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Sabatini S, Martyr A, Hunt A, Gamble LD, Matthews FE, Thom JM, Jones RW, Allan L, Knapp M, Quinn C, Victor C, Pentecost C, Rusted JM, Morris RG, Clare L. Health conditions in spousal caregivers of people with dementia and their relationships with stress, caregiving experiences, and social networks: longitudinal findings from the IDEAL programme. BMC Geriatr 2024; 24:171. [PMID: 38373905 PMCID: PMC10875834 DOI: 10.1186/s12877-024-04707-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 01/13/2024] [Indexed: 02/21/2024] Open
Abstract
OBJECTIVES Longitudinal evidence documenting health conditions in spousal caregivers of people with dementia and whether these influence caregivers' outcomes is scarce. This study explores type and number of health conditions over two years in caregivers of people with dementia and subgroups based on age, sex, education, hours of care, informant-rated functional ability, neuropsychiatric symptoms, cognition of the person with dementia, and length of diagnosis in the person with dementia. It also explores whether over time the number of health conditions is associated with caregivers' stress, positive experiences of caregiving, and social networks METHODS: Longitudinal data from the IDEAL (Improving the experience of Dementia and Enhancing Active Life) cohort were used. Participants comprised spousal caregivers (n = 977) of people with dementia. Self-reported health conditions using the Charlson Comorbidity Index, stress, positive experiences of caregiving, and social network were assessed over two years. Mixed effect models were used RESULTS: On average participants had 1.5 health conditions at baseline; increasing to 2.1 conditions over two years. More health conditions were reported by caregivers who were older, had no formal education, provided 10 + hours of care per day, and/or cared for a person with more neuropsychiatric symptoms at baseline. More baseline health conditions were associated with greater stress at baseline but not with stress over time. Over two years, when caregivers' health conditions increased, their stress increased whereas their social network diminished DISCUSSION: Findings highlight that most caregivers have their own health problems which require management to avoid increased stress and shrinking of social networks.
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Affiliation(s)
- Serena Sabatini
- Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Anthony Martyr
- University of Exeter Medical School, University of Exeter, Exeter, UK.
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK.
| | - Anna Hunt
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Laura D Gamble
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Fiona E Matthews
- Institute for Clinical and Applied Health Research, Hull York Medical School, University of Hull, Hull, UK
| | - Jeanette M Thom
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Roy W Jones
- Research Institute for the Care of Older People (RICE), Bath, UK
| | - Louise Allan
- University of Exeter Medical School, University of Exeter, Exeter, UK
- NIHR Applied Research Collaboration South-West Peninsula, Exeter, UK
| | - Martin Knapp
- London School of Economics and Political Science, London, UK
| | - Catherine Quinn
- Centre for Applied Dementia Studies, Bradford University, Bradford, UK
- Wolfson Centre for Applied Health Research, Bradford, UK
| | - Christina Victor
- College of Health, Medicine and Life Sciences, Department of Health Sciences, Brunel University London, London, UK
| | - Claire Pentecost
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | | | - Robin G Morris
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Linda Clare
- University of Exeter Medical School, University of Exeter, Exeter, UK
- NIHR Applied Research Collaboration South-West Peninsula, Exeter, UK
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Sabatini S, Martyr A, Hunt A, Gamble LD, Matthews FE, Thom JM, Jones RW, Allan L, Knapp M, Victor C, Pentecost C, Rusted JM, Morris RG, Clare L. Comorbid health conditions and their impact on social isolation, loneliness, quality of life, and well-being in people with dementia: longitudinal findings from the IDEAL programme. BMC Geriatr 2024; 24:23. [PMID: 38182985 PMCID: PMC10768096 DOI: 10.1186/s12877-023-04601-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 12/14/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Most people with dementia have multiple health conditions. This study explores (1) number and type of health condition(s) in people with dementia overall and in relation to age, sex, dementia type, and cognition; (2) change in number of health conditions over two years; and (3) whether over time the number of health conditions at baseline is related to social isolation, loneliness, quality of life, and/or well-being. METHODS Longitudinal data from the IDEAL (Improving the experience of Dementia and Enhancing Active Life) cohort were used. Participants comprised people with dementia (n = 1490) living in the community (at baseline) in Great Britain. Health conditions using the Charlson Comorbidity Index, cognition, social isolation, loneliness, quality of life, and well-being were assessed over two years. Mixed effects modelling was used. RESULTS On average participants had 1.8 health conditions at baseline, excluding dementia; increasing to 2.5 conditions over two years. Those with vascular dementia or mixed (Alzheimer's and vascular) dementia had more health conditions than those with Alzheimer's disease. People aged ≥ 80 had more health conditions than those aged < 65 years. At baseline having more health conditions was associated with increased loneliness, poorer quality of life, and poorer well-being, but was either minimally or not associated with cognition, sex, and social isolation. Number of health conditions had either minimal or no influence on these variables over time. CONCLUSIONS People with dementia in IDEAL generally had multiple health conditions and those with more health conditions were lonelier, had poorer quality of life, and poorer well-being.
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Affiliation(s)
- Serena Sabatini
- Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Anthony Martyr
- University of Exeter Medical School, University of Exeter, Exeter, UK.
| | - Anna Hunt
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Laura D Gamble
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | - Fiona E Matthews
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | - Jeanette M Thom
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Roy W Jones
- Research Institute for the Care of Older People (RICE), Bath, UK
| | - Louise Allan
- University of Exeter Medical School, University of Exeter, Exeter, UK
- NIHR Applied Research Collaboration South-West Peninsula, Exeter, UK
| | - Martin Knapp
- London School of Economics and Political Science, London, UK
| | - Christina Victor
- College of Health, Medicine and Life Sciences, Department of Health Sciences, Brunel University London, London, UK
| | - Claire Pentecost
- Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Robin G Morris
- King's College Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Linda Clare
- University of Exeter Medical School, University of Exeter, Exeter, UK
- NIHR Applied Research Collaboration South-West Peninsula, Exeter, UK
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Collins R, Martyr A, Hunt A, Quinn C, Pentecost C, Hughes JC, Clare L. Methods and approaches to facilitate inclusion of the views, perspectives and preferences of people with moderate-to-severe dementia in research: A narrative systematic review. Int J Older People Nurs 2024; 19:e12594. [PMID: 38084053 DOI: 10.1111/opn.12594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 08/17/2023] [Accepted: 11/27/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND The perspectives of people with moderate-to-severe dementia are rarely directly elicited in research studies. OBJECTIVES This systematic review will explore methods and approaches for including the perspectives and preferences of people with moderate-to-severe dementia in research. METHODS AgeLine, CINAHL, Embase, PsycINFO, PubMed, Social Policy and Practice and Web of Science were searched until June 16 2022. Study quality was assessed using the 16-item Quality Assessment Tool. We described specific communication tools, reviewed the evidence for their effectiveness and considered their strengths and limitations. We examined the more general communication skills and techniques applied to support the use of these tools using thematic synthesis. The review protocol was registered with PROSPERO CRD42019130386 and the review was conducted and reported according to PRISMA guidelines. RESULTS Seven studies reported in 11 publications were included. In these studies five specific communication tools were used: Talking Mats, Augmentative and Alternative Communication Flexiboard, generic photographs in combination with a preference placement board, consultation ballot and personalised communication prescriptions. Each tool identified had advantages and disadvantages depending on dementia severity, verbal or physical ability, expense, researcher training requirements and ease of use. Thematic synthesis identified five general approaches to optimising communication that were employed to support use of the tools: ensuring conversations are individual and person-centred, managing external influences, engaging others, creating structure and facilitation skills. CONCLUSION All tools had some utility and there was no clear evidence to support the recommendation of any one specific tool; therefore, researchers are advised to select the tool most appropriate to their context. IMPLICATIONS FOR PRACTICE The findings offer general guidance for researchers and practitioners on how to facilitate communication with people with moderate-to-severe dementia.
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Affiliation(s)
- Rachel Collins
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
| | - Anthony Martyr
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
| | - Anna Hunt
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
| | - Catherine Quinn
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
- Wolfson Centre for Applied Health Research, Bradford, UK
| | - Claire Pentecost
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
| | - Julian C Hughes
- Population Health Science Institute, Bristol Medical School, University of Bristol, Bristol, UK
| | - Linda Clare
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
- NIHR Applied Research Collaboration South West Peninsula, Exeter, UK
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Martyr A, Ravi M, Gamble LD, Morris RG, Rusted JM, Pentecost C, Matthews FE, Clare L. Trajectories of cognitive and perceived functional decline in people with dementia: Findings from the IDEAL programme. Alzheimers Dement 2024; 20:410-420. [PMID: 37658739 PMCID: PMC10916967 DOI: 10.1002/alz.13448] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 07/21/2023] [Accepted: 07/28/2023] [Indexed: 09/05/2023]
Abstract
INTRODUCTION Impaired cognition and instrumental activities of daily living (iADL) are key diagnostic features of dementia; however, few studies have compared trajectories of cognition and iADL. METHODS Participants from the IDEAL study comprised 1537, 1183, and 851 people with dementia, and 1277, 977, and 749 caregivers at baseline, 12 and 24 months, respectively. Addenbrooke's Cognitive Examination-III and Functional Activities Questionnaire were used to measure cognition and iADL, respectively. Scores were converted to deciles. RESULTS Self-rated iADL declined on average by -0.08 (-0.25, 0.08) decile points per timepoint more than cognition. Informant-rated iADL declined on average by -0.31 (-0.43, -0.18) decile points per timepoint more than cognition. DISCUSSION Cognition and self-rated iADL declined at a similar rate. Informant-rated iADL declined at a significantly greater rate than cognition. Therefore, either cognition and perceived iADL decline at different rates or informants overestimate increasing iADL difficulties compared to both cognition and self-ratings. HIGHLIGHTS Self-ratings of the degree of functional difficulties were consistent with cognition Decline in self-rated everyday activities was consistent with cognitive decline Informant-ratings of everyday activities declined more than cognition.
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Affiliation(s)
- Anthony Martyr
- Centre for Research in Ageing and Cognitive HealthUniversity of Exeter Medical SchoolSt Luke's CampusExeterUK
| | - Madhumathi Ravi
- Centre for Research in Ageing and Cognitive HealthUniversity of Exeter Medical SchoolSt Luke's CampusExeterUK
| | - Laura D. Gamble
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneExeterUK
| | - Robin G Morris
- Department of PsychologyKing's College London Institute of PsychiatryPsychology and NeuroscienceLondonUK
| | | | - Claire Pentecost
- Centre for Research in Ageing and Cognitive HealthUniversity of Exeter Medical SchoolSt Luke's CampusExeterUK
| | - Fiona E. Matthews
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneExeterUK
| | - Linda Clare
- Centre for Research in Ageing and Cognitive HealthUniversity of Exeter Medical SchoolSt Luke's CampusExeterUK
- NIHR Applied Research Collaboration South‐West PeninsulaExeterUK
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Alexander CM, Martyr A, Gamble LD, Quinn C, Pentecost C, Morris RG, Clare L. Dyadic influences on awareness of condition in people with dementia: findings from the IDEAL cohort. Front Aging Neurosci 2023; 15:1277336. [PMID: 38146375 PMCID: PMC10749333 DOI: 10.3389/fnagi.2023.1277336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/20/2023] [Indexed: 12/27/2023] Open
Abstract
Introduction The discrepancy between caregiver-ratings and self-ratings of abilities is commonly used to assess awareness in people with dementia. We investigated the contribution of caregiver and dyadic characteristics to the difference in perspective between caregiver-informants and people with dementia about difficulties experienced, when considering awareness of condition. Methods We conducted exploratory cross-sectional analyses using data from the IDEAL cohort. Participants were 1,038 community-dwelling people with mild-to-moderate dementia, and coresident spouse/partner caregivers. The Representations and Adjustment to Dementia Index (RADIX) checklist reporting difficulties commonly experienced in dementia was completed by 960 caregiver-informants and 989 people with dementia. Difference in scores was calculated for 916 dyads. Demographic information, cognition, informant-rated functional ability and neuropsychiatric symptoms were recorded for the person with dementia. Self-reported data were collected on mood, comorbidity, religion, importance of religion, relationship quality, and caregiver stress. Results For most dyads, caregivers reported more RADIX difficulties than people with dementia. Caregiver RADIX ratings were more closely associated with informant-rated functional ability and neuropsychiatric symptoms than with cognition. More RADIX difficulties and higher stress were reported by female caregivers. Greater RADIX difference was associated with more caregiver stress, and older age but less depression in people with dementia. Conclusion Few dyadic characteristics were important, but caregiver stress was higher where caregivers reported more RADIX difficulties and/or the difference in perspective was greater, whereas partners with dementia reported better mood. In addition to offering information about awareness of condition, the caregiver rating and difference in perspectives could indicate where more support is needed.
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Affiliation(s)
- Catherine M. Alexander
- The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, United Kingdom
- NIHR Applied Research Collaboration South West Peninsula, Exeter, United Kingdom
| | - Anthony Martyr
- The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, United Kingdom
| | - Laura D. Gamble
- Population Health Sciences Institute, Newcastle upon Tyne University, Newcastle, United Kingdom
| | - Catherine Quinn
- Centre for Applied Dementia Studies, University of Bradford, Bradford, United Kingdom
- Wolfson Centre for Applied Health Research, Bradford, United Kingdom
| | - Claire Pentecost
- The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, United Kingdom
| | - Robin G. Morris
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Linda Clare
- The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, United Kingdom
- NIHR Applied Research Collaboration South West Peninsula, Exeter, United Kingdom
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Martyr A, Rusted JM, Quinn C, Gamble LD, Collins R, Morris RG, Clare L. Resilience in caregivers of people with mild-to-moderate dementia: findings from the IDEAL cohort. BMC Geriatr 2023; 23:804. [PMID: 38053063 PMCID: PMC10696882 DOI: 10.1186/s12877-023-04549-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 11/30/2023] [Indexed: 12/07/2023] Open
Abstract
OBJECTIVES A novel model of resilience was tested in caregivers of people with mild-to-moderate dementia and was extended to explore whether including self-efficacy, optimism, and self-esteem improved its predictive value. DESIGN Cross-sectional. SETTING Data from the IDEAL cohort were used. PARTICIPANTS The study comprised 1222 caregivers of people with dementia. MEASUREMENTS A composite resilience score was calculated from five measures. Multivariable regressions were used to investigate factors associated with resilience. RESULTS Greater resilience was associated with being older, being male, and caregiving for older people with dementia. Greater resilience was also observed when people with dementia had fewer functional difficulties and/or fewer neuropsychiatric symptoms, there was a stronger dyadic relationship, and the caregiver had fewer social restrictions, less neuroticism, and greater perceived competence. Surprisingly, caregiver self-efficacy, optimism, and self-esteem were unrelated to resilience. CONCLUSION Caregivers of people with mild-to-moderate dementia generally scored well for resilience. Resilience was associated with both the personal characteristics of caregivers and level of care need among people with dementia. Future work is needed to determine whether the caregivers in this cohort appeared resilient because the care recipients had relatively low care needs and consequently placed fewer demands on caregiver well-being than would be the case where dementia is more advanced.
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Affiliation(s)
- Anthony Martyr
- Centre for Research in Ageing and Cognitive Health, Faculty of Health and Life Sciences, University of Exeter, St Luke's Campus, Exeter, UK.
| | | | - Catherine Quinn
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
- Wolfson Centre for Applied Health Research, Bradford, UK
| | - Laura D Gamble
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Rachel Collins
- Centre for Research in Ageing and Cognitive Health, Faculty of Health and Life Sciences, University of Exeter, St Luke's Campus, Exeter, UK
| | - Robin G Morris
- Department of Psychology, King's College London Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Linda Clare
- Centre for Research in Ageing and Cognitive Health, Faculty of Health and Life Sciences, University of Exeter, St Luke's Campus, Exeter, UK
- NIHR Applied Research Collaboration South-West Peninsula, Exeter, UK
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Martyr A, Nelis SM, Morris RG, Marková IS, Roth I, Woods RT, Clare L. Exploring longitudinal changes in implicit awareness of dementia: An investigation of the emotional Stroop effect in healthy ageing and mild dementia. J Neuropsychol 2023. [PMID: 37658549 DOI: 10.1111/jnp.12344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/15/2023] [Accepted: 08/17/2023] [Indexed: 09/03/2023]
Abstract
The aim of the study was to investigate responses to dementia-relevant words in healthy older people and to investigate changes in response over 20-months in people with early-stage dementia. An emotional Stroop task, using colour-naming dementia-relevant words, was used as an indicator of implicit awareness of dementia. Overall, 24 people with dementia and 24 healthy older people completed an emotional Stroop task (T1). People with dementia completed the same task again after 12 (T2) and 20 (T3) months. For people with dementia emotional Stroop performance was contrasted with ratings of explicit awareness based on a detailed interview at T1 and at T2. For healthy older people and people with dementia response times to dementia-relevant words were significantly longer than those for neutral words. The effect was absent for people with dementia at T3. This decline in the emotional Stroop effect was not associated with cognitive decline as measured by the MMSE. Ratings of explicit awareness showed no significant change over time. There was no association between explicit awareness and implicit awareness. Implicit awareness of the condition is evident in early-stage dementia and can be elicited even where there is reduced explicit awareness. The emotional Stroop effect for dementia-relevant words in people with dementia appears to decline over time, independently of changes in MMSE score, suggesting that implicit awareness fades as time progresses.
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Affiliation(s)
- Anthony Martyr
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
| | - Sharon M Nelis
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
| | - Robin G Morris
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ivana S Marková
- Hull York Medical School, Allam Medical Building University of Hull, Hull, UK
| | - Ilona Roth
- School of Life, Health and Chemical Sciences, STEM Faculty, The Open University, Milton Keynes, UK
| | - Robert T Woods
- Dementia Services Development Centre (DSDC) Wales, School of Medical & Health Sciences, Bangor University, Bangor, UK
| | - Linda Clare
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
- NIHR Applied Research Collaboration South-West Peninsula, Exeter, UK
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Kudlicka A, Martyr A, Bahar-Fuchs A, Sabates J, Woods B, Clare L. Cognitive rehabilitation for people with mild to moderate dementia. Cochrane Database Syst Rev 2023; 6:CD013388. [PMID: 37389428 PMCID: PMC10310315 DOI: 10.1002/14651858.cd013388.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
BACKGROUND Cognitive impairments affect functional ability in people with dementia. Cognitive rehabilitation (CR) is a personalised, solution-focused approach that aims to enable people with mild-to-moderate dementia to manage everyday activities and maintain as much independence as possible. OBJECTIVES To evaluate the effects of CR on everyday functioning and other outcomes for people with mild-to-moderate dementia, and on outcomes for care partners. To identify and explore factors that may be associated with the efficacy of CR. SEARCH METHODS We searched the Cochrane Dementia and Cognitive Improvement Group Specialised Register, which contains records from MEDLINE, EMBASE, CINAHL, PsycINFO, LILACS, and other clinical trial databases, and grey literature sources. The most recent search was completed on 19 October 2022. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing CR with control conditions and reporting relevant outcomes for the person with dementia and/or the care partner. DATA COLLECTION AND ANALYSIS We extracted relevant data from published manuscripts and contacted trial authors if necessary. Within each of the comparisons, we pooled data for each outcome of interest and conducted inverse-variance, random-effects meta-analyses. We evaluated the certainty of the evidence using GRADEpro GDT. MAIN RESULTS We identified six eligible RCTs published in English between 2010 and 2022, which together included 1702 participants. The mean age of participants ranged from 76 to 80 and the proportion of male participants was between 29.4% and 79.3%. Most participants, in the studies where the type of dementia was reported, had a diagnosis of Alzheimer's disease (AD; n = 1002, 58.9% of the whole sample, 81.2% of the participants for whom the specific diagnosis was reported). Risk of bias in the individual studies was relatively low. The exception was a high risk of bias in relation to blinding of participants and practitioners, which is not usually feasible with psychosocial interventions. Our primary outcome of everyday functioning was operationalised in the included studies as goal attainment in relation to activities targeted in the intervention. For our main comparison of CR with usual care, we pooled data for goal attainment evaluated from three perspectives (self-rating of performance, informant rating of performance, and self-rating of satisfaction with performance) at end of treatment and at medium-term follow-up (3 to 12 months). We could also pool data at these time points for 20 and 19 secondary outcomes respectively. The review findings were strongly driven by one large, high-quality RCT. We found high-certainty evidence of large positive effects of CR on all three primary outcome perspectives at the end of treatment: participant self-ratings of goal attainment (standardised mean difference (SMD) 1.46, 95% confidence interval (CI) 1.26 to 1.66; I2 = 0%; 3 RCTs, 501 participants), informant ratings of goal attainment (SMD 1.61, 95% CI 1.01 to 2.21; I2 = 41%; 3 RCTs, 476 participants), and self-ratings of satisfaction with goal attainment (SMD 1.31, 95% CI 1.09 to 1.54; I2 = 5%; 3 RCTs, 501 participants), relative to an inactive control condition. At medium-term follow-up, we found high-certainty evidence showing a large positive effect of CR on all three primary outcome perspectives: participant self-ratings of goal attainment (SMD 1.46, 95% CI 1.25 to 1.68; I2 = 0%; 2 RCTs, 432 participants), informant ratings of goal attainment (SMD 1.25, 95% CI 0.78 to 1.72; I2 = 29%; 3 RCTs, 446 participants), and self-ratings of satisfaction with goal attainment (SMD 1.19, 95% CI 0.73 to 1.66; I2 = 28%; 2 RCTs, 432 participants), relative to an inactive control condition. For participants at the end of treatment we found high-certainty evidence showing a small positive effect of CR on self-efficacy (2 RCTs, 456 participants) and immediate recall (2 RCTs, 459 participants). For participants at medium-term follow-up we found moderate-certainty evidence showing a small positive effect of CR on auditory selective attention (2 RCTs, 386 participants), and a small negative effect on general functional ability (3 RCTs, 673 participants), and we found low-certainty evidence showing a small positive effect on sustained attention (2 RCTs, 413 participants), and a small negative effect on memory (2 RCTs, 51 participants) and anxiety (3 RCTs, 455 participants). We found moderate- and low-certainty evidence indicating that at the end of treatment CR had negligible effects on participant anxiety, quality of life, sustained attention, memory, delayed recall, and general functional ability, and at medium-term follow-up on participant self-efficacy, depression, quality of life, immediate recall, and verbal fluency. For care partners at the end of treatment we found low-certainty evidence showing a small positive effect on environmental aspects of quality of life (3 RCTs, 465 care partners), and small negative effects of CR on level of depression (2 RCTs, 32 care partners) and on psychological wellbeing (2 RCTs, 388 care partners). For care partners at medium-term follow-up we found high-certainty evidence showing a small positive effect of CR on social aspects of quality of life (3 RCTs, 436 care partners) and moderate-certainty evidence showing a small positive effect on psychological aspects of quality of life (3 RCTs, 437 care partners). We found moderate- and low-certainty evidence at the end of treatment that CR had negligible effects on care partners' physical health, psychological and social aspects of quality of life, and stress, and at medium-term follow-up for the physical health aspect of care partners' quality of life and psychological wellbeing. AUTHORS' CONCLUSIONS CR is helpful in enabling people with mild or moderate dementia to improve their ability to manage the everyday activities targeted in the intervention. Confidence in these findings could be strengthened if more high-quality studies contributed to the observed effects. The available evidence suggests that CR can form a valuable part of a clinical toolkit to assist people with dementia in overcoming some of the everyday barriers imposed by cognitive and functional difficulties. Future research, including process evaluation studies, could help identify avenues to maximise CR effects and achieve wider impacts on functional ability and wellbeing.
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Affiliation(s)
| | | | - Alex Bahar-Fuchs
- School of Psychology, Deakin University, Melbourne, Australia
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Julieta Sabates
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Bob Woods
- Dementia Services Development Centre Wales, Bangor University, Bangor, UK
| | - Linda Clare
- University of Exeter Medical School, Exeter, UK
- NIHR Applied Research Collaboration South West Peninsula, Exeter, UK
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Hunt A, Martyr A, Gamble LD, Morris RG, Thom JM, Pentecost C, Clare L. The associations between personality traits and quality of life, satisfaction with life, and well-being over time in people with dementia and their caregivers: findings from the IDEAL programme. BMC Geriatr 2023; 23:354. [PMID: 37280511 DOI: 10.1186/s12877-023-04075-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 05/27/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Cross-sectional evidence indicates that certain personality traits may influence how well people with dementia and their caregivers are able to live alongside the condition. However, no studies to date have explored these associations longitudinally. The present study aimed to explore whether each of the Five-Factor personality traits were associated with change over two years in perceptions of 'living well' for people with dementia and their caregivers. 'Living well' was conceptualized as a composite of quality of life, satisfaction with life, and subjective well-being. METHODS Data were analyzed from 1487 people with dementia and 1234 caregivers who took part in the IDEAL cohort. Participants were categorized into low, medium, and high groups for each trait using stanine scores. Latent growth curve models investigated associations between these groups and 'living well' scores for each trait at baseline and at 12 and 24 months. Covariates included cognition in people with dementia and stress in caregivers. A Reliable Change Index was calculated against which to evaluate changes in 'living well' scores over time. RESULTS At baseline, neuroticism was negatively associated with 'living well' scores for people with dementia, while conscientiousness, extraversion, openness, and agreeableness were positively associated. For caregivers, neuroticism was negatively associated with 'living well' scores at baseline while conscientiousness and extraversion were positively associated. 'Living well' scores were mostly stable over time with no influence of personality traits on observed changes. CONCLUSIONS Findings suggest that personality traits, particularly neuroticism, have a meaningful impact on how people with dementia and caregivers rate their capability to 'live well' at baseline. Over time 'living well' scores for each personality trait group were largely stable. Studies utilizing longer follow-up periods and more appropriate measures of personality are needed to corroborate and extend the findings of the present study.
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Affiliation(s)
- Anna Hunt
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
| | - Anthony Martyr
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK.
| | - Laura D Gamble
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | - Robin G Morris
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jeanette M Thom
- School of Health Sciences, The University of Sydney, Sydney, Australia
| | - Claire Pentecost
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
| | - Linda Clare
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
- NIHR Applied Research Collaboration South-West Peninsula, Exeter, UK
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10
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Sabatini S, Martyr A, Gamble LD, Collins R, Matthews FE, Morris RG, Rusted JM, Pentecost C, Quinn C, Clare L. Longitudinal Predictors of Informant-Rated Involvement of People with Dementia in Everyday Decision-Making: Findings from the IDEAL Program. J Appl Gerontol 2023; 42:290-301. [PMID: 36193737 PMCID: PMC9841822 DOI: 10.1177/07334648221128558] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The extent to which people with dementia are involved in everyday decision-making is unclear. We explored informant-rated involvement of people with dementia in everyday decision-making over 2 years and whether functional, behavioral, and psychological factors related to the person with dementia and the caregiver explain variability in involvement of people with dementia in everyday decision-making. We used IDEAL data for 1182 people with dementia and their caregivers. Baseline mean score on the decision-making involvement scale was 31/45; it minimally declined over time. People with dementia who were female, single, and/or whose caregiver was younger had greater involvement in everyday decision-making than those without these characteristics. Better cognition, fewer functional difficulties, fewer neuropsychiatric symptoms, less caregiver stress, and better informant-rated relationship quality were associated with higher involvement in everyday decision-making. Cognitive and functional rehabilitation, and educational resources for caregivers, could prolong involvement of people with dementia in everyday decision-making.
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Affiliation(s)
- Serena Sabatini
- Faculty of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland
| | - Anthony Martyr
- Centre for Research in Ageing and Cognitive Health, Faculty of Health and Life Sciences, University of Exeter Medical School, Exeter, UK
| | - Laura D. Gamble
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | - Rachel Collins
- Centre for Research in Ageing and Cognitive Health, Faculty of Health and Life Sciences, University of Exeter Medical School, Exeter, UK
| | - Fiona E. Matthews
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | - Robin G. Morris
- Department of Psychology, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | | | - Claire Pentecost
- Centre for Research in Ageing and Cognitive Health, Faculty of Health and Life Sciences, University of Exeter Medical School, Exeter, UK
| | - Catherine Quinn
- Centre for Applied Dementia Studies, Bradford University, Bradford, UK,Wolfson Centre for Applied Health Research, Bradford, UK
| | - Linda Clare
- Centre for Research in Ageing and Cognitive Health, Faculty of Health and Life Sciences, University of Exeter Medical School, Exeter, UK,Linda Clare, Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter EX1 2LU, UK.
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11
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Martyr A, Gamble LD, Nelis SM, Collins R, Alexander CM, Morris RG, Quinn C, Pentecost C, Rusted JM, Victor C, Thom JM, Matthews FE, Clare L. Predictors of Awareness of Functional Ability in People with Dementia: The Contribution of Personality, Cognition, and Neuropsychiatric Symptoms - Findings from the IDEAL Program. Dement Geriatr Cogn Disord 2022; 51:221-232. [PMID: 35533657 DOI: 10.1159/000524607] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/07/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Discrepancy scores reflecting the difference between parallel ratings made by people living with dementia (PwD) in the mild-to-moderate stages and by their informants provide a way to investigate awareness of functional ability in relation to activities of daily living (ADL). METHODS Two measures of ADL (Functional Activities Questionnaire; Dependence Scale) were completed by 1,227 PwD and their informants in the IDEAL cohort study baseline assessment. Self-rated and informant-rated scores were used to calculate discrepancies, which were used as an indicator of awareness of functional ability. Smaller discrepancy scores were considered to reflect greater awareness on the part of PwD. PwD completed questionnaires on depression, personality, comorbidities, neuropsychiatric symptoms, and completed a measure of cognition. Informants provided ratings of stress. Univariable and multiple regressions were used to investigate factors related to ADL discrepancy. RESULTS A similar pattern of associations were found for both ADL discrepancy scores. Smaller discrepancy scores were associated with higher levels of depression, higher neuroticism, fewer neuropsychiatric symptoms, higher comorbidity, lower carer stress, and receipt of less than 1 hour of care per day from the informant. DISCUSSION/CONCLUSION There was a clear pattern of factors that were associated with greater awareness for both measures of functional ability. These factors associated with smaller discrepancy scores could be used to identify PwD who might benefit from targeted interventions to support their independence.
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Affiliation(s)
- Anthony Martyr
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, University of Exeter, St Luke's Campus, Exeter, United Kingdom
| | - Laura D Gamble
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Sharon M Nelis
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, University of Exeter, St Luke's Campus, Exeter, United Kingdom
| | - Rachel Collins
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, University of Exeter, St Luke's Campus, Exeter, United Kingdom
| | - Catherine M Alexander
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, University of Exeter, St Luke's Campus, Exeter, United Kingdom
| | - Robin G Morris
- Department of Psychology, King's College London Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Catherine Quinn
- Centre for Applied Dementia Studies, University of Bradford, Bradford, United Kingdom.,Wolfson Centre for Applied Health Research, Bradford, United Kingdom
| | - Claire Pentecost
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, University of Exeter, St Luke's Campus, Exeter, United Kingdom
| | - Jennifer M Rusted
- School of Psychology, University of Sussex, Brighton, United Kingdom
| | - Christina Victor
- Department of Health Sciences, College of Health, Medicine and Life Sciences, Brunel University London, London, United Kingdom
| | - Jeanette M Thom
- School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Fiona E Matthews
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Linda Clare
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, University of Exeter, St Luke's Campus, Exeter, United Kingdom.,NIHR Applied Research Collaboration South-West Peninsula, Exeter, United Kingdom
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12
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Sabatini S, Martyr A, Ukoumunne OC, Ballard C, Collins R, Pentecost C, Rusted JM, Quinn C, Anstey KJ, Kim S, Corbett A, Brooker H, Clare L. Attitudes toward own aging and cognition among individuals living with and without dementia: findings from the IDEAL programme and the PROTECT study. BMC Geriatr 2022; 22:641. [PMID: 35927646 PMCID: PMC9351129 DOI: 10.1186/s12877-022-03336-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 07/23/2022] [Indexed: 11/24/2022] Open
Abstract
Background It is unclear whether people with dementia (PwD) have more negative attitudes toward own aging (ATOA) than people without dementia and what factors influence ATOA among PwD. We investigated whether PwD have more negative ATOA than individuals without dementia and whether cognition and dementia subtype are associated with ATOA in PwD. Methods Data from the IDEAL and PROTECT studies were used to compare ATOA between 1502 PwD (mean (SD) age = 76.3 (8.5)) and 6377 individuals without dementia (mean (SD) age = 66.1 (7.1)). Linear regressions and ANOVA were used. Results PwD reported slightly more negative ATOA than people without dementia; this relationship disappeared after controlling for depression and self-rated health. In PwD more positive ATOA showed negligible associations with better general cognition, memory performance, verbal fluency, and visuospatial ability. However, after adjusting for covariates only better visuospatial ability predicted more positive ATOA. Additional analyses showed that before and after controlling for covariates, individuals with poorer self-reported visual acuity have more negative ATOA. Amongst dementia subtypes, people with Parkinson’s disease dementia and dementia with Lewy bodies reported most negative ATOA. Conclusions ATOA between PwD and people without dementia do not differ. ATOA in PwD appear to be affected not by cognitive impairment but by other characteristics that vary across dementia subtypes. Among PwD, those with Parkinson’s disease dementia and dementia with Lewy bodies may have higher risk of experiencing negative ATOA due to the motor and visual impairments that they experience. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03336-5.
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Affiliation(s)
- Serena Sabatini
- Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, South Cloisters, St Luke's Campus, University of Exeter, Exeter, EX1 2LU, UK.
| | - Anthony Martyr
- Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, South Cloisters, St Luke's Campus, University of Exeter, Exeter, EX1 2LU, UK
| | - Obioha C Ukoumunne
- NIHR ARC South West Peninsula (PenARC), University of Exeter, Exeter, United Kingdom
| | - Clive Ballard
- Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, South Cloisters, St Luke's Campus, University of Exeter, Exeter, EX1 2LU, UK
| | - Rachel Collins
- Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, South Cloisters, St Luke's Campus, University of Exeter, Exeter, EX1 2LU, UK
| | - Claire Pentecost
- Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, South Cloisters, St Luke's Campus, University of Exeter, Exeter, EX1 2LU, UK
| | | | - Catherine Quinn
- The Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Kaarin J Anstey
- Ageing Futures Institute, University of New South Wales, Sydney, and Neuroscience Research Australia, Sydney, Australia
| | - Sarang Kim
- Wicking Dementia Research & Education Centre, University of Tasmania, Hobart, Australia
| | - Anne Corbett
- Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, South Cloisters, St Luke's Campus, University of Exeter, Exeter, EX1 2LU, UK
| | - Helen Brooker
- Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, South Cloisters, St Luke's Campus, University of Exeter, Exeter, EX1 2LU, UK
| | - Linda Clare
- Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, South Cloisters, St Luke's Campus, University of Exeter, Exeter, EX1 2LU, UK
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13
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Sabatini S, Martyr A, Gamble LD, Jones IR, Collins R, Matthews FE, Victor CR, Quinn C, Pentecost C, Thom JM, Clare L. Profiles of social, cultural, and economic capital as longitudinal predictors of stress, positive experiences of caring, and depression among spousal carers of people with dementia. Aging Ment Health 2022:1-9. [PMID: 35899421 DOI: 10.1080/13607863.2022.2098920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE We explored (1) social, cultural, and economic capital in spousal carers of people with dementia; (2) profiles of carers with different levels of capital; (3) whether the identified profiles differ in levels of stress and positive experiences of caring, and likelihood of depression over time. METHODS Baseline (2014-2016), 12-month, and 24-month follow-up data were analyzed for 984 coresident spousal carers of people with dementia. We assessed social, cultural, and economic capital, stress, positive experiences of caring, depression. RESULTS On average, carers reported infrequent social and cultural participation. Most carers were not socially isolated, trusted their neighbours, had education at least to age 16, and had an income aligned with the 2014 UK average. We identified four groups of carers with different levels of capital. Although on average stress was low, depression was infrequent, and positive experiences of caring were moderately frequent, the group of carers with lowest capital was the least stressed and reported the most positive experiences of caring over time. Compared to the two groups with better capital, those with poorer capital were more likely to be depressed over time. CONCLUSION Social, cultural, and economic resources may decrease likelihood of depression, but not stress, in carers of people with dementia.
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Affiliation(s)
- Serena Sabatini
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Anthony Martyr
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Laura D Gamble
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom
| | - Ian R Jones
- Wales Institute for Social and Economic Research and Data (WISERD), Cardiff University, Cardiff, United Kingdom
| | - Rachel Collins
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Fiona E Matthews
- Wales Institute for Social and Economic Research and Data (WISERD), Cardiff University, Cardiff, United Kingdom
| | - Christina R Victor
- Department of Health Sciences, College of Health, Medicine and Life Sciences, Brunel University London, Bath, United Kingdom
| | - Catherine Quinn
- The Centre for Applied Dementia Studies, University of Bradford, Bradford, United Kingdom.,Wolfson Centre for Applied Health Research, Bradford, United Kingdom
| | - Claire Pentecost
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Jeanette M Thom
- Faculty of Medicine and Health, University of New South Wales (UNSW), Sydney, Australia
| | - Linda Clare
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom.,NIHR Applied Research Collaboration South, West Peninsula, United Kingdom
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14
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Clare L, Gamble LD, Martyr A, Sabatini S, Nelis SM, Quinn C, Pentecost C, Victor C, Jones RW, Jones IR, Knapp M, Litherland R, Morris RG, Rusted JM, Thom JM, Collins R, Henderson C, Matthews FE. 'Living well' trajectories among family caregivers of people with mild-to-moderate dementia in the IDEAL cohort. J Gerontol B Psychol Sci Soc Sci 2022; 77:1852-1863. [PMID: 35796675 PMCID: PMC9535787 DOI: 10.1093/geronb/gbac090] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Indexed: 11/23/2022] Open
Abstract
Objectives Understanding whether and how caregivers’ capability to “live well” changes over time, and the factors associated with change, could help target effective caregiver support. Methods We analyzed 3 time points (12 months apart) of Improving the experience of Dementia and Enhancing Active Life (IDEAL) cohort data from coresident spouse caregivers of community-dwelling individuals who had mild-to-moderate dementia at baseline, using latent growth and growth mixture models. Capability to “live well” was derived from measures of quality of life, well-being, and satisfaction with life. Results Data from 995 spouse caregivers at Time 1, 780 at Time 2, and 601 at Time 3 were included. The mean “living well” score decreased slightly over time. We identified 3 classes of caregivers: one with higher baseline scores declining slightly over time (Stable; 66.8%), one with low baseline scores remaining stable (Lower Stable; 26.0%), and one with higher baseline scores showing marked decline (Declining; 7.2%). Scores on baseline measures differentiated the Lower Stable, but not the Declining, from the Stable class. Longitudinally, the Declining class was associated with care recipient cognitive decline and increasing hours providing care, as well as caregiver stress and depression. Findings were similar when caregivers with other kin relationships were included. Discussion The findings indicate the importance of prompt identification of, and support for, caregivers at risk of the declining capability to “live well” and may assist in identifying those caregivers who could benefit most from targeted support.
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Affiliation(s)
- Linda Clare
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, UK.,NIHR Applied Research Collaboration South-West Peninsula, Exeter, UK
| | - Laura D Gamble
- Population Health Sciences Institute, Newcastle University, UK
| | - Anthony Martyr
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, UK
| | - Serena Sabatini
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, UK
| | - Sharon M Nelis
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, UK
| | - Catherine Quinn
- Centre for Applied Dementia Studies, Bradford University, UK.,Wolfson Centre for Applied Health Research, Bradford, UK
| | - Claire Pentecost
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, UK
| | - Christina Victor
- College of Health, Medicine and Life Sciences, Brunel University London, UK
| | - Roy W Jones
- Research Institute for the Care of Older People (RICE), Bath, UK
| | - Ian R Jones
- Wales Institute for Social and Economic Research, Data and Methods, Cardiff University, UK
| | - Martin Knapp
- Care Policy and Evaluation Centre, London School of Economics and Political Science, UK
| | | | - Robin G Morris
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | | | - Jeanette M Thom
- School of Health Sciences, The University of Sydney, Sydney, Australia
| | - Rachel Collins
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, UK
| | - Catherine Henderson
- Care Policy and Evaluation Centre, London School of Economics and Political Science, UK
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15
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Gamble LD, Parker S, Quinn C, Bennett HQ, Martyr A, Sabatini S, Pentecost C, Collins R, Dawson E, Hunt A, Allan L, Burns A, Litherland R, Victor C, Matthews FE, Clare L. A Comparison of Well-Being of Carers of People with Dementia and Their Ability to Manage Before and During the COVID-19 Pandemic: Findings from the IDEAL Study. J Alzheimers Dis 2022; 88:679-692. [PMID: 35634850 DOI: 10.3233/jad-220221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Social restriction measures imposed to curb the spread of COVID-19 in the United Kingdom impacted on carers of people with dementia, limiting access to support services and increasing perceived burden of caring. Few studies have compared data collected both during and before the pandemic to examine the effect of these changes. OBJECTIVE To explore whether the COVID-19 pandemic affected the well-being of carers of people with dementia living in the community, and their ability to cope with their caring responsibilities. METHODS Analysis was conducted on two groups of carers who were enrolled in the IDEAL programme; the 'pre-pandemic group' (n = 312), assessed at two time points prior to the pandemic, and the 'pandemic group', assessed prior to and several months into the pandemic (n = 156). For the pre-pandemic group, carers were matched 2:1 to carers in the pandemic group on certain characteristics. Differences in change over time between the two groups on self-reported well-being, quality of life, coping, perceived competence, and role captivity, was investigated using mixed effect modelling. RESULTS Compared to the pre-pandemic group, those in the pandemic group appeared to cope better and had more stable self-rated competency and role captivity. They did not differ in terms of well-being or quality of life. CONCLUSIONS Despite reports of negative impacts on carers early in the pandemic, the findings suggest the pandemic had little negative longer-term impact on carers of people with dementia, and in fact they appeared to have a more positive attitude towards coping several months into the pandemic.
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Affiliation(s)
- Laura D Gamble
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, UK
| | - Sophie Parker
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
| | - Catherine Quinn
- Centre for Applied Dementia Studies, Bradford University, UK
| | - Holly Q Bennett
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, UK
| | - Anthony Martyr
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
| | - Serena Sabatini
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
| | - Claire Pentecost
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
| | - Rachel Collins
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
| | - Eleanor Dawson
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
| | - Anna Hunt
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
| | - Louise Allan
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
| | - Alistair Burns
- Institute of Brain, Behaviour and Mental Health, University of Manchester, UK
| | | | - Christina Victor
- College of Health, Medicine and Life Sciences, Brunel University London, UK
| | - Fiona E Matthews
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, UK
| | - Linda Clare
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, UK.,NIHR Applied Research Collaboration South-West Peninsula, UK
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16
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Gamble LD, Matthews FE, Jones IR, Hillman AE, Woods B, Macleod CA, Martyr A, Collins R, Pentecost C, Rusted JM, Clare L. Characteristics of people living with undiagnosed dementia: findings from the CFAS Wales study. BMC Geriatr 2022; 22:409. [PMID: 35538522 PMCID: PMC9088129 DOI: 10.1186/s12877-022-03086-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 04/26/2022] [Indexed: 11/13/2022] Open
Abstract
Background Many people living with dementia remain undiagnosed, with diagnosis usually occurring long after signs and symptoms are present. A timely diagnosis is important for the wellbeing of the person living with dementia and the family, allowing them to plan and have access to support services sooner. The aim of this study was to identify demographic characteristics and neuropsychiatric symptoms associated with being undiagnosed, which may help clinicians be more aware of signs that could be indicative of early-stage or undetected dementia. Methods This cross-sectional study uses data from waves 1 and 2 (two years apart) of the Cognitive Function and Ageing Studies Wales (CFAS Wales). CFAS Wales participants were included who had a study assessment of dementia, as determined by the Automated Geriatric Examination for Computer Assisted Taxonomy (AGECAT) algorithm and by expert assessment, and who had had their primary care records checked for a clinical diagnosis of dementia. We identified 19 people with a diagnosis of dementia and 105 people living with undiagnosed dementia, and explored demographic characteristics and the presence or absence of a range of neuropsychiatric symptoms in the undiagnosed population using logistic regression. Results Findings suggest that people living with dementia who have better cognition, have more years of education, or live in more deprived areas are less likely to have a diagnosis. In terms of neuropsychiatric symptoms, depression and sleep problems were associated with being undiagnosed. Apathy was common across all people living with dementia, but those with a diagnosis were more likely to have severe apathy. Conclusions This study has clinical practice implications as the findings may help clinicians be more aware of characteristics and symptoms of people who are undiagnosed or who are at greater risk of remaining undiagnosed, enabling them to be more vigilant in picking up signs of dementia at an earlier stage. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03086-4.
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Affiliation(s)
- Laura D Gamble
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.
| | - Fiona E Matthews
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Ian R Jones
- Wales Institute for Social and Economic Research and Data, Cardiff University, Cardiff, UK
| | - Alex E Hillman
- Department of Public Health, Policy and Social Sciences, College of Health and Human Sciences, Swansea University, Swansea, UK
| | - Bob Woods
- Dementia Services Development Centre Wales, School of Medical and Health Sciences, Bangor University, Bangor, UK
| | - Catherine A Macleod
- Dementia Services Development Centre Wales, School of Medical and Health Sciences, Bangor University, Bangor, UK
| | - Anthony Martyr
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
| | - Rachel Collins
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
| | - Claire Pentecost
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
| | | | - Linda Clare
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK.,NIHR Applied Research Collaboration South-West Peninsula, Exeter, UK
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Kelly M, Nelis S, Martyr A, Gamble LD, Clare L. Trajectories of socio-emotional functioning in early-stage dementia: implications for the individual with dementia and their family carer. Aging Ment Health 2022; 26:1069-1077. [PMID: 33682523 DOI: 10.1080/13607863.2021.1895069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND OBJECTIVES Changes in socio-emotional functioning in people living with dementia (PLWD) are common; however, little is known about the broader effects these may have on wellbeing. This study examined socio-emotional functioning over time and associations with the wellbeing of PLWD and their family carers. METHOD One hundred and one individuals with a diagnosis of dementia and their respective carers completed the Social Emotional Questionnaire (assessing emotion recognition, empathy, social relationships and social behaviour) alongside measures of dementia severity, cognition, mood, stress, and relationship quality. Sixty-six dyads were reassessed on the same measures at 12 months post-baseline, and 51 dyads again at 20 months post-baseline. RESULTS When rated by the PLWD, there was no change in socio-emotional functioning over time; however, carers reported a significant decline over time. For both carers and the PLWD, poorer wellbeing measures were indicative of worse socio-emotional functioning at Time 1, though only dementia type, quality of life and relationship quality impacted upon the trajectory of socio-emotional decline over time. CONCLUSIONS Changes in social and emotional functioning are evident early in the course of dementia and worsen within 20 months. Both carer characteristics and those of the PWLD affected reporting of social and emotional functioning. These data are useful for guiding the provision of appropriate education and care.
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Affiliation(s)
- Michelle Kelly
- Centre for Brain and Mental Health Research, School of Psychology, University of Newcastle, Newcastle, Australia
| | - Sharon Nelis
- Centre for Research in Ageing and Cognitive Health, School of Psychology, University of Exeter, Exeter, United Kingdom
| | - Anthony Martyr
- Centre for Research in Ageing and Cognitive Health, School of Psychology, University of Exeter, Exeter, United Kingdom
| | - Laura D Gamble
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Linda Clare
- Centre for Research in Ageing and Cognitive Health, School of Psychology, University of Exeter, Exeter, United Kingdom
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Quinn C, Gamble LD, Parker S, Martyr A, Collins R, Victor C, Dawson E, Hunt A, Pentecost C, Allan L, Clare L. Impact of COVID-19 on carers of people with dementia in the community: Findings from the British IDEAL cohort. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5708. [PMID: 35394090 PMCID: PMC9087398 DOI: 10.1002/gps.5708] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/21/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Unpaid carers for people with dementia play a crucial role in society. Emerging evidence suggests the COVID-19 pandemic has negatively impacted on carers. This study sought to explore the impact of the COVID-19 pandemic on carers for community-dwelling people with dementia and compare responses with pre-pandemic data. METHODS Data were collected between September 2020 and April 2021 in England and Wales. Carers were identified from the Improving the experience of Dementia and Enhancing Active Life (IDEAL) cohort and data were collected either through the telephone, video conferencing, or an online questionnaire. Responses from 242 carers were compared against benchmark data from the IDEAL cohort collected pre-pandemic. Analyses were conducted for the full sample of carers and spousal/partner carers only. RESULTS In total 48.8% of carers thought their healthcare needs were negatively affected during the pandemic. Compared with pre-pandemic data carers were more lonely and experienced less life satisfaction. There was little impact on carers' experience of caregiving, although carers felt trapped in their caregiving role. Carers were more optimistic and had higher social contact with relatives. There were changes in the methods carers used for contacting relatives and friends. Most carers coped very or fairly well during the pandemic. There was little difference in the experiences of spousal/partner carers and the full sample. CONCLUSIONS After a long period of providing care under pandemic conditions carers require additional support. This support needs to be focused on alleviating feelings of loneliness and increasing life satisfaction. Services need to consider how to improve access to health care, particularly resuming face-to-face appointments.
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Affiliation(s)
- Catherine Quinn
- Centre for Applied Dementia Studies, Faculty of Health StudiesBradford UniversityBradfordUK
- Wolfson Centre for Applied Health ResearchBradfordUK
| | - Laura D. Gamble
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Sophie Parker
- College of Medicine and HealthUniversity of ExeterExeterUK
| | - Anthony Martyr
- College of Medicine and HealthUniversity of ExeterExeterUK
| | - Rachel Collins
- College of Medicine and HealthUniversity of ExeterExeterUK
| | - Christina Victor
- College of Health, Medicine and Life SciencesBrunel University LondonLondonUK
| | - Eleanor Dawson
- College of Medicine and HealthUniversity of ExeterExeterUK
| | - Anna Hunt
- College of Medicine and HealthUniversity of ExeterExeterUK
| | | | - Louise Allan
- College of Medicine and HealthUniversity of ExeterExeterUK
- NIHR Applied Research Collaboration South‐West PeninsulaExeterUK
| | - Linda Clare
- College of Medicine and HealthUniversity of ExeterExeterUK
- NIHR Applied Research Collaboration South‐West PeninsulaExeterUK
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Alexander CM, Martyr A, Clare L. Changes in awareness of condition in people with mild-to-moderate dementia: Longitudinal findings from the IDEAL cohort. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5702. [PMID: 35294792 PMCID: PMC9314100 DOI: 10.1002/gps.5702] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/01/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Awareness of difficulties shown by people with dementia is known to vary, but few studies have explored changes in awareness over time. Investigating this could further the understanding of surrounding concepts and reasons for impaired awareness. Recognising emerging or diminishing awareness could facilitate discussions about diagnosis and appropriate post-diagnostic support. METHODS Using longitudinal data from the Improving the experience of Dementia and Enhancing Active Life (IDEAL) cohort, awareness in community-dwelling people with mild-to-moderate dementia was assessed at three timepoints over 2 years. A validated checklist was used to evaluate awareness of difficulties associated with dementia. We examined changes in awareness for people with low awareness at baseline, and used case-matching to describe differences in characteristics between people who gained awareness, and those who continued with low awareness. RESULTS At baseline, 83 people from a sample of 917 showed low awareness. The majority of those remaining in the study at later timepoints had gained awareness, some as late as four or more years after diagnosis. Case-matched comparisons revealed few distinguishing characteristics: cases with stable low awareness had similar or better cognitive and functional ability than those who gained and retained awareness at 12 and 24 months, but may have had more co-morbidities. CONCLUSIONS Self-reported awareness of difficulties can change and may increase over time in people with mild-to-moderate dementia. There may be individual reasons for ongoing low awareness, not explained by cognitive or functional ability. This challenges the view that a single record of low awareness represents a fixed disease-related symptom, and highlights the complex, individual and dynamic nature of awareness.
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Affiliation(s)
- Catherine M. Alexander
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, University of Exeter, South Cloisters, St Luke's CampusExeterUK
| | - Anthony Martyr
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, University of Exeter, South Cloisters, St Luke's CampusExeterUK
| | - Linda Clare
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, University of Exeter, South Cloisters, St Luke's CampusExeterUK
- National Institute for Health Research Applied Research Collaboration South‐West PeninsulaExeterUK
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van Horik JO, Collins R, Martyr A, Henderson C, Jones RW, Knapp M, Quinn C, Thom JM, Victor C, Clare L. Limited receipt of support services among people with mild-to-moderate dementia: Findings from the IDEAL cohort. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5688. [PMID: 35128725 PMCID: PMC9306706 DOI: 10.1002/gps.5688] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 01/26/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND Global initiatives that promote public health responses to dementia have resulted in numerous countries developing new national policies. Current policy guidelines in England, for example, recommend that people diagnosed with mild-to-moderate dementia receive information and psychosocial interventions to improve their ability to 'live well'. However, it remains unclear to what extent these recommendations are being achieved. METHODS Self-reported information from 1537 people living with dementia and informant-reported information from 1277 carers of people living with dementia was used to quantify receipt of community-based dementia support services, including health and social care services provided by statutory or voluntary-sector organisations, in Britain from 2014 to 2016. Demographic factors associated with differences in receipt of support services were also investigated to identify particularly vulnerable groups of people living with dementia. RESULTS Both self- and informant reports suggested that approximately 50% of people living with dementia received support services for dementia. Receipt of support services was lower among people living with dementia who are older, female, and have fewer educational qualifications. Receipt of support services also differed according to diagnosis and carer status, but was unrelated to marital status. CONCLUSIONS Limited receipt of dementia support services among people living with dementia in Britain provides a baseline to assess the efficacy of current policy guidelines regarding provision of information and support. Targeted efforts to facilitate receipt of support services among the particularly vulnerable groups identified in the current study could improve the efficacy of dementia support services both in Britain and internationally, and should inform policy development.
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Affiliation(s)
- Jayden O. van Horik
- REACH: The Centre for Research in Ageing and Cognitive HealthUniversity of ExeterExeterUK,Clinical Trials UnitUniversity of Exeter Medical SchoolExeterUK
| | - Rachel Collins
- REACH: The Centre for Research in Ageing and Cognitive HealthUniversity of ExeterExeterUK
| | - Anthony Martyr
- REACH: The Centre for Research in Ageing and Cognitive HealthUniversity of ExeterExeterUK
| | - Catherine Henderson
- Care Policy and Evaluation CentreLondon School of Economics and Political ScienceLondonUK
| | - Roy W. Jones
- RICE: The Research Institute for the Care of Older PeopleRoyal United HospitalsBathUK
| | - Martin Knapp
- Care Policy and Evaluation CentreLondon School of Economics and Political ScienceLondonUK
| | - Catherine Quinn
- The Centre for Applied Dementia StudiesUniversity of BradfordBradfordUK,Wolfson Centre for Applied Health ResearchBradfordUK
| | - Jeanette M. Thom
- School of Medical SciencesUniversity of New South WalesSydneyAustralia
| | - Christina Victor
- College of Health, Medicine and Life Sciences, Department of Health Sciences, Brunel University LondonUxbridgeUK
| | - Linda Clare
- REACH: The Centre for Research in Ageing and Cognitive HealthUniversity of ExeterExeterUK,NIHR Applied Research Collaboration South‐West PeninsulaDevonUK
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Collins R, Hunt A, Quinn C, Martyr A, Pentecost C, Clare L. Methods and approaches for enhancing communication with people with moderate-to-severe dementia that can facilitate their inclusion in research and service evaluation: Findings from the IDEAL programme. Dementia (London) 2022; 21:1135-1153. [PMID: 35156412 PMCID: PMC9109550 DOI: 10.1177/14713012211069449] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives Dementia can affect language processing and production, making communication more
difficult. This creates challenges for including the person’s perspective in research
and service evaluation. This study aims to identify methods, tools and approaches that
could facilitate meaningful communication with people with moderate-to-severe dementia
and support the inclusion of their perspectives. Methods This qualitative study was conducted as part of the IDEAL programme and involved
in-depth, semi-structured interviews with 17 dementia research and/or care professionals
with expertise in communication. Transcripts were analysed using framework analysis. Findings Three main themes each with sub-themes were identified: (1) Awareness, knowledge and
experience; (2) Communication approach and (3) Personalization. A person-centred
orientation based on getting to know the participant and developing a bi-directional
exchange formed the fundamental context for effective communication. Building on this
foundation, an approach using pictures, photographs or objects that are meaningful to
the person and appropriate for that person’s preferences and ability could help to
facilitate conversations. The findings were integrated into a diagram illustrating how
the topics covered by the themes interrelate to facilitate communication. Conclusions Useful skills and approaches were identified to help researchers engage and work with
people with moderate-to-severe dementia and ensure their perspective is included. These
covered getting to know the participant, using a variety of tangible tools and
interactional techniques and considering the environment and context of the
conversation.
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Affiliation(s)
- Rachel Collins
- College of Medicine and Health, 3286University of Exeter, Exeter, UK
| | - Anna Hunt
- College of Medicine and Health, 3286University of Exeter, Exeter, UK
| | - Catherine Quinn
- The Centre for Applied Dementia Studies, 1905University of Bradford, Bradford, UK; Wolfson Centre for Applied Health Research, Bradford, UK
| | - Anthony Martyr
- College of Medicine and Health, 3286University of Exeter, Exeter, UK
| | - Claire Pentecost
- College of Medicine and Health, 3286University of Exeter, Exeter, UK
| | - Linda Clare
- College of Medicine and Health, 3286University of Exeter, Exeter, UK; 3286NIHR Applied Research Collaboration South-West Peninsula, Exeter, UK
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Clare L, Gamble LD, Martyr A, Sabatini S, Nelis SM, Quinn C, Pentecost C, Victor C, Jones RW, Jones IR, Knapp M, Litherland R, Morris RG, Rusted JM, Thom JM, Collins R, Henderson C, Matthews FE. Longitudinal trajectories of quality of life among people with mild-to-moderate dementia: a latent growth model approach with IDEAL cohort study data. J Gerontol B Psychol Sci Soc Sci 2022; 77:1037-1050. [PMID: 35134935 PMCID: PMC9159063 DOI: 10.1093/geronb/gbac022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Indexed: 11/14/2022] Open
Abstract
Objectives We aimed to examine change over time in self-rated quality of life (QoL) in people with mild-to-moderate dementia and identify subgroups with distinct QoL trajectories. Methods We used data from people with mild-to-moderate dementia followed up at 12 and 24 months in the Improving the experience of Dementia and Enhancing Active Life (IDEAL) cohort study (baseline n = 1,537). A latent growth model approach examined mean change over time in QoL, assessed with the QoL-AD scale, and investigated associations of baseline demographic, cognitive, and psychological covariates with the intercept and slope of QoL. We employed growth mixture modeling to identify multiple growth trajectories. Results Overall mean QoL scores were stable and no associations with change over time were observed. Four classes of QoL trajectories were identified: 2 with higher baseline QoL scores, labeled Stable (74.9%) and Declining (7.6%), and 2 with lower baseline QoL scores, labeled Stable Lower (13.7%) and Improving (3.8%). The Declining class had higher baseline levels of depression and loneliness, and lower levels of self-esteem and optimism, than the Stable class. The Stable Lower class was characterized by disadvantage related to social structure, poor physical health, functional disability, and low psychological well-being. The Improving class was similar to the Stable Lower class but had lower cognitive test scores. Discussion Understanding individual trajectories can contribute to personalized care planning. Efforts to prevent decline in perceived QoL should primarily target psychological well-being. Efforts to improve QoL for those with poorer QoL should additionally address functional impairment, isolation, and disadvantage related to social structure.
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Affiliation(s)
- Linda Clare
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, UK
- NIHR Applied Research Collaboration South-West Peninsula, Exeter, UK
| | - Laura D Gamble
- Population Health Sciences Institute, Newcastle University, UK
| | - Anthony Martyr
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, UK
| | - Serena Sabatini
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, UK
| | - Sharon M Nelis
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, UK
| | - Catherine Quinn
- Centre for Applied Dementia Studies, Bradford University, UK
- Wolfson Centre for Applied Health Research, Bradford, UK
| | - Claire Pentecost
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, UK
| | - Christina Victor
- College of Health, Medicine and Life Sciences, Brunel University London, UK
| | - Roy W Jones
- Research Institute for the Care of Older People (RICE), Bath, UK
| | - Ian R Jones
- Wales Institute for Social and Economic Research, Data and Methods, Cardiff University, UK
| | - Martin Knapp
- Care Policy and Evaluation Centre, London School of Economics and Political Science, UK
| | | | - Robin G Morris
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
| | | | - Jeanette M Thom
- School of Health Sciences, University of New South Wales, Sydney, Australia
| | - Rachel Collins
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, UK
| | - Catherine Henderson
- Care Policy and Evaluation Centre, London School of Economics and Political Science, UK
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Sabatini S, Bennett HQ, Martyr A, Collins R, Gamble LD, Matthews FE, Pentecost C, Dawson E, Hunt A, Parker S, Allan L, Burns A, Litherland R, Quinn C, Clare L. Minimal Impact of COVID-19 Pandemic on the Mental Health and Wellbeing of People Living With Dementia: Analysis of Matched Longitudinal Data From the IDEAL Study. Front Psychiatry 2022; 13:849808. [PMID: 35370851 PMCID: PMC8965515 DOI: 10.3389/fpsyt.2022.849808] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 02/14/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Research suggests a decline in the mental health and wellbeing of people with dementia (PwD) during the COVID-19 pandemic; however few studies have compared data collected pre-pandemic and during the pandemic. Moreover, none have compared this change with what would be expected due to dementia progression. We explored whether PwD experienced changes in mental health and wellbeing by comparing pre-pandemic and pandemic data, and drew comparisons with another group of PwD questioned on two occasions prior to the pandemic. METHODS Community-dwelling PwD enrolled in the IDEAL programme were split into two groups matched for age group, sex, dementia diagnosis, and time since diagnosis. Although each group was assessed twice, one was assessed prior to and during the pandemic (pandemic group; n = 115) whereas the other was assessed prior to the pandemic (pre-pandemic group; n = 230). PwD completed measures of mood, sense of self, wellbeing, optimism, quality of life, and life satisfaction. RESULTS Compared to the pre-pandemic group, the pandemic group were less likely to report mood problems, or be pessimistic, but more likely to become dissatisfied with their lives. There were no changes in continuity in sense of self, wellbeing, and quality of life. DISCUSSION Results suggest the pandemic had little effect on the mental health and wellbeing of PwD, with any changes observed likely to be consistent with expected rates of decline due to dementia. Although personal accounts attest to the challenges experienced, PwD appear to have been resilient to the impact of lockdown and social restrictions during the pandemic.
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Affiliation(s)
- Serena Sabatini
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Holly Q Bennett
- Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Anthony Martyr
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Rachel Collins
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Laura D Gamble
- Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Fiona E Matthews
- Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Claire Pentecost
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Eleanor Dawson
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Anna Hunt
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Sophie Parker
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Louise Allan
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Alistair Burns
- School of Social Sciences, Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, United Kingdom
| | - Rachael Litherland
- Innovations in Dementia Community Interest Company (CIC), Exeter, United Kingdom
| | - Catherine Quinn
- Centre for Applied Dementia Studies, Bradford University, Bradford, United Kingdom
| | - Linda Clare
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom.,National Institute for Health Research (NIHR) Applied Research Collaboration South-West Peninsula, London, United Kingdom
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Abstract
The focus on living well with dementia encourages a more positive and empowering approach. The right support can improve the experience of living with dementia. An holistic approach to assessing the needs of people with dementia and identifying the factors that impact on their well‐being is essential. Enabling people to live better requires a broad approach that encompasses both health and social systems and the wider community.
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Affiliation(s)
- Catherine Quinn
- Centre for Applied Dementia Studies, Faculty of Health StudiesUniversity of BradfordBradfordUK,Wolfson Centre for Applied Health ResearchBradfordUK
| | | | | | - Robin G. Morris
- King's College Institute of Psychiatry, Psychology and NeuroscienceLondonUK
| | - Anthony Martyr
- REACH: The Centre for Research in Ageing and Cognitive Health, College of Medicine and HealthUniversity of ExeterExeterUK
| | - Linda Clare
- REACH: The Centre for Research in Ageing and Cognitive Health, College of Medicine and HealthUniversity of ExeterExeterUK,NIHR Applied Research Collaboration South‐West PeninsulaExeterUK
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25
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Henderson C, Knapp M, Martyr A, Gamble LD, Nelis SM, Quinn C, Pentecost C, Collins R, Wu YT, Jones IR, Victor CR, Pickett JA, Jones RW, Matthews FE, Morris RG, Rusted J, Thom JM, Clare L. The Use and Costs of Paid and Unpaid Care for People with Dementia: Longitudinal Findings from the IDEAL Cohort. J Alzheimers Dis 2021; 86:135-153. [PMID: 35001888 DOI: 10.3233/jad-215117] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND The drivers of costs of care for people with dementia are not well understood and little is known on the costs of care for those with rarer dementias. OBJECTIVE To characterize use and costs of paid and unpaid care over time in a cohort of people with dementia living in Britain. To explore the relationship between cohort members' demographic and clinical characteristics and service costs. METHODS We calculated costs of health and social services, unpaid care, and out-of-pocket expenditure for people with mild-to-moderate dementia participating in three waves of the IDEAL cohort (2014- 2018). Latent growth curve modelling investigated associations between participants' baseline sociodemographic and diagnostic characteristics and mean weekly service costs. RESULTS Data were available on use of paid and unpaid care by 1,537 community-dwelling participants with dementia at Wave 1, 1,199 at Wave 2, and 910 at Wave 3. In models of paid service costs, being female was associated with lower baseline costs and living alone was associated with higher baseline costs. Dementia subtype and caregiver status were associated with variations in baseline costs and the rate of change in costs, which was additionally influenced by age. CONCLUSION Lewy body and Parkinson's disease dementias were associated with higher service costs at the outset, and Lewy body and frontotemporal dementias with more steeply increasing costs overall, than Alzheimer's disease. Planners of dementia services should consider the needs of people with these relatively rare dementia subtypes as they may require more resources than people with more prevalent subtypes.
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Affiliation(s)
- Catherine Henderson
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Martin Knapp
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Anthony Martyr
- REACH: The Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Laura D Gamble
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Sharon M Nelis
- REACH: The Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Catherine Quinn
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Claire Pentecost
- REACH: The Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Rachel Collins
- REACH: The Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Yu-Tzu Wu
- REACH: The Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, University of Exeter, Exeter, UK.,Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Ian R Jones
- Wales Institute for Social and Economic Research and Data, Cardiff University, Cardiff, UK
| | - Christina R Victor
- College of Health, Medicine and Life Sciences, Brunel University London, London, UK
| | | | - Roy W Jones
- The Research Institute for the Care of Older People (RICE), Bath, UK
| | - Fiona E Matthews
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Robin G Morris
- King's College London Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | | | - Jeanette M Thom
- School of Health Sciences, University of New South Wales, Kensington, Australia
| | - Linda Clare
- REACH: The Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, University of Exeter, Exeter, UK.,National Institute of Health Research (NIHR) Applied Research Collaboration South-West Peninsula (PenARC), Exeter, UK
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Clare L, Gamble LD, Martyr A, Quinn C, Litherland R, Morris RG, Jones IR, Matthews FE. Psychological processes in adapting to dementia: Illness representations among the IDEAL cohort. Psychol Aging 2021; 37:524-541. [PMID: 34881948 PMCID: PMC9134708 DOI: 10.1037/pag0000650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
How people understand and adapt to living with dementia may influence well-being. Leventhal’s Common Sense Model (CSM) of Self-Regulation provides a theoretical basis for exploring this process. We used cross-sectional and longitudinal data from 1,109 people with mild-to-moderate dementia in the Improving the experience of Dementia and Enhancing Active Life (IDEAL) cohort. We elicited dementia representations (DRs) using the Representations and Adjustment to Dementia Index (RADIX), a validated measure based on the CSM, identified groups sharing distinct DR profiles, and explored predictors of group membership and associations with well-being, and whether problem-focused coping played a mediating role in these associations. We identified four DR classes: people who see the condition as a disease and adopt a diagnostic label; people who see the condition as a disease but refer to symptoms rather than a diagnostic label; those who see the condition as part of aging; and those who are unsure how to make sense of the condition. A fifth group did not acknowledge any difficulties. “Disease” representations were associated with better cognition and younger age, while “aging” and “no problem” representations were associated with better mood and well-being. The association with well-being remained stable over 24 months. There was limited partial support for a mediating role of problem-focused coping. Variations in DRs may reflect individual differences in the psychological processes involved in adjusting to dementia. DRs provide a framework for personalizing and tailoring both communications about dementia and interventions aimed at supporting people in coping with dementia. There is a need to debate what constitutes a positive DR and how its development might be encouraged.
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Affiliation(s)
- Linda Clare
- REACH-Centre for Research in Ageing and Cognitive Health
| | | | - Anthony Martyr
- REACH-Centre for Research in Ageing and Cognitive Health
| | | | | | | | - Ian R Jones
- Wales Institute for Social and Economic Research and Data
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Clare L, Martyr A, Gamble LD, Pentecost C, Collins R, Dawson E, Hunt A, Parker S, Allan L, Burns A, Hillman A, Litherland R, Quinn C, Matthews FE, Victor C. Impact of COVID-19 on 'Living Well' with Mild-to-Moderate Dementia in the Community: Findings from the IDEAL Cohort. J Alzheimers Dis 2021; 85:925-940. [PMID: 34776448 DOI: 10.3233/jad-215095] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Negative impacts of the COVID-19 pandemic on people with dementia have been widely-documented, but most studies have relied on carer reports and few have compared responses to information collected before the pandemic. OBJECTIVE We aimed to explore the impact of the pandemic on community-dwelling individuals with mild-to-moderate dementia and compare responses with pre-pandemic data. METHODS During the second wave of the pandemic, we conducted structured telephone interviews with 173 people with dementia and 242 carers acting as informants, all of whom had previously participated in the IDEAL cohort. Where possible, we benchmarked responses against pre-pandemic data. RESULTS Significant perceived negative impacts were identified in cognitive and functional skills and ability to engage in self-care and manage everyday activities, along with increased levels of loneliness and discontinuity in sense of self and a decline in perceived capability to 'live well'. Compared to pre-pandemic data, there were lower levels of pain, depression, and anxiety, higher levels of optimism, and better satisfaction with family support. There was little impact on physical health, mood, social connections and relationships, or perceptions of neighborhood characteristics. CONCLUSION Efforts to mitigate negative impacts of pandemic-related restrictions and restore quality of life could focus on reablement to address the effects on participation in everyday activities, creating opportunities for social contact to reduce loneliness, and personalized planning to reconnect people with their pre-COVID selves. Such efforts may build on the resilience demonstrated by people with dementia and carers in coping with the pandemic.
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Affiliation(s)
- Linda Clare
- College of Medicine and Health, University of Exeter, Exeter, UK.,NIHR Applied Research Collaboration South-West Peninsula, Exeter, UK
| | - Anthony Martyr
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Laura D Gamble
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Claire Pentecost
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Rachel Collins
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Eleanor Dawson
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Anna Hunt
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Sophie Parker
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Louise Allan
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Alistair Burns
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Alexandra Hillman
- Department of Public Health Policy and Social Sciences, Swansea University, Swansea, Wales, UK
| | | | - Catherine Quinn
- Centre for Applied Dementia Studies, Bradford University, Bradford, UK.,Wolfson Centre for Applied Health Research, Bradford, UK
| | - Fiona E Matthews
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Christina Victor
- College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, UK
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Alexander CM, Martyr A, Gamble LD, Savage SA, Quinn C, Morris RG, Collins R, Clare L. Does awareness of condition help people with mild-to-moderate dementia to live well? Findings from the IDEAL programme. BMC Geriatr 2021; 21:511. [PMID: 34563135 PMCID: PMC8467163 DOI: 10.1186/s12877-021-02468-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 09/06/2021] [Indexed: 01/07/2023] Open
Abstract
Background People living with dementia vary in awareness of their abilities. We explored awareness of the condition and diagnosis in people with mild-to-moderate dementia, and how this relates to quality of life, well-being, life satisfaction, and caregiver stress. Methods This study was a cross-sectional exploratory analysis of data from the IDEAL cohort, which recruited people with dementia living at home and available caregivers from 29 research sites in Great Britain. Our study included 917 people with mild-to-moderate dementia and 755 carers. Low and high awareness groups were derived from self-reported responses to a dementia representation measure. Logistic regression was used to explore predictors of awareness of condition and diagnosis using demographic, cognitive, functional and psychological measures, and the relationship with quality of life, well-being and life satisfaction (‘living well’), and caregiver stress. Results There were 83 people with low awareness of their condition. The remaining 834 people showed some awareness and 103 of these had high awareness of their condition and diagnosis. Psychosocial factors were stronger predictors of awareness than cognitive and functional ability. Those with higher awareness reported lower mood, and lower scores on indices of living well as well as lower optimism, self-efficacy and self-esteem. Low awareness was more likely in those aged 80y and above, and living in more socially deprived areas. No relationship was seen between caregiver stress and awareness. Conclusions Awareness of the condition and diagnosis varies in people with mild-to-moderate dementia and is relevant to the capability to live well. Awareness should be considered in person-centered clinical care. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02468-4.
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Affiliation(s)
- Catherine M Alexander
- REACH: The Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, University of Exeter Medical School, University of Exeter, South Cloisters, St Luke's Campus, Exeter, EX1 2LU, UK.
| | - Anthony Martyr
- REACH: The Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, University of Exeter Medical School, University of Exeter, South Cloisters, St Luke's Campus, Exeter, EX1 2LU, UK
| | - Laura D Gamble
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Sharon A Savage
- School of Psychology, The University of Newcastle, Australia, Newcastle, Australia
| | - Catherine Quinn
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Robin G Morris
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Rachel Collins
- REACH: The Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, University of Exeter Medical School, University of Exeter, South Cloisters, St Luke's Campus, Exeter, EX1 2LU, UK
| | - Linda Clare
- REACH: The Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, University of Exeter Medical School, University of Exeter, South Cloisters, St Luke's Campus, Exeter, EX1 2LU, UK.,National Institute for Health Research Applied Research Collaboration South-West Peninsula, Exeter, UK
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Choi A, Ballard C, Martyr A, Collins R, Morris RG, Clare L. The impact of auditory hallucinations on "living well" with dementia: Findings from the IDEAL programme. Int J Geriatr Psychiatry 2021; 36:1370-1377. [PMID: 33734483 DOI: 10.1002/gps.5533] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 03/04/2021] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To determine whether auditory hallucinations in community-dwelling people with dementia (PwD) living in the community impacted on quality of life (QoL), subjective wellbeing and life satisfaction. DESIGN Cross-sectional cohort study. SETTINGS AND PARTICIPANTS 1251 community-dwelling PwD and caregivers were included in this study. MEASURES Neuropsychiatric Inventory Questionnaire completed by caregiver interview. Mean differences between the absence and presence of auditory hallucinations were compared to scores on three validated measures of living well: QoL in Alzheimer's disease scale (QoL-AD), World Health Organization-Five Well-being Index and Satisfaction with Life Scale. Analysis of covariance determined the confounding contributions of cognition via Mini-Mental State Examination, depression via Geriatric Depression Scale-10, caregiver stress via Relative Stress Scale and whether antipsychotic drugs were prescribed. RESULTS Auditory hallucinations were associated with lower scores for QoL (p < 0.001, η2 = 0.01), wellbeing (p < 0.001, η2 = 0.02) and life satisfaction (p < 0.001, η2 = 0.01). After controlling for background measures, which were potential confounds, the relationship between auditory hallucinations and QoL (p = 0.04, pη2 = 0.01) and wellbeing (p < 0.000, pη2 = 0.02) remained significant but there was no significant association with life satisfaction. CONCLUSION Auditory hallucinations are associated with lower QoL and wellbeing in PwD living in the community. This has implications for targeted therapies in PwD with psychotic symptoms.
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Affiliation(s)
- Aaron Choi
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Clive Ballard
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Anthony Martyr
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Rachel Collins
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Robin G Morris
- Department of Psychology, King's College London Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Linda Clare
- College of Medicine and Health, University of Exeter, Exeter, UK.,NIHR Applied Research Collaboration South-West Peninsula, University of Exeter, Exeter, UK
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Abstract
BACKGROUND Awareness of the diagnosis or related changes in functioning varies in people with dementia (PwD), with implications for the well-being of PwD and their carers. Measuring awareness in a clinical setting could facilitate tailored support and optimize involvement in personal health and care decisions. This scoping review aimed to identify validated methods of assessing awareness in dementia and appraise their clinical utility. METHOD A systematic search was conducted of English-language publications that measured awareness in PwD, in 6 electronic databases. Search terms included dement*, Alzheimer*, Pick disease, and awareness, unawareness, anosognosia, insight, denial, metacognit*, or discrepanc*. RESULTS We screened 30,634 articles, finding 345 articles that met our inclusion criteria. We identified 76 measures, most commonly using a discrepancy questionnaire comparing evaluations of function by PwD and an informant. There were 30 awareness measures developed and validated for use in dementia populations but few designed for general clinical use. CONCLUSIONS Although we found a range of clinical indications for measuring awareness, there were few studies investigating clinical applications and few tools designed for clinical purposes. Further investigation and development of a person-centered tool could facilitate health and care choices in mild-to-moderate dementia.
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Affiliation(s)
- Catherine M. Alexander
- University of Exeter Medical School, South Cloisters, St Luke’s Campus, Exeter, United Kingdom,Catherine M. Alexander, University of Exeter Medical School, South Cloisters, St Luke’s Campus, Exeter EX1 2LU, United Kingdom.
| | - Anthony Martyr
- University of Exeter Medical School, South Cloisters, St Luke’s Campus, Exeter, United Kingdom
| | - Sharon A. Savage
- Psychology Department, University of Exeter, Washington Singer Laboratories, Streatham Campus, Exeter, United Kingdom
| | - Robin G. Morris
- King's College Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Linda Clare
- University of Exeter Medical School, South Cloisters, St Luke’s Campus, Exeter, United Kingdom
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Martyr A, Nelis SM, Quinn C, Wu YT, Lamont RA, Henderson C, Clarke R, Hindle JV, Thom JM, Jones IR, Morris RG, Rusted JM, Victor CR, Clare L. Living well with dementia: a systematic review and correlational meta-analysis of factors associated with quality of life, well-being and life satisfaction in people with dementia - CORRIGENDUM. Psychol Med 2021; 51:1590. [PMID: 32476638 PMCID: PMC8311816 DOI: 10.1017/s0033291720001713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Anthony Martyr
- School of Psychology, University of Exeter, EX4 4QG, UK
- PenCLAHRC, Institute of Health Research, University of Exeter Medical School, EX1 2LU, UK
| | - Sharon M Nelis
- School of Psychology, University of Exeter, EX4 4QG, UK
- PenCLAHRC, Institute of Health Research, University of Exeter Medical School, EX1 2LU, UK
| | - Catherine Quinn
- School of Psychology, University of Exeter, EX4 4QG, UK
- PenCLAHRC, Institute of Health Research, University of Exeter Medical School, EX1 2LU, UK
| | - Yu-Tzu Wu
- School of Psychology, University of Exeter, EX4 4QG, UK
- PenCLAHRC, Institute of Health Research, University of Exeter Medical School, EX1 2LU, UK
| | - Ruth A Lamont
- School of Psychology, University of Exeter, EX4 4QG, UK
- PenCLAHRC, Institute of Health Research, University of Exeter Medical School, EX1 2LU, UK
| | - Catherine Henderson
- Personal Social Services Research Unit, London School of Economics and Political Science, WC2A 2AE, UK
| | - Rachel Clarke
- School of Psychology, University of Sussex, BN1 9RH, UK
- School of Education and Social Work, University of Sussex, BN1 9RH, UK
| | - John V Hindle
- School of Psychology, Bangor University, LL57 2AS, UK
- Department of Care for the Elderly, Betsi Cadwaladr University Health Board, Llandudno, LL30 1LB, UK
| | - Jeanette M Thom
- School of Medical Sciences, University of New South Wales, NSW 2052, Australia
| | - Ian Rees Jones
- Wales Institute of Social and Economic Research, Data and Methods, Cardiff University, CF10 3BB, UK
| | - Robin G Morris
- Department of Psychology, King's College London Institute of Psychiatry, Psychology and Neuroscience, London, SE5 8AF, UK
| | | | | | - Linda Clare
- School of Psychology, University of Exeter, EX4 4QG, UK
- PenCLAHRC, Institute of Health Research, University of Exeter Medical School, EX1 2LU, UK
- Wellcome Centre for Cultures and Environments of Health, University of Exeter, Exeter, UK
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Victor CR, Rippon I, Quinn C, Nelis SM, Martyr A, Hart N, Lamont R, Clare L. The prevalence and predictors of loneliness in caregivers of people with dementia: findings from the IDEAL programme. Aging Ment Health 2021; 25:1232-1238. [PMID: 32306759 DOI: 10.1080/13607863.2020.1753014] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To establish the prevalence of loneliness among family caregivers of people with dementia and to identify potential risk factors for loneliness. METHODS Using data from the baseline wave of the Improving the experience of Dementia and Enhancing Active Life (IDEAL) cohort study, we examined loneliness in 1283 family caregivers of people with mild-to-moderate dementia living in Great Britain. Multinomial regression was used to examine the relative influence of a series of risk factors for caregiver loneliness. RESULTS Almost half, 43.7%, of caregivers reported moderate loneliness and 17.7% reported severe loneliness. Greater social isolation and increased caregiving stress were linked with both moderate and severe loneliness. Better quality of relationship with the person with dementia along with increased levels of well-being and life satisfaction were associated with a lower relative risk of reporting both moderate and severe loneliness. DISCUSSION This study examines the prevalence and predictors of loneliness in a large sample of family caregivers of people with dementia. Notably over two-thirds of caregivers in our sample reported feeling lonely. Interventions aimed at reducing caregiving stress and supporting meaningful relationships may go some way towards helping to reduce loneliness.
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Affiliation(s)
- Christina R Victor
- Department of Clinical Sciences, College of Health and Life Sciences, Brunel University London, Uxbridge, UK
| | - Isla Rippon
- Department of Clinical Sciences, College of Health and Life Sciences, Brunel University London, Uxbridge, UK
| | - Catherine Quinn
- The Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Sharon M Nelis
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter, St Luke's Campus, Exeter, UK
| | - Anthony Martyr
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter, St Luke's Campus, Exeter, UK
| | | | - Ruth Lamont
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter, St Luke's Campus, Exeter, UK
| | - Linda Clare
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter, St Luke's Campus, Exeter, UK
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Sabatini S, Silarova B, Martyr A, Collins R, Ballard C, Anstey KJ, Kim S, Clare L. Associations of Awareness of Age-Related Change With Emotional and Physical Well-being: A Systematic Review and Meta-analysis. Gerontologist 2021; 60:e477-e490. [PMID: 31350849 PMCID: PMC7427487 DOI: 10.1093/geront/gnz101] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Indexed: 01/07/2023] Open
Abstract
Background and Objectives This systematic review aimed to synthesize and quantify the associations of awareness of age-related change (AARC) with emotional well-being, physical well-being, and cognitive functioning. Research Design and Methods We conducted a systematic review with a correlational random effects meta-analysis. We included quantitative studies, published from January 1, 2009 to October 3, 2018, exploring associations between AARC and one or more of the following outcomes: emotional well-being, physical well-being, and cognitive functioning. We assessed heterogeneity (I2) and publication bias. Results We included 12 studies in the review, 9 exploring the association between AARC and emotional well-being and 11 exploring the association between AARC and physical well-being. No study explored the association between AARC and cognitive functioning. Six articles were included in the meta-analysis. We found a moderate association between a higher level of AARC gains and better emotional well-being (r = .33; 95% CI 0.18, 0.47; p <.001; I2 = 76.01) and between a higher level of AARC losses and poorer emotional (r = −.31; 95% CI −0.38, −0.24; p < .001; I2 = 0.00) and physical well-being (r = −.38; 95% CI −0.51, −0.24; p < .001; I2 = 83.48). We found a negligible association between AARC gains and physical well-being (r = .08; 95% CI 0.02, 0.14; p < .122; I2 = 0.00). Studies were of medium to high methodological quality. Discussion and Implications There is some indication that AARC gains and losses can play a role in emotional well-being and that AARC losses are associated with physical well-being. However, the number of included studies is limited and there was some indication of heterogeneity. PROSPERO Registration CRD42018111472.
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Affiliation(s)
- Serena Sabatini
- Centre for Research in Ageing and Cognitive Health, University of Exeter, University of New South Wales, Sydney, Australia
| | - Barbora Silarova
- Centre for Research in Ageing and Cognitive Health, University of Exeter, University of New South Wales, Sydney, Australia
| | - Anthony Martyr
- Centre for Research in Ageing and Cognitive Health, University of Exeter, University of New South Wales, Sydney, Australia
| | - Rachel Collins
- Centre for Research in Ageing and Cognitive Health, University of Exeter, University of New South Wales, Sydney, Australia
| | - Clive Ballard
- Centre for Research in Ageing and Cognitive Health, University of Exeter, University of New South Wales, Sydney, Australia
| | - Kaarin J Anstey
- Ageing Futures Institute, University of New South Wales, Sydney, Australia.,Neuroscience Research Australia (NeuRA), University of New South Wales, Sydney, Australia
| | - Sarang Kim
- Wicking Dementia Research & Education Centre, University of Tasmania, Hobart, Australia
| | - Linda Clare
- Centre for Research in Ageing and Cognitive Health, University of Exeter, University of New South Wales, Sydney, Australia
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Wu YT, Clare L, Jones IR, Nelis SM, Quinn C, Martyr A, Victor CR, Lamont RA, Rippon I, Matthews FE. Perceived and objective availability of green and blue spaces and quality of life in people with dementia: results from the IDEAL programme. Soc Psychiatry Psychiatr Epidemiol 2021; 56:1601-1610. [PMID: 33484297 PMCID: PMC8429369 DOI: 10.1007/s00127-021-02030-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 01/06/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim of this study was to investigate the associations between quality of life and both perceived and objective availability of local green and blue spaces in people with dementia, including potential variation across rural/urban settings and those with/without opportunities to go outdoors. METHODS This study was based on 1540 community-dwelling people with dementia in the Improving the experience of Dementia and Enhancing Active Life (IDEAL) programme. Quality of life was measured by the Quality of Life in Alzheimer's Disease (QoL-AD) scale. A list of 12 types of green and blue spaces was used to measure perceived availability while objective availability was estimated using geographic information system data. Regression modelling was employed to investigate the associations of quality of life with perceived and objective availability of green and blue spaces, adjusting for individual factors and deprivation level. Interaction terms with rural/urban areas or opportunities to go outdoors were fitted to test whether the associations differed across these subgroups. RESULTS Higher QoL-AD scores were associated with higher perceived availability of local green and blue spaces (0.82; 95% CI 0.06, 1.58) but not objective availability. The positive association between perceived availability and quality of life was stronger for urban (1.50; 95% CI 0.52, 2.48) than rural residents but did not differ between participants with and without opportunities to go outdoors. CONCLUSIONS Only perceived availability was related to quality of life in people with dementia. Future research may investigate how people with dementia utilise green and blue spaces and improve dementia-friendliness of these spaces.
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Affiliation(s)
- Yu-Tzu Wu
- Social Epidemiology Research Group, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK. .,Population Health Sciences Institute, Newcastle University, The Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE4 5PL, UK.
| | - Linda Clare
- College of Medicine and Health, University of Exeter, St Luke’s Campus, Exeter, EX1 2LU UK
| | - Ian Rees Jones
- Wales Institute of Social and Economic Research and Data, Cardiff University, Cardiff, CF10 3BB UK
| | - Sharon M. Nelis
- College of Medicine and Health, University of Exeter, St Luke’s Campus, Exeter, EX1 2LU UK
| | - Catherine Quinn
- Centre for Applied Dementia Studies, University of Bradford, Bradford, BD7 1DP UK
| | - Anthony Martyr
- College of Medicine and Health, University of Exeter, St Luke’s Campus, Exeter, EX1 2LU UK
| | - Christina R. Victor
- Department of Clinical Sciences, College of Health and Life Sciences, Brunel University London, Uxbridge, UB8 3PH UK
| | - Ruth A. Lamont
- College of Medicine and Health, University of Exeter, St Luke’s Campus, Exeter, EX1 2LU UK
| | - Isla Rippon
- Department of Clinical Sciences, College of Health and Life Sciences, Brunel University London, Uxbridge, UB8 3PH UK
| | - Fiona E. Matthews
- Population Health Sciences Institute, Newcastle University, The Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE4 5PL UK
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Bahar‐Fuchs A, Martyr A, Goh AMY, Sabates JM, Clare L. Cognitive training for people with dementia: A Cochrane review. Alzheimers Dement 2020. [DOI: 10.1002/alz.044133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | | | - Anita M Y Goh
- Neuropsychiatry Royal Melbourne Hospital Parkville VIC Australia
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Affiliation(s)
- Aaron Choi
- University of Exeter Exeter United Kingdom
| | - Clive Ballard
- University of Exeter Medical School Exeter United Kingdom
| | | | | | - Robin G. Morris
- King s College London, Institute of Psychiatry London United Kingdom
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Rippon I, Victor CR, Quinn C, Martyr A, Matthews FE, Clare L. Loneliness and isolation among people with dementia and their carers: Prevalence, risk factors and a dyadic analysis. Alzheimers Dement 2020. [DOI: 10.1002/alz.041922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Clare L, Martyr A, Henderson C, Gamble L, Matthews FE, Quinn C, Nelis SM, Rusted J, Thom J, Knapp M, Hart N, Victor C. Living Alone with Mild-To-Moderate Dementia: Findings from the IDEAL Cohort. J Alzheimers Dis 2020; 78:1207-1216. [PMID: 33104029 DOI: 10.3233/jad-200638] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND A significant proportion of people with dementia live alone, but little is known about their specific needs. OBJECTIVE To understand the profile of people living alone with mild-to-moderate dementia in the UK and identify any systematic differences associated with living situation. METHODS We analyzed cross-sectional data from 1,541 people with mild-to-moderate dementia and 1,277 caregivers participating in the IDEAL cohort at the first wave of assessment. RESULTS There were 1,256 (81.5%) people with dementia living with others and 285 (18.5%) living alone, of whom 51 (3% of whole sample) reported little or no informal support. There were relatively few differences associated with living situation and odds ratios were generally small. People living alone were older on average, and more likely to be female, than those living with others. Those living alone were more likely to have higher cognitive ability and self-reported functional ability, and more social contact with those from other households. They were also lonelier, expressed less satisfaction with life, and used home care services and equipment more. There were no differences in symptoms, mood, quality of life, or well-being. CONCLUSION The findings support the view that it is possible to 'live well' with mild-to-moderate dementia while living alone, given appropriate support, including home care and equipment. Nevertheless, it is important to consider how those living alone may be supported to have a more satisfactory experience, and how health and social care services can best respond to their needs.
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Affiliation(s)
- Linda Clare
- REACH: The Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, University of Exeter, St Luke's Campus, Exeter, UK
| | - Anthony Martyr
- REACH: The Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, University of Exeter, St Luke's Campus, Exeter, UK
| | - Catherine Henderson
- Personal Social Services Research Unit>, London School of Economics and Political Science, London, UK
| | - Laura Gamble
- Institute for Health and Society, Newcastle University, Newcastle, UK
| | - Fiona E Matthews
- Institute for Health and Society, Newcastle University, Newcastle, UK
| | - Catherine Quinn
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Sharon M Nelis
- REACH: The Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, University of Exeter, St Luke's Campus, Exeter, UK
| | | | - Jeanette Thom
- School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - Martin Knapp
- Personal Social Services Research Unit>, London School of Economics and Political Science, London, UK
| | - Nicola Hart
- Research Development and Evaluation, Alzheimer's Society, London, UK
| | - Christina Victor
- College of Health and Life Sciences, Brunel University London, London, UK
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Abstract
BACKGROUND There is some evidence to suggest that social isolation may be associated with poor cognitive function in later life. However, findings are inconsistent and there is wide variation in the measures used to assess social isolation. OBJECTIVE We conducted a systematic review and meta-analysis to investigate the association between social isolation and cognitive function in later life. METHODS A search for longitudinal studies assessing the relationship between aspects of social isolation (including social activity and social networks) and cognitive function (including global measures of cognition, memory, and executive function) was conducted in PsycInfo, CINAHL, PubMed, and AgeLine. A random effects meta-analysis was conducted to assess the overall association between measures of social isolation and cognitive function. Sub-analyses investigated the association between different aspects of social isolation and each of the measures of cognitive function. RESULTS Sixty-five articles were identified by the systematic review and 51 articles were included in the meta-analysis. Low levels of social isolation characterized by high engagement in social activity and large social networks were associated with better late-life cognitive function (r = 0.054, 95% CI: 0.043, 0.065). Sub-analyses suggested that the association between social isolation and measures of global cognitive function, memory, and executive function were similar and there was no difference according to gender or number of years follow-up. CONCLUSIONS Aspects of social isolation are associated with cognitive function in later life. There is wide variation in approaches to measuring social activity and social networks across studies which may contribute to inconsistencies in reported findings.
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Affiliation(s)
- Isobel E M Evans
- Centre for Research in Ageing and Cognitive Health (REACH), School of Psychology, University of Exeter, Exeter, UK
| | - Anthony Martyr
- Centre for Research in Ageing and Cognitive Health (REACH), School of Psychology, University of Exeter, Exeter, UK
| | - Rachel Collins
- Centre for Research in Ageing and Cognitive Health (REACH), School of Psychology, University of Exeter, Exeter, UK
| | - Carol Brayne
- Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Linda Clare
- Centre for Research in Ageing and Cognitive Health (REACH), School of Psychology, University of Exeter, Exeter, UK.,University of Exeter Medical School, Exeter, UK.,Wellcome Centre for Cultures and Environments of Health, University of Exeter, Exeter, UK.,Centre for Research Excellence in Promoting Cognitive Health, University of New South Wales, Sydney, Australia
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Opdebeeck C, Katsaris MA, Martyr A, Lamont RA, Pickett JA, Rippon I, Thom JM, Victor C, Clare L. What Are the Benefits of Pet Ownership and Care Among People With Mild-to-Moderate Dementia? Findings From the IDEAL programme. J Appl Gerontol 2020; 40:1559-1567. [PMID: 33025847 PMCID: PMC8564240 DOI: 10.1177/0733464820962619] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Pet ownership has been associated with positive outcomes in many populations, yet
the associations with physical and psychological wellbeing in people with
dementia remain unclear. The current study used baseline data from 1,542 people
living at home with mild-to-moderate dementia from the Improving the experience
of Dementia and Enhancing Active Life (IDEAL) programme. Regression analyses
investigated associations of pet ownership and pet care with self-reports of
walking, loneliness, depression, and quality of life (QoL). After adjusting for
covariates, having any pet was associated with higher likelihood of walking over
3 hr in the last week. Those with a dog and who were involved in its care were
less likely to be lonely than those with no dog. Having any pet but no
involvement in its care was associated with increased depression and decreased
QoL compared with those without a pet. The key factor in the associations was
involvement in the care of the pet by the person with dementia.
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Affiliation(s)
- Carol Opdebeeck
- Manchester Metropolitan University,
UK
- Carol Opdebeeck, Department of Psychology,
Manchester Metropolitan University, Manchester, M15 6GX, UK.
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41
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Rippon I, Quinn C, Martyr A, Morris R, Nelis SM, Jones IR, Victor CR, Clare L. The impact of relationship quality on life satisfaction and well-being in dementia caregiving dyads: findings from the IDEAL study. Aging Ment Health 2020; 24:1411-1420. [PMID: 31140291 DOI: 10.1080/13607863.2019.1617238] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Objectives: The quality of the relationship between people with dementia and their informal caregiver maybe an important determinant of life satisfaction and well-being for both members of the dyad. Taking a dyadic perspective, the aim of this study was to examine whether self- and partner-rated relationship quality influences life satisfaction and well-being for both people with dementia and their caregivers.Design and methods: Using data from 1283 dyads in the Improving the Experience of Dementia and Enhancing Active Life (IDEAL) cohort, we examined the impact of current relationship quality on life satisfaction and well-being in dementia caregiving dyads. Data were analysed using the Actor-Partner Interdependence Model (APIM) framework.Results: Self-rated relationship quality was associated with own life satisfaction and well-being for both people with dementia and caregivers. Partner-rated relationship quality did not influence own life satisfaction or well-being for either member of the dyad.Conclusion: This study is the first to use the APIM framework to explore the dyadic associations between relationship quality and life satisfaction and well-being in a large cohort of dementia caregiving dyads. The obtained findings suggest that the individual perception of the quality of the caregiving relationship held by each member of the caregiving dyad is an important factor for that member's life satisfaction and well-being, while the partner's perception of relationship quality is not. The findings highlight the importance of considering the individual perspective of both the person with dementia and the caregiver and enabling each to maintain positive perceptions of relationship quality.
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Affiliation(s)
- Isla Rippon
- College of Health and Life Sciences, Brunel University London, Uxbridge, UK
| | - Catherine Quinn
- The Centre for Applied Dementia Studies, University of Bradford, Bradford, UK.,REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter, Exeter, UK
| | - Anthony Martyr
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter, Exeter, UK
| | - Robin Morris
- Department of Psychology, King's College London Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Sharon M Nelis
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter, Exeter, UK
| | - Ian Rees Jones
- Wales Institute for Social and Economic Research, Data and Methods, Cardiff University, Cardiff, UK
| | - Christina R Victor
- College of Health and Life Sciences, Brunel University London, Uxbridge, UK
| | - Linda Clare
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter, Exeter, UK
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42
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Abstract
Objectives: The capability to 'live well' in people with dementia can be influenced by many factors, including those related to the experiences of their informal caregiver. How caregivers experience their own role can affect not only their well-being but also the way they provide care and hence the experience of the person with dementia. The aim of this study is to identify the potential impact of the caregiver's perception of the caregiving experience on how people with mild to moderate dementia self-rate their QoL, well-being and satisfaction with life.Method: This study utilised time-point 1 data from 1283 informal caregiver and the 1283 people with dementia whom they provide care from the IDEAL cohort study. Multivariate modelling was used to investigate the associations between measures related to the caregiver's perception of the caregiving experience (caregiving stress, perceived social restrictions, caregiving competence, positive aspects of caregiving, and coping) and the self-ratings of QoL, satisfaction with life, and well-being by the person with dementia.Results: Lower QoL ratings by the person with dementia were associated with high caregiver stress (-1.98; 95% CI: -2.89, -1.07), high perceived social restrictions (-2.04; 95% CI: -2.94, -1.14) and low caregiving competence (-2.01; 95% CI: -2.95, -1.06). Similar associations were found for satisfaction with life and wellbeing. Positive aspects of caregiving and coping were not associated with outcomes for the person with dementia.Conclusion: The findings indicate that how the caregiver experiences caregiving can affect the person with dementia. This finding reinforces the importance of providing support to caregivers.
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Affiliation(s)
- Catherine Quinn
- Centre of Applied Dementia Studies, University of Bradford, Bradford, UK.,REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School and College of Life and Environmental Sciences, Exeter, UK
| | - Sharon M Nelis
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School and College of Life and Environmental Sciences, Exeter, UK
| | - Anthony Martyr
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School and College of Life and Environmental Sciences, Exeter, UK
| | - Robin G Morris
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Christina Victor
- Department of Clinical Sciences, College of Health and Life Sciences, Brunel University London, London, UK
| | - Linda Clare
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School and College of Life and Environmental Sciences, Exeter, UK
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43
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Victor CR, Rippon I, Nelis SM, Martyr A, Litherland R, Pickett J, Hart N, Henley J, Matthews F, Clare L. Prevalence and determinants of loneliness in people living with dementia: Findings from the IDEAL programme. Int J Geriatr Psychiatry 2020; 35:851-858. [PMID: 32281151 DOI: 10.1002/gps.5305] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 03/25/2020] [Accepted: 03/29/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To establish the prevalence and determinants of loneliness among people living with dementia. METHODS Using data from the baseline wave of the Improving the experience of Dementia and Enhancing Active Life (IDEAL) cohort study, we examined the prevalence and predictors of loneliness in 1547 people with mild-to-moderate dementia. Loneliness was assessed using the six-item De Jong Gierveld loneliness scale. RESULTS About 30.1% of people with dementia reported feeling moderately lonely and 5.2% severely lonely. Depressive symptoms and increased risk of social isolation were associated with both moderate and severe loneliness. Those living alone were more likely to experience severe loneliness as were those reporting poorer quality of life. Marital status was not associated with loneliness nor were dementia diagnosis or cognitive function. CONCLUSIONS This is one of the few large-scale studies to explore the prevalence of and determinants of loneliness among people living with dementia. Social isolation, depression and living alone were associated with experiencing loneliness. Longitudinal studies are needed to determine the directionality of these associations.
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Affiliation(s)
- Christina R Victor
- Department of Clinical Sciences, College of Health and Life Sciences, Brunel University London, Uxbridge, UK
| | - Isla Rippon
- Department of Clinical Sciences, College of Health and Life Sciences, Brunel University London, Uxbridge, UK
| | - Sharon M Nelis
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter, Exeter, UK
| | - Anthony Martyr
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter, Exeter, UK
| | | | | | | | - Josie Henley
- Wales Institute for Social and Economic Research, Data and Methods, Cardiff University, Cardiff, UK
| | - Fiona Matthews
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Linda Clare
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter, Exeter, UK
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44
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Lamont RA, Nelis SM, Quinn C, Martyr A, Rippon I, Kopelman MD, Hindle JV, Jones RW, Litherland R, Clare L. Psychological predictors of 'living well' with dementia: findings from the IDEAL study. Aging Ment Health 2020; 24:956-964. [PMID: 30836765 DOI: 10.1080/13607863.2019.1566811] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Objectives: Increasingly, research has explored how psychological resources enable adaptation to illness. However, it is unclear whether psychological resources protect against the potential negative effects on living well with a progressive and life-limiting condition such as dementia. This paper examines the association between psychological resources and the ability to 'live well' with dementia.Method: Data from 1547 people with mild-to-moderate dementia in the Improving the experience of Dementia and Enhancing Active Life (IDEAL) cohort were used. Multivariate linear regression was employed to examine the association between self-reported measures of psychological resources (self-efficacy, optimism and self-esteem) and indices of capability to 'live well' (quality of life, well-being and life satisfaction).Results: All three measures of psychological resources had positive and independent associations with indices of living well and the effect sizes were similar. Effect sizes reduced when accounting for shared variance between psychological resources, showing some overlap in these constructs.Conclusion: Self-efficacy, optimism and self-esteem were each associated with capability to 'live well'. Overlap between these three resources is evident and when combined they may provide greater resilience when dealing with the challenges of living with dementia. Interventions for people with dementia could seek to improve levels of these potentially-modifiable psychological resources.
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Affiliation(s)
- Ruth A Lamont
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
| | - Sharon M Nelis
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
| | - Catherine Quinn
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
| | - Anthony Martyr
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
| | - Isla Rippon
- Department of Clinical Sciences, Brunel University, London, UK
| | - Michael D Kopelman
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - John V Hindle
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
| | - Roy W Jones
- Research Institute for the Care of Older People, Bath, UK
| | | | - Linda Clare
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
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45
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Wu YT, Nelis SM, Quinn C, Martyr A, Jones IR, Victor CR, Knapp M, Henderson C, Hindle JV, Jones RW, Kopelman MD, Morris RG, Pickett JA, Rusted JM, Thom JM, Litherland R, Matthews FE, Clare L. Factors associated with self- and informant ratings of quality of life, well-being and life satisfaction in people with mild-to-moderate dementia: results from the Improving the experience of Dementia and Enhancing Active Life programme. Age Ageing 2020; 49:446-452. [PMID: 32037460 DOI: 10.1093/ageing/afz177] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 11/13/2019] [Accepted: 12/11/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND a large number of studies have explored factors related to self- and informant ratings of quality of life in people with dementia, but many studies have had relatively small sample sizes and mainly focused on health conditions and dementia symptoms. The aim of this study is to compare self- and informant-rated quality of life, life satisfaction and well-being, and investigate the relationships of the two different rating methods with various social, psychological and health factors, using a large cohort study of community-dwelling people with dementia and carers in Great Britain. METHODS this study included 1,283 dyads of people with mild-to-moderate dementia and their primary carers in the Improving the experience of Dementia and Enhancing Active Life study. Multivariate modelling was used to investigate associations of self- and informant-rated quality of life, life satisfaction and well-being with factors in five domains: psychological characteristics and health; social location; capitals, assets and resources; physical fitness and health; and managing everyday life with dementia. RESULTS people with dementia rated their quality of life, life satisfaction and well-being more highly than did the informants. Despite these differences, the two approaches had similar relationships with social, psychological and physical health factors in the five domains. CONCLUSION although self- and informant ratings differ, they display similar results when focusing on factors associated with quality of life, life satisfaction and well-being. Either self- or informant ratings may offer a reasonable source of information about people with dementia in terms of understanding associated factors.
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Affiliation(s)
- Yu-Tzu Wu
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School and College of Life and Environment Sciences, Exeter, UK
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Sharon M Nelis
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School and College of Life and Environment Sciences, Exeter, UK
| | - Catherine Quinn
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School and College of Life and Environment Sciences, Exeter, UK
- Centre of Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Anthony Martyr
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School and College of Life and Environment Sciences, Exeter, UK
| | - Ian R Jones
- Wales Institute for Social and Economic Research, Data and Methods, Cardiff University, Cardiff, UK
| | - Christina R Victor
- College of Health and Life Sciences, Brunel University London, Uxbridge, UK
| | - Martin Knapp
- Personal Social Services Research Unit, London School of Economics and Political Science, London, UK
| | - Catherine Henderson
- Personal Social Services Research Unit, London School of Economics and Political Science, London, UK
| | - John V Hindle
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School and College of Life and Environment Sciences, Exeter, UK
| | - Roy W Jones
- Research Institute for the Care of Older People (RICE), Bath, UK
| | - Michael D Kopelman
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Robin G Morris
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | | | | | - Jeanette M Thom
- School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | | | - Fiona E Matthews
- Institute for Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Linda Clare
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School and College of Life and Environment Sciences, Exeter, UK
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Bahar-Fuchs A, Martyr A, Goh AM, Sabates J, Clare L. Cognitive training for people with mild to moderate dementia: a Cochrane Review. BJPsych advances 2020. [DOI: 10.1192/bja.2019.74] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Clare L, Martyr A, Morris RG, Tippett LJ. Discontinuity in the Subjective Experience of Self Among People with Mild-To-Moderate Dementia Is Associated with Poorer Psychological Health: Findings from the IDEAL Cohort. J Alzheimers Dis 2020; 77:127-138. [PMID: 32804138 PMCID: PMC7592652 DOI: 10.3233/jad-200407] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND The onset and progression of dementia can result in changes in the subjective experience of self, impacting on psychological health. OBJECTIVE We aimed to explore the extent to which people with mild-to-moderate dementia experience discontinuity in the subjective experience of self, and the factors associated with this experience for people with dementia and their family caregivers. METHODS We used data from the baseline assessment of the IDEAL cohort. Discontinuity in the subjective experience of self was assessed by asking participants about their agreement with the statement 'I feel I am the same person that I have always been'. Participants were divided into those who did and did not experience discontinuity, and the two groups were compared in terms of demographic and disease-related characteristics, psychological well-being, measures of 'living well', and caregiver stress. RESULTS Responses to the continuity question were available for 1,465 participants with dementia, of whom 312 (21%) reported experiencing discontinuity. The discontinuity group experienced significantly poorer psychological well-being and had significantly lower scores on measures of 'living well'. There was no clear association with demographic or disease-related characteristics, but some indication of increased caregiver stress. CONCLUSION A significant proportion of people with mild-to-moderate dementia describe experiencing discontinuity in the subjective sense of self, and this is associated with poorer psychological health and reduced ability to 'live well' with the condition. Sensitively asking individuals with dementia about the subjective experience of self may offer a simple means of identifying individuals who are at increased risk of poor well-being.
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Affiliation(s)
- Linda Clare
- REACH: The Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, University of Exeter, St Luke’s Campus, Exeter, UK
| | - Anthony Martyr
- REACH: The Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, University of Exeter, St Luke’s Campus, Exeter, UK
| | - Robin G. Morris
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Lynette J. Tippett
- School of Psychology, The University of Auckland, Auckland, New Zealand
- Centre for Brain Research, The University of Auckland, Auckland, New Zealand
- Brain Research New Zealand, Auckland, New Zealand
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Clare L, Clare L, Martyr A, Quinn C, Victor C, Matthews F. LIVING ALONE WITH DEMENTIA: FINDINGS FROM THE IDEAL COHORT. Innov Aging 2019. [PMCID: PMC6840457 DOI: 10.1093/geroni/igz038.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
We aimed to better understand the profile of people living alone with mild-to-moderate dementia in the UK and to identify any systematic differences between those living alone and those living with others. We analysed cross-sectional data from 1541 people with mild-to-moderate dementia participating in the IDEAL cohort at the first wave of assessment. There were 285 participants (18.5%) living alone and 1256 (81.5%) living with others, usually a spouse/partner. Among those living alone, 145 (50.9%) had no care partner participating in the study, and 56 (19%) had received no help from a relative or friend in the past week. People living alone were older on average than those living with others, reported fewer functional difficulties, had slightly smaller social networks, engaged in fewer cultural activities, and experienced slightly more loneliness. People living alone had lower satisfaction with life scores, but quality of life scores did not differ between the groups.
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Affiliation(s)
- Linda Clare
- University of Exeter, Exeter, England, United Kingdom
| | - Linda Clare
- University of Exeter, Exeter, England, United Kingdom
| | | | | | | | - Fiona Matthews
- NewcCastle University, Newcastle, England, United Kingdom
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Sabatini S, Silarova B, Martyr A, Collins R, Ballard C, Anstey KJ, Kim S, Clare L. META-ANALYSIS OF AARC AND EMOTIONAL AND PHYSICAL WELL-BEING. Innov Aging 2019. [PMCID: PMC6840464 DOI: 10.1093/geroni/igz038.1412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Associations of awareness of age-related change (AARC) with emotional and physical well-being and cognitive functioning were synthesised in a systematic review with a correlational random-effects meta-analysis. Twelve studies were included in the review, nine exploring the association between AARC and emotional well-being and eleven exploring the association between AARC and physical well-being. No study explored the association between AARC and cognition. There is evidence of weak associations between higher level of AARC gains and better emotional well-being and between higher level of AARC losses and both poorer emotional well-being and poorer physical well-being. There was no association between AARC gains and physical well-being. There is some indication that AARC gains and losses can play a role in emotional well-being and that AARC losses are associated with physical well-being but these associations are weak. Due to the limited number of studies and their high heterogeneity, interpretation of these results remains unclear.
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Affiliation(s)
- Serena Sabatini
- Centre for Research in Ageing and Cognitive Health, University of Exeter, Exeter, United Kingdom, University of Exeter, United Kingdom
| | | | | | | | - Clive Ballard
- University of Exeter, Exeter, England, United Kingdom
| | - Kaarin J Anstey
- University of New South Wales, Sidney, New South Wales, Australia
| | - Sarang Kim
- University of Tasmania, Hobart, Tasmania, Australia
| | - Linda Clare
- University of Exeter, Exeter, England, United Kingdom
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Victor C, Rippon I, Martyr A, Mathews F, Clare L. HOW LONELY AND ISOLATED ARE OLDER PEOPLE WITH DEMENTIA AND THEIR CARERS: A DYADIC ANALYSIS. Innov Aging 2019. [PMCID: PMC6840791 DOI: 10.1093/geroni/igz038.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Studies of loneliness and isolation have rarely explored is how these experiences are reported within couples or the wider households. The IDEAL study has collected details of loneliness, as measured by the de Jong Gierveld (DJG) scale (range 0-6) and a single-item self-report measure, and isolation, using the six-item Lubben social network scale (range 0-30) from both people with dementia and carers. Loneliness is classified into three groups: not lonely (score 0-2), moderately lonely (3-4) and severely lonely (5+) and isolation into two: not isolated (score of 13+) or isolated (12 or less). Of the 1547 people with dementia and 1283 carers interviewed at baseline we have 1089 dyads who provided complete data on loneliness and 1204 for social isolation. Loneliness ratings are congruent between 43.1% of dyads and for 67.8% for isolation highlighting the subjective evaluative nature of loneliness as compared with more objectively measured isolation.
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Affiliation(s)
| | - Isla Rippon
- Brunel University London, Uxbridge, England, United Kingdom
| | | | - Fiona Mathews
- Newcastle University, Newcastle, England, United Kingdom
| | - Linda Clare
- University of Exeter, Exeter, England, United Kingdom
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