Implementation of the Macao dementia policy: a scoping review for the way forward

Background

The implementation of dementia policy is a complex process of translating policy goals to actions to address the changing needs of people living with dementia. Leveraging on others' experiences would help policy decision-makers and actors better prepare for the challenges.

Purpose

This study explored the development, the implementation and the impact of the dementia policy in Macao, a "role model" recognized by the Alzheimer's Disease International.

Methods

A scoping review of policies, strategies, and news articles, as well as scholarly work from 6 scientific databases dated till March 2023 was conducted under the guidance of the Health Policy Triangle Framework.

Results

According to 284 documents, the dementia policy in Macao, driven by government leadership and supported with public-private partnership, aimed to integrate health and social services to achieve the goals of "Early prevention, Early detection, Early diagnosis, Early treatment and Early support." Promoting the preparedness according to the dementia burden trajectory, empowering the public and the service providers with training and education, and encouraging services-related research were among the key actions. With major changes in dementia care configuration, a dementia service network, a dementia-friendly community and a one-stop service model for disease screening, diagnosis, treatment and support have been developed.

Discussion

Reconfiguring existing resources in the health and social services to form an integrated service network at the community level could be considered a priority of action. Continuous engagement, collaboration and empowerment at different levels across these sectors is crucial for the sustainability of a dementia policy.

Researched Apps Used in Dementia Care for People Living With Dementia and Their Informal Caregivers: Systematic Review on App Features, Security, and Usability

BACKGROUND

Studies have shown that mobile apps have the potential to serve as nonpharmacological interventions for dementia care, improving the quality of life of people living with dementia and their informal caregivers. However, little is known about the needs for and privacy aspects of these mobile apps in dementia care.

OBJECTIVE

This review seeks to understand the landscape of existing mobile apps in dementia care for people living with dementia and their caregivers with respect to app features, usability testing, privacy, and security.

METHODS

ACM Digital Library, Cochrane Central Register of Controlled Trials, Compendex, Embase, Inspec, Ovid MEDLINE, PsycINFO, and Scopus were searched. Studies were included if they included people with dementia living in the community, their informal caregivers, or both; focused on apps in dementia care using smartphones or tablet computers; and covered usability evaluation of the app. Records were independently screened, and 2 reviewers extracted the data. The Centre for Evidence-Based Medicine critical appraisal tool and Mixed Methods Appraisal Tool were used to assess the risk of bias in the included studies. Thematic synthesis was used, and the findings were summarized and tabulated based on each research aim.

RESULTS

Overall, 44 studies were included in this review, with 39 (89%) published after 2015. In total, 50 apps were included in the study, with more apps developed for people living with dementia as end users compared with caregivers. Most studies (27/44, 61%) used tablet computers. The most common app feature was cognitive stimulation. This review presented 9 app usability themes: user interface, physical considerations, screen size, interaction challenges, meeting user needs, lack of self-awareness of app needs, stigma, technological inexperience, and technical support. In total, 5 methods (questionnaires, interviews, observations, logging, and focus groups) were used to evaluate usability. There was little focus on the privacy and security aspects, including data transfer and protection, of mobile apps for people living with dementia.

CONCLUSIONS

The limitations of this review include 1 reviewer conducting the full-text screening, its restriction to studies published in English, and the exclusion of apps that lacked empirical usability testing. As a result, there may be an incomplete representation of the available apps in the field of dementia care. However, this review highlights significant concerns related to the usability, privacy, and security of existing mobile apps for people living with dementia and their caregivers. The findings of this review provide a valuable framework to guide app developers and researchers in the areas of privacy policy development, app development strategies, and the importance of conducting thorough usability testing for their apps. By considering these factors, future work in this field can be advanced to enhance the quality and effectiveness of dementia care apps.

TRIAL REGISTRATION

PROSPERO CRD42020216141; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=216141.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1159/000514838.

Experiences of abuse in Australian family carers and predictors of mental health and well-being

Caregivers for family or friends who are elderly people or have a disability provide critical supports, with a range of positive and negative consequences associated with their role. This research explores the positive and negative aspects of care-giving, including the experience of abuse within the caring relationship, through an anonymous online survey of the mental health, well-being and caring experience of Australian family carers (N = 305). The voluntary participants were recruited through local and national carer associations. Over 40% of respondents reported having experienced abuse by the person they cared for, with the most common form of abuse being verbal abuse (35% of the respondents reporting abuse) and physical abuse (14%). The experience of abuse was related to poorer mental health as measured by the DASS-21 and a lower reported quality of life. Financial stress, lack of support and the negative impacts of care-giving were also significantly associated with mental health and well-being outcomes. The current research is among the first to directly assess the experience of abuse within a broad sample of caregivers, identifying this as a significant issue for caregivers. The findings have clear implications for programs and policies that protect the rights, safety and well-being of caregivers.

Healthcare professionals' dementia knowledge and attitudes towards dementia care and family carers' perceptions of dementia care in China: An integrative review

AIMS AND OBJECTIVES

To establish an understanding of healthcare professionals' dementia knowledge and attitudes towards dementia care, and family carers' perceptions of dementia care in China.

BACKGROUND

Healthcare professionals and family carers of people with dementia deliver most of the dementia care in China. However, little research on healthcare professionals' dementia knowledge and attitudes towards dementia care, and family carers' dementia care perceptions has been conducted in China.

METHODS

An integrative review was conducted and reported based on the PRISMA guidelines and Whittemore and Knafl's framework. Eight English databases were searched without date restriction: CINAHL Plus with Full Text, MEDLINE, PubMed, Web of Science, Cochrane Library, Embase, PsycINFO and Scopus; and three Chinese databases: China National Knowledge Infrastructure, Chongqing Weipu and Wanfang, plus a manual search of reference lists.

RESULTS

Thirty-eight primary research papers were included in the review. Three themes were identified from the synthesis: (a) knowledge and competency; (b) attitudes towards dementia care; and (c) carers' burden and unmet needs. Healthcare professionals' dementia knowledge ranged from low to moderate levels and attitudes towards dementia care were generally negative. With low levels of knowledge of dementia and negative attitudes including stigma, family carers were under stress with insufficient support, and they expected more support from community nurses.

CONCLUSIONS

There is an apparent need for a national policy on healthcare professional education and training to improve dementia care practice in China. Such a policy may improve support services for family carers.

RELEVANCE TO CLINICAL PRACTICE

Nurses, and particularly community nurses, are well-positioned to support family carers in China. However, healthcare professionals in China are not prepared for this. Therefore, education and training on dementia care should be integrated into medical and nursing undergraduate programmes and provided for healthcare professionals after commencing employment, and strategies to reduce stigma are needed.

Vereinbarkeit von Pflege bei Demenz, Familie und Beruf

Hintergrund

Pflegende Angehörige (PA) von Menschen mit Demenz (MMD) sind eine vulnerable Personengruppe, die nicht nur mit den Belastungen aufgrund der Pflege, sondern auch mit Anforderungen aus ihrem Familien- und Berufsleben konfrontiert sein können. Der nationale Forschungsstand zum Erleben des Spannungsfelds zwischen Pflege, Familie und Beruf ist unzureichend.

Ziel der Arbeit

Die vorliegende Studie ist eine rekonstruktive Analyse der Vereinbarkeit der Pflege eines MMD mit den Lebensbereichen Familie und Beruf, in der Haupt- und Nebenpflegende des MMD berücksichtigt wurden.

Methoden

Es wurden 14 narrative Interviews mit PA von MMD geführt. Die Auswertung erfolgte anhand der Dokumentarischen Methode nach Nohl und mündete in Typenbildungen.

Ergebnisse

In pflegenden Familien eines MMD bedingen sich Beziehungsqualität und Aufgabenverteilung gegenseitig. Dies hat Auswirkungen auf das Erleben der Pflege. Stabile Beziehungen und fair verteilte Aufgaben können die Pflege erleichtern, wohingegen konfliktbelastete Beziehungen und ungleich verteilte oder ungeteilte Aufgaben die Pflegebelastung der Familie erhöhen. Erwerbstätige PA nehmen die Lebensbereiche Pflege und Beruf als getrennt voneinander, miteinander in Konflikt geratend oder sich gegenseitig unterstützend wahr.

Diskussion

Die Belastungen aufgrund der Pflege eines MMD führen zu Beeinträchtigungen im Familien- und Berufsleben, was negative Folgen für die Gesundheit der PA haben kann. Doch ebenso können die Familie sowie der Beruf die Belastung reduzieren, wenn PA beispielsweise durch therapeutische Angebote darin unterstützt werden, positive Pflegeerfahrungen wie gestärkte Familienbeziehungen und -funktionalität zu erleben, und wenn erwerbstätige PA den Beruf als einen stärkenden Lebensbereich erfahren.

Zusatzmaterial online

Zusätzliche Informationen sind in der Online-Version dieses Artikels (10.1007/s00391-020-01764-9) enthalten.