiences, priorities, and preferences of caregivers of people with dementia residing in nursing homes. RESULTS We identified 114 articles that revealed nine themes: (1) communication, (2) transition to nursing home, (3) quality of care, (4) quality of life, (5) informal caregiver role, (6) knowledge of dementia, (7) end-of-life preferences, (8) medication use to manage neuropsychiatric behaviors, and (9) finances. CONCLUSION Informal caregivers described aspects of care that led to both positive and negative experiences with and perceptions of nursing home care. The shortcomings in communication were discussed most frequently, indicating a high priority area. While researchers define the identified themes individually, informal caregivers perceive them to be interwoven as they relate to person-centered care delivery. Although we did not assess the quality of included articles, by identifying themes relevant to caregivers' perspectives of nursing home care, our findings may help to inform efforts to optimize caregivers' satisfaction with nursing home care for residents with dementia.
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Affiliation(s)
- Alexandra E Harper
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, 6614University of Pittsburgh, Pittsburgh, PA, USA
| | - Lauren Terhorst
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, 6614University of Pittsburgh, Pittsburgh, PA, USA
| | - Marybeth Moscirella
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, 6614University of Pittsburgh, Pittsburgh, PA, USA
| | - Rose L Turner
- Health Sciences Library System, 499478University of Pittsburgh, Pittsburgh, PA, USA
| | - Catherine V Piersol
- Department of Occupational Therapy, Jefferson College of Rehabilitation Sciences, 6559Thomas Jefferson University, Philadelphia, PA, USA
| | - Natalie E Leland
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, 6614University of Pittsburgh, Pittsburgh, PA, USA
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16
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Whitehead PB, Gamaluddin S, DeWitt S, Stewart C, Kim KY. Caring for Patients With Dementia at End of Life. Am J Hosp Palliat Care 2021; 39:716-724. [PMID: 34519251 DOI: 10.1177/10499091211046247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Care of the dementia patient continues to be challenging. It is a terminal condition that many times goes undiagnosed leading to improper evidence-based interventions. Healthcare professionals (HCPs) should initiate goals of care conversations early with patients and their families in order to align treatment preferences. Early integration of palliative medicine is an important intervention that can lead to better manage symptoms and lessen the strain on loved ones. Additionally, early enrollment into hospice should be encouraged with loved ones to promote quality of life as defined by the patient.
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Affiliation(s)
- Phyllis B Whitehead
- Carilion Roanoke Memorial Hospital Palliative Care Service, Roanoke, VA, USA.,Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | | | - Sarah DeWitt
- Carilion Roanoke Memorial Hospital Palliative Care Service, Roanoke, VA, USA.,Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Christi Stewart
- Carilion Roanoke Memorial Hospital Palliative Care Service, Roanoke, VA, USA.,Virginia Tech Carilion School of Medicine, Roanoke, VA, USA.,Carilion Center for Healthy Aging, Roanoke, VA, USA
| | - Kye Y Kim
- Virginia Tech Carilion School of Medicine, Roanoke, VA, USA.,Carilion Center for Healthy Aging, Roanoke, VA, USA
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17
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Bolt SR, van der Steen JT, Khemai C, Schols JMGA, Zwakhalen SMG, Meijers JMM. The perspectives of people with dementia on their future, end of life and on being cared for by others: A qualitative study. J Clin Nurs 2021; 31:1738-1752. [PMID: 33432696 PMCID: PMC9290953 DOI: 10.1111/jocn.15644] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/05/2020] [Accepted: 12/31/2020] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To explore the perspectives of people with dementia on being cared for by others, on the future and on the end of life, and to evaluate the capability and willingness of participants to have these conversations. BACKGROUND Awareness about perspectives of people with dementia should decrease stigmatisation and improve their quality of life. Applying palliative care principles from an early stage is important to address diverse needs and to anticipate the future. Few studies investigate perspectives of people with dementia regarding palliative care, including advance care planning. DESIGN Qualitative descriptive design. METHODS We performed in-depth interviews with 18 community-dwelling persons with dementia in South-Limburg, the Netherlands. Transcripts were analysed using an inductive content analysis. Two authors coded the data and regularly compared coding. All authors discussed abstraction into categories and themes. We followed the COREQ reporting guidelines. RESULTS Five overarching themes derived from the interviews were as follows: (a) My life still has value and meaning, (b) I am my own unique individual, (c) I place my trust in other people, (d) The future worries me, and (e) I accept and embrace what life brings. CONCLUSIONS Participants' thoughts about the future and the end of life involved feelings of ambiguity and anxiety, but also of contentment and resignation. Despite worrying thoughts of decline, participants primarily demonstrated resilience and acceptance. They expressed appreciation and trust towards those who care for them. They wished to be recognised as unique and worthy humans, until the end of life. RELEVANCE TO CLINICAL PRACTICE This study demonstrates capability and willingness of people with dementia to discuss the future and end-of-life topics. Public and professional awareness may facilitate opportunities for informal end-of-life discussions. Healthcare professionals should promote belongingness of persons with dementia and strive to build equal, trustful care relationships with them and their families.
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Affiliation(s)
- Sascha R Bolt
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.,Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - 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
| | - Chandni Khemai
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.,Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Jos M G A Schols
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.,Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Sandra M G Zwakhalen
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.,Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Judith M M Meijers
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.,Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands.,Zuyderland Care, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
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18
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Bolt SR, Meijers JM, van der Steen JT, Schols JM, Zwakhalen SM. Nursing Staff Needs in Providing Palliative Care for Persons With Dementia at Home or in Nursing Homes: A Survey. J Nurs Scholarsh 2020; 52:164-173. [PMID: 32039556 PMCID: PMC7078976 DOI: 10.1111/jnu.12542] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE This study aimed to evaluate what types and forms of support nursing staff need in providing palliative care for persons with dementia. Another aim was to compare the needs of nursing staff with different educational levels and working in home care or in nursing homes. DESIGN A cross-sectional, descriptive survey design was used. METHODS A questionnaire was administered to a convenience sample of Dutch nursing staff working in the home care or nursing home setting. Data were collected from July through October 2018. Quantitative survey data were analyzed using descriptive statistics. Data from two open-ended survey questions were investigated using content analysis. FINDINGS The sample comprised 416 respondents. Nursing staff with different educational levels and working in different settings indicated largely similar needs. The highest-ranking needs for support were in dealing with family disagreement in end-of-life decision making (58%), dealing with challenging behaviors (41%), and recognizing and managing pain (38%). The highest-ranking form of support was peer-to-peer learning (51%). If respondents would have more time to do their work, devoting personal attention would be a priority. CONCLUSIONS Nursing staff with different educational levels and working in home care or in nursing homes endorsed similar needs in providing palliative care for persons with dementia and their loved ones. CLINICAL RELEVANCE It is critical to understand the specific needs of nursing staff in order to develop tailored strategies. Interventions aimed at increasing the competence of nursing staff in providing palliative care for persons with dementia may target similar areas to support a heterogeneous group of nurses and nurse assistants, working in home care or in a nursing home.
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Affiliation(s)
- Sascha R. Bolt
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health Medicine and LifesciencesMaastricht UniversityMaastrichtThe Netherlands
| | - Judith M.M. Meijers
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health Medicine and Lifesciences, Maastricht University, Maastricht, The Netherlands, and Zuyderland CareZuyderland Medical CenterSittard‐GeleenThe Netherlands
| | - Jenny T. van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands, and Department of Primary and Community CareRadboud university medical centerNijmegenThe Netherlands
| | - Jos M.G.A. Schols
- Department of Health Services Research and Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Faculty of Health Medicine and LifesciencesMaastricht UniversityMaastrichtThe Netherlands
| | - Sandra M.G. Zwakhalen
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health Medicine and LifesciencesMaastricht UniversityMaastrichtThe Netherlands
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