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Neller SA, Hebdon MT, Wickens E, Scammon DL, Utz RL, Dassel KB, Terrill AL, Ellington L, Kirby AV. Family caregiver experiences and needs across health conditions, relationships, and the lifespan: a Qualitative analysis. Int J Qual Stud Health Well-being 2024; 19:2296694. [PMID: 38213230 PMCID: PMC10791097 DOI: 10.1080/17482631.2023.2296694] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 12/14/2023] [Indexed: 01/13/2024] Open
Abstract
PURPOSE The purpose of this study was to understand the lived experiences of family caregivers who provide care to individuals across a broad range of ages, caregiving relationships, and health conditions and/or disabilities. Family caregiver research is typically siloed by health condition or by caregiving relationship, leaving gaps in understanding similarities and differences among caregivers. METHODS We hosted three virtual focus groups with diverse family caregivers (n = 26) caring for an individual with a long-term disability and/or health condition(s). We conducted a qualitative thematic analysis using an iterative, inductive process. RESULTS Participants primarily expressed shared experiences, despite having unique caregiving situations. We identified themes among a) caregiver experiences: Trying to Do It All, Balancing Complex Emotions, Managing Expectations, and Adjusting to Changes Over Time and b) caregiver needs: Longing for Breaks and Self-Care; Lacking Help, Support and Resources; and Desiring Understanding and Recognition. CONCLUSIONS These findings emphasize that many elements of the caregiving experience transcend care recipient age, condition, and relationship and are applicable to clinicians, researchers, and policy makers. The evidence of shared caregiver experiences can guide efficiencies in policy and practice (e.g., pooling of existing resources, expansion of interventions) to meet the needs of a broader population of caregivers.
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Affiliation(s)
- Sarah A. Neller
- College of Nursing, University of Tennessee, Knoxville, TN, USA
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | | | - Emily Wickens
- College of Social and Behavioral Sciences, University of Utah, Salt Lake City, UT, USA
| | - Debra L. Scammon
- David Eccles School of Business, University of Utah, Salt Lake City, UT, USA
| | - Rebecca L. Utz
- College of Social and Behavioral Sciences, University of Utah, Salt Lake City, UT, USA
| | - Kara B. Dassel
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | | | - Lee Ellington
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | - Anne V. Kirby
- College of Health, University of Utah, Salt Lake City, UT, USA
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Dassel KB, Iacob E, Utz RL, Supiano KP, Fuhrmann H. Promoting Advance Care Planning for Persons with Dementia: Study Protocol for the LEAD (Life-Planning in Early Alzheimer's and Other Dementias) Clinical Trial. OBM Integr Compliment Med 2023; 8:26. [PMID: 37859668 PMCID: PMC10586385 DOI: 10.21926/obm.icm.2301004] [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] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
Due to the insidious progression of Alzheimer's disease and related dementias (ADRD), surrogate decision-makers typically make medical and long-term-care decisions for a care recipient, most often a family care partner. Unfortunately, many care recipient/care partner dyads have failed to engage in advance care planning or have lost the opportunity to do so due to the cognitive decline of the care recipient. To address this need, our team created a validated dementia-focused advance care planning tool known as the LEAD Guide (Life-Planning in Early Alzheimer's and Other Dementias). With funding from the National Alzheimer's Association and in consultation with our community advisory board, we developed a preliminary web-based intervention. This intervention integrates the LEAD Guide with self-paced educational modules that lead dyads through conversations and dementia-focused advance care planning processes. In this concept paper, we describe the aims of our funded R01 clinical trial (National Institute on Aging), where we aim to refine our preliminary web-based platform for use in a 5-month mixed-method NIH Stage-1 behavioral intervention. Using a sample of diverse community-based ADRD dyads (n = 60), we aim to: 1) describe the acceptability, usability, and feasibility of the intervention, 2) assess the initial efficacy of the intervention on the primary outcome (decision-making self-efficacy), and secondary outcomes (relationship quality, subjective well-being, anxiety) as perceived by both the care recipient and the care partner, and 3) examine advance care planning congruence as a mechanism of action. The LEAD clinical trial addresses public health challenges by guiding and supporting families through challenging advance care planning conversations, facilitating the transfer of knowledge regarding care preferences and values from the care recipient to the care partner, with the ultimate goal of improving the quality of life for both individuals with ADRD and their care partners.
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Affiliation(s)
- Kara B. Dassel
- University of Utah, College of Nursing, 10 S. 2000 E., Salt Lake City, UT, USA
| | - Eli Iacob
- University of Utah, College of Nursing, 10 S. 2000 E., Salt Lake City, UT, USA
| | - Rebecca L. Utz
- University of Utah, College of Social and Behavioral Sciences, 260 South Central Campus Drive, Salt Lake City, UT, USA
| | | | - Hollie Fuhrmann
- University of Utah, College of Nursing, 10 S. 2000 E., Salt Lake City, UT, USA
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Dassel KB, Edelman LS, Moye J, Catlin C, Farrell TW. "I worry about this patient EVERY day": Geriatrics Clinicians' Challenges in Caring for Unrepresented Older Adults. J Appl Gerontol 2021; 41:1167-1174. [PMID: 34463148 DOI: 10.1177/07334648211041261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Indexed: 11/15/2022] Open
Abstract
Unrepresented older adults are at risk for adverse outcomes, and clinicians who care for them may face ethical dilemmas and unique challenges when making person-centered care recommendations. However, little is known about their perspectives on clinical challenges in caring for this population. An online survey was used to assess issues around providing care for unrepresented patients. Ninety-two American Geriatrics Society members working with older adults in inpatient and/or outpatient settings completed the survey. Descriptive qualitative analysis of narrative survey responses identified five broad themes: (a) health risk characteristics of patients, (b) care decisions facing the team, (c) psychosocial considerations by the team, (d) patient outcomes, and (e) burden of the provider and/or health system. These findings demonstrate that geriatrics clinicians face challenges in working with unrepresented adults in both inpatient and outpatient settings. We interpret these results in light of existing literature and propose collaborative approaches that may improve outcomes.
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Affiliation(s)
| | | | - Jennifer Moye
- Boston VA Research Institute, Inc., MA, USA
- VA New England Geriatric Research Education and Clinical Center, Boston, MA, USA
- VA Boston Healthcare System, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | - Timothy W Farrell
- University of UT, Salt Lake City, USA
- VA Salt Lake City Geriatric Research, Education, and Clinical Center
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Dassel KB, Towsley GL, Utz RL, Ellington L, Terrill A, Scammon D, Bristol AA, Thompson A, Mickens M. A Limited Opportunity: COVID-19 and Promotion of Advance Care Planning. Palliat Med Rep 2021; 2:194-198. [PMID: 34223520 PMCID: PMC8244510 DOI: 10.1089/pmr.2021.0013] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2021] [Indexed: 12/30/2022] Open
Abstract
Background: Little is known about how COVID-19 has influenced the role of family caregivers in advance care planning (ACP). Objectives: To explore the experiences of family caregivers and ACP in the United States during the COVID-19 pandemic. Design: Exploratory sequential mixed-methods design of caregiver characteristics and pandemic response to ACP. Settings/Subjects: Family caregivers of care recipients with varied caregiving needs (dementia, mental illness, etc.). Measurements: Quantitative survey was done of fixed-choice questions of 82 caregivers. Semistructured qualitative telephone interviews were performed of a subsample of participants (n = 28). Results: Some (19%) of family caregivers revisited or updated advance directives of care recipients and/or had some type of contingency plan (33%) if they were to become ill. We identified three barriers caregivers faced during the pandemic that may have limited their engagement with ACP. Conclusions: Family caregivers need education regarding ACP and specific resources that can guide and support them through the process of ACP, for both themselves and care recipients.
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Affiliation(s)
- Kara B. Dassel
- College of Nursing, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Gail L. Towsley
- College of Nursing, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Rebecca L. Utz
- Department of Sociology, College of Social and Behavioral Sciences, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Lee Ellington
- College of Nursing, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Alexandra Terrill
- Department of Occupational and Recreational Therapies, College of Health, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Debra Scammon
- Department of Marketing, David Eccles School of Business, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Alycia A. Bristol
- College of Nursing, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Amber Thompson
- Department of Sociology, College of Social and Behavioral Sciences, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Melody Mickens
- Division of Physical Medicine and Rehabilitation, School of Medicine, University of Utah, Salt Lake City, Utah, USA
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Bristol AA, Mata AC, Mickens M, Dassel KB, Ellington L, Scammon D, Thompson A, Towsley GL, Utz RL, Terrill AL. "You Feel Very Isolated": Effects of COVID-19 Pandemic on Caregiver Social Connections. Gerontol Geriatr Med 2021; 7:23337214211060166. [PMID: 34993276 PMCID: PMC8724994 DOI: 10.1177/23337214211060166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/08/2021] [Accepted: 10/28/2021] [Indexed: 12/02/2022] Open
Abstract
One in five individuals in the United States provides care and support to ill, disabled, and aging family members in the home, leading to feelings of burden, stress, and poor health and well-being. Social support represents an important buffer for family caregivers that allows them to feel less isolated and more positive about their caregiving role. This sequential mixed-methods study aimed to examine the effect of the COVID-19 pandemic on family caregivers' social connections. Eighty-two caregivers completed a web-based survey which comprised of fixed-choice and open-ended questions. Survey data showed that the majority of caregivers (83%) reported an increase in stress and feeling lonely (77%) during the pandemic. Qualitative interviews with a subsample of caregivers (n=27) further explored social connections during the pandemic. Three themes echoed the quantitative findings and centered around defining boundaries, intentionality in social interactions, and loss of social resources. Although caregivers were often strained by new or increased caregiving demands, many experienced positive changes such as feeling a deeper connection with the care-recipient. Findings from this study highlight the need for further consideration of the impact of social isolation on the well-being of caregivers.
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Affiliation(s)
- Alycia A. Bristol
- College of Nursing, University of Utah, Salt Lake City, UT, USA
- Gerontology Interdisciplinary Program, University of Utah, Salt Lake City, UT, USA
| | - Aaron C. Mata
- College of Social & Behavioral Sciences, University of Utah, Salt Lake City, UT, USA
| | - Melody Mickens
- Division of Rehabilitative Medicine, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Kara B. Dassel
- Gerontology Interdisciplinary Program, University of Utah, Salt Lake City, UT, USA
| | - Lee Ellington
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | - Debra Scammon
- Department of Marketing, School of Business, University of Utah, Salt Lake City, UT, USA
| | - Amber Thompson
- Department of Sociology, University of Utah, Salt Lake City, UT, USA
| | - Gail L. Towsley
- College of Nursing, University of Utah, Salt Lake City, UT, USA
- Gerontology Interdisciplinary Program, University of Utah, Salt Lake City, UT, USA
| | - Rebecca L. Utz
- Department of Sociology, University of Utah, Salt Lake City, UT, USA
| | - Alexandra L. Terrill
- Department of Occupational & Recreational Therapy, College of Health, University of Utah, Salt Lake City, UT, USA
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Dassel KB, Felsted K, Eaton J. THE INFLUENCE OF REVISING AN ONLINE GERONTOLOGY PROGRAM ON THE STUDENT EXPERIENCE. Innov Aging 2019. [PMCID: PMC6841445 DOI: 10.1093/geroni/igz038.235] [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
The University of Utah’s Gerontology Interdisciplinary Program (UUGIP), a fully online program recently aligned all courses to meet the 2014 Academy of Gerontology in Higher Education (AGHE) “Gerontology Competencies for Undergraduate and Graduate Education” and to meet best practices in online teaching. These efforts led to the GIP Masters of Science program being recognized in 2017 by AGHE as a Program of Merit as well as a publication in the AGHE Journal of Gerontology & Geriatrics Education (Dassel, Eaton, & Felsted, 2018). In an effort to further this work, we analyzed student evaluations in core Master of Science program courses prior to and following these program revisions, assessed by qualitative and quantitative evaluation data from two semesters immediately prior and two semesters immediately following revisions. This presentation will discuss results, implications, and future applications of this analysis.
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Affiliation(s)
- Kara B Dassel
- University of Utah, Salt Lake City, Utah, United States
| | - Katarina Felsted
- University of Utah College of Nursing, Salt Lake City, Utah, United States
| | - Jacqueline Eaton
- University of Utah College of Nursing, Salt Lake City, Utah, United States
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Dassel KB, Supiano K, Utz R, Bybee S, Iacob E. THE LEAD GUIDE: LIFE PLANNING IN EARLY ALZHEIMER’S AND DEMENTIA. Innov Aging 2019. [PMCID: PMC6840935 DOI: 10.1093/geroni/igz038.004] [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: 11/13/2022] Open
Abstract
Abstract
To address the characteristics of Alzheimer’s disease and related dementias (ADRD) that complicate end-of-life (EOL), we created and validated a dementia-specific EOL planning instrument. This instrument can be used to facilitate discussions and provide documentation of EOL values and care preferences prior to loss of decisional capacity. Instrument development used a mixed-method design that included: a) conducting a series of focus groups (healthy adults, persons with early-stage ADRD, and dementia caregivers) to develop and confirm content, comprehensiveness, and usability, b) evaluation by content experts to verify instrument utility in clinical practice; and c) conducting a national survey of healthy older adults and adults with early-stage ADRD to evaluate instrument psychometric properties. We describe the expansion of the instrument from survey tool into a user-friendly guide: “The LEAD Guide” or Life-Planning in Early Alzheimer’s and Dementias Guide. We describe the utility of the LEAD Guide for persons planning ahead for the possibility of ADRD, those with MCI and their families, for providers to use with patients and families, and for researchers studying the EOL preferences and values of persons in these populations. Instructions specific to each user group are health literacy appropriate, and include a glossary of terms. Age-friendly graphic design and availability in both print and e-versions enhance utility. The LEAD Guide can be utilized to help inform EOL care decisions and ensure that they align with the patient’s values and may serve as the basis of an intervention to support choice in persons with dementia.
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Affiliation(s)
- Kara B Dassel
- University of Utah, Salt Lake City, Utah, United States
| | | | - Rebecca Utz
- University of Utah, Salt Lake City, Utah, United States
| | - Sara Bybee
- University of Utah, Salt Lake City, Utah, United States
| | - Eli Iacob
- University of Utah, Salt Lake City, Utah, United States
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Dassel KB, Rupper R, Supiano K, Andersen T, Butler J, Telonidis J, Edelman LS. GERIATRIC WORKFORCE ENHANCEMENT PROGRAM: EDUCATIONAL OUTCOMES OF DEMENTIA CAREGIVER CONFERENCES IN RURAL UTAH. Innov Aging 2019. [PMCID: PMC6847619 DOI: 10.1093/geroni/igz038.3392] [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
The University of Utah was awarded federal funds to establish a Geriatrics Workforce Enhancement Program (GWEP) focused on integrating geriatric training into 20 long-term care centers across the state of Utah. One specific objective of the GWEP was to: Provide community-based dementia education to 500 community participants from four geographically diverse urban and rural locations. In year four of the project, an interdisciplinary academic and community-based team planned and implemented dementia caregiver conferences in two rural areas in Utah that included American Indian (AI) tribal communities. Educational topics included an overview of dementia, engaging in goals of care discussions, managing caregiver stress, and finding local resources. Demographic surveys and pre-post modified 15-item version of the Alzheimer’s Disease Knowledge Scale (ADKS; Carpenter et al., 2009) were administered. A total of 148 participants attended the conferences. Participants were primarily female (76.6%), white (84.2%), and self-identified as family/informal caregivers (35.0%). Of the participants, 17.8% self-identified as AI. Overall, there were no significant differences on the pre- and post ADKS scores (mean scores of 12.45 and 12.5 out of 15 possible points, respectively). However, AI ADKS mean scores were lower (10.2 and 10.5, respectively; range 9-13) than white participants (12.7 for both, respectively; range 12-13) reflecting a greater need for ADRD education in AI tribal communities. The conferences were well-received with 82.5% of attendees said that the conference met their educational needs and 83.9% reported that the information would improve the type of care they provide to someone with dementia.
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Affiliation(s)
- Kara B Dassel
- University of Utah, Salt Lake City, Utah, United States
| | - Rand Rupper
- University of Utah, Salt Lake City, Utah, United States
| | | | - Troy Andersen
- University of Utah, Salt Lake City, Utah, United States
| | - Jorie Butler
- University of Utah, Salt Lake City, Utah, United States
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Dassel KB, Flattes V, Eaton J, Towsley G, Moyers L, Edelman L. Development of a Gerontology Graduate Certificate in Post-Acute and Long-Term Care. J Gerontol Nurs 2019; 45:47-52. [PMID: 31560076 DOI: 10.3928/00989134-20190825-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 07/23/2019] [Indexed: 11/20/2022]
Abstract
Nurse practitioners (NPs) can provide safe, effective, quality care to older adults in post-acute and long-term care (PALTC) settings. However, there is a paucity of exposure to PALTC settings in most NP educational programs. Therefore, the current authors developed an elective graduate certificate in gerontology with an emphasis in PALTC for NP students. The graduate certificate curriculum was developed by faculty with expertise in nursing and gerontology education. The PALTC certificate comprises 15 credit hours of online didactic courses, 80 leadership hours, 200 clinical hours, and a scholarly project dedicated to PALTC. Completion of a graduate certificate in PALTC is a novel model for preparing NP students for practice in PALTC settings. The current article serves as a framework for other programs to reference as they develop individualized graduate certificate PALTC programs in their academic institutions. [Journal of Gerontological Nursing, 45(10), 47-52.].
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Supiano KP, McGee N, Dassel KB, Utz R. A Comparison of the Influence of Anticipated Death Trajectory and Personal Values on End-of-Life Care Preferences: A Qualitative Analysis. Clin Gerontol 2019; 42:247-258. [PMID: 28990872 DOI: 10.1080/07317115.2017.1365796] [Citation(s) in RCA: 5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES We examined anticipated preferences for end-of-life (EOL) care in healthy older adults in the context of various terminal disease scenarios to explore the relationship between personal values and diseases and conditions that would influence EOL care choices. METHODS Qualitative Descriptive Analysis was used to derive themes and the relationship between EOL preference themes and personal value themes in 365 respondents in a national sample of healthy older adults who completed a survey on their anticipated preferences for end-of-life (EOL) care. RESULTS Reluctance to burden close others was the most frequently voiced personal value across all conditions affecting EOL preferences, followed by the personal value of quality of life. Concern about whether one's wishes would be honored was more commonly voiced in the context of hypothetical, prospective terminal cancer than in neurological conditions. Respondents who voiced desire for autonomy in how they would die clearly attributed extreme pain as the primary influence on EOL preferences. CONCLUSIONS Comprehensive assessment of patient personal values should include consideration of particular chronic disease scenarios and death trajectories to fully inform EoL preferences. CLINICAL IMPLICATIONS Because personal values do influence EOL preferences, care should be taken to ascertain patient values when presenting diagnoses, prognoses, and treatment options. In particular, patients and families of patients with progressive neurological diseases will likely face a time when the patient cannot self-represent EOL wishes. Early discussion of values and preferences, particularly in the context of cognitive disease is vital to assure patient-directed care.
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Affiliation(s)
| | - Nancy McGee
- a College of Nursing , University of Utah , Salt Lake City , Utah , USA.,b University of Utah , Salt Lake City , Utah , USA
| | - Kara B Dassel
- a College of Nursing , University of Utah , Salt Lake City , Utah , USA
| | - Rebecca Utz
- a College of Nursing , University of Utah , Salt Lake City , Utah , USA.,c Department of Sociology , University of Utah , Salt Lake City , Utah , USA
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Abstract
A better understanding of social environments will benefit facilitation of social cultures within senior housing communities. Social cliques naturally form among groups of people, particularly those living in close proximity. Research has shown that often older adults experience stigma based upon their health status and are excluded from social groups. This study examined residents' perceptions of life in senior housing, social stigma, and cliques. Forty-eight residents from two types of senior housing communities participated in the study. Qualitative thematic coding was used to analyze responses to open-ended interview questions. Overall, residents reported satisfaction with the community and their privacy and reported difficulties with distance from family, caregiving, and bereavement. The majority were able to identify cliques, defining them based upon common interests, health status, and shared histories. The most salient finding was that while social cliques existed they were not a source of dissatisfaction or stigma.
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Affiliation(s)
- Heidi H Ewen
- University of Indianapolis, University of Georgia
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Dassel KB, Supiano K, Utz R, Bybee S. DEVELOPMENT OF AN END-OF-LIFE PLANNING TOOL SPECIFIC TO PERSONS WITH DEMENTIA. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1630] [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: 11/13/2022] Open
Affiliation(s)
- K B Dassel
- University of Utah College of Nursing, Pepper Pike, Ohio, United States
| | - K Supiano
- University of Utah, College of Nursing, Salt Lake City, UT
| | - R Utz
- University of Utah, College of Social and Behavioral Sciences, Salt Lake City, UT
| | - S Bybee
- University of Utah, College of Nursing, Salt Lake City, UT
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13
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Dassel KB. Caregiving: The Need For A Modern Paradigm. The Gerontologist 2018. [DOI: 10.1093/geront/gny057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Dassel KB, Utz R, Supiano K, McGee N, Latimer S. The Influence of Hypothetical Death Scenarios on Multidimensional End-of-Life Care Preferences. Am J Hosp Palliat Care 2016; 35:52-59. [DOI: 10.1177/1049909116680990] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Differences in end-of-life (EOL) care preferences (eg, location of death, use of life-sustaining treatments, openness to hastening death, etc) based on hypothetical death scenarios and associated physical and/or cognitive losses have yet to be investigated within the palliative care literature. Aim: The purpose of this study was to explore the multidimensional EOL care preferences in relation to 3 different hypothetical death scenarios: pancreatic cancer (acute death), Alzheimer disease (gradual death), and congestive heart failure (intermittent death). Design: General linear mixed-effects regression models estimated whether multidimensional EOL preferences differed under each of the hypothetical death scenarios; all models controlled for personal experience and familiarity with the disease, presence of an advance directive, religiosity, health-related quality of life, and relevant demographic characteristics. Setting/Participants: A national sample of healthy adults aged 50 years and older (N = 517) completed electronic surveys detailing their multidimensional preferences for EOL care for each hypothetical death scenario. Results: The average age of the participants was 60.1 years (standard deviation = 7.6), 74.7% were female, and 66.1% had a college or postgraduate degree. Results revealed significant differences in multidimensional care preferences between hypothetical death scenarios related to preferences for location of death (ie, home vs medical facility) and preferences for life-prolonging treatment options. Significant covariates of participants’ multidimensional EOL care preferences included age, sex, health-related quality of life, and religiosity. Conclusion: Our hypothesis that multidimensional EOL care preferences would differ based on hypothetical death scenarios was partially supported and suggests the need for disease-specific EOL care discussions.
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Affiliation(s)
- Kara B. Dassel
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | - Rebecca Utz
- College of Social and Behavioral Science, University of Utah, Salt Lake City, UT, USA
| | | | - Nancy McGee
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | - Seth Latimer
- College of Nursing, University of Utah, Salt Lake City, UT, USA
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Braden BB, Dassel KB, Bimonte-Nelson HA, O'Rourke HP, Connor DJ, Moorhous S, Sabbagh MN, Caselli RJ, Baxter LC. Sex and post-menopause hormone therapy effects on hippocampal volume and verbal memory. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn 2016; 24:227-246. [PMID: 27263667 DOI: 10.1080/13825585.2016.1182962] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Many studies suggest sex differences in memory and hippocampal size, and that hormone therapy (HT) may positively affect these measures in women; however, the parameters of HT use that most likely confer benefits are debated. We evaluated the impact of sex and postmenopausal HT use on verbal learning and memory and hippocampal size in 94 cognitively intact women and 49 men. Using analysis of covariance that controlled for age and education, women had better total word learning and delayed verbal memory performance than men. HT analyses showed that non-HT users performed similarly to men, while HT users performed better than men in Delayed Memory regardless of whether use was current or in the past. Women had larger hippocampal volumes than men regardless of whether they were HT users. Using univariate linear models, we assessed group differences in the predictive value of hippocampal volumes for verbal learning and memory. Hippocampal size significantly predicted memory performance for men and non-HT users, but not for HT users. This lack of relationship between hippocampal size and verbal learning and memory performance in HT users suggests HT use may impact memory through extra-hippocampal neural systems.
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Affiliation(s)
- B Blair Braden
- a Department of Neuropsychology , Barrow Neurological Institute , Phoenix , AZ , USA
| | - Kara B Dassel
- a Department of Neuropsychology , Barrow Neurological Institute , Phoenix , AZ , USA
| | | | - Holly P O'Rourke
- b Department of Psychology , Arizona State University , Tempe , AZ , USA
| | - Donald J Connor
- c The Cleo Roberts Center for Clinical Research, Banner Sun Health Research Institute , Sun City , AZ , USA
| | - Sallie Moorhous
- a Department of Neuropsychology , Barrow Neurological Institute , Phoenix , AZ , USA
| | - Marwan N Sabbagh
- c The Cleo Roberts Center for Clinical Research, Banner Sun Health Research Institute , Sun City , AZ , USA
| | - Richard J Caselli
- d Department of Neurology , Mayo Clinic Arizona , Scottsdale , AZ , USA
| | - Leslie C Baxter
- a Department of Neuropsychology , Barrow Neurological Institute , Phoenix , AZ , USA
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Dassel KB, Carr DC. Does Dementia Caregiving Accelerate Frailty? Findings From the Health and Retirement Study. Gerontologist 2014; 56:444-50. [PMID: 25161263 DOI: 10.1093/geront/gnu078] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [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: 02/27/2014] [Accepted: 06/19/2014] [Indexed: 11/12/2022] Open
Abstract
PURPOSE OF THE STUDY Numerous studies have discovered negative health consequences associated with spousal caregiving at the end of life; however, little is known about how care-recipient cognitive status impacts caregiver health outcomes, specifically in the area of frailty, and whether health consequences remain over time. This study examines differences in frailty between spousal caregivers of persons with and without a dementia diagnosis. DESIGN AND METHODS Using 7 biannual waves of the Health and Retirement Study data (1998-2010), we examined odds of becoming frailer among surviving spouses of individuals who died between 2000 and 2010 (N = 1,246) with and without dementia. To assess increased frailty, we used a Frailty Index, which assesses chronic diseases, mobility, functional status, depressive symptoms, and subjective health. Logistic regression was used to examine the relationship between care-recipient cognitive status and whether, compared with the wave prior to death of the care-recipient, spousal caregivers were frailer: (1) in the wave the death was reported and (2) 2 years after the death was reported. RESULTS Dementia caregivers had 40.5% higher odds of experiencing increased frailty by the time the death was reported and 90% higher odds in the following wave compared with non-dementia caregivers. IMPLICATIONS Given our findings, we discuss public health implications regarding the health and well-being of caregivers of persons with dementia. Given projected increases in dementia diagnoses as the population ages, we propose a need for interventions that provide enhanced support for dementia caregivers.
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Affiliation(s)
- Kara B Dassel
- Gerontology Interdisciplinary Program, University of Utah, Salt Lake City.
| | - Dawn C Carr
- Stanford Center on Longevity, Stanford University, California
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Locke DE, Dassel KB, Hall G, Baxter LC, Woodruff BK, Hoffman Snyder C, Miller BL, Caselli RJ. Assessment of patient and caregiver experiences of dementia-related symptoms: development of the Multidimensional Assessment of Neurodegenerative Symptoms questionnaire. Dement Geriatr Cogn Disord 2009; 27:260-72. [PMID: 19246911 PMCID: PMC2743176 DOI: 10.1159/000203890] [Citation(s) in RCA: 8] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/09/2008] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND To provide preliminary validation data on a self- or informant-report multidimensional questionnaire of symptoms associated with neurodegenerative disorders. METHODS Participants from 2 trials (n = 125), the Arizona APOE Cohort and the Arizona Alzheimer's Disease Center, completed the Multidimensional Assessment of Neurodegenerative Symptoms questionnaire (MANS) and other related measures. RESULTS Measures of central tendency are provided for the sample as a whole and by cognitive status. Internal consistency of the MANS is excellent (alpha = 0.98). Factor analysis suggests 4 factors. Correlational analyses support the construct validity of the MANS with moderate to high (r = 0.54-0.87) correlations between the MANS and measures of mood, cognition and daily functioning. CONCLUSION Results provide initial support for the MANS as a brief measure that is a reliable and valid indicator of cognitive, personality, functional and motor symptoms potentially related to neurodegenerative etiologies. Further research with the MANS is warranted.
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Affiliation(s)
- Dona E.C. Locke
- Division of Psychology, University of California, San Francisco, Calif., USA,*Dona E.C. Locke, PhD, Division of Psychology, Mayo Clinic, 13400 E. Shea Boulevard, Scottsdale, AZ 85259 (USA), Tel. +1 480 301 8297, Fax +1 480 301 6258, E-Mail
| | - Kara B. Dassel
- Barrow Neurological Institute, University of California, San Francisco, Calif., USA
| | - Geri Hall
- Banner Alzheimer's Institute, Phoenix, Ariz., University of California, San Francisco, Calif., USA
| | - Leslie C. Baxter
- Barrow Neurological Institute, University of California, San Francisco, Calif., USA
| | - Bryan K. Woodruff
- Division of Psychology, University of California, San Francisco, Calif., USA
| | | | - Bruce L. Miller
- Department of Neurology and Memory and Aging Center, University of California, San Francisco, Calif., USA
| | - Richard J. Caselli
- Department of Neurology, Mayo Clinic, Scottsdale, Ariz., University of California, San Francisco, Calif., USA
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Dassel KB. Alzheimer's Disease and the Disablement Process: Directions for Future Research. Physical & Occupational Therapy In Geriatrics 2009. [DOI: 10.1080/02703180902856240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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