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Kılıç BŞ, Hiçdurmaz D, Ayhan Y, Saka E. Perspectives of Family Caregivers of People With Alzheimer's Disease on Caregiving Experience and Needs: A Qualitative Study. J Psychosoc Nurs Ment Health Serv 2024; 62:36-45. [PMID: 37956348 DOI: 10.3928/02793695-20231106-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
The current study aimed to investigate the perspectives of family caregivers of people with Alzheimer's disease on caregiving experience and needs. A qualitative descriptive method was used with a sample of 23 family caregivers. Data were collected through in-depth, face-to-face interviews using a pilot-tested semi-structured interview guide. Data analysis was performed via content analysis. Three major themes emerged: (1) Stuck in Caregiving, (2) A Life in Metamorphosis, and (3) Needs. Findings revealed that caregivers struggled to manage the care process, adapt to life changes, and fulfill their needs. This study provides rich data to help create interventions to assist family caregivers. [Journal of Psychosocial Nursing and Mental Health Services, 62(6), 36-45.].
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Thyrian JR, Boekholt M, Biernetzky O, Blotenberg I, Teipel S, Killimann I, Hoffmann W. Informal Caregivers of People with Dementia in Germany: Psychosocial Characteristics and Unmet Needs. J Alzheimers Dis 2024; 99:1235-1242. [PMID: 38759002 DOI: 10.3233/jad-231055] [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: 05/19/2024]
Abstract
Background Caregivers of people with dementia living at home (CPwDh) are likely to be affected by a range of health problems. However, CPwDh are often regarded as accompanying persons and receive less attention in research and care. Little is known about this population and their needs in Germany. However, better knowledge of CPwDH is needed to design effective interventions. Objective The objective of this report is to describe the situation of CPwDh and highlight differences based on sex and living situation. Methods This was a cross-sectional analysis of the psychosocial characteristics of participants in the GAIN trial, a cluster-randomized, controlled intervention trial investigating the effectiveness of a care management program. A total of n = 192 CPwDh were recruited in GP offices, memory clinics or through public campaigns in the German federal state of Mecklenburg-Western Pomerania. The inclusion criteria were an age of 18 years or above, being a CPwDh, written informed consent. In a comprehensive digital assessment, psychosocial variables, burden, and care needs were assessed. Results Partners, women, and people living in the same household represented the majority of caregivers, and their mean number of needs was 8.7. Overall, participants indicated a mild to moderate burden. There are differences in burden based on sex and living situation, with caregivers living with people with dementia showing less burden and different psychosocial demographics. Conclusions There is a need for interventions to reduce caregivers' unmet needs in the CPwDh. Such interventions should consider differences in sex and living situation to better address individual caregiver needs.
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Affiliation(s)
- Jochen René Thyrian
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Greifswald, Germany
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Melanie Boekholt
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Greifswald, Germany
| | - Olga Biernetzky
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Rostock, Germany
| | - Iris Blotenberg
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Greifswald, Germany
| | - Stefan Teipel
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Rostock, Germany
- Department for Psychosomatic and Psychotherapeutical Medicine, Rostock University Medical Center, Rostock, Germany
| | - Ingo Killimann
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Rostock, Germany
- Department for Psychosomatic and Psychotherapeutical Medicine, Rostock University Medical Center, Rostock, Germany
| | - Wolfgang Hoffmann
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Greifswald, Germany
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
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Marx Y, Bauer A, Unverzagt S, Stark U, Frese T. Instruments in general practice to identify and to measure (over)burden due to informal care for caring relatives: a scoping review protocol. BMJ Open 2023; 13:e067934. [PMID: 37380204 PMCID: PMC10410812 DOI: 10.1136/bmjopen-2022-067934] [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: 09/01/2022] [Accepted: 06/06/2023] [Indexed: 06/30/2023] Open
Abstract
INTRODUCTION Family caregivers provide by far the largest share of long-term, unpaid care for their primarily elderly and chronically ill relatives or friends. This is associated with a higher risk of psychological and physical overload for the caregivers due to the persistently high time, financial and emotional burden.Recognising the effects of persistent burden on caring relatives at an early stage significantly contributes to the appropriate coordination of available resources and mediation of individual support to maintain a functional caring relationship without excessive demands. General practitioners are usually responsible for the early detection of burden arising from informal care and the coordination of adequate measures. The objective of this review is to give an overview of instruments to identify and measure (over)burden of caring relatives in German general practice and to describe their characteristics. METHODS AND ANALYSIS We used the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist in addition to the Joanna Briggs Institute Reviewer's Manual to describe the aims and methods of the planned scoping reviews. This protocol has been registered with Open Science Framework (OSF), https://osf.io/9ce2k. Two reviewers will run the search to identify studies in four databases (PubMed, LIVIVO, the Cochrane Library and CINAHL) in June and July 2023. Abstracts, titles and full-text publications will be screened to extract data from each included study using a data extraction form. Additionally, an overview of all studies including main study characteristics and detailed information on identification instruments will be given to map the different instruments and tools and to clarify statements concerning their use and practicability in general practice. ETHICS AND DISSEMINATION Ethical approval or consent to participate is not required, as data in this study consists of published studies and not individual data from human or animal participants. Dissemination will consist of publications, presentations and other knowledge translation activities.
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Affiliation(s)
- Yvonne Marx
- Medical Faculty, Institute of General Practice and Family Medicine, Center of Health Sciences, Martin Luther University Halle Wittenberg, Halle (Saale), Germany
| | - Alexander Bauer
- Medical Faculty, Institute of General Practice and Family Medicine, Center of Health Sciences, Martin Luther University Halle Wittenberg, Halle (Saale), Germany
| | - Susanne Unverzagt
- Medical Faculty, Institute of General Practice and Family Medicine, Center of Health Sciences, Martin Luther University Halle Wittenberg, Halle (Saale), Germany
| | - Undine Stark
- Medical Faculty, Institute of General Practice and Family Medicine, Center of Health Sciences, Martin Luther University Halle Wittenberg, Halle (Saale), Germany
| | - Thomas Frese
- Medical Faculty, Institute of General Practice and Family Medicine, Center of Health Sciences, Martin Luther University Halle Wittenberg, Halle (Saale), Germany
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[Caring relatives in General practice-General practitioners' perspectives and solution approaches]. Z Gerontol Geriatr 2023; 56:23-28. [PMID: 34935065 PMCID: PMC9877090 DOI: 10.1007/s00391-021-02000-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 11/23/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND General practitioners are usually responsible for the early detection of burden due to informal care and the coordination of adequate measures. Their individual perspectives and approaches for identifying and supporting caregiving relatives have hardly been examined yet. OBJECTIVE The study therefore examined subjective perspectives of general practitioners regarding the identification and care of family caregivers in general practitioners' practices. The results will help to evaluate the needs for improvement and conditions for implementation of an instrument to identify informal carers. MATERIAL AND METHODS To answer the question, we conducted 12 guideline-based expert interviews with general practitioners from Saxony-Anhalt. To evaluate the interviews, we used qualitative content analysis (Mayring). RESULTS With respect to the medical care and support of caring relatives, the examination of subjective attitudes and perspectives confirmed that general practitioners occupy a central position. It also showed possibilities to improve or to facilitate support of caring relatives. Time-dependent problems and a lack of communication complicate support. Home care services and regional consulting services are available but a systematic cooperation and coordination of competences is still lacking. CONCLUSION A screening instrument for family caregivers (identification, measuring subjective burden) represents a meaningful intervention. The special requirements and characteristics of interventions used in general medical practice have to be researched, the burden scale for family caregivers should be adapted and implemented accordingly. The cooperation of all actors must be a central aspect of future efforts.
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Cheong MJ, Lee DE, Kim J, Son IH, Kim SC, Kang HW. A case study on the application evaluation of integrative medical service model for the improvement of quality of life for dementia patients and caregivers. Medicine (Baltimore) 2022; 101:e32282. [PMID: 36595753 PMCID: PMC9794262 DOI: 10.1097/md.0000000000032282] [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] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Since 4 major diseases and geriatric diseases require consistent management, individuals with any of these diseases cannot live alone and need caregivers' assistance. Given these characteristics, an integrative medical service model for 4 major diseases and geriatric diseases was developed in Korea, currently. Dementia, one of the typical geriatric diseases, requires caregivers' assistance from the beginning because of its enormous burden. Thus, it is necessary to provide an integrative medical service that can improve the quality of life (QoL) for both patients and caregivers. Therefore, this study aims to collect various feedback by applying an integrative medical service, which was developed to improve the QoL in patients with dementia and their caregivers, to a single case, and to modify and improve the integrative medical service model based on the results. METHOD/DESIGN The integrative medical service program, which was developed to improve the QoL in patients with dementia and their caregivers in Korea, will be used for a patient-caregiver pair. This is an observational study with quantitative and qualitative feedback from various viewpoints. The program will be conducted in 8 sessions (twice a week, within 120 minutes). The patient will receive both Western and Korean medicine, and an integrative service will be provided to improve cognitive rehabilitation and QoL. Feedback collected at each session will be reflected on the program of the subsequent session. RESULTS This study will then modify and improve the program with feedback and provide integrative medical services to a patient with dementia and caregiver. DISCUSSION Patients with dementia need a program that would help them maintain cognitive function, and caregivers need a program that would improve their QoL by reducing the caregiving burden. This study is unique because the developed program is performed after modification based on feedback from the previous session. Accordingly, the patient and caregiver can check which program is the most satisfactory and helpful in improving their QoL. We expect that this study can modify the integrative medical service model to the optimized patient-based model. This study can also be used as basic data for a clinical pathway development study that applies the modified model to medical institutes.
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Affiliation(s)
- Moon Joo Cheong
- Rare Diseases Integrative Treatment Research Institute, Wonkwang University Jangheung Integrative Medical Hospital, Jangheung-gun, Jeollanam-do, Republic of Korea
| | - Do-Eun Lee
- Rare Diseases Integrative Treatment Research Institute, Wonkwang University Jangheung Integrative Medical Hospital, Jangheung-gun, Jeollanam-do, Republic of Korea
- Department of Korean Neuropsychiatry Medicine, College of Korean Medicine, Wonkwang University, Iksan-si, Jeollabuk-do, Republic of Korea
| | - Jeesu Kim
- Rare Diseases Integrative Treatment Research Institute, Wonkwang University Jangheung Integrative Medical Hospital, Jangheung-gun, Jeollanam-do, Republic of Korea
- Department of Korean Neuropsychiatry Medicine, College of Korean Medicine, Wonkwang University, Iksan-si, Jeollabuk-do, Republic of Korea
| | - Il-Hong Son
- Department of Neurology, Wonkwang University Sanbon Hospital, Gunpo-si, Gyeonggi-do, Republic of Korea
| | - Sung Chul Kim
- Department of Acupuncture & Moxibustion Medicine, Gwangju Korean Medical Hospital of Wonkwang University, Nam-gu, Gwangju, Republic of Korea
| | - Hyung Won Kang
- Rare Diseases Integrative Treatment Research Institute, Wonkwang University Jangheung Integrative Medical Hospital, Jangheung-gun, Jeollanam-do, Republic of Korea
- Department of Korean Neuropsychiatry Medicine, College of Korean Medicine, Wonkwang University, Iksan-si, Jeollabuk-do, Republic of Korea
- * Correspondence: Hyung Won Kang, Department of Korean Neuropsychiatry Medicine, College of Korean Medicine, Wonkwang University, 460, Iksan-daero, Iksan-si, Jeollabuk-do 54538, Republic of Korea (e-mail: )
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Nelson A, Rosenberg PB, Cotter VT. Dementia care in the age of COVID-19: Community resources for nurses. Nursing 2022; 52:36-39. [PMID: 35085194 DOI: 10.1097/01.nurse.0000816348.80336.73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
ABSTRACT The COVID-19 pandemic and related measures, such as social distancing, have adversely impacted persons with dementia (PWD) and their caregivers. Nurses must be able to identify the care needs of PWD and their caregivers and intervene with relevant resources.
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Affiliation(s)
- Andrea Nelson
- Andrea Nelson is the director of the Memory Care Programs, Memory and Alzheimer's Treatment Center at Johns Hopkins Bayview Medical Center. Paul B. Rosenberg is a professor of psychiatry and behavioral sciences at John Hopkins University School of Medicine. Valerie T. Cotter is an associate professor at Johns Hopkins School of Nursing
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Drewelow E, Altiner A, Biedenweg B, Buchhholz M, Henning E, Hoffmann W, Kohlmann T, Lücker P, Michalowsky B, Oppermann RF, Rädke A, Zorn D, Wollny A. [Task sharing in outpatient dementia care - Focus groups with GPs and nurses]. Pflege 2021; 35:215-222. [PMID: 34814707 DOI: 10.1024/1012-5302/a000851] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Task sharing in outpatient dementia care - Focus groups with GPs and nurses Abstract. Background: Caring for people with dementia (PWD) is challenging for the health system and family carers and can only be managed through interprofessional medical and nursing care. AIM The AHeaD study investigated attitudes of general practitioners (GPs) and nurses towards the transfer of activities previously performed by GPs to advanced nurses in the outpatient care of PWDs. METHODS In four focus group discussions with 10 GPs and 13 nurses, qualitative content analysis was used to investigate attitudes towards the transfer of certain tasks and to identify opportunities and barriers to their introduction. RESULTS GPs primarily preferred the transfer of nursing activities such as blood sampling, assessments, their monitoring or follow-up prescriptions for nursing aids. "Classical" medical tasks (e. g. diagnosis of diseases, initial prescription of medication) are still seen in the hands of GPs. Nurses demanded more appreciation and recognition for the relationship between GPs and nurse and criticised the lack of trust and insufficient communication. Both sides pointed to tight time budgets that were hardly oriented towards the actual needs of the PWD. CONCLUSIONS The implementation of a redistribution of tasks requires the creation of legal and financial framework conditions, time resources, concrete task descriptions as well as a stronger cooperation between the professional groups involved. Innovative concepts could contribute to the sensible use of the resources GP and nurses and strengthen the care of PWDs.
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Affiliation(s)
- Eva Drewelow
- Institut für Allgemeinmedizin der Universitätsmedizin Rostock, Rostock
| | - Attila Altiner
- Institut für Allgemeinmedizin der Universitätsmedizin Rostock, Rostock
| | - Bianca Biedenweg
- Institut für Community Medicine, Abteilung Methoden der Community Medicine der Universitätsmedizin Greifswald, Greifswald
| | - Maresa Buchhholz
- Institut für Community Medicine, Abteilung Methoden der Community Medicine der Universitätsmedizin Greifswald, Greifswald
| | - Esther Henning
- Institut für Community Medicine, Abteilung Methoden der Community Medicine der Universitätsmedizin Greifswald, Greifswald
| | - Wolfgang Hoffmann
- Institut für Community Medicine Abteilung Versorgungsepidemiologie und Community Health der Universitätsmedizin Greifswald, Greifswald
| | - Thomas Kohlmann
- Institut für Community Medicine, Abteilung Methoden der Community Medicine der Universitätsmedizin Greifswald, Greifswald
| | - Petra Lücker
- Institut für Community Medicine Abteilung Versorgungsepidemiologie und Community Health der Universitätsmedizin Greifswald, Greifswald
| | | | - Roman F Oppermann
- Fachbereich Gesundheit, Pflege, Management der Hochschule Neubrandenburg, Neubrandenburg
| | - Anika Rädke
- Deutsches Zentrum für Neurodegenerative Erkrankungen DZNE e. V., Greifswald
| | - Daniela Zorn
- Fachbereich Gesundheit, Pflege, Management der Hochschule Neubrandenburg, Neubrandenburg
| | - Anja Wollny
- Institut für Allgemeinmedizin der Universitätsmedizin Rostock, Rostock
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Khanassov V, Rojas-Rozo L, Sourial R, Yang XQ, Vedel I. Needs of patients with dementia and their caregivers in primary care: lessons learned from the Alzheimer plan of Quebec. BMC FAMILY PRACTICE 2021; 22:186. [PMID: 34525960 PMCID: PMC8441033 DOI: 10.1186/s12875-021-01528-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 08/18/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Persons living with dementia have various health and social care needs and expectations, some which are not fully met by health providers, including primary care clinicians. The Quebec Alzheimer plan, implemented in 2014, aimed to cover these needs, but there is no research on the effect this plan had on the needs and expectations of persons living with dementia. The objective of this study is to identify persons living with dementia and caregivers' met and unmet needs and to describe their experience. METHODS This is a sequential mixed methods explanatory design: Phase 1: cross-sectional study to describe the met and unmet health and social care needs of community-dwelling persons living with dementia using Camberwell Assessment of Need of the Elderly and Carers' Assessment for Dementia tools. Phase 2: qualitative descriptive study to explore and understand the experiences of persons living with dementia and caregivers with the use of social and healthcare services, using semi-structured interviews. Data from phase 1 was analyzed with descriptive statistics, and from phase 2, with inductive thematic analysis. Results from phases 1 and 2 were compared, contrasted and interpreted together. RESULTS The mean total number of needs reported by the patients was 5.03 (4.48 and 0.55 met and unmet needs, respectively). Caregivers had 0.52 met needs (3.16 unmet needs). The main needs for both were memory, physical health, eyesight/hearing/communication, medication, looking after home, money/budgeting. Three categories were mentioned by the participants: Persons living with dementia and caregiver's attitude towards memory decline, their perception of community health services and of the family medicine practice. CONCLUSIONS Our study confirms the findings of other studies on the most common unmet needs of the patients and caregivers that are met partially or not at all. In addition, the participants were satisfied with access to care, and medical services in primary practices, being confident in their family. Our results indicate persons living with dementia and their caregivers need a contact person, a clear explanation of their dementia diagnosis, a care plan, written information on available services, and support for the caregivers.
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Affiliation(s)
- Vladimir Khanassov
- Herzl Clinic, Jewish General Hospital and Department of Family Medicine, McGill University, Montreal, Canada.
| | - Laura Rojas-Rozo
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
| | - Rosa Sourial
- Department of Family Medicine, McGill University, Montreal, Canada
| | - Xin Qiang Yang
- Department of Family Medicine, McGill University, Montreal, Canada
| | - Isabelle Vedel
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada.,Department of Family Medicine, McGill University, Montreal, Canada
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Bablok I, Binder H, Stelzer D, Kaier K, Graf E, Wangler J, Jansky M, Löhr M, Schulz M, Kockläuner M, Geschke K, Wuttke-Linnemann A, Fellgiebel A, Farin E. Primary dementia care based on the individual needs of the patient: study protocol of the cluster randomized controlled trial, DemStepCare. BMC Geriatr 2021; 21:222. [PMID: 33794789 PMCID: PMC8012747 DOI: 10.1186/s12877-021-02114-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/24/2021] [Indexed: 11/27/2022] Open
Abstract
Background Most people with dementia (PwD) are cared for at home, with general practitioners (GPs) playing a key part in the treatment. However, primary dementia care suffers from a number of shortcomings: Often, diagnoses are made too late and therapies by GPs do not follow the guidelines. In cases of acute crises, PwD are too often admitted to hospital with adverse effects on the further course of the disease. The aim of this study is to implement and evaluate a new GP-based, complex dementia care model, DemStepCare. DemStepCare aims to ensure demand-oriented, stepped care for PwD and their caregivers. Methods/design In a cluster randomized controlled trial, the care of PwD receiving a complex intervention, where the GP is supported by a multi-professional team, is compared to (slightly expanded) usual care. GPs are clustered by GP practice, with 120 GP practices participating in total. GP practices are randomized to an intervention or a control group. 800 PwD are to be included per group. Recruitment takes place in Rhineland-Palatinate, Germany. In addition, a second control group with at least 800 PwD will be formed using aggregated routine data from German health insurance companies. The intervention comprises the training of GPs, case management including repeated risk assessment of the patients’ care situation, the demand-oriented service of an outpatient clinic, an electronic case record, external medication analyses and a link to regional support services. The primary aims of the intervention are to positively influence the quality of life for PwD, to reduce the caregivers’ burden, and to reduce the days spent in hospital. Secondary endpoints address medication adequacy and GPs’ attitudes and sensitivity towards dementia, among others. Discussion The GP-based dementia care model DemStepCare is intended to combine a number of promising interventions to provide a complex, stepped intervention that follows the individual needs of PwD and their caregivers. Its effectiveness and feasibility will be assessed in a formative and a summative evaluation. Trial registration German Register of Clinical Trials (Deutsches Register Klinischer Studien, DRKS), DRKS00023560. Registered 13 November 2020 - Retrospectively registered. HTML&TRIAL_ID=DRKS00023560.
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Affiliation(s)
- Isabella Bablok
- Institute of Medical Biometry and Statistics, Section of Health Care Research and Rehabilitation Research, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany.
| | - Harald Binder
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Dominikus Stelzer
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Klaus Kaier
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Erika Graf
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Julian Wangler
- Center for General and Geriatric Medicine, University Medical Center Mainz, Johannes Gutenberg University, Mainz, Germany
| | - Michael Jansky
- Center for General and Geriatric Medicine, University Medical Center Mainz, Johannes Gutenberg University, Mainz, Germany
| | - Michael Löhr
- Landschaftsverband Westfalen-Lippe, Hospital Gütersloh, Gütersloh, Germany.,Diakonie University of Applied Sciences, Bielefeld, Germany
| | - Michael Schulz
- Landschaftsverband Westfalen-Lippe, Hospital Gütersloh, Gütersloh, Germany.,Diakonie University of Applied Sciences, Bielefeld, Germany
| | - Marie Kockläuner
- Department of Pharmacy, University Medical Center Mainz, Johannes Gutenberg University, Mainz, Germany
| | - Katharina Geschke
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Johannes Gutenberg University, Mainz, Germany.,Center for Mental Health in Old Age, Landeskrankenhaus (AöR), Mainz, Germany
| | - Alexandra Wuttke-Linnemann
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Johannes Gutenberg University, Mainz, Germany.,Center for Mental Health in Old Age, Landeskrankenhaus (AöR), Mainz, Germany
| | - Andreas Fellgiebel
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Johannes Gutenberg University, Mainz, Germany.,Center for Mental Health in Old Age, Landeskrankenhaus (AöR), Mainz, Germany
| | - Erik Farin
- Institute of Medical Biometry and Statistics, Section of Health Care Research and Rehabilitation Research, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
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Killackey T, Lovrics E, Saunders S, Isenberg SR. Palliative care transitions from acute care to community-based care: A qualitative systematic review of the experiences and perspectives of health care providers. Palliat Med 2020; 34:1316-1331. [PMID: 32772787 DOI: 10.1177/0269216320947601] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Transitioning from the hospital to community is a vulnerable point in patients' care trajectory, yet little is known about this experience within the context of palliative care. While some studies have examined the patient and caregiver experience, no study to date has synthesized the literature on the healthcare provider's perspective on their role and experience facilitating these transitions. AIM The purpose of this systematic review was to understand the experience and perspective of healthcare providers who support the transition of patients receiving palliative care as they move from acute care to community settings. DESIGN A qualitative systematic review of studies using thematic analysis as outlined by Thomas and Harden. PROSPERO: ID # CRD42018109662. DATA SOURCES We searched four databases: MEDLINE, Embase, ProQuest and CINAHL for studies published in English from 1995 until May 22, 2020. Four reviewers screened records using the following selection criteria: (1) peer-reviewed empirical study, (2) adult sample, (3) qualitative study design, (4) perspective of healthcare providers, and (5) included a component of transitions between acute to community-based palliative care. Study findings were analyzed using thematic analysis which entailed: (1) grouping the findings into recurring themes; (2) iteratively referring back to the articles to obtain nuances of the theme and quotations; and (3) defining and solidifying the themes. RESULTS Overall 1,791 studies were identified and 15 met inclusion criteria. Studies were published recently (>2015, n = 12, 80%) and used a range of qualitative methods including semi-structured interviews, focus groups, and field interviews. Three core themes related to the role and experience of healthcare providers were identified: (1) assessing and preparing for transition; (2) organizing and facilitating the logistics of transition; and (3) coordinating and collaborating transitional care across sectors. The majority of studies focused on the discharge process from acute care; there was a lack of studies exploring the experiences of healthcare providers in the community who receive patients from acute care and provide them with palliative care at home. CONCLUSION This review identified studies from a range of relatively high-income countries that included a diverse sample of healthcare providers. The results indicate that healthcare providers experience multiple complex roles during the transition facilitation process, and future research should examine how to better assist clinicians in supporting these transitions within the context of palliative care provision.
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Affiliation(s)
- Tieghan Killackey
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Emily Lovrics
- Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto, ON, Canada
| | - Stephanie Saunders
- Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto, ON, Canada
| | - Sarina R Isenberg
- Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto, ON, Canada.,Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
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11
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Mayo AM, Siegle K, Savell E, Bullock B, Preston GJ, Peavy GM. Lay Caregivers' Experiences With Caring for Persons With Dementia: A Phenomenological Study. J Gerontol Nurs 2020; 46:17-27. [PMID: 32491183 PMCID: PMC8915949 DOI: 10.3928/00989134-20200527-02] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 03/16/2020] [Indexed: 11/20/2022]
Abstract
Today, biomedical advancements allow older adults, including those with dementia, to live longer, with most living at home with a lay caregiver. Recent research details the stressful role of caregiving to persons with dementia (PWD). The current qualitative phenomenological study describes the lived experience of caregivers caring for PWD, including their experience with palliative care. A community sample of lay caregivers (N = 11) underwent recorded individual interviews. Interviews were analyzed following van Manen's approach to isolate thematic statements. Most caregivers were older (mean age = 71, SD = 9.6; range = 53 to 84 years) and female (n = 10). Study themes included: (a) Uncertainty: The Slippery Slope, (b) The Sense of Loneliness, (c) Complexities of Frustration, and (d) On the Other Side of the Spectrum. Findings show these caregivers are dealing with a dynamic range of feelings about their experiences. Opportunities exist for health care professionals to discuss such feelings and refer caregivers to supportive services, including palliative care. [Journal of Gerontological Nursing, 46(8), 17-27.].
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Tulek Z, Baykal D, Erturk S, Bilgic B, Hanagasi H, Gurvit IH. Caregiver Burden, Quality of Life and Related Factors in Family Caregivers of Dementia Patients in Turkey. Issues Ment Health Nurs 2020; 41:741-749. [PMID: 32286096 DOI: 10.1080/01612840.2019.1705945] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
This study aimed to evaluate caregiver burden and quality of life (QoL) and their predictors in family caregivers of dementia patients. A descriptive cross-sectional survey was carried out with a sample of 102 patients and their family caregivers. The Caregiver Burden Inventory (CBI) and Short Form-12 (SF-12) were used to collect data. CBI mean score was 37.97 ± 21.30. Mean scores of SF-12 sub-domains varied between 36.02 and 77.94 and were significantly lower as compared to normative means of the general population, excluding only the physical health subdomain. Among several patient and caregiver-related correlations, the number of medications and worse cognitive function of the patient, caregiver's age and having limited space at home were found as predictors of burden, whereas caregiver's chronic disease and having a limited space were predictors of QoL. Also, the burden and QoL were correlated. This study demonstrated a high burden and low QoL in dementia caregivers. In societies where caregivers are mostly informal such as that in Turkey, supportive systems should be established.
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Affiliation(s)
- Zeliha Tulek
- Department of Medical Nursing, Istanbul University-Cerrahpasa Florence Nightingale Faculty of Nursing, Istanbul, Turkey
| | - Dilek Baykal
- Department of Medical Nursing, Halic University School of Health Sciences, Istanbul, Turkey
| | - Sumeyye Erturk
- Istanbul University-Cerrahpasa Institute of Graduate Studies, Istanbul, Turkey
| | - Basar Bilgic
- Istanbul University Faculty of Medicine, Department of Neurology, Behavioral Neurology and Movement Disorders Unit, Istanbul, Turkey
| | - Hasmet Hanagasi
- Istanbul University Faculty of Medicine, Department of Neurology, Behavioral Neurology and Movement Disorders Unit, Istanbul, Turkey
| | - I Hakan Gurvit
- Istanbul University Faculty of Medicine, Department of Neurology, Behavioral Neurology and Movement Disorders Unit, Istanbul, Turkey
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Abstract
This article describes the public health impact of Alzheimer's disease (AD), including incidence and prevalence, mortality and morbidity, use and costs of care, and the overall impact on caregivers and society. The Special Report discusses the future challenges of meeting care demands for the growing number of people living with Alzheimer's dementia in the United States with a particular emphasis on primary care. By mid-century, the number of Americans age 65 and older with Alzheimer's dementia may grow to 13.8 million. This represents a steep increase from the estimated 5.8 million Americans age 65 and older who have Alzheimer's dementia today. Official death certificates recorded 122,019 deaths from AD in 2018, the latest year for which data are available, making Alzheimer's the sixth leading cause of death in the United States and the fifth leading cause of death among Americans age 65 and older. Between 2000 and 2018, deaths resulting from stroke, HIV and heart disease decreased, whereas reported deaths from Alzheimer's increased 146.2%. In 2019, more than 16 million family members and other unpaid caregivers provided an estimated 18.6 billion hours of care to people with Alzheimer's or other dementias. This care is valued at nearly $244 billion, but its costs extend to family caregivers' increased risk for emotional distress and negative mental and physical health outcomes. Average per-person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are more than three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 23 times as great. Total payments in 2020 for health care, long-term care and hospice services for people age 65 and older with dementia are estimated to be $305 billion. As the population of Americans living with Alzheimer's dementia increases, the burden of caring for that population also increases. These challenges are exacerbated by a shortage of dementia care specialists, which places an increasing burden on primary care physicians (PCPs) to provide care for people living with dementia. Many PCPs feel underprepared and inadequately trained to handle dementia care responsibilities effectively. This report includes recommendations for maximizing quality care in the face of the shortage of specialists and training challenges in primary care.
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Zwingmann I, Michalowsky B, Esser A, Kaczynski A, Monsees J, Keller A, Hertel J, Wucherer D, Thyrian JR, Eichler T, Kilimann I, Teipel S, Dreier Wolfgramm A, Hoffmann W. Identifying Unmet Needs of Family Dementia Caregivers: Results of the Baseline Assessment of a Cluster-Randomized Controlled Intervention Trial. J Alzheimers Dis 2020; 67:527-539. [PMID: 30584136 PMCID: PMC6398541 DOI: 10.3233/jad-180244] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Caregivers providing informal care for people with dementia (PwD) often report unmet needs, burden, and health impairments. Optimal support for family dementia caregivers will likely benefit from better understanding and assessment of the prevalence and types of caregivers' unmet needs and associated socio-demographic and clinical characteristics. OBJECTIVE The present study investigates 1) the number and types of caregivers' unmet needs, 2) socio-demographic and clinical characteristics of both PwD and caregivers, and 3) caregivers' burden and health-related outcomes that are related to caregivers' unmet needs. METHODS The present analyses are based on cross-sectional data of n = 226 dyads of caregivers and their community-dwelling PwD participating in a comprehensive standardized, computer-based caregivers' needs assessment within a general practitioner (GP)-based, cluster-randomized intervention trial. RESULTS A total of n = 505 unmet needs were identified for n = 171 caregivers from the intervention group at baseline. Only 24.3% caregivers reported no unmet need (n = 55), whereas 75.7% caregivers had at least one unmet need (n = 171). Caregivers had on average 2.19 unmet needs (mean = 2.19, SD = 2.15). Specifically, 53.1% of caregivers had one up to three unmet needs (n = 120), 18.6% (n = 42) had three up to six unmet needs, and 4.0% (n = 9) had more than six unmet needs. DISCUSSION Our results underline the importance of a comprehensive needs assessment for family dementia caregivers to develop and implement concepts that can provide family dementia caregivers with optimal support.
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Affiliation(s)
- Ina Zwingmann
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany
| | - Bernhard Michalowsky
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany
| | - Alexander Esser
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany
| | - Anika Kaczynski
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany
| | - Jessica Monsees
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany
| | - Armin Keller
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany.,Institute of Medical Psychology and Medical Sociology, University Medicine Rostock, Rostock, Germany
| | - Johannes Hertel
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany.,Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Diana Wucherer
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany
| | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany
| | - Tilly Eichler
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany
| | - Ingo Kilimann
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany.,Department of Psychosomatic Medicine, University Medicine Rostock, Rostock, Germany
| | - Stefan Teipel
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany.,Department of Psychosomatic Medicine, University Medicine Rostock, Rostock, Germany
| | - Adina Dreier Wolfgramm
- Department Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany.,Department Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
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Prevalence of depression and burden among informal care-givers of people with dementia: a meta-analysis. AGEING & SOCIETY 2019. [DOI: 10.1017/s0144686x19000527] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
AbstractThis meta-analysis examined the prevalence of depression and burden among informal care-givers of people with dementia (PwD) and compared the prevalence of depression between male and female, and spousal and non-spousal, care-givers. The quality of studies was evaluated and moderator variables explored. A search of six electronic databases (PsycARTICLES, PsycINFO, MEDLINE Complete, SCOPUS, Web of Science and ProQuest) was conducted from the first available date to the 31 October 2017. Inclusion criteria involved observational studies on the prevalence of burden or depression among informal care-givers of PwD. Forty-three studies were examined with a total of 16,911 participants. The adjusted pooled prevalence of depression was 31.24 per cent (95% confidence interval (CI) = 27.70, 35.01) and burden was 49.26 per cent (95% CI = 37.15, 61.46), although heterogeneity among prevalence estimates was high. Depression prevalence estimates differed according to the instrument used and the continent where the study was conducted. The odds of having depression were almost one and a half times higher in female compared to male care-givers. No significant difference was observed between spouses and non-spouses. Most studies had a medium risk of bias. Results suggest a great need within this population for interventions that are effective at reducing burden and depressive symptoms. It therefore appears imperative for dementia services that are not providing such interventions to do so.
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Factors emerging from the "Zarit Burden Interview" and predictive variables in a UK sample of caregivers for people with dementia. Int Psychogeriatr 2018; 30:1671-1678. [PMID: 29562953 DOI: 10.1017/s1041610218000315] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
UNLABELLED ABSTRACTBackground:Caring for persons with dementia (PWD) can create "caregiver burden," which is associated with negative outcomes for caregivers and PWD. The ZBI (Zarit Burden Interview) is a widely used unitary measure of caregiver burden. However, recent research has found caregiver burden to be multi-dimensional. The purpose of this study was to explore the factor structure of the ZBI within a sample of UK caregivers. A secondary aim was to identify variables that predicted burden dimensions found. METHODS A total of 110 unpaid community caregivers of PWD completed the ZBI. They also completed the EACQ (Experiential Avoidance in Caregiving Questionnaire), DEX (Dysexecutive Questionnaire), PACS (Positive Aspects of Caregiving Scale), and a demographic questionnaire. ZBI data were analyzed via exploratory factor analysis (principal axis factoring). Relationships between burden factors and other variables were studied using Pearson correlations and multiple regression. RESULTS Analysis identified three burden factors, namely direct impact of caregiving, uncertainty around the future, and frustration/embarrassment. A direct impact of caregiving and frustration/embarrassment has been found previously. Uncertainty over the future is a new factor, which was predicted by adult-child caregiver role, highlighting that spouses and adult children are likely to have different burden experiences. Additionally, uncertainty over the future and frustration/embarrassment were inversely predicted by PACS, suggesting that being mindful of positive aspects of caregiving may function as a protective factor for burden. CONCLUSIONS This study found caregiver burden to be multi-dimensional and uncovered a novel factor in uncertainty over the future, which warrants further exploration. Burden factors were associated with a range of modifiable variables that could be targeted within health and social care interventions to improve outcomes for caregivers and PWD.
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Caldas CP, Berterö C. Taking the responsibility in dementia care: A concept analysis about facticity. Nurs Open 2018; 5:310-316. [PMID: 30062024 PMCID: PMC6056445 DOI: 10.1002/nop2.162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 02/02/2018] [Indexed: 11/08/2022] Open
Abstract
AIM The aim of this study is to develop a comprehensive definition of facticity, applicable to dementia nursing. METHODS Walker and Avant's Concept Analysis was used to analyse facticity. Published literature found in PubMed, CINAHL, PsycInfo, and Scopus using the search term facticity and nursing, as well as books and dictionaries and empirical data was used to clarify the concept. RESULTS Facticity in nursing dementia care is being in reality taking on responsibility to truth. Antecedents of facticity include persons occupied with caring a demented older person including full-time duties, often accompanied by resistive behaviours. They are overloaded both physically and psychologically. Being present and feeling compassion and nurturing the relationship with the demented older persons and in that way strengthen the caregiving process. CONCLUSION Nurses need to be aware that all human beings are living with facticity.
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Affiliation(s)
| | - Carina Berterö
- Division of Nursing ScienceDepartment of Medical and Health SciencesLinköping UniversityLinköpingSweden
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Zhang M, Chang YP, Liu YJ, Gao L, Porock D. Burden and Strain among Familial Caregivers of Patients with Dementia in China. Issues Ment Health Nurs 2018; 39:427-432. [PMID: 29775139 DOI: 10.1080/01612840.2017.1418034] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Alzheimer's disease is one of a variety of progressive and ultimately fatal neurodegenerative diseases that are characterized by a number of nervous and mental symptoms and behavior disorders. These problems are likely to cause burden and strain on caregivers. In this study, we demonstrated the level and relationship of burden and strain among caregivers of dementia patients in China. METHODS A total of 212 caregivers of family members with dementia responded to the survey. A 22-item of the Zarit Burden Interview and a 13-item Caregiver Strain Index (CSI) were used. RESULTS The results showed that women comprised 88.2% of caregivers, and 58.5% of caregivers reported a level of medium burden. Over one-half of the caregivers reported a level of high strain, with the low income group being more likely to have high levels of burden and strain. CONCLUSION Chinese familial caregivers of patients with dementia experience a moderate level of burden and a high level of strain. The main strain factors that affected the burden were changes in personal plans, time demands, and emotional adjustment.
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Affiliation(s)
- Min Zhang
- a Beihua University , School of Nursing , Jilin, Jilin , China
| | - Yu-Ping Chang
- b University at Buffalo , The State University of New York, School of Nursing , Buffalo , New York , USA
| | - Yu Jin Liu
- c Northeast Normal University , Nursing Department, College of Humanities , Changchun , Jilin , China
| | - Ling Gao
- a Beihua University , School of Nursing , Jilin, Jilin , China
| | - Davina Porock
- d City University of New York City , Lehman College , New York , New York , USA
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Zwingmann I, Hoffmann W, Michalowsky B, Wucherer D, Eichler T, Teipel S, Dreier-Wolfgramm A, Kilimann I, Thyrian JR. [Unmet needs of family dementia caregivers of persons with dementia : Primary medical care]. DER NERVENARZT 2018; 89:495-499. [PMID: 29619534 DOI: 10.1007/s00115-018-0509-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Results of current research studies revealed that providing informal care for people with dementia (PwD) is associated with caregivers' burden and a variety of health impairments. In order to provide optimal support for family caregivers of PwD, general practitioners and specialists should be able to identify caregivers' unmet needs in primary care. OBJECTIVES The present article provides an overview of unmet needs of family caregivers that are relevant for general practitioners as well as specialists in neurology, psychiatry, psychotherapy and psychosomatics. MATERIAL AND METHODS The present overview is based on current reviews on unmet needs of caregivers of PwD and on results of the general practitioner-based, cluster-randomized controlled intervention trial DelpHi-MV (Life- and person-centred help in Mecklenburg-Western Pomerania, Germany; Identifier: NCT01401582). RESULTS The article provides an overview of unmet needs of family caregivers for PwD, especially in the domains of social integration, psychological and physical health, legal and financial issues, as well as available and valid measurements. DISCUSSION The article illustrates the importance and the possibilities for general practitioners and specialists to identify caregivers' unmet needs. The question to what extent unmet needs' assessments for family caregivers of PwD could be implemented and financed in routine care is still under debate.
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Affiliation(s)
- I Zwingmann
- Standort Rostock/Greifswald, Deutsches Zentrum für Neurodegenerative Erkrankungen e. V. (DZNE), Ellernholzstr. 1-2, 17487, Greifswald, Deutschland.
| | - W Hoffmann
- Standort Rostock/Greifswald, Deutsches Zentrum für Neurodegenerative Erkrankungen e. V. (DZNE), Ellernholzstr. 1-2, 17487, Greifswald, Deutschland
- Institut für Community Medicine, Abteilung Versorgungsepidemiologie und Community Health, Universitätsmedizin Greifswald, Greifswald, Deutschland
| | - B Michalowsky
- Standort Rostock/Greifswald, Deutsches Zentrum für Neurodegenerative Erkrankungen e. V. (DZNE), Ellernholzstr. 1-2, 17487, Greifswald, Deutschland
| | - D Wucherer
- Standort Rostock/Greifswald, Deutsches Zentrum für Neurodegenerative Erkrankungen e. V. (DZNE), Ellernholzstr. 1-2, 17487, Greifswald, Deutschland
| | - T Eichler
- Standort Rostock/Greifswald, Deutsches Zentrum für Neurodegenerative Erkrankungen e. V. (DZNE), Ellernholzstr. 1-2, 17487, Greifswald, Deutschland
| | - S Teipel
- Standort Rostock/Greifswald, Deutsches Zentrum für Neurodegenerative Erkrankungen e. V. (DZNE), Ellernholzstr. 1-2, 17487, Greifswald, Deutschland
- Klinik für Psychosomatik und Psychotherapeutische Medizin, Universitätsmedizin Rostock, Rostock, Deutschland
| | - A Dreier-Wolfgramm
- Standort Rostock/Greifswald, Deutsches Zentrum für Neurodegenerative Erkrankungen e. V. (DZNE), Ellernholzstr. 1-2, 17487, Greifswald, Deutschland
| | - I Kilimann
- Standort Rostock/Greifswald, Deutsches Zentrum für Neurodegenerative Erkrankungen e. V. (DZNE), Ellernholzstr. 1-2, 17487, Greifswald, Deutschland
- Klinik für Psychosomatik und Psychotherapeutische Medizin, Universitätsmedizin Rostock, Rostock, Deutschland
| | - J R Thyrian
- Standort Rostock/Greifswald, Deutsches Zentrum für Neurodegenerative Erkrankungen e. V. (DZNE), Ellernholzstr. 1-2, 17487, Greifswald, Deutschland
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