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Waterschoot K, Roelofs TSM, van Dam A, Luijkx KG. Exploring the gender-sensitive feelings of nurses towards residents with intimate and sexual needs in dementia nursing care. Geriatr Nurs 2024; 59:312-320. [PMID: 39098269 DOI: 10.1016/j.gerinurse.2024.07.025] [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: 03/26/2024] [Revised: 07/02/2024] [Accepted: 07/22/2024] [Indexed: 08/06/2024]
Abstract
INTRODUCTION Person-centered care emphasizes close care relations regardless of gender. However, when residents with dementia express intimate or sexual needs, nurses may struggle with their own emotions and need to include personal boundaries. METHODS 277 (vocational) nurses from 25 Dutch nursing homes completed a survey, including the Feeling Word Checklist for a resident with perceived sexual needs and another for a resident with perceived intimate needs. RESULTS Positive-nurturing sentiments towards residents prevail, yet residents expressing intimate needs elicit higher levels of positive-nurturing and lower levels of negative emotions than those with sexual needs. Male residents, who expressed more pronounced sexual needs, received less affection and interest from female nurses who felt especially close to female residents with intimate needs. CONCLUSION Close care relations established through nurses' personal emotions inadvertently introduce gender-sensitive and differing emotions towards residents. Nurses' capability to include personal boundaries benefits the relationship and well-being of both parties.
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Affiliation(s)
- Karien Waterschoot
- Tranzo, Scientific Center for Care and Welfare, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands.
| | - Tineke S M Roelofs
- Tranzo, Scientific Center for Care and Welfare, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands; Archipel Landrijt, Expertise Center for Specialized Care, Eindhoven, the Netherlands
| | - Arno van Dam
- Tranzo, Scientific Center for Care and Welfare, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands; Research and Innovation, GGZ WNB Mental Health Institute, Halsteren, the Netherlands
| | - Katrien G Luijkx
- Tranzo, Scientific Center for Care and Welfare, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands
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Kim HT, Çakmak G, Lee YH, Jo YH, Yoon HI, Yilmaz B. Mechanical properties, cytotoxicity, and protein adsorption of three-dimensionally printable hybrid resin containing zwitterionic polymer and silicate-based composites for dental restorations. J Dent 2024; 147:105134. [PMID: 38885733 DOI: 10.1016/j.jdent.2024.105134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 05/28/2024] [Accepted: 06/14/2024] [Indexed: 06/20/2024] Open
Abstract
OBJECTIVE To evaluate the mechanical and biological properties of three-dimensionally (3D) printable resins filled with 2-methacryloyloxyethyl phosphorylcholine (MPC) and silicate-based composites and compare with those of a commercially available 3D-printable resin for definitive restorations. METHODS A group of 3D-printable hybrid resins (HRs) filled with 6 wt% MPC and three different compositions of silicate-based composites (barium silicate to zirconium silicate ratios: 1.50:1 for HR1, 0.67:1 for HR2, and 0.25:1 for HR3) were prepared. The HR groups were compared with the commercially available unfilled 3D-printable resin (CR) marketed for definitive restorations in terms of flexural strength and modulus, fracture toughness, surface roughness, Vickers hardness, light transmittance (all, n = 15), cytotoxicity, and protein adsorption (both, n = 3). All data were analyzed by using non-parametric Kruskal-Wallis and Dunn's tests (α=0.05). RESULTS The HR groups had significantly higher flexural strength, modulus, fracture toughness, and hardness values than the CR (P < 0.001). HR3 had the highest surface roughness and light transmittance among the groups (P ≤ 0.006). None of tested resins showed cytotoxicity. Both HR2 and HR3 showed significantly lower protein adsorption than the CR, with a difference of approximately 60% (P ≤ 0.026). CONCLUSION Both HR2 and HR3 exhibited superior mechanical properties (flexural strength, flexural modulus, fracture toughness, and Vickers hardness), light transmittance, and protein-repellent activity than the CR, with no impact on cytotoxicity. CLINICAL SIGNIFICANCE The MPC/silicate-based composite-filled resins may be a suitable alternative for definitive restorations, given their higher mechanical properties and promising biological properties to prevent microbial adhesion and subsequent biofilm formation, as well as their non-cytotoxic properties.
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Affiliation(s)
- Hyun-Tae Kim
- Department of Prosthodontics, Seoul National University Dental Hospital, Seoul, Republic of Korea
| | - Gülce Çakmak
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | | | - Ye-Hyeon Jo
- Dental Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Hyung-In Yoon
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland; Department of Prosthodontics, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Republic of Korea.
| | - Burak Yilmaz
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland; Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Bern, Switzerland; Division of Restorative and Prosthetic Dentistry, The Ohio State University, Columbus, OH, United States
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Como DH, Lekovitch C, Wong CM, Chew F, Bieber DC, Leland NE. Perspectives of Nursing Home Staff: Application of Dementia Training Approaches. J Appl Gerontol 2024:7334648241265195. [PMID: 39047383 DOI: 10.1177/07334648241265195] [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: 07/27/2024] Open
Abstract
Non-pharmacological strategies are prioritized to manage dementia-related symptoms in nursing homes (NHs). A multiple-case study design, embedded within a pragmatic trial, examined NH staff perspectives of applying a team-based (TB) or problem-based dementia training program to resident care. A purposive sample of staff was recruited from 23 NHs to participate in one-on-one interviews, which were analyzed using a rapid qualitative approach. Both approaches yielded staff who were able to apply their training to resident care. Staff described similarities in communication strategies, family interactions, recognizing sources of behaviors, providing comfort, and ensuring resident safety. In addition, staff demonstrated increased self-efficacy when caring for residents. Differences emerged for team collaboration, engaging residents, and managing behaviors. Among TB staff, training impacted how staff cared for residents and increased teamwork. Leaders may want to consider the benefits of each approach as they deliberate on which dementia care training to provide to their staff.
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Affiliation(s)
- Dominique H Como
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Cara Lekovitch
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Carin M Wong
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Felicia Chew
- Department of Occupational Therapy, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Natalie E Leland
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
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White J, Falcioni D, Barker R, Bajic-Smith J, Krishnan C, Mansfield E, Hullick C. Understanding Dementia Carer Experiences Before Admission to a Residential Aged Care Facility: Implications for Integrated Care. J Appl Gerontol 2024:7334648241261454. [PMID: 39023911 DOI: 10.1177/07334648241261454] [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: 07/20/2024] Open
Abstract
In-depth understanding of dementia carer experience can assist clinicians by providing insight into dementia onset, symptoms and management, and help conceptualize and understand the pattern of dementia progress over time and what help is needed. We undertook a qualitative study to understand dementia carers experiences of providing care and reasons for admission to a residential aged care facility (RACF). Three themes were identified: (1) Challenges in the path to diagnosis and care, leading to delays accessing support; (2) Carer role impacted by living circumstances; and (3) Variation in decision support prior to admission to a RACF. Identifying dementia carer experiences, reinforces the need for more timely diagnosis, referral for support and interventions to promote better quality of life for a people living with dementia and their carer and to delay premature RACF placement.
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Affiliation(s)
- Jennifer White
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Dane Falcioni
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Roslyn Barker
- Hunter New England Local Health District, New Lambton Heights, NSW, Australia
| | | | - Chitra Krishnan
- Hunter New England Local Health District, New Lambton Heights, NSW, Australia
| | - Elise Mansfield
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Carolyn Hullick
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Hunter New England Local Health District, New Lambton Heights, NSW, Australia
- Australian Commission of Safety and Quality in Health Care, Sydney, NSW, Australia
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5
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Kelemen L, Gupta I, Yavarow Z, Smith SI, Johnson KG, Boucher NA. Clinician's perspectives on gene therapy for Alzheimer's disease: A qualitative study. PLoS One 2024; 19:e0307567. [PMID: 39024352 PMCID: PMC11257239 DOI: 10.1371/journal.pone.0307567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 07/08/2024] [Indexed: 07/20/2024] Open
Abstract
INTRODUCTION We aimed to understand clinician views regarding gene therapy as a future treatment for Alzheimer's disease (AD) and potential barriers and facilitators to its use. METHODS We interviewed ten clinicians who treat patients with AD. Clinicians helped design a semi-structured interview including the following domains: establishing understanding, cost/access, quality of life, and religion/spirituality. Transcripts were analyzed by a coding team using descriptive content analysis with inductive approach. RESULTS Clinicians identified three main areas of concern: 1) potential clinician and patient understanding of gene therapy and Alzheimer's disease 2) consideration of inequity (i.e., care access, disease awareness along with education level, family support, trust in care systems); and 3) considerations in decision-making (i.e., religious/spiritual beliefs and method of treatment delivery as a decision-making tools). DISCUSSION AND CONCLUSION Findings highlight areas for knowledge-building for patients and clinicians alike. Clinicians must be aware of patient/family educational needs and gaps in their own clinical knowledge before engaging patients/families with new technology. Allowing time for questions is crucial to building rapport and trust.
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Affiliation(s)
- Lilly Kelemen
- Duke University, Durham, NC, United States of America
| | - Ishika Gupta
- Duke University, Durham, NC, United States of America
| | | | - Samantha I Smith
- Sanford School of Public Policy, Duke University, Durham, NC, United States of America
| | - Kim G Johnson
- Department of Neurology, School of Medicine, Duke University, Durham, NC, United States of America
| | - Nathan A Boucher
- Sanford School of Public Policy, Duke University, Durham, NC, United States of America
- Division of Geriatric Medicine, School of Medicine, Duke University, Durham, NC, United States of America
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Shaban M, Mohammed HH, Gomaa Mohamed Amer F, Shaban MM, Abdel-Aziz HR, Ibrahim AM. Exploring the nurse-patient relationship in caring for the health priorities of older adults: qualitative study. BMC Nurs 2024; 23:480. [PMID: 39010101 PMCID: PMC11247866 DOI: 10.1186/s12912-024-02099-1] [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: 02/20/2024] [Accepted: 06/17/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND Person-centered care (PCC) is critical in addressing the diverse health priorities of older adults. Nurses play a pivotal role in implementing PCC, yet the nuances of the nurse-patient relationship in outpatient settings remain underexplored. This study aimed to gain insights into nurses' experiences, challenges, and strategies in caring for older adults through the lens of PCC. METHODS A qualitative descriptive design was employed, involving semi-structured interviews with 12 registered nurses from outpatient clinics serving older adults. Thematic analysis was conducted following the principles of trustworthiness and credibility. RESULTS Five main themes emerged: (1)Understanding and Implementing Person-Centered Care (PCC) (2) Experiences in Older Adult Care, highlighting the significance of trust-building, adapting care approaches, interdisciplinary collaboration, and emotional rewards; (3) Challenges in Care Delivery, including resource constraints, navigating family dynamics, keeping up with medical advances, and emotional strain; (4) Impact on Care Quality, encompassing consistency in care, patient satisfaction, professional development, and ethical considerations; and (5) Coping Strategies, such as peer support, work-life balance, reflective practice, and resilience building. CONCLUSIONS The study underscores the complexities and rewards of the nurse-patient relationship in caring for older adults in outpatient settings. Nurses face formidable challenges but employ various coping strategies to maintain high-quality, person-centered care. Findings have implications for nursing practice, education, policy, and future research, emphasizing the need for supportive environments, continuous professional development, and recognition of the critical role nurses play in addressing the health priorities of the aging population.
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Affiliation(s)
| | | | | | | | - Hassanat Ramadan Abdel-Aziz
- Department of Nursing, College of Applied Medical Sciences in Al-Kharj, Prince Sattam Bin Abdulaziz University, Al-Kharj, 11942, Saudi Arabia
- Gerontological Nursing Department, Faculty of Nursing, Zagazig University, Zagazig, Egypt
| | - Ateya Megahed Ibrahim
- College of Nursing, Prince Sattam bin Abdulaziz University, Al-Kharj, 11942, Saudi Arabia
- Family and Community Health Nursing Department, Faculty of Nursing, Port Said University, Port Said, Egypt
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Balasubramanian I, Poco LC, Andres EB, Chaudhry I, Østbye T, Malhotra C. Caregiver coping mediates the relationship between caregivers' understanding of dementia as terminal and their distress. Alzheimers Dement 2024. [PMID: 38971964 DOI: 10.1002/alz.14102] [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: 02/28/2024] [Revised: 06/04/2024] [Accepted: 06/06/2024] [Indexed: 07/08/2024]
Abstract
We assessed which coping strategies (problem-focused, emotion-focused, dysfunctional) mediate the association between caregivers' understanding of dementia as terminal and their distress. A total of 215 caregivers of community-dwelling persons with severe dementia were surveyed every 4 months over 3 years. A generalized structural equation model was used to test mediation. Caregivers who correctly understood dementia as terminal and those unsure (vs incorrect), experienced more distress (correct: β [95% confidence interval (CI)]: 0.80 [0.00 to 1.60]; unsure: 0.95 [0.04 to 1.87]). Caregivers with correct understanding of dementia as terminal (vs incorrect) employed more dysfunctional (2.01 [0.60 to 3.42]) and problem-focused coping strategies (2.56 [0.08 to 5.05]). Although dysfunctional and problem-focused coping (associated with higher distress) mediated the positive association between caregivers' understanding that dementia is terminal and their distress, emotion-focused coping (associated with lower distress) did not offset this relationship. Results suggest that terminal illness disclosure to caregivers should be accompanied by interventions to promote emotion-focused coping strategies. Highlights Caregivers who understood dementia as terminal experienced more distress. Dysfunctional and problem-focused coping mediated the positive relationship between terminal illness understanding and caregiver distress. Emotion-focused coping did not offset this relationship.
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Affiliation(s)
| | - Louisa Camille Poco
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore
| | | | - Isha Chaudhry
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore
| | - Truls Østbye
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore
- Family Medicine and Community Health, Duke University, Durham, North Carolina, USA
| | - Chetna Malhotra
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
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Lee KH, Lee JY, Park JY, McConnell ES. The relationship between caregivers' behaviors and resistant behaviors of persons living with dementia during personal care in long-term care facilities: A lag sequential analysis. Geriatr Nurs 2024; 58:368-372. [PMID: 38878736 DOI: 10.1016/j.gerinurse.2024.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 05/26/2024] [Accepted: 06/03/2024] [Indexed: 08/06/2024]
Abstract
Many older adults living with dementia exhibit resistant behaviors. Person-centered care is the gold standard of care; however, the sequential relationship between resistant and caregiving behaviors has not been identified. This study examined the sequential relationship between caregiving and care-resistant behaviors and analyzed 68 videos of personal care encounters of 21 residents living in four long-term care facilities. The videos were coded focusing on two sequences of behavior: residents' resistant behaviors and caregivers' behaviors. Lag sequential analysis was conducted using initial-response behavior pairs (resident-caregiver behavior or caregiver-resident behavior pairs). Person-centered care led to less resistant behavior (odds ratio 0.23; 95 % confidence interval 0.16, 0.33), whereas less person-centered care was followed by resistant behaviors (odds ratio 0.42; 95 % confidence interval 0.30, 0.59). A significant sequential association was found between task-centered behavior and resistant behavior. Hence, rigorous efforts are recommended to provide person-centered care through multilevel efforts.
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Affiliation(s)
- Kyung Hee Lee
- Yonsei University College of Nursing and Mo-Im Kim Nursing Research Institute, Seoul, South Korea
| | - Ji Yeon Lee
- Inha University School of Nursing, Incheon, South Korea.
| | - Ji Yeong Park
- Yonsei University College of Nursing and Mo-Im Kim Nursing Research Institute, Seoul, South Korea
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Budgett J, Sommerlad A, Kupeli N, Zabihi S, Rockwood K, Cooper C. Personalized goals of people living with dementia and family carers: A content analysis of goals set within an individually tailored psychosocial intervention trial. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2024; 10:e12493. [PMID: 39011459 PMCID: PMC11247364 DOI: 10.1002/trc2.12493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 06/06/2024] [Indexed: 07/17/2024]
Abstract
Introduction Person-centered goals capture individual priorities in personal contexts. Goal Attainment Scaling (GAS) has been used in drug trials involving people living with dementia (PLWD) but GAS has been characterized as difficult to incorporate into trials and clinical practice. We used GAS in a trial of New Interventions for Independence in Dementia Study (NIDUS)-family, a manualized care and support intervention, as the primary outcome and to tailor the interventions to goals set. We aimed to assess the feasibility and content of baseline goal-setting. Methods We developed training for nonclinical facilitators to set individualized GAS goals remotely with PLWD and family carer dyads, or carers alone, in the intervention trial, during the COVID-19 pandemic. A qualitative content analysis of the goals set explored participants' priorities and unmet needs, to consider how existing GAS goal domains might be extended in a psychosocial intervention trial context. Results Eleven facilitators were successfully trained to set and score GAS goals. A total of 313/328 (95%) participants were able to collaboratively set three to five goals with the facilitators. Of these, 302 randomized participating dyads set 1043 (mean 3.5, range 3 to 5) goals. We deductively coded 719 (69%) goals into five existing GAS domains (mood, behavior, self-care, cognition, and instrumental activities of daily living); 324 (31%) goals were inductively coded into four new domains: carer break, carer mood, carer behavior, and carer sleep. The most frequently set goals pertained to social support. There was little variation in types of goals set based on the context of who set them or level of pandemic restrictions in place. Discussion It is feasible for people without clinical training to set GAS holistic goals for PLWD and family carers in the community. GAS has potential to facilitate personalization of care and support interventions, such as NIDUS-family, and facilitate the roll out of more personalized care. Highlights Goal Attainment Scaling (GAS) can capture meaningful priorities of people with dementia and their family carers.A psychosocial intervention RCT used GAS as the primary outcome measure and goals were set collaboratively by non-clinically trained facilitators.The findings underscore the feasibility of using GAS as an outcome measure with this population.The content analysis findings unveiled the diversity in experiences and priorities of the study participants.GAS has the potential to support the implementation of more person-centred approaches to dementia care.
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Affiliation(s)
- Jessica Budgett
- Centre for Psychiatry and Mental HealthWolfson Institute of Population HealthQueen Mary University of LondonLondonUK
- Division of PsychiatryUniversity College LondonLondonUK
| | - Andrew Sommerlad
- Division of PsychiatryUniversity College LondonLondonUK
- Islington Memory Service, Camden and Islington NHS Foundation TrustLondonUK
| | - Nuriye Kupeli
- Marie Curie Palliative Care Research Department, Division of PsychiatryLondonUK
| | - Sedigheh Zabihi
- Preventive Neurology Unit, Wolfson Institute of Population HealthQueen Mary University of LondonLondonUK
| | - Kenneth Rockwood
- Divisions of Geriatric Medicine & NeurologyDepartment of MedicineDalhousie UniversityHalifaxNova ScotiaCanada
| | - Claudia Cooper
- Centre for Psychiatry and Mental HealthWolfson Institute of Population HealthQueen Mary University of LondonLondonUK
- Memory Services, East London NHS Foundation TrustLondonUK
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Monro C, Mackenzie L, duToit S. The quality of residential aged care in the context of the Australian aged care reforms: A scoping review. Australas J Ageing 2024. [PMID: 38923339 DOI: 10.1111/ajag.13349] [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: 11/25/2023] [Revised: 04/16/2024] [Accepted: 05/21/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVE Australia has been undergoing a major aged care reform process since 2012 focused on consumer-oriented home and community-supported care, but little is known about the impact of these reforms on residential aged care delivery. This study aimed to review research about the quality of residential aged care service delivery during the implementation period of these reforms. METHODS The review followed a five-stage scoping review framework and searched five databases for articles published between 2012 and February 2022 (the 10-year implementation period of the reforms). Initial searches identified 495 articles. Articles were imported to Covidence™ for title, abstract and full-text screening. RESULTS Twenty-two articles were included in the review. Articles were framed using the micro (residents and families)/meso (staff)/macro (governance, government) continuum in the operation of residential aged care facilities. Most articles focused on workforce perspectives. DISCUSSION Attention was paid to workforce issues and a limited focus was on consumer experience and expectations. There is a need for an evaluation of the reforms as a vehicle for promoting consumer empowerment. Many contributing factors to quality of care were identified, and there were some quality issues that were contrary to the intended objectives of the reforms. These warrant closer attention.
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Affiliation(s)
- Cathy Monro
- Faculty of Medicine and Health, School of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Lynette Mackenzie
- Faculty of Medicine and Health, School of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Sanetta duToit
- Faculty of Medicine and Health, School of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
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Adam E, Meiland F, Frielink N, Meinders E, Smits R, Embregts P, Smaling H. User Requirements and Perceptions of a Sensor System for Early Stress Detection in People With Dementia and People With Intellectual Disability: Qualitative Study. JMIR Form Res 2024; 8:e52248. [PMID: 38905626 PMCID: PMC11245304 DOI: 10.2196/52248] [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: 08/29/2023] [Revised: 04/09/2024] [Accepted: 04/24/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND Timely detection of stress in people with dementia and people with an intellectual disability (ID) may reduce the occurrence of challenging behavior. However, detecting stress is often challenging as many long-term care (LTC) residents with dementia and residents with ID have communication impairments, limiting their ability to express themselves. Wearables can help detect stress but are not always accepted by users and are uncomfortable to wear for longer periods. Integrating sensors into clothing may be a more acceptable approach for users in LTC. To develop a sensor system for early stress detection that is accepted by LTC residents with dementia and residents with ID, understanding their perceptions and requirements is essential. OBJECTIVE This study aimed to (1) identify user requirements for a garment-integrated sensor system (wearable) for early stress detection in people with dementia and people with ID, (2) explore the perceptions of the users toward the sensor system, and (3) investigate the implementation requirements in LTC settings. METHODS A qualitative design with 18 focus groups and 29 interviews was used. Focus groups and interviews were conducted per setting (dementia, ID) and target group (people with dementia, people with ID, family caregivers, health care professionals). The focus groups were conducted at 3 time points within a 6-month period, where each new focus group built on the findings of previous rounds. The data from each round were used to (further) develop the sensor system. A thematic analysis with an inductive approach was used to analyze the data. RESULTS The study included 44 participants who expressed a positive attitude toward the idea of a garment-integrated sensor system but also identified some potential concerns. In addition to early stress detection, participants recognized other potential purposes or benefits of the sensor system, such as identifying triggers for challenging behavior, evaluating intervention effects, and diagnostic purposes. Participants emphasized the importance of meeting specific system requirements, such as washability and safety, and user requirements, such as customizability and usability, to increase user acceptance. Moreover, some participants were concerned the sensor system could contribute to the replacement of human contact by technology. Important factors for implementation included the cost of the sensor system, added value to resident and health care professionals, and education for all users. CONCLUSIONS The idea of a garment-integrated sensor system for early stress detection in LTC for people with dementia and people with ID is perceived as positive and promising by stakeholders. To increase acceptability and implementation success, it is important to develop an easy-to-use, customizable wearable that has a clear and demonstrable added value for health care professionals and LTC residents. The next step involves pilot-testing the developed wearable with LTC residents with dementia and residents with ID in clinical practice.
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Affiliation(s)
- Esmee Adam
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- University Network for Care sector Zuid-Holland, Leiden University Medical Center, Leiden, Netherlands
| | - Franka Meiland
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- Department of Medicine for Older people, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Noud Frielink
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
| | | | - Reon Smits
- Mentech Innovation B.V., Eindhoven, Netherlands
| | - Petri Embregts
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
| | - Hanneke Smaling
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- University Network for Care sector Zuid-Holland, Leiden University Medical Center, Leiden, Netherlands
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12
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Zhang Y, Lingler JH, Bender CM, Seaman JB. Dignity in people with dementia: A concept analysis. Nurs Ethics 2024:9697330241262469. [PMID: 38907527 DOI: 10.1177/09697330241262469] [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: 06/24/2024]
Abstract
Background: Dignity, an abstract and complex concept, is an essential part of humanity and an underlying guiding principle in healthcare. Previous literature indicates dignity is compromised in people with dementia (PwD), but those PwD maintain the capacity to live with dignity with appropriate external support. Alzheimer's disease and related dementias (ADRDs) lead to progressive functional decline and increased vulnerability and dependence, leading to heightened risks of PwD receiving inappropriate or insufficient care that diminishes dignity. Considering the increased disease prevalence and the continuously escalating costs of dementia care, establishing a productive value-based guideline may prevent suffering, maximize dignity, and thus promote quality of life (QoL).Aim: The goal of this project is to identify actionable targets for integrating dignity harmoniously and practically into care planning and management for PwD.Research Design: We conducted a concept analysis using Walker and Avant's eight-step process. A comprehensive literature search was conducted (PubMed and CINAHL) with the keywords "dignity," "dementia," "Alzheimer's disease," and "dementia care."Results: A total of 42 out of 4910 publications were included. The concept of dignity in PwD is operationalized as the promotion of worthiness and the accordance of respect that allows the presence and expression of a person's sense of self, regardless of physical, mental, or cognitive health. The concept has two subdimensions: absolute dignity which encompasses the inherent self and relative dignity characterized by its dynamic reflective nature. Worthiness and respect are the two main attributes, while autonomy is an underlying component of dignity. Specific antecedents of dignity in PwD are empowerment, non-maleficence, and adaptive environmental scaffolding. As a consequence of facilitating dignity in PwD, QoL may be enhanced.Conclusion: As a foundational and necessary humanistic value, incorporating dignity into dementia care can lead to efficient and effective care that optimizes QoL in PwD throughout their disease progression.
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Inoue M, Ihara ES, Layman S, Li MH, Nosrat S, Mehak S, Barrett K, Magee C, McNally KA, Moore M, Tompkins CJ. A Personalized Music Intervention in Nursing Home Residents Living With Dementia: Findings From a Randomized Study. J Appl Gerontol 2024:7334648241257797. [PMID: 38867708 DOI: 10.1177/07334648241257797] [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: 06/14/2024] Open
Abstract
Utilizing a randomized control design, this mixed method study aimed to assess the impact of a personalized music intervention on mood, agitation level, and psychotropic drug use in individuals with moderate to advanced dementia residing in long-term care facilities. The sample comprised of 261 participants, with 148 in the intervention group and 113 in the control group. Data were collected from three sources: quantitative data from the Minimum Data Set and the Cohen-Mansfield Agitation Inventory, observational data of music-listening sessions, and an administrator survey regarding the lead staff person's perceptions of the intervention. Findings, based on Mixed Effect Models and content analyses, revealed positive impacts of the personalized music intervention on residents living with dementia. This low-cost, easily implementable intervention, requiring no special licensure for administration, can significantly enhance the quality of life for nursing facility residents.
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Affiliation(s)
- Megumi Inoue
- Department of Social Work, George Mason University, Fairfax, VA, USA
| | - Emily S Ihara
- Department of Social Work, George Mason University, Fairfax, VA, USA
| | - Shannon Layman
- Department of Social Work, George Mason University, Fairfax, VA, USA
| | - Meng-Hao Li
- Schar School of Policy and Government, George Mason University, Fairfax, VA, USA
| | - Sarah Nosrat
- Department of Social Work, George Mason University, Fairfax, VA, USA
| | - Samreen Mehak
- Department of Biology, George Mason University, Fairfax, VA, USA
| | | | - Catherine Magee
- Paving the Way MSI (Multi Service Institute), Washington, DC, USA
| | - Kimberly A McNally
- Department of Global and Community Health, George Mason University, Fairfax, VA, USA
| | - Morgan Moore
- Department of Social Work, George Mason University, Fairfax, VA, USA
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Leibing A, Katz S. Dilemmas of intervention: From person-centred to alienation-centred dementia care. J Aging Stud 2024; 69:101224. [PMID: 38834244 DOI: 10.1016/j.jaging.2024.101224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 03/09/2024] [Accepted: 03/11/2024] [Indexed: 06/06/2024]
Abstract
Discussions regarding personhood and dementia care are often based on practices of recognition; on notions of being-or not being- 'one of us'. This article provides a short overview of personhood as articulated in dementia care, especially in the assemblage of practices known as 'person-centred care' (PCC), and in post-human approaches that developed following the critique of PCC. This article posits an alternative framework, based on a rereading of the concept of alienation, that we want to call 'alienation-centred care'. It considers the extent to which dynamic prosthetic networks can be adapted to the lives of people with dementia, rather than only examining the individual's reactivity to dementia interventions that define traditional approaches. It further urges us to understand the multiple origins of alienating states. Conclusions explore how this framework might address some of the limitations identified in both humanist and post-human approaches to personhood and dementia.
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Affiliation(s)
- Annette Leibing
- Medical anthropology, Faculté des sciences infirmières, Université de Montréal, CP 6128, succ. Centre-ville, Montreal, QC H3C 3J7, Canada.
| | - Stephen Katz
- Department of sociology, Trent University, 1600 West Bank Drive, Peterborough, ON K9L 0G2, Canada
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Gordon CJ, Fernandez T, Chen E, Basheti M, Rahimi M, Saini B. Nurses' attitudes, beliefs and knowledge of sleep health in residential aged care: An integrative literature review. J Adv Nurs 2024. [PMID: 38819604 DOI: 10.1111/jan.16249] [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: 10/11/2023] [Revised: 04/25/2024] [Accepted: 05/10/2024] [Indexed: 06/01/2024]
Abstract
AIM To identify, synthesize and evaluate primary research on registered nurses' (RN) knowledge, attitudes and beliefs about sleep health and sleep health management of older adults living in residential aged care. DESIGN Integrative review. DATA SOURCES Medline, Embase and CINAHL databases from inception to September 2023. REVIEW METHODS Databases were searched using a combination of key words, subject heading terms. All abstracts and full-text articles were screened by two researchers. Qualitative synthesis of the included articles was conducted. Inductive content analysis was used to identify themes and analyse data. RESULTS A total of 923 abstracts were screened resulting in a final yield of 13 articles. Three themes were identified: (i) RN experience with sleep-disturbed residents, (ii) the emotional burden of sleep disturbances on RN and, (iii) organizational barriers to promoting resident's healthy sleep. Inappropriate administration of benzodiazepines and psychotropic drugs to manage residents' sleep disturbances was a major issue and lack of resources in residential aged care to facilitate sleep. There were concerns on nursing activity that disturbed residents' sleep and striking a balance between facilitating sleep and meeting managerial expectations was challenging. CONCLUSION This review identified that nurses' decision-making has an integral role in the management of sleep health in residents in aged care. Whilst evidence-based guidelines for managing sleep in residential aged care are available, there is a lack of translation to practice. Understanding RN perspectives is critical to improving sleep health models of care in residential aged care. IMPACT This review found that RN are attuned to the implications of sleep disturbance in residential aged care but are constrained by current sleep health models of care. PATIENT OR PUBLIC CONTRIBUTION Not applicable.
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Affiliation(s)
- Christopher J Gordon
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney, New South Wales, Australia
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Tracee Fernandez
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Emily Chen
- Sydney Pharmacy School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Mariam Basheti
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney, New South Wales, Australia
- Sydney Pharmacy School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Matthew Rahimi
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney, New South Wales, Australia
| | - Bandana Saini
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney, New South Wales, Australia
- Sydney Pharmacy School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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Wittmann J, Bieber A, Carroll J, Forristal K, Hopper L, Janssen N, Meyer G, Riello M, de Vugt M, Bauernschmidt D. Exploring self-experience practices in dementia care: A scoping review. PLoS One 2024; 19:e0302929. [PMID: 38713699 PMCID: PMC11075864 DOI: 10.1371/journal.pone.0302929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 04/15/2024] [Indexed: 05/09/2024] Open
Abstract
BACKGROUND Recognised as essential for high-quality dementia service, person-centred care aims to understand and respect the unique needs of each individual. Self-experience practices may offer caregivers an opportunity to acquire knowledge, empathy, and skills related to person-centred care, especially through recreating experiences similar to dementia. Given the need to enhance the understanding of self-experience practices in dementia care, a more comprehensive investigation of these training interventions for (future) caregivers is needed. METHODS We conducted a scoping review to map the evidence on the use of self-experience practices in dementia training. We systematically searched Cochrane Library, MEDLINE via PubMed, CINAHL, and Web of Science. We also searched for grey literature, as well as registry entries, and conducted backward citation tracking of included reviews. We analysed data on intervention characteristics, factors influencing the implementation, and learning outcomes based on Kirkpatrick's model. RESULTS We included 44 reports across 30 intervention programmes. The majority of reports (91%) were published from 2016 onwards, with 32% originating from the USA and 25% from the UK. We identified passive, interactive, immersive, and multicomponent self-experience interventions in dementia education and training. Learning outcomes based on Kirkpatrick's model were fairly distributed across all identified modalities. Both consumers and providers emphasised aspects related to the development and implementation of practices, particularly organisational-related considerations such as temporal and spatial planning of trainings. CONCLUSIONS Our review highlights diverse interventions incorporating self-experience practices, with an increasing role for technological tools. While self-experience interventions engage participants, the impact on individuals with dementia and organisational levels remain largely unreported. Our overview, informed by current literature, underscores unique considerations and challenges associated with dementia-related self-experience practices. Implementing and evaluating complex training interventions using self-experience practices should consider ethical aspects. TRIAL REGISTRATION Registry: Registered within the Open Science Framework (available at https://osf.io/fycxa/).
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Affiliation(s)
- Janina Wittmann
- Institute of Health and Nursing Science, University Medicine Halle, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Anja Bieber
- Institute of Health and Nursing Science, University Medicine Halle, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Joanne Carroll
- School of Psychology, Dublin City University, Dublin, Ireland
| | | | - Louise Hopper
- School of Psychology, Dublin City University, Dublin, Ireland
| | - Niels Janssen
- Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Gabriele Meyer
- Institute of Health and Nursing Science, University Medicine Halle, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | | | - Marjolein de Vugt
- Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Dorothee Bauernschmidt
- Institute of Health and Nursing Science, University Medicine Halle, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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Zidén L, Erhag HF, Wijk H. Person-centered care as a tool to reduce behavioral and psychological symptoms in older adults with dementia living in residential care facilities. Geriatr Nurs 2024; 57:51-57. [PMID: 38522128 DOI: 10.1016/j.gerinurse.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 02/21/2024] [Accepted: 03/07/2024] [Indexed: 03/26/2024]
Abstract
Among older adults living in dementia residential care facilities (RCF) behavioral and psychological symptoms (BPSD) are common, affecting the quality of life (QOL) for the residents as well as being challenging for the staff. The person-centered care (PCC) approach addresses BPSD by giving trained staff mandate to focus on the relation and to adapt the encounter and the environment to increase QoL for the person with dementia. The aims with this study were to improve PCC, decrease BPSD and improve QOL among older persons with dementia living in RCFs, and to explore leaders' and healthcare staff's experiences of a PCC intervention. An educational program was implemented at two RCFs. Data was collected through questionnaires, from national quality registries and through focus group interviews. A significant increase in PCC and QOL at three months was seen. However, no significant difference in BPSD was seen. The interviews showed the importance of a trust-based relationship, and support from an active management to improve PCC, as well as changing old patterns and recognising competence among staff. Factors that affect implementation of PCC in RCF are discussed in the article.
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Affiliation(s)
- Lena Zidén
- Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Neuroscience and Physiology, Dept of Rehabilitation, Sahlgrenska Academy, University of Gothenburg, Sweden.
| | - Hanna Falk Erhag
- Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Neuroscience and Physiology, Dept of Rehabilitation, Sahlgrenska Academy, University of Gothenburg, Sweden; Institute of Health and Care Science, Sahlgrenska Academy, University of Gothenburg, Sweden; Centre for Ageing and Health - AgeCap, University of Gothenburg, Sweden.
| | - Helle Wijk
- Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Health and Care Science, Sahlgrenska Academy, University of Gothenburg, Sweden; Chalmers University, Gothenburg, Sweden.
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Beres LK, Underwood A, Le Tourneau N, Kemp CG, Kore G, Yaeger L, Li J, Aaron A, Keene C, Mallela DP, Khalifa BAA, Mody A, Schwartz SR, Baral S, Mwamba C, Sikombe K, Eshun‐Wilson I, Geng EH, Lavoie MC. Person-centred interventions to improve patient-provider relationships for HIV services in low- and middle-income countries: a systematic review. J Int AIDS Soc 2024; 27:e26258. [PMID: 38740547 PMCID: PMC11090778 DOI: 10.1002/jia2.26258] [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] [Accepted: 04/16/2024] [Indexed: 05/16/2024] Open
Abstract
INTRODUCTION Person-centred care (PCC) has been recognized as a critical element in delivering quality and responsive health services. The patient-provider relationship, conceptualized at the core of PCC in multiple models, remains largely unexamined in HIV care. We conducted a systematic review to better understand the types of PCC interventions implemented to improve patient-provider interactions and how these interventions have improved HIV care continuum outcomes and person-reported outcomes (PROs) among people living with HIV in low- and middle-income countries. METHODS We searched databases, conference proceedings and conducted manual targeted searches to identify randomized trials and observational studies published up to January 2023. The PCC search terms were guided by the Integrative Model of Patient-Centeredness by Scholl. We included person-centred interventions aiming to enhance the patient-provider interactions. We included HIV care continuum outcomes and PROs. RESULTS We included 28 unique studies: 18 (64.3%) were quantitative, eight (28.6.%) were mixed methods and two (7.1%) were qualitative. Within PCC patient-provider interventions, we inductively identified five categories of PCC interventions: (1) providing friendly and welcoming services; (2) patient empowerment and improved communication skills (e.g. supporting patient-led skills such as health literacy and approaches when communicating with a provider); (3) improved individualized counselling and patient-centred communication (e.g. supporting provider skills such as training on motivational interviewing); (4) audit and feedback; and (5) provider sensitisation to patient experiences and identities. Among the included studies with a comparison arm and effect size reported, 62.5% reported a significant positive effect of the intervention on at least one HIV care continuum outcome, and 100% reported a positive effect of the intervention on at least one of the included PROs. DISCUSSION Among published HIV PCC interventions, there is heterogeneity in the components of PCC addressed, the actors involved and the expected outcomes. While results are also heterogeneous across clinical and PROs, there is more evidence for significant improvement in PROs. Further research is necessary to better understand the clinical implications of PCC, with fewer studies measuring linkage or long-term retention or viral suppression. CONCLUSIONS Improved understanding of PCC domains, mechanisms and consistency of measurement will advance PCC research and implementation.
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Affiliation(s)
- Laura K. Beres
- Johns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Centre for Infectious Disease Research in Zambia (CIDRZ)LusakaZambia
| | - Ashley Underwood
- Washington University in St. Louis School of MedicineSt LouisMissouriUSA
| | - Noelle Le Tourneau
- Washington University in St. Louis School of MedicineSt LouisMissouriUSA
| | | | - Gauri Kore
- Johns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Lauren Yaeger
- Washington University in St. Louis School of MedicineSt LouisMissouriUSA
| | - Jingjia Li
- Johns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Alec Aaron
- Johns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | | | | | | | - Aaloke Mody
- Centre for Infectious Disease Research in Zambia (CIDRZ)LusakaZambia
| | | | - Stefan Baral
- Johns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Chanda Mwamba
- Centre for Infectious Disease Research in Zambia (CIDRZ)LusakaZambia
| | | | | | - Elvin H. Geng
- Washington University in St. Louis School of MedicineSt LouisMissouriUSA
| | - Marie‐Claude C. Lavoie
- Center for International Health Education and BiosecurityUniversity of Maryland School of MedicineBaltimoreMarylandUSA
- Institute of Human VirologyUniversity of Maryland School of MedicineBaltimoreMarylandUSA
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19
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Gengeswaran N, Brandwood A, Anderson NN, Ramlakhan JU, Gagliardi AR. Do clinical guidelines support person-centred care for women affected by dementia: A content analysis. DEMENTIA 2024; 23:525-549. [PMID: 38567809 PMCID: PMC11059842 DOI: 10.1177/14713012241244982] [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: 05/01/2024]
Abstract
BACKGROUND Dementia disproportionately affects women including persons living with dementia and caregivers. Person-centered care, rather than disease-focused, is recommended to improve care for affected persons including caregivers. General practitioners play a central role in dementia care but find it challenging due to inadequate training. The study aimed to assess if and how dementia guidelines provide clinicians with guidance on person-centred care for women affected by dementia. METHODS We searched for publicly available English-language guidelines on the overall management of dementia in MEDLINE, EMBASE and the Guidelines International Network repository. We employed deductive and summative content analysis, and categorized person-centered care guideline content based on established frameworks, and conveyed our results using summary statistics, text, and tables. RESULTS We reviewed 15 guidelines published from 2006 to 2020 in eight countries. Few (4, 23%) involved persons living with dementia or caregivers in guideline development. Regarding general person-centred care, guidelines mostly addressed the domains of exchange information (93%), share decisions (93%), enable self-management (93%) and address emotions (87%), while few offered content on manage uncertainty (33%) or foster a healing relationship (13%). Regarding dementia-specific person-centred care, most guidelines addressed intersectionality (tailoring care for diverse characteristics) (80%), but few included content on the domains of quality of life (67%), dignity (53%) or sex/gender issues (20%). Even when mentioned, the guidance was typically brief. We identified 32 general and 18 dementia-specific strategies to achieve person-centered care by compiling information from these guidelines. CONCLUSIONS This study identified inconsistent and insufficient guideline content on person-centred care for women with dementia. Compiled strategies for achieving person-centred care could be used by developers to enhance existing and future dementia guidelines; and inform the development of policies or programs, education, tools for clinicians, and quality improvement measures for evaluating dementia care. Future research is crucial for promoting person-centred dementia care for women living with dementia.
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Affiliation(s)
- Nevetda Gengeswaran
- Toronto General Hospital Research Institute, University Health Network, Canada
| | - Alec Brandwood
- Toronto General Hospital Research Institute, University Health Network, Canada
| | - Natalie N Anderson
- Toronto General Hospital Research Institute, University Health Network, Canada
| | - Jessica U Ramlakhan
- Toronto General Hospital Research Institute, University Health Network, Canada
| | - Anna R Gagliardi
- Toronto General Hospital Research Institute, University Health Network, Canada
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Berkovic D, Macrae A, Gulline H, Horsman P, Soh SE, Skouteris H, Ayton D. The Delivery of Person-Centered Care for People Living With Dementia in Residential Aged Care: A Systematic Review and Meta-Analysis. THE GERONTOLOGIST 2024; 64:gnad052. [PMID: 37144737 PMCID: PMC11020247 DOI: 10.1093/geront/gnad052] [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: 08/10/2022] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Person-centered care is the gold standard of care for people living with dementia, yet few systematic reviews have detailed how it is delivered in practice. This mixed-methods review aimed to examine the delivery of person-centered care, and its effectiveness, for people living with dementia in residential aged care. RESEARCH DESIGN AND METHODS A systematic review and meta-analysis. Eligible studies were identified across 4 databases. Quantitative and qualitative studies containing data on person-centered care delivered to people with dementia living in residential aged care were included. Meta-analysis using a random-effects model was conducted where more than 3 studies measured the same outcome. A narrative meta-synthesis approach was undertaken to categorize verbatim participant quotes into representative themes. Risk of bias was undertaken using quality appraisal tools from the Joanna Briggs Institute. RESULTS 41 studies were identified for inclusion. There were 34 person-centered care initiatives delivered, targeting 14 person-centered care outcomes. 3 outcomes could be pooled. Meta-analyses demonstrated no reduction in agitation (standardized mean difference -0.27, 95% confidence interval [CI], -0.58, 0.03), improvement in quality of life (standardized mean difference -0.63, 95% CI: -1.95, 0.70), or reduced neuropsychiatric symptoms (mean difference -1.06, 95% CI: -2.16, 0.05). Narrative meta-synthesis revealed barriers (e.g., time constraints) and enablers (e.g., staff collaboration) to providing person-centered care from a staff perspective. DISCUSSION AND IMPLICATIONS The effectiveness of person-centered care initiatives delivered to people with dementia in residential aged care is conflicting. Further high-quality research over an extended time is required to identify how person-centered care can be best implemented to improve resident outcomes.
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Affiliation(s)
- Danielle Berkovic
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ann Macrae
- Mission & Corporate Development, Baptcare, Melbourne, Victoria, Australia
| | - Hannah Gulline
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Phillipa Horsman
- Service Strategy Manager, Baptcare, Melbourne, Victoria, Australia
| | - Sze-Ee Soh
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia
| | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Monash Warwick Professor in Health and Social Care Improvement and Implementation Science, Melbourne, Victoria, Australia
| | - Darshini Ayton
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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21
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Wong B, Ismail Z, Watt J, Holroyd-Leduc J, Goodarzi Z. Barriers and facilitators to care for agitation and/or aggression among persons living with dementia in long-term care. BMC Geriatr 2024; 24:330. [PMID: 38600482 PMCID: PMC11008022 DOI: 10.1186/s12877-024-04919-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 03/25/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Agitation and/or aggression affect up to 60% of persons living with dementia in long-term care (LTC). It can be treated via non-pharmacological and pharmacological interventions, but the former are underused in clinical practice. In the literature, there is currently a lack of understanding of the challenges to caring for agitation and/or aggression among persons living with dementia in LTC. This study assesses what barriers and facilitators across the spectrum of care exist for agitation and/or aggression among people with dementia in LTC across stakeholder groups. METHODS This was a qualitative study that used semi-structured interviews among persons involved in the care and/or planning of care for people with dementia in LTC. Participants were recruited via purposive and snowball sampling, with the assistance of four owner-operator models. Interviews were guided by the Theoretical Domains Framework and transcribed and analyzed using Framework Analysis. RESULTS Eighteen interviews were conducted across 5 stakeholder groups. Key identified barriers were a lack of agitation and/or aggression diagnostic measures, limited training for managing agitation and/or aggression in LTC, an overuse of physical and chemical restraints, and an underuse of non-pharmacological interventions. Facilitators included using an interdisciplinary team to deliver care and having competent and trained healthcare providers to administer non-pharmacological interventions. CONCLUSIONS This study advances care for persons living with dementia in LTC by drawing attention to unique and systemic barriers present across local and national Canadian LTC facilities. Findings will support future implementation research endeavours to eliminate these identified barriers across the spectrum of care, thus improving care outcomes among people with dementia in LTC.
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Affiliation(s)
- Britney Wong
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Zahinoor Ismail
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Jennifer Watt
- Division of Geriatric Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jayna Holroyd-Leduc
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Department of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Zahra Goodarzi
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
- Department of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada.
- O'Brien Institute of Public Health, University of Calgary, Calgary, AB, Canada.
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22
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Liu PL, Zhang L, Ma X, Zhao X. Communication Matters: The Role of Patient-Centered Communication in Improving Old Adults' Health Competence and Health Outcomes. HEALTH COMMUNICATION 2024; 39:363-375. [PMID: 36628509 DOI: 10.1080/10410236.2023.2166209] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Research has demonstrated links between patient-centered communication (PCC) and patients' health outcomes. However, little is known about the underlying processes that may mediate the relationship. This study is one of the first to examine the influence of PCC on older adults' health outcomes, as well as the mediation role of health competence, from a longitudinal perspective. With a general basis of Street et al.'s pathway model, we proposed and tested mediation pathways linking patient-centered communication to the older population's general and mental health, mediated by health competence. Data from 2011, 2017 and 2020 iterations of the Health Information National Trends Survey (HINTS) were used for this study. This study focused on older adults aged 60 and above. Results indicated that after controlling participants' age, gender, education, income and race, PCC is related to the older people's health outcomes either directly or indirectly, irrespective of time series. Specifically, health competence was found to significantly mediate the associations between PCC and the older adults' general health or mental health over the three iterations. Noteworthily, findings from this study also revealed that different dimensions of PCC might exert different influences on older patients' health competence and health outcomes.
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Affiliation(s)
| | - Lianshan Zhang
- School of Media and Communication, Shanghai Jiao Tong University
| | - Xiaofen Ma
- Research Center of Journalism and Social Development, School of Journalism and Communication, Renmin University of China
| | - Xinshu Zhao
- Department of Communication, University of Macau
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Nishimura M, Harrison Dening K, Sampson EL, Vidal EIDO, Nakanishi M, Davies N, Abreu W, Kaasalainen S, Eisenmann Y, Dempsey L, Moore KJ, Bolt SR, Meijers JMM, Dekker NL, Miyashita M, Nakayama T, van der Steen JT. A palliative care goals model for people with dementia and their family: Consensus achieved in an international Delphi study. Palliat Med 2024; 38:457-470. [PMID: 38634232 PMCID: PMC11025301 DOI: 10.1177/02692163241234579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
BACKGROUND Advance care planning in dementia includes supporting the person and their family to consider important goals of care. International research reports the importance of psycho-social-spiritual aspects towards end of life. AIM To develop a multidimensional international palliative care goals model in dementia for use in practice. DESIGN International Delphi study integrating consensus and evidence from a meta-qualitative study. The Delphi panel rated statements about the model on a 5-point agreement scale. The criteria for consensus were pre-specified. SETTING/PARTICIPANTS Seventeen researchers from eight countries developed an initial model, and 169 candidate panellists were invited to the international online Delphi study. RESULTS Panellists (107; response 63.3%) resided in 33 countries. The model comprised four main care goals: (1) Comfort ensured; (2) Control over function maintained; (3) Identity protected and personhood respected and (4) Coping with grief and loss-person and caregiver supported. The model reflects how needs and care goals change over time with the progression of dementia, concluding with bereavement support. The first version of the model achieved a consensus after which it was slightly refined based on feedback. We did not achieve a consensus on adding a goal of life prolongation, and on use of the model by people with dementia and family themselves. CONCLUSION A new palliative care goals model for people with dementia and their families includes relationship aspects for use by professionals and achieved a consensus among a panel with diverse cultural background. The position of life prolongation in relation to palliative care goals needs further research.
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Affiliation(s)
- Mayumi Nishimura
- Department of Health Informatics, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto Prefecture, Japan
| | | | - Elizabeth L Sampson
- Royal London Hospital and Centre for Psychiatry and Mental health, East London NHS Foundation Trust, London, UK
- Wolfson Institute of Population Health, Queen Mary University London, London, UK
| | | | - Miharu Nakanishi
- Department of Psychiatric Nursing, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Nathan Davies
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Wilson Abreu
- Center for Health Technology and Ser- vices Research, University of Porto (ESEP/CINTESIS), Porto, Portugal
| | | | - Yvonne Eisenmann
- Department of Palliative Medicine, University Hospital of Cologne, Cologne, North Rhine-Westphalia, Germany
| | - Laura Dempsey
- Department of Nursing and Healthcare, Technological University of the Shannon: Midlands Midwest, Athlone, Ireland
| | - Kirsten J Moore
- National Ageing Research Institute, Parkville, VIC, Australia
- Medicine-Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia
| | - Sascha R Bolt
- Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, North Brabant, The Netherlands
| | - Judith MM Meijers
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, Limburg, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
- Zuyderland Care, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | - Natashe Lemos Dekker
- Institute of Cultural Anthropology and Development Sociology, Leiden University, Leiden, South Holland, The Netherlands
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Takeo Nakayama
- Department of Health Informatics, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto Prefecture, Japan
| | - Jenny T van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, South Holland, The Netherlands
- Department of Primary and Community Care, Radboud University, Nijmegen, The Netherlands
- Cicely Saunders Institute, King’s College London, UK
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24
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Oliveira D, da Mata FAF, Aubeeluck A. Quality of life of family carers of people living with dementia: review of systematic reviews of observational and intervention studies. Br Med Bull 2024; 149:1-12. [PMID: 38050333 DOI: 10.1093/bmb/ldad029] [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] [Accepted: 11/16/2023] [Indexed: 12/06/2023]
Abstract
INTRODUCTION Family members are the primary source of support for the growing number of people living with dementia (PLWD) worldwide. However, caring for a person living with dementia can have detrimental impacts on the carer quality of life (QoL). This review of systematic reviews explored the factors associated with the QoL of family carers of PLWD and interventions aimed at improving their QoL. SOURCES OF DATA Several health-related databases (PUBMED, Psychinfo, Google Scholar and COCHRANE) were consulted in November 2022. Nineteen systematic reviews were included, and their methodological quality was assessed via AMSTAR-2. AREAS OF AGREEMENT Better carer physical and mental health, provision of formal support, relationship quality between carers and PLWD, as well as positive psychological traits were associated with better carer QoL. There is no one-size-fits-all intervention that can improve the QoL of all carers, but promising results were found in most of the interventions. AREAS OF CONTROVERSY There is inconsistency in evidence on the association between the carer age and QoL. The use of a wide range of QoL measures, particularly generic QoL scales, has contributed to inconsistencies when comparing the efficacy of interventions. GROWING POINTS Evidence suggests the need for a person-centred approach to improving carer QoL, considering individual and contextual needs as well as the continuum and progressive nature of dementia care. TIMELY AREAS FOR DEVELOPING RESEARCH Future research should be focused on understanding how to best implement and measure person-centred care approaches to carer QoL, including cost-effectiveness. More qualitative studies are necessary to explore carer negative and positive experiences of QoL.
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Affiliation(s)
- Déborah Oliveira
- Faculty of Nursing, Universidad Andrés Bello, Campus Viña del Mar, Viña del Mar, 980 Quillota, Tower D, 3rd floor, 2531015, Chile
- Millennium Institute for Care Research (MICARE), 227 Avenida República, Región Metropolitana, Santiago, 8370146, Chile
| | - Fabiana Araújo Figueiredo da Mata
- Department of Psychiatry, Faculty of Medicine, Universidade Federal de Sao Paulo (UNIFESP), 241 Major Maragliano, Vila Mariana, Sao Paulo 04021001, Brazil
- Social Sustainability and Responsibility Centre, Hospital Alemão Oswaldo Cruz (HAOC), 1815 Treze de Maio, Bela Vista, 01323020, São Paulo 01508000, São Paulo, Brazil
| | - Aimee Aubeeluck
- School of Health Sciences, Faculty of Medicine & Health Sciences, University of Nottingham, Queen's Medical Centre, Derby Road, NG7 2RD, Nottingham, UK
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25
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Jaarsma P. Two cases of nursing older nursing home residents during COVID-19. Nurs Ethics 2024; 31:256-267. [PMID: 37597000 PMCID: PMC11181722 DOI: 10.1177/09697330231185944] [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: 08/21/2023]
Abstract
INTRODUCTION Two ethical challenges of nursing home nurses during the COVID-19 pandemic in Sweden are discussed in this paper. BACKGROUND Historically, the nurse's primary concern is for the person who is ill, which is the core of nurses' moral responsibility and identity. In Sweden, person-centered care is generally deemed important in nursing older nursing home residents. OBJECTIVE To chart moral responsibilities of nursing home nurses in two cases involving older residents during the COVID-19 pandemic in Sweden. METHODS We used Margaret Urban Walker's framework for moral responsibilities and the International Council of Nurses (ICN) code of ethics for nurses (2021) for our normative analysis. ETHICAL CONSIDERATIONS Written and verbal consent was obtained before the interviews, and information was given that participation was entirely voluntary and possible to cancel at any time before the work was published. The Swedish Ethical Review Agency gave an advisory opinion stating that there were no ethical objections to this research project (Dnr. 2020-05649). FINDINGS Case #1: a palliative older nursing home resident who was coercively tested for COVID-19, and case #2: a COVID-19-infected resident with dementia who was isolated using sedation. The decision that was finally made in the respective case was analyzed in the light of either consequentialist/utilitarian or non-consequentialist/deontological reasons. DISCUSSION Empowerment of nurses as moral agents is required for the application of practical wisdom in the balancing of different care relationships (responsibilities), moral identities (professional virtues), and competing moral values. This requires resources and opens possibilities for profound ethical reflection in nursing education and at work. CONCLUSION During the COVID-19 pandemic, the moral and professional responsibility of nursing home nurses to deliver person-centered care was sometimes problematically abandoned in favor of a more utilitarian manner of ethical decision-making.
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Affiliation(s)
- Pier Jaarsma
- Department of Health, Medicine and Caring Sciences, Linköping University, Sweden
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26
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Nguyen AN, Nguyen BT, Nguyen BT, Nguyen BTT, Nguyen NTA, Dang NTK, Nguyen ATP, Nguyen AT, Pham T, Mantyh WG, Tran D, Le OTP, Ta M. Care needs assessment of older adults with dementia in a semi-rural district in Vietnam: A community-based cross-sectional study. Psychogeriatrics 2024; 24:249-258. [PMID: 38155441 PMCID: PMC11058465 DOI: 10.1111/psyg.13068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 12/10/2023] [Accepted: 12/11/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND The increasing needs of people living with dementia (PLWD) in Vietnam present an enormous public health challenge. Vietnam is an understudied country, and little is known regarding the overall unmet needs of caregivers or the demographic risk factors associated with unmet caregiving needs. This study aimed to determine the burden of unmet care needs of community-dwelling PLWD and identify sociodemographic risks associated with unmet care needs. METHODS A cross-sectional study in a rural area facing urbanisation in Hanoi, Vietnam recruited PWLD-caregiver dyads with multistage sampling. We utilised the Camberwell Assessment of Need for the Elderly (CANE) instrument to evaluate care needs across four domains. Caregivers rated PLWD needs, with higher scores indicating greater unmet needs. The Mann-Whitney test was employed for comparing two groups, while the Kruskal-Wallis test was used for comparisons involving more than two groups in the analysis, and a P-value of less than 0.05 was considered statistically significant. RESULTS Among 90 PLWD participating in the study, the overall mean care needs score was 11.6 ± 4.3, with only 16.2% of PLWD having their care needs met. Environmental and physical needs were more frequently met than psychological or social needs. Only 48.0% and 43.9% of environmental and physical needs were met respectively, and a meagre 20.9% and 23.6% for psychological and social needs. Unmet care needs were more frequent for PWLD who were female, single or divorced, had lower monthly household income, or who were in more advanced stages of dementia, as indicated by Clinical Dementia Rating scores ≥1. CONCLUSIONS Unmet needs for PWLD are common. Increased caregiver education, resources, and services in Vietnam are urgently required to improve the quality of life for this population.
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Affiliation(s)
- Anh Ngoc Nguyen
- Department of Neurology and Alzheimer’s Disease, National Geriatric Hospital, Hanoi, Vietnam
| | - Binh Thanh Nguyen
- Department of Neurology and Alzheimer’s Disease, National Geriatric Hospital, Hanoi, Vietnam
- Hanoi Medical University, Hanoi, Vietnam
| | - Binh Thanh Nguyen
- Department of Neurology and Alzheimer’s Disease, National Geriatric Hospital, Hanoi, Vietnam
| | - Binh Thi Thanh Nguyen
- Department of Neurology and Alzheimer’s Disease, National Geriatric Hospital, Hanoi, Vietnam
| | - Nguyet Thi Anh Nguyen
- Department of Neurology and Alzheimer’s Disease, National Geriatric Hospital, Hanoi, Vietnam
| | - Nhung Thi Kim Dang
- Department of Neurology and Alzheimer’s Disease, National Geriatric Hospital, Hanoi, Vietnam
| | | | - Anh Trung Nguyen
- Hanoi Medical University, Hanoi, Vietnam
- National Geriatric Hospital, Hanoi, Vietnam
| | - Thang Pham
- National Geriatric Hospital, Hanoi, Vietnam
| | | | - Duyen Tran
- Department of Neurology, University of California, Davis, Sacramento, CA, USA
| | - Oanh Thi Phương Le
- Department of Neurology, University of California, Davis, Sacramento, CA, USA
| | - My Ta
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, CA, USA
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27
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Waterschoot K, Roelofs TSM, van Dam A, Luijkx KG. Including personal boundaries scale: development and psychometric properties of a measurement for nurses' self-efficacy toward intimate and sexual behavior in dementia care. FRONTIERS IN DEMENTIA 2024; 3:1304438. [PMID: 39081612 PMCID: PMC11285599 DOI: 10.3389/frdem.2024.1304438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 01/29/2024] [Indexed: 08/02/2024]
Abstract
Background Person-centered nursing home care recognizes the intimate and sexual needs of residents with dementia but lacks guidance for nurses to address them while effectively respecting their personal boundaries. The Including Personal Boundaries (IPB) scale was developed to complement clinical and scientific efforts to support both nurse and resident wellbeing. Methods Through a co-creative process, theoretical principles, day-to-day experiences, and expert knowledge were integrated into an initial nineteen-item version of the IPB scale. The pilot sample comprised 297 Dutch (vocational) nurses in dementia nursing care. Results After Principal Component Analysis, nine items with strong factor loadings (>0.6) were retained. Internal reliability measures supported the item selection, such as high internal consistency (α = 0.866) and adequate corrected item-total correlations (0.532-0.781). Conclusion The presented IPB scale, a nine-item scale, is a short, robust measure to assess nurses' self-efficacy in their capabilities to include personal boundaries (physical and emotional) when confronted with the intimate and sexual behaviors of residents with dementia. Further validation is recommended. The IPB scale could provide valuable insights for research, clinical practice, and education.
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Affiliation(s)
- Karien Waterschoot
- Tranzo, Scientific Center for Care and Welfare, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
| | - Tineke S. M. Roelofs
- Tranzo, Scientific Center for Care and Welfare, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
- Psychogeriatric Psychology, Archipel Zorggroep Care Institute, Eindhoven, Netherlands
| | - Arno van Dam
- Tranzo, Scientific Center for Care and Welfare, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
- Research and Innovation, GGZ WNB Mental Health Institute, Halsteren, Netherlands
| | - Katrien G. Luijkx
- Tranzo, Scientific Center for Care and Welfare, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
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28
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Kasler K, Heppner A, Van Haitsma K, Abbott KM. Evaluating the Implementation of the Individualized Positive Psychosocial Interaction (IPPI) as a Quality Improvement Project in Nursing Homes. Clin Gerontol 2024:1-15. [PMID: 38367005 DOI: 10.1080/07317115.2024.2317403] [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: 02/19/2024]
Abstract
OBJECTIVES The Individualized Positive Psychosocial Interaction (IPPI) is a non-pharmacological, person-centered, intervention for nursing home (NH) residents living with moderate to severe dementia. The purpose of this study was to assess the pragmatic implementation of the IPPI by leveraging Ohio's Nursing Home Quality Improvement Program (QIP). METHODS Implementation teams collected resident mood ratings pre- and post-IPPI and completed virtual interviews to assess their Organizational Readiness for Implementing Change as well as the acceptability, feasibility, and appropriateness of the IPPI. Implementation strategies included: providing ongoing consultation; identifying and preparing champions; assessing for readiness and identifying barriers; and developing and distributing effective educational materials. RESULTS Fifteen NHs completed the QIP (65% completion rate) and reported high organizational commitment to change and high change efficacy. NHs engaged n = 65 residents in n = 638 IPPIs. Residents experienced a positive mood change after 47% of IPPIs. NHs found the IPPI program to be highly acceptable, feasible, and appropriate. CONCLUSIONS Overall, 65% of NHs successfully implemented the IPPI QIP with people living with moderate to severe dementia. CLINICAL IMPLICATIONS Given the positive mood changes and high staff satisfaction, results suggest that these brief, individualized activities can be effective strategies to address the communication of distress among PLWD.
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Affiliation(s)
- Kamryn Kasler
- Scripps Gerontology Center, Miami University, Oxford, Ohio, USA
| | | | - Kimberly Van Haitsma
- Ross and Carol Nese College of Nursing, Adjunct Senior Research Scientist, The Polisher Research Institute at Abramson Senior Care, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Katherine M Abbott
- Scripps Gerontology Center, Miami University, Oxford, Ohio, USA
- Department of Sociology and Gerontology, Executive Director, Scripps Gerontology Center, Miami University, Oxford, Ohio, USA
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29
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Watson J, Green MA, Giebel C, Akpan A. Identifying longitudinal healthcare pathways and subsequent mortality for people living with dementia in England: an observational group-based trajectory analysis. BMC Geriatr 2024; 24:150. [PMID: 38350866 PMCID: PMC10865521 DOI: 10.1186/s12877-024-04744-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 01/24/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND The number of people living with dementia (PLWD) continues to increase, particularly those with severe symptomatology. Severe symptoms and greater ill-health result in more acute care need. Early healthcare interventions can prove beneficial. Healthcare use has not been analysed as a holistic set of interlinked events. This study explores different healthcare pathways among PLWD, social or spatial inequalities in healthcare pathways and subsequent mortality risk. METHODS Group-based trajectory models (GBTM) were applied to electronic healthcare records. We generated clusters of PLWD with similar five-year, post-diagnosis trajectories in rates of primary and secondary healthcare use. Potential social and spatial variations in healthcare use clusters were examined. Cox Proportional Hazards used to explore variation in subsequent mortality risk between healthcare use clusters. RESULTS Four healthcare use clusters were identified in both early- (n = 3732) and late-onset (n = 6224) dementia populations. Healthcare use variations were noted; consistent or diminishing healthcare use was associated with lower subsequent mortality risk. Increasing healthcare use was associated with increased mortality risk. Descriptive analyses indicated social and spatial variation in healthcare use cluster membership. CONCLUSION Healthcare pathways can help indicate changing need and variation in need, with differential patterns in initial healthcare use post-diagnosis, producing similar subsequent mortality risk. Care in dementia needs to be more accessible and appropriate, with care catered to specific and changing needs. Better continuity of care and greater awareness of dementia in primary can enhance prospects for PLWD. Research needs to further illuminate holistic care need for PLWD, including health and social care use, inequalities in care, health and outcomes.
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Affiliation(s)
- James Watson
- Department of Primary Care and Mental Health, The University of Liverpool, 1st Floor, Waterhouse Building B, Liverpool, L69 3GF, UK.
| | - Mark A Green
- School of Environmental Sciences, The University of Liverpool, Liverpool, UK
| | - Clarissa Giebel
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
- Applied Research Collaboration North West Coast, Liverpool, UK
| | - Asangaedem Akpan
- Department of Medicine for Older People and Stroke, Liverpool University Hospitals NHS FT, Liverpool, UK
- Healthy Ageing Group, University of Cumbria, Carlisle, UK
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Clinical Research Network, North West Coast, Liverpool, UK
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30
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Gabay G, Ornoy H, Gere A, Moskowitz H. Personalizing Communication of Clinicians with Chronically Ill Elders in Digital Encounters-A Patient-Centered View. Healthcare (Basel) 2024; 12:434. [PMID: 38391809 PMCID: PMC10888115 DOI: 10.3390/healthcare12040434] [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: 11/29/2023] [Revised: 01/31/2024] [Accepted: 02/04/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Chronically ill elderly patients are concerned about losing the personal connection with clinicians in digital encounters and clinicians are concerned about missing nonverbal cues that are important for the diagnosis, thus jeopardizing quality of care. AIMS This study validated the expectations and preferences of chronically ill elderly patients regarding specific communication messages for communication with clinicians in telemedicine. METHODS The sample comprised 600 elderly chronically ill patients who use telehealth. We used a conjoint-based experimental design to test numerous messages. The outcome variable is elder patient expectations from communication with clinicians in telemedicine. The independent variables were known categories of patient-clinician communication. Respondents rated each of the 24 vignettes of messages. RESULTS Mathematical clustering yielded three mindsets, with statistically significant differences among them. Members of mindset 1 were most concerned with non-verbal communication, members of mindset 2 prefer communication that enhances the internal locus of control, and members of mindset 3 have an external locus of control and strongly oppose any dialogue about their expectations from communication. CONCLUSIONS The use of the predictive algorithm that we developed enables clinicians to identify the belonging of each chronically ill elderly patient in the clinic to a sample mindset, and to accordingly personalize the communication in the digital encounters while structuring the encounter with greater specificity, therefore enhancing patient-centered care.
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Affiliation(s)
- Gillie Gabay
- Faculty of Social Sciences, Achva Academic College, Arugot 7980400, Israel
| | - Hana Ornoy
- Faculty of Business, Ono Academic College, Kiryat Ono 5545173, Israel
| | - Attila Gere
- Institute of Food Science and Technology, Hungarian University of Agriculture and Life Sciences, 1118 Budapest, Hungary
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31
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Prendergast LM, Davies CT. 'A lot of people think it's just a Mickey Mouse role': Role ambiguity among dementia support workers within secondary care and community hospital settings. DEMENTIA 2024; 23:191-209. [PMID: 38100306 PMCID: PMC10807186 DOI: 10.1177/14713012231220461] [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: 12/17/2023]
Abstract
Purpose: Dementia support workers (DSWs) are employed to improve the hospital care for patients living with dementia. An evaluation sought to understand the perspectives and experiences of DSWs and related healthcare practitioners within one health board, to identify any role ambiguity and inform future role development.Design/methodology/approach: Framework analysis was used to synthesise data from semi-structured interviews and focus groups with dementia support workers, and a wider group of related healthcare practitioners.Findings: Thirteen semi-structured interviews were conducted with DSWs. Two focus groups were held with DSWs (n = 2 and 4) and two with associated healthcare practitioners (n = 3 and 5). Participants described inconsistencies in the understanding and delivery of the DSW role. Role ambiguity was identified as a key theme.Originality/value: This paper offers insight into challenges experienced by DSWs and addresses factors that could help improve and support the DSW role, and potentially the experience of other staff, and patients/people living with dementia. Overall, this evaluation highlights both the value of the DSW role in supporting the needs of patients/people living with dementia and the potential for person-centred activities to be used as therapeutic interventions.
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Budgett J. Setting individualised goals for people living with dementia and their family carers: A systematic review of goal-setting outcome measures and their psychometric properties. DEMENTIA 2024; 23:312-340. [PMID: 38105445 PMCID: PMC10807246 DOI: 10.1177/14713012231222309] [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: 12/19/2023]
Abstract
BACKGROUND Individualised goal-setting outcome measures can be a useful way of reflecting people living with dementia and family carers' differing priorities regarding quality-of-life domains in the highly heterogeneous symptomatology of the disease. Evaluating goal-setting measures is challenging, and there is limited evidence for their psychometric properties. AIM (1) To describe what goal-setting outcomes have been used in this population; (2) To evaluate their validity, reliability, and feasibility in RCTs. METHOD We systematically reviewed studies that utilised goal-setting outcome measures for people living dementia or their family carers. We adapted a risk of bias and quality rating system based on the COSMIN guidelines to evaluate the measurement properties of outcomes when used within RCTs. RESULTS Thirty studies meeting inclusion criteria used four different goal-setting outcome measures: Goal Attainment Scaling (GAS), Bangor Goal Setting Interview (BGSI), Canadian Occupational Performance Measure (COPM) and Individually Prioritized Problems Assessment (IPPA); other papers have reported study-specific goal-setting attainment systems. Only GAS has been used as an outcome over periods greater than 9 months (up to a year). Within RCTs there was moderate quality evidence for sufficient content validity and construct validity for GAS, COPM and the BGSI. Reliability was only assessed in one RCT (using BGSI); in which two raters reviewed interview transcripts to rate goals with excellent inter-rater reliability. Feasibility was reported as good across the measures with a low level of missing data. CONCLUSION We found moderate quality evidence for good content and construct validity and feasibility of GAS, BGSI and COPM. While more evidence of reliability of these measures is needed, we recommend that future trials consider using individualised goal setting measures, to report the effect of interventions on outcomes that are most meaningful to people living with dementia and their families.
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Affiliation(s)
- Jessica Budgett
- Division of Psychiatry, University College London, and Centre for Psychiatry and Mental Health, Wolfsen Institute of Population Health, Queen Mary University of London UK
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Tieu M, Matthews S. The Relational Care Framework: Promoting Continuity or Maintenance of Selfhood in Person-Centered Care. THE JOURNAL OF MEDICINE AND PHILOSOPHY 2024; 49:85-101. [PMID: 37776569 PMCID: PMC10787111 DOI: 10.1093/jmp/jhad044] [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: 10/02/2023] Open
Abstract
We argue that contemporary conceptualizations of "persons" have failed to achieve the moral goals of "person-centred care" (PCC, a model of dementia care developed by Tom Kitwood) and that they are detrimental to those receiving care, their families, and practitioners of care. We draw a distinction between personhood and selfhood, pointing out that continuity or maintenance of the latter is what is really at stake in dementia care. We then demonstrate how our conceptualization, which is one that privileges the lived experiences of people with dementia, and understands selfhood as formed relationally in connection with carers and the care environment, best captures Kitwood's original idea. This conceptualization is also flexible enough to be applicable to the practice of caring for people at different stages of their dementia. Application of this conceptualization into PCC will best promote the well-being of people with dementia, while also encouraging respect and dignity in the care environment.
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Affiliation(s)
- Matthew Tieu
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Steve Matthews
- Plunkett Center for Ethics, Australian Catholic University, Sydney, Australia
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Kelsall-Knight L, Stevens R. Exploring the implementation of person-centred care in nursing practice. Nurs Stand 2024; 39:70-75. [PMID: 38093586 DOI: 10.7748/ns.2023.e12190] [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] [Accepted: 10/30/2023] [Indexed: 01/04/2024]
Abstract
Person-centred care involves nurses working in partnership with patients to ensure their needs and preferences are at the centre of their healthcare, as well as considering the biographical and social factors that are relevant to the person's health. This aims to support patients in developing the knowledge, confidence and skills to make informed decisions about treatment and to manage their own care where possible. This article discusses the concept of person-centred care and considers some of the facilitators and barriers that may affect its implementation in healthcare practice. It also explores some of the approaches that nurses can use to support person-centred care, such as cultural humility and role modelling.
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Affiliation(s)
| | - Rhian Stevens
- College of Medical and Dental Sciences, University of Birmingham, Edgbaston, England
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Wu QL, Brannon GE. What's after COVID-19?: Communication pathways influencing future use of telehealth. PATIENT EDUCATION AND COUNSELING 2024; 118:108025. [PMID: 37852153 DOI: 10.1016/j.pec.2023.108025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 10/07/2023] [Accepted: 10/11/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVE Telehealth usage for healthcare encounters has increased dramatically due to the coronavirus disease (COVID-19) precautions. As the pandemic health threat subsides, it is important to understand how telehealth encounters are perceived by users. In this study, we explore how patient-centered communication (PCC), and media and organizational factors, influence patients' intentions to use telehealth in the future. METHODS An online survey was conducted among 326 adult patients who reported visiting a healthcare provider using telehealth within the past 12 months. Structural equation modeling explored how contextual factors influenced patients' adoption of telehealth. RESULTS PCC and ease of use indirectly predicted telehealth adoption through enhanced patient satisfaction and sense of care continuity. Sense of security indirectly predicted telehealth adoption via its association with enhanced rating of care quality. CONCLUSION The functionality of telehealth technology does not solely determine patients' telehealth adoption. Instead, positive healthcare experiences, facilitated by organizational support, quality media designs, as well as patient-centered communication, are associated with telehealth adoption. PRACTICE IMPLICATIONS Healthcare providers should strategically improve telehealth-related communication processes that can lead to better patient health outcomes.
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Affiliation(s)
- Qiwei Luna Wu
- School of Communication, Cleveland State University, USA.
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Chenoweth L, Burley C, Cook J, Cheah SL, Reyes P, Maiden G, McGuire J, McCade D, Brodaty H, Sukhapure M, Harrison F, Williams A. Improving Healthcare Quality and Clinical Outcomes for Persons with Dementia in the Sub-Acute Hospital Through Person-Centered Care Practice. J Alzheimers Dis 2024; 98:619-628. [PMID: 38427481 DOI: 10.3233/jad-231056] [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: 03/03/2024]
Abstract
Background Person-centered care is considered beneficial for persons with dementia. Objective To evaluate the impact of a person-centered knowledge translation intervention on the quality of healthcare and outcomes for persons with dementia. Methods Over nine months, sub-acute hospital nursing, allied health, and medical staff (n = 90) participated in online and/or face-to-face person-centered education and were supported by senior nursing, allied health, and medical staff champions (n = 8) to implement person-centered healthcare. The quality of healthcare service, ward climate and care delivery were evaluated pre/post study intervention. In the week following hospital admission (Time 1) and week of discharge (Time 3), agitation incidence (co-primary outcome) was assessed in participants with dementia (n = 80). Participant delirium (co-primary outcome), accidents/injuries, psychotropic medicines, length of stay, readmission and discharge destination (secondary outcomes) were compared with a retrospective group (n = 77) matched on demographics, cognition and function in activities of daily living. Results Improvements occurred post-intervention in service quality by 17.5% (p = 0.369, phi = 0.08), ward climate by 18.1% (p = 0.291, phi = 0.08), and care quality by 50% (p = 0.000, phi = 0.37). Participant agitation did not change from Time 1 to Time 3 (p = 0.223). Relative to the retrospective group, significant reductions occurred in participant delirium (p = 0.000, phi = 0.73), incidents/injuries (p = 0.000, phi = 0.99), psychotropic medicine use (p = 0.030, phi = 0.09), and hospital readmissions within 30 days (p = 0.002, phi = 0.25), but not in discharge to home (p = 0.171). Conclusions When person-centered healthcare knowledge is translated through staff education and practice support, persons with dementia can experience improved healthcare services and clinical outcomes, while healthcare services can benefit through reductions in unplanned service use.
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Affiliation(s)
- Lynn Chenoweth
- Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry, UNSW Medicine and Health, UNSW, Sydney, Australia
| | - Claire Burley
- Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry, UNSW Medicine and Health, UNSW, Sydney, Australia
| | - Jacquelene Cook
- Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry, UNSW Medicine and Health, UNSW, Sydney, Australia
- Department of Aged Health, Chronic Care and Rehabilitation, Concord Hospital, Sydney, Australia
| | - Seong-Leang Cheah
- Research Unit, Justice Health and Forensic Mental Health Network, AGSM (G27), UNSW, Sydney, Australia
| | - Patricia Reyes
- War Memorial Hospital, St Vincent's Hospital Health Network, Sydney, Australia
- Discipline of Medicine, UNSW Medicine and Health, UNSW, Sydney, Australia
| | - Genevieve Maiden
- War Memorial Hospital, St Vincent's Hospital Health Network, Sydney, Australia
| | - Jane McGuire
- War Memorial Hospital, St Vincent's Hospital Health Network, Sydney, Australia
| | - Donna McCade
- War Memorial Hospital, St Vincent's Hospital Health Network, Sydney, Australia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry, UNSW Medicine and Health, UNSW, Sydney, Australia
| | - Mayouri Sukhapure
- Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry, UNSW Medicine and Health, UNSW, Sydney, Australia
| | - Fleur Harrison
- Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry, UNSW Medicine and Health, UNSW, Sydney, Australia
| | - Anna Williams
- School of Nursing and Midwifery, Western Sydney University, NSW, Penrith, Australia
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Mazzola P, Zanetti M, Ferraguzzi G, Villa ML, Sandrini MC, Fumagalli M, Volpi M, Caggiu G, Monzio Compagnoni M, Mecocci P, Bellelli G. Shifting the Paradigm of Nursing Home Care for People with Dementia: The Italian Experience of Il Paese Ritrovato and the Impact of SARS-CoV-2. J Alzheimers Dis 2024; 97:741-752. [PMID: 38143344 DOI: 10.3233/jad-230229] [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: 12/26/2023]
Abstract
BACKGROUND Il Paese Ritrovato is an Italian nursing home founded in 2018, it is based on the Alzheimer village model and admits people with mild-to-moderate dementia. OBJECTIVE Describe the impact of the SARS-CoV-2 pandemic on people living at Il Paese Ritrovato through a Comprehensive Geriatric Assessment (CGA) regularly administered prior to and during the pandemic. METHODS We explored the effects of a person-centered approach. We assessed 64 subjects (enrolled and followed between June 2018 and December 2020), who underwent at least 18 months of observation prior to the pandemic. Each subject was evaluated using a CGA on admission time (T0) and at defined time-points: T6, T12, T18. One last CGA evaluation was performed during the SARS-CoV-2 pandemic (TCovid-19). Temporal trends during T0-T18, and differences between T18 and TCovid-19 were calculated. RESULTS The mean age was 82 years with a prevalence for females (77.0%) and Alzheimer's disease diagnosis (60%). Psychiatric and behavioral disorders were the most common conditions (80%). We utilized a nonpharmacological approach aimed at promoting the residents' overall wellbeing and observed satisfactory performance during the first 18 months. In comparison with the pre-pandemic period, TCovid-19 enlightened +11.7% use of antidepressants and a decline of Mini-Mental State Examination mean values (not statistically significant), while engagement in activities dropped. CONCLUSIONS The pandemic may have disrupted the existing model of care, but at the same time, it confirmed that the Il Paese Ritrovato approach, which encompasses symptoms improvement and multicomponent support, is in fact beneficial.
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Affiliation(s)
- Paolo Mazzola
- School of Medicine and Surgery, Università degli Studi di Milano-Bicocca, Monza, Italy
- Fondazione IRCCS San Gerardo dei Tintori, Acute Geriatrics Unit, Monza, Italy
- NeuroMI - Milan Center for Neuroscience, Clinical Neurosciences research area, Milano, Italy
| | | | - Gaia Ferraguzzi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
| | | | | | | | | | - Giulia Caggiu
- Department of Statistics and Quantitative Methods, Università degli Studi di Milano-Bicocca, Milano, Italy
| | - Matteo Monzio Compagnoni
- Department of Statistics and Quantitative Methods, Università degli Studi di Milano-Bicocca, Milano, Italy
| | - Patrizia Mecocci
- Department of Biomedical Sciences for Health, Università di Perugia, Perugia, Italy
| | - Giuseppe Bellelli
- School of Medicine and Surgery, Università degli Studi di Milano-Bicocca, Monza, Italy
- Fondazione IRCCS San Gerardo dei Tintori, Acute Geriatrics Unit, Monza, Italy
- NeuroMI - Milan Center for Neuroscience, Clinical Neurosciences research area, Milano, Italy
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Scharf A, Kleinke F, Michalowsky B, Rädke A, Pfitzner S, Mühlichen F, Buchholz M, van den Berg N, Hoffmann W. Sociodemographic and Clinical Characteristics of People Living with Dementia and Their Associations with Unmet Healthcare Needs: Insights from the Baseline Assessment of the InDePendent Study. J Alzheimers Dis 2024; 99:559-575. [PMID: 38669533 PMCID: PMC11191535 DOI: 10.3233/jad-231173] [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] [Accepted: 03/13/2024] [Indexed: 04/28/2024]
Abstract
Background The healthcare needs of People living with Dementia (PlwD) (such as Alzheimer's disease) are often unmet. Information about the needs of community-dwelling PlwD and their association with sociodemographic and clinical characteristics is needed to fill the knowledge gap regarding factors influencing unmet needs among PlwD and to conduct a comprehensive needs assessment to develop tailored interventions. Objective To describe sociodemographic and clinical characteristics of the InDePendent study population with particular reference to determinants of unmet needs. Methods We analyzed baseline data of the multi-centre cluster-randomized controlled trial (InDePendent) using descriptive statistics to describe patients' sociodemographic and clinical characteristics and Poisson regression models to predict unmet needs, separated by sex. Data were collected personally via face-to-face interviews. Results Most of the n = 417 participating PlwD were mild to moderately cognitively impaired, were not depressed, had an average of 10.8 diagnoses, took 6.7 medications, and had, on average, 2.4 unmet needs (62% of PlwD had at least one unmet need) measured by the Camberwell Assessment of Need for the Elderly (CANE). Low social support, a high body-mass-index, a lower education, functional impairment, and worse health status were associated with more unmet needs, regardless of sex. In women, higher unmet needs were associated with more depressive symptoms, a poor financial situation, living alone and not being recently treated by a general practitioner. In males, unmet needs increased with the number of medications taken. Conclusions PlwD had a broad array of unmet healthcare needs, indicating primary healthcare provision improvement potentials. The results underscore the significance of early assessment of patient's clinical characteristics and unmet needs as a basis for individualized gender-sensible intervention strategies.∥ClinicalTrials.gov Identifier: NCT04741932, Registered on February 5, 2021.
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Affiliation(s)
- Annelie Scharf
- Deutsches Zentum für Neurodegenerative Erkrankungen (DZNE), Rostock/Greifswald, Greifswald, Germany
| | - Fabian Kleinke
- Department of Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Bernhard Michalowsky
- Deutsches Zentum für Neurodegenerative Erkrankungen (DZNE), Rostock/Greifswald, Greifswald, Germany
| | - Anika Rädke
- Deutsches Zentum für Neurodegenerative Erkrankungen (DZNE), Rostock/Greifswald, Greifswald, Germany
| | - Stefanie Pfitzner
- Department of Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Franka Mühlichen
- Deutsches Zentum für Neurodegenerative Erkrankungen (DZNE), Rostock/Greifswald, Greifswald, Germany
| | - Maresa Buchholz
- Deutsches Zentum für Neurodegenerative Erkrankungen (DZNE), Rostock/Greifswald, Greifswald, Germany
| | - Neeltje van den Berg
- Deutsches Zentum für Neurodegenerative Erkrankungen (DZNE), Rostock/Greifswald, Greifswald, Germany
| | - Wolfgang Hoffmann
- Deutsches Zentum für Neurodegenerative Erkrankungen (DZNE), Rostock/Greifswald, Greifswald, Germany
- Department of Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
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Ito D, Mori N, Shimizu A, Narita A, Sakata S, Honaga K, Kondo K, Otaka Y. Presence and Characteristics of Behavioral and Psychological Symptoms in Subacute Stroke Patients with Cognitive Impairment. Behav Neurol 2023; 2023:6636217. [PMID: 38179433 PMCID: PMC10766468 DOI: 10.1155/2023/6636217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 10/19/2023] [Accepted: 12/09/2023] [Indexed: 01/06/2024] Open
Abstract
This retrospective cross-sectional study is aimed at investigating the prevalence and characteristics of behavioral and psychological symptoms (BPS) in subacute stroke patients with cognitive impairment. The Neuropsychiatric Inventory-Questionnaire (NPI-Q) was used to assess BPS. A total of 358 consecutive patients with first-ever stroke admitted to rehabilitation wards and with Mini-Mental State Examination (MMSE) scores < 24 on admission were included. BPS was defined as a total NPI-Q Severity or Distress score ≥ 1. Differences between the severity and presence of BPS among patients with severe cognitive impairment (MMSE scores 0-17) and those with mild cognitive impairment (MMSE scores 18-23) were analyzed using the Mann-Whitney U test and chi-squared test, respectively. Eighty-one patients (mean (standard deviation) age, 73.5 (13.1) years) were enrolled for analysis. BPS were observed in 69.1% and 74.1% of patients when assessed with NPI-Q Severity and NPI-Q Distress, respectively. The most frequently observed BPS was apathy, followed by depression (approximately 44% and 40%, respectively). The severity and frequency of delusions, euphoria, apathy, and disinhibition were significantly higher in the severe cognitive impairment group than in the mild cognitive impairment group. However, the severity, distress, and frequency of depression were not dependent on the severity of cognitive impairment. The presence of BPS, especially apathy and depression, in subacute stroke patients with cognitive impairment is high. The severity and frequency of some BPS are higher in patients with severe cognitive impairment than in those with mild cognitive impairment. However, depression is highly prevalent among the patients regardless of the severity of cognitive impairment.
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Affiliation(s)
- Daisuke Ito
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
| | - Naoki Mori
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
- Department of Well-Being and Rehabilitation, School of Medicine, Fujita Health University, Aichi, Japan
| | - Ayaka Shimizu
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
| | - Ayako Narita
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
| | - Sachiko Sakata
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
| | - Kaoru Honaga
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
- Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kunitsugu Kondo
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
| | - Yohei Otaka
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Aichi, Japan
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Huang SF, Wang BY, Liao JY. Experiences of person-centered care for sundown syndrome among nurses and nurse aides in dementia special care units: a qualitative study. BMC Nurs 2023; 22:435. [PMID: 37978485 PMCID: PMC10655402 DOI: 10.1186/s12912-023-01598-x] [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: 06/06/2023] [Accepted: 11/07/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND To explore the response and management experiences of nurses and nurse aides in dementia special care units when caring for residents with sundown syndrome based on the person-centered care model. METHODS Focus group interviews were conducted among nurses and nurse aides from four dementia special care units that have been accredited by the Ministry of Health and Welfare in Taiwan. Content analysis was used for data analysis. RESULTS The 29 nurses and nurse aides were recruited to participate in the study. Analysis of interview content revealed six themes, identifying the intra-individual, inter-individual, and organizational dimensions. The central topic was commitment. Under the umbrella of commitment, six themes including self-preparation, non-suppression, diversion, pacification, continuity of meeting, and collaboration, which had 18 subthemes, emerged as responsive care practices for person-centered care when supporting residents with sundown syndrome. CONCLUSIONS The findings provide responsive care practices based on person-centered care for people living with dementia who develop sundown syndrome. The study can inform practices for quality of care for dementia in long-term care institutions and contribute to the development of materials for nursing training and education.
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Affiliation(s)
- Su-Fei Huang
- Department of Intelligent Technology and Long-Term Care, MacKay Junior College of Medicine, Nursing, and Management, No.92, Shengjing Rd, Taipei, 11260, Taiwan
| | - Bow-Yin Wang
- St. Joseph Home for Alzheimer's Disease and Related Dementia, No.11, Lane 125, De Chang St, Taipei, 10867, Taiwan
| | - Jung-Yu Liao
- Department of Health Promotion and Health Education, National Taiwan Normal University, No.162, Sec. 1, He-ping East Road, Taipei, 10610, Taiwan.
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Weni WM, Shimizu M, Ando-Ohmura C, Ohashi Y, Edvardsson D, Backman A, Baxter R, Kloos N, Ozaki A. Psychometric evaluation of the Indonesian version of the Person-centered Care Assessment Tool. Int J Older People Nurs 2023; 18:e12565. [PMID: 37587650 DOI: 10.1111/opn.12565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 07/07/2023] [Accepted: 07/27/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND The number of Indonesian care staff working in hospitals and long-term care facilities caring for persons with dementia in Japan is increasing; however, there is no instrument available in the Indonesian language to assess their dementia care practice. OBJECTIVES This study aimed to translate the Person-centered Care Assessment Tool (P-CAT) and evaluate its psychometric properties in a sample of Indonesian care staff working in dementia care and long-term care facilities in Japan. METHODS This is a descriptive, methodological, and cross-sectional study. The P-CAT was translated into the Indonesian language. The draft was administered to Indonesian care staff (n = 218) working at long-term care facilities in Japan. Data were analysed using exploratory factor analysis (EFA), confirmatory factor analysis (CFA), known-group validity, internal consistency, and test-retest reliability. RESULTS EFA showed three-factor and CFA of the three-factor indicated that the model had an acceptable fit (chi-squared statistics/degree of freedom = 1.78, comparative fit index = 0.94, root mean square error of approximation = 0.06) with a slightly different structure compared to the original P-CAT. Regarding known-group validity, the P-CAT total score was significantly higher for those who had training in dementia, who knew about person-centred care, and who showed satisfaction in the job. Internal consistency (Cronbach's α) of the total scale was 0.68 which is considered acceptable, and the test-retest reliability intraclass correlation coefficient was 0.61 which is considered moderate. CONCLUSION The Indonesian P-CAT indicated sound validity and reliability to measure person-centred care among Indonesian care staff working in dementia care and long-term care facilities in Japan. IMPLICATION FOR PRACTICE The development of Indonesian P-CAT allows the evaluation of dementia care, promotes and further improves person-centred care for persons with dementia provided by Indonesian care staff working in long-term care facilities in Japan.
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Affiliation(s)
- Woro Mustika Weni
- Department of Gerontological and Home Healthcare Nursing, Tohoku University, Sendai, Japan
| | - Megumi Shimizu
- Department of Gerontological and Home Healthcare Nursing, Tohoku University, Sendai, Japan
| | | | - Yuki Ohashi
- Rakuwakai Otowa Rehabilitation Hospital, Kyoto, Japan
| | - David Edvardsson
- Department of Nursing, Umeå University, Umeå, Sweden
- Division of Nursing and Midwifery, La Trobe University, Victoria, Melbourne, Australia
| | | | - Rebecca Baxter
- Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
| | - Noortje Kloos
- Division of Nursing and Midwifery, La Trobe University, Victoria, Melbourne, Australia
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
| | - Akiko Ozaki
- Department of Gerontological and Home Healthcare Nursing, Tohoku University, Sendai, Japan
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Maeker É, Franchet M, Maeker-Poquet B. [The nurse, recurrent cries]. SOINS. GERONTOLOGIE 2023; 28:24-26. [PMID: 37977761 DOI: 10.1016/j.sger.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Recurrent screaming and vocal agitation complicate geriatric and psychogeriatric care. They are among the psychobehavioral symptoms that accompany neurocognitive diseases. Reputedly difficult to manage, they require a comprehensive pharmacological and non-pharmacological approach. How can the care team deal with these disorders in the absence of a doctor?
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Affiliation(s)
- Éric Maeker
- Association Emp@thies, 62223 Anzin-Saint-Aubin, France.
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Moermans VRA, Hamers JPH, Verbeek H, de Casterlé BD, Milisen K, Bleijlevens MHC. District nurses' experiences with involuntary treatment in dementia care at home: a qualitative descriptive study. BMC Nurs 2023; 22:394. [PMID: 37853344 PMCID: PMC10585764 DOI: 10.1186/s12912-023-01553-w] [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: 01/13/2023] [Accepted: 10/05/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Research shows that half of person(s) living with dementia (PLWD) receive care which they resist and/or have not given consent to, defined as involuntary treatment. District nurses play a key role in providing this care. Knowledge about how district nurses experience involuntary treatment is lacking. Therefore, the aim of this study was to describe the experiences of district nurses who used involuntary treatment for PLWD at home. METHODS A qualitative descriptive design using semi-structured interviews. Sixteen district nurses with experience in involuntary treatment for PLWD were recruited through purposive sampling. Data were analysed using the Qualitative Analysis Guide of Leuven. RESULTS District nurses' experiences with involuntary treatment were influenced by their involvement in the decision-making process. When they were involved, they considered involuntary treatment use to be appropriate care. However, at the moment that involuntary treatment use was started, district nurses were worried that its use was unjust since they wished to respect the wishes of the PLWD. Eventually, district nurses found, from a professional perspective, that involuntary treatment use was necessary, and that safety outweighed the autonomy of the PLWD. District nurses experienced dealing with this dilemma as stressful, due to conflicting values. If district nurses were not involved in the decision-making process regarding the use of involuntary treatment, family caregivers generally decided on its use. Often, district nurses perceived this request as inappropriate dementia care and they first tried to create a dialogue with the family caregivers to reach a compromise. However, in most cases, family caregivers stood by their request and the district nurse still provided involuntary treatment and found this difficult to tolerate. CONCLUSIONS Our results show that district nurses experience involuntary treatment use as stressful due to dealing with obverse values of safety versus autonomy. To prevent involuntary treatment use and obverse values, we need to increase their ethical awareness, communication skills, knowledge and skills with person-centred care so they can deal with situations that can evolve into involuntary treatment use in a person-centred manner.
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Affiliation(s)
- Vincent R A Moermans
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Duboisdomein 30, Maastricht, 6229 GT, The Netherlands.
- Department of Nursing, White Yellow Cross Limburg, Genk, Belgium.
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands.
| | - Jan P H Hamers
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Duboisdomein 30, Maastricht, 6229 GT, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
| | - Hilde Verbeek
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Duboisdomein 30, Maastricht, 6229 GT, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
| | | | - Koen Milisen
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Michel H C Bleijlevens
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Duboisdomein 30, Maastricht, 6229 GT, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
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Otaka Y, Kitamura S, Suzuki M, Maeda A, Kato C, Ito R, Hirano A, Okochi Y, Mizutani K, Yoshino H, Takechi H. EFFECTS OF REHABILITATION PROGRAM FOCUSED ON IMPROVING REAL-LIFE DAILY ACTIVITIES OF PATIENTS WITH MILD COGNITIVE IMPAIRMENTS OR DEMENTIA AND THEIR CAREGIVERS. JOURNAL OF REHABILITATION MEDICINE. CLINICAL COMMUNICATIONS 2023; 6:12293. [PMID: 37829668 PMCID: PMC10566518 DOI: 10.2340/jrmcc.v6.12293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/01/2023] [Indexed: 10/14/2023]
Abstract
Objective To evaluate the effectiveness of a dyadic outpatient rehabilitation program focused on improving the real-life daily activities of patients with mild cognitive impairments or dementia and their caregivers. Design Retrospective study. Subjects Eight patients with mild cognitive impairments or dementia and their caregivers. Methods The rehabilitation program comprised eight 1-hour sessions by occupational therapists with patients and his/her caregivers. Patients were assessed for motor function, cognitive function, and quality of life, and their caregivers were assessed for depression and caregiver burden. Participants were assessed at pre-program and post-program, and 3-month follow-up. Results The scores of caregiver-assessed Quality of life in Alzheimer's disease scale in patients significantly improved at post-program (median [interquartile range], 30.0 [7.0]) compared with pre-program (27.0 [2.8], effect size = 0.77, p = 0.029). In caregivers, the Zarit Caregiver Burden Interview scores decreased significantly at post-program (16.5 [13.0]) compared with pre-program (22.0 [17.5], effect size = 0.72, p = 0.042). There were no significant differences in other assessments. Conclusions The rehabilitation program focused on real daily activities and demonstrated to improve patients' quality of life and caregivers' depression and caring burden through patient-caregiver interaction. Future enhanced follow-up systems are warranted.
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Affiliation(s)
- Yohei Otaka
- Department of Rehabilitation Medicine I, School of Medicine
| | - Shin Kitamura
- Department of Rehabilitation Medicine I, School of Medicine
- Faculty of Rehabilitation, School of Health Sciences
| | - Megumi Suzuki
- Faculty of Rehabilitation, School of Health Sciences
| | - Akiko Maeda
- Faculty of Rehabilitation, School of Health Sciences
| | - Chinami Kato
- Department of Rehabilitation, Fujita Health University Hospital, Aichi, Japan
| | - Rena Ito
- Department of Rehabilitation, Fujita Health University Hospital, Aichi, Japan
| | - Asuka Hirano
- Department of Rehabilitation, Fujita Health University Hospital, Aichi, Japan
| | - Yuki Okochi
- Department of Rehabilitation, Fujita Health University Hospital, Aichi, Japan
| | - Koji Mizutani
- Department of Rehabilitation, Fujita Health University Hospital, Aichi, Japan
| | - Hiroshi Yoshino
- Department of Geriatrics and Cognitive Disorders, School of Medicine, Fujita Health University, Aichi, Japan
| | - Hajime Takechi
- Department of Geriatrics and Cognitive Disorders, School of Medicine, Fujita Health University, Aichi, Japan
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Willems J, Passos VL, Hamers JPH, Bleijlevens MHC. Professional caregivers' perceived barriers hindering the prevention and reduction of involuntary treatment among older persons receiving long-term care: A mixed methods study. J Clin Nurs 2023; 32:7175-7192. [PMID: 37458214 DOI: 10.1111/jocn.16796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 03/14/2023] [Accepted: 05/30/2023] [Indexed: 07/27/2023]
Abstract
AIMS To gain insights into the barriers towards the prevention and/or reduction of involuntary treatment in long-term geriatric care. DESIGN Mixed methods. BACKGROUND Measures to which a person resists and/or does not provide consent for are defined as involuntary treatment. The use of involuntary treatment violates the autonomy of (older) persons and causes more harm than benefit. Moreover, it contradicts the values of person-centred care. Nevertheless, its use among people living with dementia (PLWD) is still common practice. METHODS We conducted a cross-sectional, mixed methods study, including an online survey for professional caregivers and a semistructured focus group interview with professional caregivers. RESULTS A total of 218 participants completed the questionnaire. The percentage of participants who perceived barriers in one of the 22 survey items ranged from 15% to 42%. Lack of time, the experienced need to use involuntary treatment, uncertainty about responsibilities of stakeholders and a lack of knowledge on methods to prevent and/or reduce the use of involuntary treatment were most seen as barriers. Nursing staff perceived a lack of time hindering them in the prevention or reduction of involuntary treatment more often than other professional caregivers. Working in home care and having no former experience with involuntary treatment usage increased perceived barriers. Participants of the focus group interview confirmed these findings and added that professional caregivers in general lack awareness on the concept of involuntary treatment. CONCLUSIONS One out of four professional caregivers experiences barriers hindering prevention and/or reduction of involuntary treatment. More research is needed to gain a better understanding of how professional caregivers can be supported to remove barriers and, consequently, prevent and/or reduce the use of involuntary treatment. RELEVANCE TO CLINICAL PRACTICE Professional caregivers experience many barriers towards the prevention and reduction of involuntary treatment. Future initiatives should aim to remove the perceived barriers.
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Affiliation(s)
- Jules Willems
- Faculty of Health, Medicine and Lifesciences, CAPHRI Care and Public Health Research Institute, Living Lab in Ageing and Long-term Care, Maastricht University, Maastricht, The Netherlands
| | - Valéria Lima Passos
- Faculty of Health, Medicine and Lifesciences, Methodology and Statistics, Maastricht University, Maastricht, The Netherlands
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | - Jan P H Hamers
- Faculty of Health, Medicine and Lifesciences, CAPHRI Care and Public Health Research Institute, Living Lab in Ageing and Long-term Care, Maastricht University, Maastricht, The Netherlands
| | - Michel H C Bleijlevens
- Faculty of Health, Medicine and Lifesciences, CAPHRI Care and Public Health Research Institute, Living Lab in Ageing and Long-term Care, Maastricht University, Maastricht, The Netherlands
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Lim ELP, Ong RHS, Thor J, Allgurin M, Gäre BA, Thumboo J. An Evaluation of the Relationship between Training of Health Practitioners in a Person-Centred Care Model and their Person-Centred Attitudes. Int J Integr Care 2023; 23:11. [PMID: 38020415 PMCID: PMC10668878 DOI: 10.5334/ijic.7564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 11/06/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction The Esther Network (EN) person-centred care (PCC) advocacy training aims to promote person-centred attitudes among health practitioners in Singapore. This study aimed to assess the relationship between the training and practitioners' PCC attributes over a 3-month period, and to explore power sharing by examining the PCC dimensions of "caring about the service user as a whole person" and the "sharing of power, control and information". Methods A repeated-measure study design utilising the Patient-Practitioner Orientation Scale (PPOS), was administered to 437 training participants at three time points - before training (T1), immediately after (T2) and three months after training (T3). A five-statement questionnaire captured knowledge of person-centred care at T1 and T2. An Overall score, Caring and Sharing sub-scores were derived from the PPOS. Scores were ranked and divided into three groups (high, medium and low). Ordinal Generalised Estimating Equation (GEE) model analysed changes in PPOS scores over time. Results A single, short-term training appeared to result in measurable improvements in person-centredness of health practitioners, with slight attenuation at T3. There was greater tendency to "care" than to "share power" with service users across all three time points, but the degree of improvement was larger for sharing after training. The change in overall person-centred scores varied by sex and profession (females score higher than males, allied health showed a smaller attenuation at T3). Conclusion Training as a specific intervention, appeared to have potential to increase health practitioners' person-centredness but the aspect of equalising power was harder to achieve within a hierarchical structure and clinician-centric culture. An ongoing network to build relationships, and a supportive system to facilitate individual and organisational reflexivity can reinforce learning.
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Affiliation(s)
- Esther Li Ping Lim
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
- Allied Health Division, Singapore General Hospital, Singapore
- Centre for Person-centred Care, Singapore Health Services, Singapore
- Population Health and Integrated Care Office, Singapore General Hospital, Singapore
| | | | - Johan Thor
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
- Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Monika Allgurin
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Boel Andersson Gäre
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
- Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden
- Futurum, Region Jönköping County, Jönköping, Sweden
| | - Julian Thumboo
- SingHealth Office of Regional Health, Singapore Health Services, Singapore
- SingHealth Centre for Population Health Research and Implementation, Singapore Health Services, Singapore
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
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Ma J, Wang Q, Lang Y, Lv S, Xu Y, Wei B. Effectiveness of creative story therapy for dementia: a systematic review and meta-analysis. Eur J Med Res 2023; 28:342. [PMID: 37705077 PMCID: PMC10500921 DOI: 10.1186/s40001-023-01337-7] [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: 07/25/2023] [Accepted: 09/01/2023] [Indexed: 09/15/2023] Open
Abstract
OBJECTIVE To conduct a meta-analysis of the effectiveness of creative story therapy versus routine nursing alone for the treatment of dementia. METHODS We manually searched PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), China VIP Database (VIP), China Biomedical Literature Database (CBM), and Wanfang Data up to May 2023. Randomized controlled trials (RCTs) of creative story therapy combined with routine nursing versus routine nursing for the treatment of dementia were included. RESULTS A total of 597 participants were enrolled in the 9 RCTs. Among them, 296 were in the creative story therapy group, and 301 were in the routine nursing group. We found statistically significant effects of creative story therapy combined with routine nursing on cognitive function [standardized mean difference (SMD) = 0.99, 95% CI 0.57, 1.41, P < 0.00001], CSDD score [mean difference (MD) = - 1.71, 95% CI - 3.27, - 0.14, P < 0.00001], quality of life [SMD = 0.97, 95% CI 0.04, 1.90, P = 0.04], and social communication [MD = 0.46, 95% CI 0.17, 0.74, P < 0.00001] between the creative story therapy group and routine nursing groups; no significant difference in change in basic needs communication [MD = 0.09, 95% CI - 0.58, 0.76, P < 0.00001]. CONCLUSION This meta-analysis shows that creative story therapy combined with routine nursing has significant effectiveness in improving cognitive function and depression in people with dementia. More high-quality RCTs are required to validate these results.
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Affiliation(s)
- Jinlong Ma
- School of Nursing, Yanbian University, Yanji, Jilin, China
| | - Qian Wang
- Department of Central Laboratory, The Affiliated Taian City Central Hospital of Qingdao University, Taian, Shandong, China
| | - Yanmei Lang
- School of Nursing, Yanbian University, Yanji, Jilin, China
| | - Shi Lv
- Department of Rehabilitation, The Second Affiliated Hospital of Shandong First Medical University, Taian, Shandong, China
| | - Yuzhen Xu
- Department of Rehabilitation, The Second Affiliated Hospital of Shandong First Medical University, Taian, Shandong, China.
| | - Baojian Wei
- School of Nursing, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, Shandong, China.
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Kanagasingam D, Hurd L, Norman M. Integrating person-centred care and social justice: a model for practice with larger-bodied patients. MEDICAL HUMANITIES 2023; 49:436-446. [PMID: 36635073 DOI: 10.1136/medhum-2021-012351] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/23/2022] [Indexed: 06/17/2023]
Abstract
Person-centred care (PCC) has been touted as a promising paradigm for improving patients' experiences and outcomes, and the overall therapeutic environment for a range of health conditions, including obesity. While this approach represents an important shift away from a paternalistic and disease-focused paradigm, we argue that PCC must be explicitly informed by a social justice lens to achieve optimal conditions for health and well-being. We suggest that existing studies on PCC for obesity only go so far in achieving social justice goals as they operate within a biomedical model that by default pathologises excess weight and predetermines patients' goals as weight loss and/or management, regardless of patients' embodied experiences and desires. There remains a dearth of empirical research on what social justice-informed PCC looks like in practice with larger patients. This interview study fills a research gap by exploring the perspectives of 1) health practitioners (n=22) who take a critical, social justice-informed approach to weight and 2) larger patients (n=20) served by such practitioners. The research question that informed this paper was: What are the characteristics of social justice-informed PCC that play out in clinical interactions between healthcare practitioners and larger-bodied patients? We identified five themes, namely: 1) Integrating evidence-based practice with compassionate, narrative-based care; 2) Adopting a curious attitude about the patient's world; 3) Centring patients' own wisdom and expertise about their conditions; 4) Working within the constraints of the system to advocate for patients to receive equitable care; 5) Collaborating across professions and with community services to address the multifaceted nature of patient health. The findings illustrate that despite participants' diverse perspectives around weight and health, they shared a commitment to PCC by upholding patient self-determination and addressing weight stigma alongside other systemic factors that affect patient health outcomes.
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Affiliation(s)
- Deana Kanagasingam
- School of Kinesiology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Laura Hurd
- School of Kinesiology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Moss Norman
- School of Kinesiology, The University of British Columbia, Vancouver, British Columbia, Canada
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Chen H, Song J, Zhang N, Li N, Jiang Q, Lu X, Liu L, Liu Y. Confidence in dementia care and care approach toward dementia among the nursing staff in long-term care facilities in China: a cross-sectional survey. Front Public Health 2023; 11:1182631. [PMID: 37663834 PMCID: PMC10470637 DOI: 10.3389/fpubh.2023.1182631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 08/03/2023] [Indexed: 09/05/2023] Open
Abstract
Background Confidence and appropriate care approach toward dementia among nursing staff (nurses and care assistants) are crucial manifestations of competency to deal with the complexity of dementia care in long-term care facilities (LTCFs). The purpose of this study was to investigate the confidence in dementia care and care approach among nursing staff in LTCFs in mainland China. Methods A cross-sectional study design was utilized in LTCFs in Shandong Province, mainland China. A convenient sample included of 317 nursing staff drawn from 15 LTCFs. Survey questions included (a) demographics, (b) dementia knowledge, (c) dementia care confidence, and (d) approach to care for people with dementia. Data were analyzed with descriptive statistics. Factors associated with confidence and care approach for people with dementia were examined using Pearson's correlation and multivariate regression analyses. Results Dementia care confidence was generally moderate. Factors affecting confidence to care for people with dementia included educational level, months of caring dementia patients, and dementia knowledge. Most nursing staff did not use a person-centered care approach which was significantly associated with their age, dementia-learning experience, and knowledge and confidence toward caring for people with dementia. Conclusion A positive correlation was identified between confidence to care for people with dementia and nursing staff care approach. Clinical recommendations are provided to further develop education strategies tailored for nursing staff to meet the growing demand for dementia care services.
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Affiliation(s)
- Haiwen Chen
- School of Nursing, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Jie Song
- School of Nursing, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Nan Zhang
- Jinan Social Welfare Institute, Jinan, China
| | - Na Li
- School of Nursing, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Qianqian Jiang
- Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Xiaohan Lu
- School of Nursing, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Lin Liu
- School of Nursing, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yue Liu
- School of Nursing, Shandong University of Traditional Chinese Medicine, Jinan, China
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Albert U, Tomasetti C, Marra C, Neviani F, Pirani A, Taddeo D, Zanetti O, Maina G. Treating depression in clinical practice: new insights on the multidisciplinary use of trazodone. Front Psychiatry 2023; 14:1207621. [PMID: 37654988 PMCID: PMC10466041 DOI: 10.3389/fpsyt.2023.1207621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/28/2023] [Indexed: 09/02/2023] Open
Abstract
Depression is estimated to be a leading contributor to the global mental health-related burden. The determinants of this huge prevalence lie in the fact that depressive symptoms may be comorbid in a wide variety of disorders, thus complicating and exacerbating their clinical framework. This makes the treatment of depressive symptoms difficult, since many pharmacological interactions should be considered by physicians planning therapy. Hence, depression still represents a challenge for both psychiatrists and other clinicians, in terms of its high rates of relapse and resistance despite well-established protocols. It is also complicated by the well-known latency in its complete response to current antidepressant treatments. In this context, the search for new strategies regarding antidepressant treatment is mandatory. Revising the use of "old" pharmacotherapies by considering their specific features may help to perfecting the treatment of depression, both in its standalone psychiatric manifestation and in the framework of other clinical conditions. Using a nominal group technique approach, the results of a consensus of expert physicians regarding the possible use of trazodone as a valuable strategy for addressing the "real world" unmet needs of depression treatment in different fields (psychiatry, primary care, neurology and geriatrics) is herein provided. This idea is based on the unique characteristics of this drug which delivers a more rapid antidepressant action as compared to other selective serotonin reuptake inhibitors. It also has pharmacodynamic malleability (i.e., the possibility of exerting different effects on depressive symptoms at different dosages) and pharmacokinetic tolerability (i.e., the possibility of being used as an add-on to other antidepressants with scarce interaction and achieving complimentary effects) when used in the milieu of other drugs in treating comorbid depressive symptoms. Moreover, the large number of formulations available permits finite dosage adjustments, and the use of trazodone for specific pathologies, such as dysphagia. Therefore, although additional studies exploring the real-world conditions of antidepressant treatment are warranted, experts agree on the idea that depressive disorder, in both its standalone and its comorbid manifestations, may surely take advantage of the particular characteristics of trazodone, thus attempting to reach the greatest effectiveness in different contexts.
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Affiliation(s)
- Umberto Albert
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
- Azienda Sanitaria Integrata Giuliano-Isontina—ASUGI, UCO Clinica Psichiatrica, Trieste, Italy
| | - Carmine Tomasetti
- ASL Teramo, Department of Mental Health of Teramo, Alzheimer Centre of Giulianova, Teramo, Italy
| | - Camillo Marra
- Neurology Unit, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
- Department of Neuroscience, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesca Neviani
- Center for Cognitive Disorders and Dementia, Chair of Geriatrics, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessandro Pirani
- Center for Cognitive Disorders and Dementia, Health County of Ferrara, Ferrara, Italy
- Alzheimer’s Association “Francesco Mazzuca”, Ferrara, Italy
| | - Daiana Taddeo
- Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Orazio Zanetti
- IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Giuseppe Maina
- San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
- Department of Neurosciences “Rita Levi Montalcini”, University of Turin, Turin, Italy
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