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Gonçalves-Pereira M, Marques MJ, F Alves R, Verdelho A, Balsinha C, Alves L, Alves Reis T, Woods B, De Vugt M, Verhey F. Needs for Care, Service Use and Quality of Life in Dementia: 12-Month Follow-Up of the Actifcare Study in Portugal. ACTA MEDICA PORT 2024. [PMID: 38457746 DOI: 10.20344/amp.20427] [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] [Received: 07/21/2023] [Accepted: 11/02/2023] [Indexed: 03/10/2024]
Abstract
INTRODUCTION The intermediate stages of dementia are relatively under-researched, including in Portugal. The Actifcare (ACcess to TImely Formal Care) EU-JPND project studied people with mild-moderate dementia, namely their needs, access to and use of community services (e.g., day centers, home support). In our baseline assessment of the Portuguese Actifcare cohort, the unmet needs of some participants would call for formal support, which was not always accessible or used. We now report the main results of the 12-month follow-up, analyzing changes in needs, service (non)use, quality of life and related variables. METHODS This was a longitudinal, observational study using a convenience sample of 54 dyads of people with dementia and their family carers. Our main outcomes were the Camberwell Assessment of Need for the Elderly (CANE) and the Resources Utilization in Dementia. Clinical-functional, quality of life, psychological distress and caregiving-related assessments were also used. RESULTS At follow-up, the cognitive and functional status of people with dementia declined (p < 0.001), and their neuropsychiatric symptoms increased (p = 0.033). Considering CANE interviewers' ratings, the total needs of people with dementia increased at follow-up (p < 0.001) but not the unmet needs. Quality of life was overall stable. The use of formal care did not increase significantly, but informal care did in some domains. Carers' depressive symptoms increased (p = 0.030) and perseverance time decreased (p = 0.045). However, carers' psychological distress unmet needs were lower (p = 0.007), and their stress and quality of life remained stable. CONCLUSION People with dementia displayed complex biopsychosocial unmet needs. Their cognitive-functional decline over one year was not accompanied by a corresponding increase in any pattern of unmet need, nor of service use. Reliance on informal care (namely supervision) may have contributed to this. Caregiving-related outcomes evolved according to different trends, although stability was almost the rule. Primary carers were even more present at follow-up, without an apparently heavier toll on their own needs, burden, and quality of life. Overall, this longitudinal study comprehensively assessed Portuguese community-dwelling people with dementia. Despite the lack of generalizability, participants' needs remained overall stable and partly unmet over one year. Longer follow-up periods are needed to understand such complex processes.
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Affiliation(s)
- Manuel Gonçalves-Pereira
- Faculdade de Ciências Médicas | NOVA Medical School. Universidade NOVA de Lisboa. Lisbon; Comprehensive Health Research Center (CHRC). Laboratório Associado REAL. Universidade NOVA de Lisboa. Lisbon. Portugal
| | - Maria J Marques
- Comprehensive Health Research Center (CHRC). Laboratório Associado REAL. Universidade NOVA de Lisboa. Lisbon; NOVA School of Public Health. Universidade NOVA de Lisboa. Lisbon. Portugal
| | - Regina F Alves
- NOVA School of Public Health. Universidade NOVA de Lisboa. Lisbon. Portugal
| | - Ana Verdelho
- Faculdade de Medicina da Universidade de Lisboa. Centro Hospitalar Universitário Lisboa Norte. Instituto de Saúde Ambiental. Lisbon. Portugal
| | - Conceição Balsinha
- Faculdade de Ciências Médicas | NOVA Medical School. Universidade NOVA de Lisboa. Lisbon; Comprehensive Health Research Center (CHRC). Laboratório Associado REAL. Universidade NOVA de Lisboa. Lisbon. Portugal
| | - Luísa Alves
- Faculdade de Ciências Médicas | NOVA Medical School. Universidade NOVA de Lisboa. Lisbon; Hospital de Egas Moniz. Centro Hospitalar de Lisboa Ocidental. Lisbon. Portugal
| | - Teresa Alves Reis
- Comprehensive Health Research Center (CHRC). Laboratório Associado REAL. Universidade NOVA de Lisboa. Lisbon; Hospital do Espírito Santo. Portugal
| | - Bob Woods
- Dementia Services Development Centre Wales. Bangor University. Bangor
| | | | - Frans Verhey
- Alzheimer Centrum Limburg. Maastricht University. Maastricht
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Marques MJ, Tan EYL, Woods B, Jelley H, Kerpershoek L, Hopper L, Irving K, Bieber A, Stephan A, Sköldunger A, Sjölund BM, Selbaek G, Røsvik J, Zanetti O, Portolani DM, Marôco J, de Vugt M, Verhey F, Gonçalves-Pereira M. Trajectories of relationship quality in dementia: a longitudinal study in eight European countries. Aging Ment Health 2022; 26:2307-2315. [PMID: 34486887 DOI: 10.1080/13607863.2021.1969641] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Relationship quality (RQ) between a person with dementia and a family carer may influence their health and quality of life. However, evidence regarding its course and influencing factors is limited. We aimed to explore RQ trajectories in dementia, and identify predictors of change. METHODS We analysed longitudinal data from a cohort of 350 community-dwelling people with dementia and their informal carers, participating in the Actifcare study in eight European countries. The Positive Affect Index, rated separately by both people with dementia and their carers, assessed RQ. Other measures included the Neuropsychiatric Inventory Questionnaire (regarding persons with dementia), and the Relative Stress Scale, Sense of Coherence Scale and Lubben Social Network Scale (for carers). Trajectories and influencing factors were explored applying a latent growth model (LGM). RESULTS RQ in the group of carers declined over 1 year, but RQ scores for the persons with dementia did not change. Higher stress in carers negatively influenced their baseline RQ ratings. Carer sense of coherence and being a spouse were associated with more positive baseline RQ carer assessments. Higher levels of neuropsychiatric symptoms were linked to decline in carers' RQ, whereas social support was associated with more positive RQ trajectories. CONCLUSION This study provides a valuable insight into the course of RQ. LGM proved useful to explore the factors that influence RQ trajectories and variability within- and between-persons. Our findings emphasise the importance of carer-perceived social support and sense of coherence, and of reducing neuropsychiatric symptoms, in maintaining a good RQ.
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Affiliation(s)
- Maria J Marques
- Comprehensive Health Research Center (CHRC), CEDOC, Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Eva Y L Tan
- Department of Psychiatry and Neuropsychology and Alzheimer Centre Limburg, School for Mental Health and Neurosciences, Maastricht University, Maastricht, The Netherlands.,Reinier van Arkel Mental Health Institute, 's-Hertogenbosch, The Netherlands
| | - Bob Woods
- Dementia Services Development Centre (DSDC) Wales, School of Health Sciences, Bangor University, Bangor, UK
| | - Hannah Jelley
- Dementia Services Development Centre (DSDC) Wales, School of Health Sciences, Bangor University, Bangor, UK
| | - Liselot Kerpershoek
- Department of Psychiatry and Neuropsychology and Alzheimer Centre Limburg, School for Mental Health and Neurosciences, Maastricht University, Maastricht, The Netherlands
| | - Louise Hopper
- School of Psychology, Dublin City University, Dublin, Ireland
| | - Kate Irving
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
| | - Anja Bieber
- Institute for Health and Nursing Science, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Astrid Stephan
- Institute for Health and Nursing Science, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Anders Sköldunger
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Britt-Marie Sjölund
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Geir Selbaek
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg; Department of Geriatric Medicine, Oslo University Hospital, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Janne Røsvik
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg; Department of Geriatric Medicine, Oslo University Hospital, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Orazio Zanetti
- Alzheimer's Research Unit-Memory Clinic, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | | | - João Marôco
- William James Center for Research, Instituto Superior de Psicologia Aplicada - Instituto Universitário (ISPA-IU), Lisboa, Portugal
| | - Marjolein de Vugt
- Department of Psychiatry and Neuropsychology and Alzheimer Centre Limburg, School for Mental Health and Neurosciences, Maastricht University, Maastricht, The Netherlands
| | - Frans Verhey
- Department of Psychiatry and Neuropsychology and Alzheimer Centre Limburg, School for Mental Health and Neurosciences, Maastricht University, Maastricht, The Netherlands
| | - Manuel Gonçalves-Pereira
- Comprehensive Health Research Center (CHRC), CEDOC, Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
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Isaac J, Heleno B, Gonçalves-Pereira M. Carta ao Editor Sobre o Artigo “Saúde Mental nos Cuidados de Saúde Primários: Desafios e Oportunidades em Contexto de Pandemia”: Questões Sobre a Doença Mental Grave. ACTA MEDICA PORT 2022; 35:407-408. [DOI: 10.20344/amp.17930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 02/09/2022] [Indexed: 11/20/2022]
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Michelet M, Selbaek G, Strand BH, Lund A, Engedal K, Bieber A, Gonçalves-Pereira M, Hopper L, Irving K, Jelley H, Marques MJ, Orrell M, Portolani DM, Sjölund BM, Sköldunger A, Stephan A, Verhey F, de Vugt M, Wolfs C, Woods B, Zanetti O, Bergh S. Associations between unmet needs for daytime activities and company and scores on the Neuropsychiatric Inventory-Questionnaire in people with dementia: a longitudinal study. Aging Ment Health 2022; 26:725-734. [PMID: 33860718 DOI: 10.1080/13607863.2021.1910792] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 10/21/2022]
Abstract
OBJECTIVES To examine prospectively the association between unmet needs for daytime activities and company and behavioural and psychological symptoms of dementia. METHODS We included 451 people with mild or moderate dementia, from eight European countries, who were assessed three times over 12 months. Unmet needs were measured with the Camberwell Assessment of Need for the Elderly. Three sub-syndromes of the Neuropsychiatric Inventory-Questionnaire were regressed, one-by-one, against unmet needs for daytime activities and company, adjusting for demographic and clinical-functional covariates. RESULTS Unmet needs for daytime activities were associated with more affective symptoms at baseline, six and twelve months, mean 0.74 (p < 0.001), 0.76 (p < 0.001) and 0.78 (p = 0.001) points higher score respectively, and with more psychotic symptoms at baseline (mean 0.39 points, p = 0.007) and at six months follow-up (mean 0.31 points, p = 0.006). Unmet needs for company were associated with more affective symptoms at baseline, six and twelve months, mean 0.44 (p = 0.033), 0.67 (p < 0.001) and 0.91 (p < 0.001) points higher score respectively, and with more psychotic symptoms at baseline (mean 0.40 points, p = 0.005) and at six months (mean 0.35 points, p = 0.002) follow-up. CONCLUSION Interventions to reduce unmet needs for daytime activities and company could reduce affective and psychotic symptoms in people with dementia.
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Affiliation(s)
- Mona Michelet
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Geir Selbaek
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Bjørn Heine Strand
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Anne Lund
- Faculty of Health Sciences, Department of Occupational Therapy, Prosthetics and Orthotics, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Knut Engedal
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Anja Bieber
- Medical Faculty, Institute of Health and Nursing Sciences, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Manuel Gonçalves-Pereira
- Comprehensive Health Research Centre (CHRC), CEDOC, Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Louise Hopper
- School of Psychology, Dublin City University, Dublin, Ireland
| | - Kate Irving
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
| | - Hannah Jelley
- Dementia Services Development Centre, Bangor University, Bangor, UK
| | - Maria J Marques
- Comprehensive Health Research Centre (CHRC), CEDOC, Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Martin Orrell
- Institute of Mental Health, Nottingham University, Nottingham, UK
| | - Daniel M Portolani
- IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Britt-Marie Sjölund
- Aging Research Center (ARC), Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet and Stockholm University, Stockholm, Sweden.,Faculty of Health and Occupational Studies, Department Caring Sciences, University of Gävle, Gävle, Sweden
| | - Anders Sköldunger
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden
| | - Astrid Stephan
- Medical Faculty, Institute of Health and Nursing Sciences, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Frans Verhey
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marjolein de Vugt
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Claire Wolfs
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Bob Woods
- Dementia Services Development Centre, Bangor University, Bangor, UK
| | - Orazio Zanetti
- IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Sverre Bergh
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
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Verdelho A, Correia M, Ferro JM, Madureira S, Vilela P, Rodrigues M, Borges M, Oliveira V, Santos AC, Gonçalves-Pereira M, Santa-Clara H. Physical Activity Self-Report Is Not Reliable Among Subjects with Mild Vascular Cognitive Impairment: The AFIVASC Study. J Alzheimers Dis 2022; 87:405-414. [PMID: 35275531 DOI: 10.3233/jad-215381] [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 The World Health Organization (WHO) recommends a minimum of 150 minutes of moderate physical activity per week. Adherence to these recommendations is difficult to assess. OBJECTIVE We aimed to evaluate the validity of self-reported physical activity in mild vascular cognitive impairment (mVCI) and whether physical activity was associated with cognitive status, by using baseline data from a randomized controlled trial. METHODS A hundred and four subjects with mVCI were included (mean age 72 years; 51% women). Subjects underwent neurological, physical, and comprehensive neuropsychological assessments. Adherence to WHO physical activity recommendations was evaluated using both self-reported information and objective measures (accelerometry). RESULTS There was poor agreement (kappa = 0.106) between self-report of following WHO recommendations and actually fulfilling them according to accelerometry. Only 16.6% of participants reported following WHO recommendations and displayed compatible values according to the accelerometer. Participants whose accelerometry values confirmed adherence to WHO recommendations had better performance in a global measure of cognition, attention, and mental speed processing. In multiple regression analyses, education and accelerometry values in accordance with WHO recommendations were independently associated with the global measure of cognition, attention, and processing speed, controlling for sex, age, and depressive symptoms. Accelerometry results were not associated with memory and executive functions. CONCLUSION In this sample of mVCI subjects, self-reported physical activity displayed poor agreement with accelerometry values, suggesting that objective measures of physical activity are preferable. Physical activity (performed, at least, according to WHO recommendations) was associated with better cognitive performance overall.
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Affiliation(s)
- Ana Verdelho
- Department of Neurosciences and Mental Health, CHLN-Hospital de Santa Maria, Lisbon, Portugal.,Instituto de Medicina Molecular João Lobo Antunes - IMM, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Instituto de Saúde Ambiental - ISAMB, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Manuel Correia
- Neurology Service, Hospital de Santo António, Centro Hospitalar do Porto and Instituto de Ciências Biomédicas Abel Salazar (ICBAS), University of Porto, Portugal
| | - José Manuel Ferro
- Department of Neurosciences and Mental Health, CHLN-Hospital de Santa Maria, Lisbon, Portugal.,Instituto de Medicina Molecular João Lobo Antunes - IMM, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Sofia Madureira
- Instituto de Medicina Molecular João Lobo Antunes - IMM, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Pedro Vilela
- Neuroradiology Department, Hospital da Luz, Lisboa, Portugal
| | - Mário Rodrigues
- Instituto de Medicina Molecular João Lobo Antunes - IMM, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Mariana Borges
- Instituto de Medicina Molecular João Lobo Antunes - IMM, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Vanessa Oliveira
- Neurology Service, Hospital de Santo António, Centro Hospitalar do Porto and Instituto de Ciências Biomédicas Abel Salazar (ICBAS), University of Porto, Portugal
| | - Ana Catarina Santos
- Instituto de Medicina Molecular João Lobo Antunes - IMM, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Manuel Gonçalves-Pereira
- Comprehensive Health Research Centre (CHRC), CEDOC, NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Helena Santa-Clara
- Exercise and Health Laboratory, Faculdade de Motricidade Humana, Centro Interdisciplinar de Estudo da Performance Humana -CIPER, Universidade de Lisboa, Lisboa, Portugal
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Røsvik J, Michelet M, Engedal K, Bergh S, Bieber A, Gonçalves-Pereira M, Portolani DM, Hopper L, Irving K, Jelley H, Kerpershoek L, Meyer G, Marques MJ, Sjølund BM, Sköldunger A, Stephan A, Verhey F, de Vugt M, Woods B, Wolfs C, Zanetti O, Selbaek G. Development of best practice recommendations to enhance access to and use of formal community care services for people with dementia in Europe: a Delphi process conducted by the Actifcare project. Aging Ment Health 2021; 25:2298-2309. [PMID: 33030026 DOI: 10.1080/13607863.2020.1822286] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 10/23/2022]
Abstract
OBJECTIVES Home-dwelling people with dementia and their informal carers experience barriers impeding access to community care services. This study is a part of the Actifcare project where eight countries participated. The aim was to achieve consensus on best practice recommendations for enhancing access to and use of formal community care services. METHOD A Delphi consensus process was conducted. A total of 48 professional experts, 14 people with dementia and 20 informal carers rated the importance of 72 statements on a 7-point Likert scale. Consensus was based on the median and level of dispersion. RESULTS Sixty-two statements reached consensus, resulting in three categories of recommendations. An appointed contact person was central in Recommendations to enhance access. Coordination and flexibility in setting and type of services were among the Recommendations to enhance use. Training of health care personnel and person-centred care were central Recommendations that can facilitate access or use indirectly. CONCLUSION The Actifcare Best Practice Recommendations suggest practical measures that can be taken by decision makers to enhance access and use of community care services, and thereby enhance quality of care and quality of life for home dwelling people with dementia and their informal carers.
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Affiliation(s)
- Janne Røsvik
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Mona Michelet
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Knut Engedal
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Sverre Bergh
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway
| | - Anja Bieber
- Institute for Health and Nursing Science, Martin Luther University, Halle-Wittenberg, Halle (Saale), Germany
| | - Manuel Gonçalves-Pereira
- Comprehensive Health Research Center/ CEDOC, Nova Medical School-Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | | | - Louise Hopper
- School of Psychology, Dublin City University, Dublin, Ireland
| | - Kate Irving
- School of Nursing Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
| | - Hannah Jelley
- Dementia Services Development Centre Wales, Bangor University, Bangor, UK
| | - Liselot Kerpershoek
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Gabriele Meyer
- Institute for Health and Nursing Science, Martin Luther University, Halle-Wittenberg, Halle (Saale), Germany
| | - Maria J Marques
- Comprehensive Health Research Center/ CEDOC, Nova Medical School-Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Britt-Marie Sjølund
- Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, University of Gävle, Gävle, Sweden
| | - Anders Sköldunger
- Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, University of Gävle, Gävle, Sweden
| | - Astrid Stephan
- Institute for Health and Nursing Science, Martin Luther University, Halle-Wittenberg, Halle (Saale), Germany
| | - Frans Verhey
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marjolein de Vugt
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Bob Woods
- Dementia Services Development Centre Wales, Bangor University, Bangor, UK
| | - Claire Wolfs
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Orazio Zanetti
- IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia
| | - Geir Selbaek
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Gonçalves-Pereira M, Verdelho A, Prina M, Marques M, Xavier M. How Many People Live with Dementia in Portugal? A Discussion Paper of National Estimates. Port J Public Health 2021. [DOI: 10.1159/000516503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Dementia poses major public health challenges, and high-quality epidemiological data are needed for service planning. Published estimates of numbers of people with dementia in Portugal have been based, in most cases, on prevalence rates derived from international studies or expert consensus. As in many other countries, Portuguese community prevalence studies’ results are nongeneralizable to a country level. Moreover, their prevalence estimates differ (not surprisingly, owing to different methodologies, e.g., design, sampling, and diagnostic criteria). Regardless, the Portuguese 10/66 Dementia Research Group (10/66 DRG) population-based survey fulfilled 10 out of 11 Alzheimer’s Disease International quality criteria for prevalence studies. It relied on cross-culturally validated methods, fostering a wide comparability of results. Therefore, we can provide rough estimates of 217,549 community dwellers with dementia in Portugal according to the 10/66 DRG criteria (that would be only 85,162 according to DSM-IV criteria). This refers to people aged 65 years or older who are not institutionalized. Although broadly consistent with international projections, these estimates must be cautiously interpreted. Particularly in the context of scarce funding, which will probably last for years, we need more efficient, evidence-based dementia policies. Concerning further epidemiological studies, high-quality methods are needed but also their comparability potential should be improved at national and international levels. Most of all, fund allocation in Portugal should now privilege routine dementia information systems in both health and social services.
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Balsinha C, Gonçalves-Pereira M, Iliffe S. Comment on: Family caregiver assessment in primary care: How to strengthen the healthcare triad? J Am Geriatr Soc 2021; 69:2361-2362. [PMID: 34019702 DOI: 10.1111/jgs.17276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 03/10/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Conceição Balsinha
- Comprehensive Health Research Centre, CEDOC, NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Manuel Gonçalves-Pereira
- Comprehensive Health Research Centre, CEDOC, NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Steve Iliffe
- Research Dept of Primary Care & Population Health, University College London, London, UK
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Rombach I, Iftikhar M, Jhuti GS, Gustavsson A, Lecomte P, Belger M, Handels R, Castro Sanchez AY, Kors J, Hopper L, Olde Rikkert M, Selbæk G, Stephan A, Sikkes SAM, Woods B, Gonçalves-Pereira M, Zanetti O, Ramakers IHGB, Verhey FRJ, Gallacher J, Actifcare Consortium, LeARN Consortium, Landeiro F, Gray AM. Obtaining EQ-5D-5L utilities from the disease specific quality of life Alzheimer's disease scale: development and results from a mapping study. Qual Life Res 2021; 30:867-879. [PMID: 33068236 PMCID: PMC7952290 DOI: 10.1007/s11136-020-02670-8] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2020] [Indexed: 11/08/2022]
Abstract
PURPOSE The Quality of Life Alzheimer's Disease Scale (QoL-AD) is commonly used to assess disease specific health-related quality of life (HRQoL) as rated by patients and their carers. For cost-effectiveness analyses, utilities based on the EQ-5D are often required. We report a new mapping algorithm to obtain EQ-5D indices when only QoL-AD data are available. METHODS Different statistical models to estimate utility directly, or responses to individual EQ-5D questions (response mapping) from QoL-AD, were trialled for patient-rated and proxy-rated questionnaires. Model performance was assessed by root mean square error and mean absolute error. RESULTS The response model using multinomial regression including age and sex, performed best in both the estimation dataset and an independent dataset. CONCLUSIONS The recommended mapping algorithm allows researchers for the first time to estimate EQ-5D values from QoL-AD data, enabling cost-utility analyses using datasets where the QoL-AD but no utility measures were collected.
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Affiliation(s)
- Ines Rombach
- Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Old Road Campus, Oxford, OX3 7LF, United Kingdom.
| | - Marvi Iftikhar
- Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Old Road Campus, Oxford, OX3 7LF, United Kingdom
| | - Gurleen S Jhuti
- Global Access, Centre of Excellence F.Hoffmann-La Roche Ltd, CH-4070, Basel, Switzerland
| | - Anders Gustavsson
- Quantify Research, Stockholm, 112 21, Sweden
- Division of Neurogeriatrics, Department for Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, 171 64, Sweden
| | - Pascal Lecomte
- Global Head Health Economic Modelling and Methodology, Novartis Pharma AG, 4002, Basel, Switzerland
| | - Mark Belger
- Global Statistical Sciences, Eli Lilly and company, Erl Wood Manor, Windlesham, GU20 6PH, United Kingdom
| | - Ron Handels
- Division of Neurogeriatrics, Department for Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, 171 64, Sweden
- Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, Maastricht University Medical Center, Maastricht, 6200 MD, The Netherlands
| | | | - Jan Kors
- Department of Medical Informatics, Erasmus MC-University Medical Center Rotterdam, Rotterdam, 3015 GD, The Netherlands
| | - Louise Hopper
- School of Psychology, Dublin City University, Dublin 9, Ireland
| | - Marcel Olde Rikkert
- Department of Geriatrics, Radboudumc Alzheimer Center, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, 6525 GA, The Netherlands
| | - Geir Selbæk
- National Advisory Unit of Ageing and Health, Vestfold Hospital Trust, 3103, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, 0372, Norway
- Faculty of Medicine, University of Oslo, Oslo, 0372, Norway
| | - Astrid Stephan
- Institute for Health and Nursing Science, Martin Luther University Halle-Wittenberg, Halle (Saale), 06112, Germany
| | - Sietske A M Sikkes
- Alzheimer Center Amsterdam, Amsterdam University Medical Centers/Amsterdam Neuroscience, Amsterdam, 1007 MB, The Netherlands
| | - Bob Woods
- Dementia Services Development Centre Wales (DSDC), Bangor University, Bangor, LL57 2PZ, United Kingdom
| | - Manuel Gonçalves-Pereira
- Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, 1169-056, Portugal
- CHRC (Comprehensive Health Research Centre), Lisbon, Portugal
| | - Orazio Zanetti
- IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, 25125, Italy
| | - Inez H G B Ramakers
- Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, Maastricht University Medical Center, Maastricht, 6200 MD, The Netherlands
| | - Frans R J Verhey
- Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, Maastricht University Medical Center, Maastricht, 6200 MD, The Netherlands
| | - John Gallacher
- Dementias Platform UK, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, United Kingdom
| | | | | | - Filipa Landeiro
- Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Old Road Campus, Oxford, OX3 7LF, United Kingdom
| | - Alastair M Gray
- Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Old Road Campus, Oxford, OX3 7LF, United Kingdom
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10
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Gonçalves-Pereira M, Zarit SH, Papoila AL, Mateos R. Positive and negative experiences of caregiving in dementia: The role of sense of coherence. Int J Geriatr Psychiatry 2021; 36:360-367. [PMID: 32944997 DOI: 10.1002/gps.5433] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 09/16/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Sense of coherence (SOC) is increasingly recognized as an important health determinant, particularly for mental health. Part of the evidence comes from informal caregivers in diverse clinical conditions. The extent to which SOC influences caregiving outcomes, however, is relatively under-researched in dementia, particularly regarding positive experiences. We analysed the association of SOC with dementia caregivers' subjective burden, psychological distress and positive aspects of care. METHODS/DESIGN This is a secondary analysis of cross-sectional data from the Lisbon study of Families of Persons with Dementia, involving a convenience sample of 99 primary caregivers of community-dwelling patients of neurology and psychiatry services. SOC was assessed with the Orientation for Life Scale. Measures of caregivers' outcomes were: the Zarit Burden Interview, the General Health Questionnaire for psychological distress and the Positive Aspects of Caregiving scale. Analyses controlled for demographics, caregiving arrangements, objective burden, social support, patients' neuropsychiatric symptoms and dementia stage. RESULTS Lower SOC was associated with higher psychological distress (p = 0.001). No significant associations were found for subjective burden (p = 0.081) or positive aspects of caregiving (p = 0.688). Additional analyses showed that lower SOC was associated with less emotional support (p < 0.001) and past psychiatric illness (p = 0.044). CONCLUSIONS These findings support previous research suggesting that SOC is protective for psychological distress, and extend evidence to the positive aspects of care in dementia. The cross-sectional design and small-scale convenience sampling preclude both causality presumptions and generalizability. SOC assessments may be useful to define subgroups of dementia caregivers at risk for anxiety and depression.
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Affiliation(s)
- Manuel Gonçalves-Pereira
- Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal.,Comprehensive Health Research Centre (CHRC), Lisbon, Portugal
| | - Steven H Zarit
- Department of Human Development and Family Studies, Penn State University, University Park, Pennsylvania, USA
| | - Ana L Papoila
- Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal.,Centre of Statistics and its Applications, University of Lisbon (CEAUL), Lisbon, Portugal
| | - Raimundo Mateos
- Department of Psychiatry, University of Santiago de Compostela (USC), Santiago de Compostela, Spain.,Psychogeriatric Unit, CHUS University Hospital, Santiago de Compostela, Spain
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11
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Gonçalves-Pereira M, Marques MJ, Balsinha C. [Persons with Dementia: The Value of Social Health and Primary Health Care]. ACTA MEDICA PORT 2021; 34:169-170. [PMID: 33641709 DOI: 10.20344/amp.15508] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 12/28/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Manuel Gonçalves-Pereira
- Comprehensive Health Research Centre (CHRC). Chronic Diseases Research Center (CEDOC). Faculdade de Ciências Médicas / NOVA Medical School. Universidade Nova de Lisboa. Lisboa. Portugal
| | - Maria J Marques
- Comprehensive Health Research Centre (CHRC). Chronic Diseases Research Center (CEDOC). Faculdade de Ciências Médicas / NOVA Medical School. Universidade Nova de Lisboa. Lisboa. Portugal
| | - Conceição Balsinha
- Comprehensive Health Research Centre (CHRC). Chronic Diseases Research Center (CEDOC). Faculdade de Ciências Médicas / NOVA Medical School. Universidade Nova de Lisboa. Lisboa. Unidade de Saúde Familiar Marginal. Agrupamento de Centros de Saúde de Cascais. São João do Estoril. Portugal
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12
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Balsinha C, Iliffe S, Dias S, Freitas A, Grave J, Gonçalves-Pereira M. What is the present role for general practitioners in dementia care? Experiences of general practitioners, patients and family carers in Portugal. Dementia (London) 2020; 20:1988-2006. [PMID: 33342279 PMCID: PMC8358531 DOI: 10.1177/1471301220977710] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 11/17/2022]
Abstract
Background Governments are being challenged to integrate at least part of dementia care into primary care. However, little is known about the current role of general practitioners (GPs) regarding dementia care, especially in countries that do not have dementia strategies in place. The aim of this study was to explore the experiences of GPs, persons with dementia and their family carers in Portuguese primary care settings, to better understand GPs’ contribution to dementia care. Methods A qualitative interview study of participants recruited from six practices in different social contexts within the Lisbon metropolitan area was carried out. Purposive sampling was used to recruit GPs, persons with dementia and carers. Interviews with GPs explored dementia care comprehensiveness, including satisfactory and challenging aspects. Interviews with patients and carers explored the experience of talking to GPs about cognitive impairments and related difficulties and the type of help received. Thematic analysis of interview transcripts was carried out using the framework approach. Results Five major themes were identified: GPs have a limited contribution to dementia care, the case of advanced dementia, doctor–patient relationships, doctor–carer relationships and management of chronic conditions other than dementia. Conclusion General practitioners seemed to contribute little to dementia care overall, particularly regarding symptom management. The exception was patients with advanced stages of dementia, given that specialists no longer followed them up. Remarkably, GPs seemed to be alone within primary care teams in providing dementia care. These findings strongly suggest that Portuguese primary care is not yet prepared to comply with policy expectations regarding the management of dementia.
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Affiliation(s)
- Conceição Balsinha
- Comprehensive Health Research Centre (CHRC); NOVA Medical School/Faculdade de Ciências Médicas, 50106Universidade Nova de Lisboa, Lisboa, Portugal; 428179Unidade de Saúde Familiar Marginal, São João do Estoril, Portugal
| | - Steve Iliffe
- Research Department of Primary Care & Population Health, University College London, London, UK
| | - Sónia Dias
- Comprehensive Health Research Centre (CHRC); NOVA National School of Public Health, Public Health Research Centre, 50106Universidade NOVA de Lisboa, Portugal
| | - Alexandre Freitas
- NOVA Medical School/Faculdade de Ciências Médicas, 50106Universidade Nova de Lisboa, Lisboa, Portugal; Unidade de Saúde Familiar Ilumina,São Domingos de Rana, Portugal
| | - Joana Grave
- NOVA Medical School/Faculdade de Ciências Médicas, 50106Universidade Nova de Lisboa, Lisboa, Portugal
| | - Manuel Gonçalves-Pereira
- Comprehensive Health Research Centre (CHRC); NOVA Medical School/Faculdade de Ciências Médicas, 50106Universidade Nova de Lisboa, Lisboa, Portugal
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13
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Moura AR, Gonçalves-Pereira M. Letter to the Editor Regarding the Article "Geriatric Assessment of the Portuguese Population Aged 65 and Over Living in the Community: The PEN-3S study". On Clinically Significant Depression and Validity of Cut-off Points. ACTA MEDICA PORT 2020; 33:784-785. [PMID: 33160431 DOI: 10.20344/amp.14789] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 08/24/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Ana Rita Moura
- Comprehensive Health Research Centre (CEDOC). NOVA Medical School / Faculdade de Ciências Médicas. Universidade NOVA de Lisboa. Lisboa; Departamento de Psiquiatria e Saúde Mental. Centro Hospitalar de Lisboa Ocidental. Lisboa. Portugal
| | - Manuel Gonçalves-Pereira
- Comprehensive Health Research Centre (CEDOC). NOVA Medical School / Faculdade de Ciências Médicas. Universidade NOVA de Lisboa. Lisboa. Portugal
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14
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Oliveira D, Jun Otuyama L, Mabunda D, Mandlate F, Gonçalves-Pereira M, Xavier M, Laks J, Ferri CP. Reducing the Number of People with Dementia Through Primary Prevention in Mozambique, Brazil, and Portugal: An Analysis of Population-Based Data. J Alzheimers Dis 2020; 70:S283-S291. [PMID: 30664504 PMCID: PMC6700611 DOI: 10.3233/jad-180636] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 11/18/2022]
Abstract
Background: Most people with dementia live in low- and middle-income countries and little is known about the potential for reducing these numbers by reducing key risk factors. Objective: To investigate the potential for dementia incidence reduction in Brazil, Mozambique, and Portugal (a culturally related, high-income country). Methods: We replicated previously published methods and based on the relative risks from previous studies, we estimated the population-attributable risk (PAR) of dementia in Mozambique, Brazil, and Portugal for seven modifiable risk factors associated with dementia (low educational attainment, physical inactivity, midlife hypertension, midlife obesity, depression, smoking, and diabetes mellitus). The combined PAR was calculated and adjusted for associations between risk factors. The potential for risk factor reduction was assessed by examining the effect of relative reductions of 10% and 20% per decade for each of the risk factors on projections for dementia cases for each decade until 2050. Results: After adjusting for non-independence of risk factors, 24.4%, 32.3%, and 40.1% of dementia cases could be related to seven potentially modifiable risk factors in Mozambique, Brazil, and Portugal, respectively. Reducing the prevalence of each risk factor by 20% per decade could, by 2050, potentially reduce the prevalence of dementia in Mozambique, Brazil, and Portugal by 12.9%, 16.2%, and 19.5%, respectively. Conclusion: There is a substantial difference between the countries in the percentage of dementia cases that could be attributable to the seven potentially modifiable risk factors. The proportion of cases that could be prevented by 2050 if measures were taken to address these main risk factors was higher in Portugal than in Brazil and Mozambique. Each country or region should consider their unique risk factor profile when developing dementia risk reduction programs.
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Affiliation(s)
- Deborah Oliveira
- Universidade Federal de Sao Paulo, Departments of Psychobiology and Department of Psychiatry Sao Paulo, Brazil
| | - Leonardo Jun Otuyama
- Universidade Federal de Sao Paulo, Departments of Psychobiology and Department of Psychiatry Sao Paulo, Brazil.,Universidade de Sao Paulo - Hospital das Clinicas da Faculdade de Medicina, Sao Paulo, Brazil
| | - Dirceu Mabunda
- Eduardo Mondlane University, Faculty of Medicine, Maputo, Mozambique
| | - Flavio Mandlate
- Eduardo Mondlane University, Faculty of Medicine, Maputo, Mozambique
| | - Manuel Gonçalves-Pereira
- Universidade Nova de Lisboa, Nova Medical School/Faculdade de Ciências Médicas, Lisboa, Portugal
| | - Miguel Xavier
- Universidade Nova de Lisboa, Nova Medical School/Faculdade de Ciências Médicas, Lisboa, Portugal
| | - Jerson Laks
- Universidade Federal do Rio de Janeiro, Brazil; Universidade do Grande Rio, Duque de Caxias, Rio de Janeiro, Brazil
| | - Cleusa P Ferri
- Universidade Federal de Sao Paulo, Departments of Psychobiology and Department of Psychiatry Sao Paulo, Brazil.,Hospital Alemao Osvaldo Cruz - Health Technology Assessment Unit, Sao Paulo, Brazil
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15
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Janssen N, Handels RL, Köhler S, Gonçalves-Pereira M, Marques MJ, Irving K, Hopper L, Bieber A, Orrell M, Selbæk G, Michelet M, Wimo A, Zanetti O, Portolani DM, Woods B, Jelley H, Evers SMAA, Verhey FRJ. Profiles of Met and Unmet Needs in People with Dementia According to Caregivers' Perspective: Results from a European Multicenter Study. J Am Med Dir Assoc 2020; 21:1609-1616.e1. [PMID: 32674953 DOI: 10.1016/j.jamda.2020.05.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 09/30/2019] [Revised: 04/23/2020] [Accepted: 05/05/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES This exploratory study aimed at investigating profiles of care needs in people with mild to moderate dementia and examined variables associated with these profiles. DESIGN A longitudinal international cohort study. SETTING AND PARTICIPANTS The baseline data of 447 community-dwelling dyads of people with dementia and their caregivers from the Access to Timely Formal Care (Actifcare) Study were included for analysis. METHODS A latent class analysis was applied to identify profiles of needs, measured with the Camberwell Assessment of Need for the Elderly as rated by the caregiver. We examined sociodemographic (eg, relative stress scale) and clinical characteristics (eg, neuropsychiatric inventory) associated with these profiles. RESULTS Four distinct need profiles were identified through latent class analysis. These comprised a "no need" profile (41% of the sample), a "met psychological needs" profile (25%), a "met social needs" profile (19%), and an "unmet social needs" profile (15%). A larger impact of caregiving on the caregiver's life as indicated by a higher relative stress scale score was associated with the "unmet social needs" profile. CONCLUSIONS AND IMPLICATIONS In this large European sample, there was a subgroup of persons with dementia with high "unmet social needs" whose caregivers simultaneously perceived high stress in their caregiving tasks. Identification of these profiles may help provision of appropriate support for these people.
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Affiliation(s)
- Niels Janssen
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands.
| | - Ron L Handels
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands; Department of Neurobiology, Care sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Sebastian Köhler
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands
| | - Manuel Gonçalves-Pereira
- CEDOC, Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Maria J Marques
- CEDOC, Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Kate Irving
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
| | - Louise Hopper
- School of Psychology, Dublin City University, Dublin, Ireland
| | - Anja Bieber
- Martin Luther University Halle-Wittenberg, Medical Faculty, Institute of Health and Nursing Sciences, Halle, Germany
| | - Martin Orrell
- Nottingham University, Institute of Mental Health, Nottingham, United Kingdom
| | - Geir Selbæk
- Norwegian National Advisory Unit on Aging and Health, Vestfold Hospital Trust, Tønsberg, Norway; Faculty om Medicine, University of Oslo, Oslo, Norway; Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Mona Michelet
- Norwegian National Advisory Unit on Aging and Health, Vestfold Hospital Trust, Tønsberg, Norway; Faculty om Medicine, University of Oslo, Oslo, Norway; Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Anders Wimo
- Department of Neurobiology, Care sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Orazio Zanetti
- IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia
| | | | - Bob Woods
- Dementia Services Development Center, Bangor University, Bangor, United Kingdom
| | - Hannah Jelley
- Dementia Services Development Center, Bangor University, Bangor, United Kingdom
| | - Silvia M A A Evers
- Department of Health Services Research, CAPHRI School of Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands; Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Center for Economic Evaluation Utrecht, the Netherlands
| | - Frans R J Verhey
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands
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16
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Røsvik J, Michelet M, Engedal K, Bieber A, Broda A, Gonçalves-Pereira M, Hopper L, Irving K, Jelley H, Kerpershoek L, Meyer G, Marques MJ, Portolani E, Sjölund BM, Sköldunger A, Stephan A, Verhey F, de Vugt M, Woods B, Wolfs C, Zanetti O, Selbaek G. Interventions to enhance access to and utilization of formal community care services for home dwelling persons with dementia and their informal carers. A scoping review. Aging Ment Health 2020; 24:200-211. [PMID: 30663890 DOI: 10.1080/13607863.2018.1523876] [Citation(s) in RCA: 4] [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: 12/16/2022]
Abstract
Objectives: Home dwelling people with dementia and their informal carers often do not receive the formal care services they need. This study examined and mapped the research regarding interventions to improve access and use of formal community care services.Method: This is a scoping review with searches in PubMed, CINAHL, PsychINFO, Medline, Cochrane Database of Systematic Reviews, Social Science Citation index and searches of grey literature in international and national databases. Studies were categorized according to the measure used to enhance access or use.Results: From international databases, 2833 studies were retrieved, 11 were included. Five studies were included from other sources. In total, 16 studies published between 1989 and 2018 were examined; seven randomized controlled trials, six pretest-posttest studies and three non-randomized controlled studies. Sample sizes varied from 29 to 2682 participants, follow-up from four weeks to four years. Five types of interventions were identified: Case management, monetary support, referral enhancing, awareness & information focused and inpatient focused. Only two studies had access or use of community services as the primary outcome. Fourteen studies, representing all five types of interventions, had positive effects on one or more relevant outcomes. Two interventions had no effect on relevant outcomes.Conclusion: The included studies varied widely regarding design, type of intervention and outcomes. Based on this, the evidence base for interventions to enhance access to and use of formal community services is judged to be limited. The most studied type of intervention was case management. More research is recommended in this field.
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Affiliation(s)
- Janne Røsvik
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Norway
| | - Mona Michelet
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Norway.,Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Knut Engedal
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Norway
| | - Anja Bieber
- Martin Luther University Halle-Wittenberg, Medical Faculty, Institute of Health and Nursing Sciences, Halle (Saale), Germany
| | - Anja Broda
- Martin Luther University Halle-Wittenberg, Medical Faculty, Institute of Health and Nursing Sciences, Halle (Saale), Germany
| | - Manuel Gonçalves-Pereira
- CEDOC, Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Louise Hopper
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
| | - Kate Irving
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
| | - Hannah Jelley
- Dementia Services Development Centre, Bangor University, Bangor, UK
| | - Liselot Kerpershoek
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Gabriele Meyer
- Martin Luther University Halle-Wittenberg, Medical Faculty, Institute of Health and Nursing Sciences, Halle (Saale), Germany
| | - Maria J Marques
- CEDOC, Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Elisa Portolani
- Alzheimer's Research Unit - Memory Clinic - IRCCS Centro San Giovanni di Dio - Fatebebenefratelli, Brescia, Italy
| | - Britt-Marie Sjölund
- Department of Neurobiology, Care sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Anders Sköldunger
- Department of Neurobiology, Care sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Astrid Stephan
- Martin Luther University Halle-Wittenberg, Medical Faculty, Institute of Health and Nursing Sciences, Halle (Saale), Germany
| | - Frans Verhey
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marjolein de Vugt
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Bob Woods
- Dementia Services Development Centre, Bangor University, Bangor, UK
| | - Claire Wolfs
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Orazio Zanetti
- Alzheimer's Research Unit - Memory Clinic - IRCCS Centro San Giovanni di Dio - Fatebebenefratelli, Brescia, Italy
| | - Geir Selbaek
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway.,Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway
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17
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Kerpershoek L, Woods B, Wolfs C, Verhey F, Jelley H, Bieber A, Stephan A, Michelet M, Selbaek G, Handels R, Wimo A, Hopper L, Irving K, Marques MJ, Gonçalves-Pereira M, Portolani E, Zanetti O, de Vugt M. Do caregiver profiles predict the use of dementia care services? Findings from the Actifcare study. Aging Ment Health 2020; 24:272-279. [PMID: 30518244 DOI: 10.1080/13607863.2018.1544215] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 10/27/2022]
Abstract
Objectives: Previously developed dementia caregiver profiles defined by caregiver age and burden, have been associated with caregiver quality of life, depression and perseverance time. The current aim was to investigate whether these caregiver profiles could predict subsequent service use. In addition, non-personal (e.g. meals on wheels) and supportive services (e.g. Alzheimer café) in early dementia were investigated as predictors.Methods: A total of 451 dyads of people with dementia and their informal caregivers from eight European countries were followed for one year. People were included if they did not use formal (personal) care but were expected to do so within 1 year. Logistic regression analyses were used with four clusters of service use as dependent variables (home social care, home personal care, day care and admission). The independent variables were caregiver profiles, and non-personal and supportive services at baseline.Results: Caregiver profiles were significant predictors of service use; those experiencing high strain were more likely to use formal care. The use of low-intensity, less intrusive services at baseline significantly predicted the use of home personal care and admission at follow-up. The use of day care at follow-up was predicted by the baseline use of supportive services.Conclusion: Caregiver profiles are valuable predictors for service use: this knowledge can aid professionals in ensuring optimal access to services, which is important for maintaining independence at home. In addition, the use of supportive and less intrusive, non-personal services in the early stages of dementia is to be advised.
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Affiliation(s)
- Liselot Kerpershoek
- Alzheimer Centre Limburg, Maastricht, Netherlands.,Maastricht University, Maastricht, Netherlands
| | | | - Claire Wolfs
- Alzheimer Centre Limburg, Maastricht, Netherlands.,Maastricht University, Maastricht, Netherlands
| | - Frans Verhey
- Alzheimer Centre Limburg, Maastricht, Netherlands.,Maastricht University, Maastricht, Netherlands
| | | | - Anja Bieber
- Martin-Luther University Halle-Wittenberg, Halle, Germany
| | - Astrid Stephan
- Martin-Luther University Halle-Wittenberg, Halle, Germany
| | - Mona Michelet
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital, Tonsberg, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Geir Selbaek
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital, Tonsberg, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway.,Centre for Old Age Psychiatry Research, Innlandet Hospital Trust, Ottestad, Norway
| | - Ron Handels
- Alzheimer Centre Limburg, Maastricht, Netherlands.,Maastricht University, Maastricht, Netherlands.,Department of Neurobiology, Care sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Anders Wimo
- Department of Neurobiology, Care sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Louise Hopper
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
| | - Kate Irving
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
| | - Maria J Marques
- Nova Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, CEDOC, Lisboa, Portugal
| | - Manuel Gonçalves-Pereira
- Nova Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, CEDOC, Lisboa, Portugal
| | - Elisa Portolani
- Alzheimer's Research Unit-Memory Clinic, IRCCS "Centro S. Giovanni di Dio, Brescia, Italy
| | - Orazio Zanetti
- Alzheimer's Research Unit-Memory Clinic, IRCCS "Centro S. Giovanni di Dio, Brescia, Italy
| | - Marjolein de Vugt
- Alzheimer Centre Limburg, Maastricht, Netherlands.,Maastricht University, Maastricht, Netherlands
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Gonçalves-Pereira M, Zarit SH, Cardoso AM, Alves da Silva J, Papoila AL, Mateos R. A comparison of primary and secondary caregivers of persons with dementia. Psychol Aging 2020; 35:20-27. [DOI: 10.1037/pag0000380] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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19
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O'Shea E, Hopper L, Marques M, Gonçalves-Pereira M, Woods B, Jelley H, Verhey F, Kerpershoek L, Wolfs C, de Vugt M, Stephan A, Bieber A, Meyer G, Wimo A, Michelet M, Selbaek G, Portolani E, Zanetti O, Irving K. A comparison of self and proxy quality of life ratings for people with dementia and their carers: a European prospective cohort study. Aging Ment Health 2020; 24:162-170. [PMID: 30381955 DOI: 10.1080/13607863.2018.1517727] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [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] [Indexed: 10/28/2022]
Abstract
Objectives: To identify correlates of self-rated and proxy-rated quality of life (QoL) in people with dementia on (i) a dementia-specific and (ii) a capability-wellbeing QoL measure at baseline and 12-month follow-up, and to consider such factors in the context of QoL intervention development.Method: Prospective clinical and demographic data were collected from 451 community-dwelling dyads (mild-moderate dementia) across eight European countries. QoL was measured using the QOL-AD and the ICECAP-O. Multivariate modelling identified correlates of self- and proxy-rated QoL at baseline and at 12-month follow-up.Results: Carer's proxy-ratings of QoL were significantly lower than self-ratings at all time-points for both measures. Proxy-ratings declined over time, but self-ratings remained stable. Baseline predictors of greater self-rated QoL were education, and greater functional ability and relationship quality. Greater proxy-rated QoL was associated with education and greater functional ability, relationship quality, carer social support and carer QoL, lower carer anxiety/depression and less severe neuropsychiatric symptoms in people with dementia. At follow-up, greater self-rated QoL was predicted by greater functional ability, relationship quality, carer social support and having a spousal carer. Greater proxy-rated QoL at follow-up was associated with the same factors as at baseline; however, the dyad living together was an additional predictive factor.Conclusion: Both proxy-ratings and self-ratings of QoL should be interpreted with caution and in the context of each individual caregiving relationship. Different functional, psychosocial, relational and contextual factors influence self- and proxy-ratings, and both sets of factors should be considered in the context of QoL intervention development for the dyad.
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Affiliation(s)
- E O'Shea
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
| | - L Hopper
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
| | - M Marques
- CEDOC, Chronic Diseases Research Centre, Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
| | - M Gonçalves-Pereira
- CEDOC, Chronic Diseases Research Centre, Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
| | - B Woods
- Dementia Services Development Centre, Bangor University, Bangor, UK
| | - H Jelley
- Dementia Services Development Centre, Bangor University, Bangor, UK
| | - F Verhey
- School for Mental Health and Neuroscience, Alzheimer Center Limburg, Department of Psychiatry and Neuropsychology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - L Kerpershoek
- School for Mental Health and Neuroscience, Alzheimer Center Limburg, Department of Psychiatry and Neuropsychology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - C Wolfs
- School for Mental Health and Neuroscience, Alzheimer Center Limburg, Department of Psychiatry and Neuropsychology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - M de Vugt
- School for Mental Health and Neuroscience, Alzheimer Center Limburg, Department of Psychiatry and Neuropsychology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - A Stephan
- Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - A Bieber
- Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - G Meyer
- Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - A Wimo
- Department of Neurobiology, Care sciences and Society, Karolinska Institut, Stockholm, Sweden
| | - M Michelet
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - G Selbaek
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - E Portolani
- Alzheimer's Research Unit-Memory Clinic, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - O Zanetti
- Alzheimer's Research Unit-Memory Clinic, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - K Irving
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
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20
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Perry-Duxbury M, van Exel J, Brouwer W, Sköldunger A, Gonçalves-Pereira M, Irving K, Meyer G, Selbæk G, Woods B, Zanetti O, Verhey F, Wimo A, Handels RLH. A validation study of the ICECAP-O in informal carers of people with dementia from eight European Countries. Qual Life Res 2019; 29:237-251. [PMID: 31595452 PMCID: PMC6962282 DOI: 10.1007/s11136-019-02317-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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] [Accepted: 09/24/2019] [Indexed: 10/28/2022]
Abstract
PURPOSE The pressure on healthcare budgets remains high, partially due to the ageing population. Economic evaluation can be a helpful tool to inform resource allocation in publicly financed systems. Such evaluations frequently use health-related outcome measures. However, in areas such as care of older people, improving health outcomes is not necessarily the main focus of care interventions and broader outcome measures, including outcomes for those providing informal care, may be preferred when evaluating such interventions. This paper validates a recently introduced well-being measure, the ICECAP-O, in a population of informal carers for people with dementia from eight European countries. METHODS Convergent and discriminant validity tests were performed to validate the ICECAP-O using data obtained in a sample of 451 respondents from Germany, Ireland, Italy, the Netherlands, Norway, Portugal, Sweden and the UK. These respondents completed a number of standardized questionnaires within the framework of the Actifcare project. RESULTS The ICECAP-O performed well among informal carers, in terms of both convergent and discriminant validity. In the multivariate analysis, it was found to be significantly associated with the age of the person with dementia, EQ-5D-5L health problem index of the person with dementia, carer-patient relationship, care recipient CDR, carer LSNS Score, the PAI score, and Perseverance Time. CONCLUSION The ICECAP-O appears to be a valid measure of well-being in informal carers for people with dementia. The ICECAP-O may therefore be useful as an outcome measure in economic evaluations of interventions aimed at such informal carers, when these aim to improve well-being beyond health.
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Affiliation(s)
- Meg Perry-Duxbury
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Job van Exel
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.,Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Werner Brouwer
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Anders Sköldunger
- Karolinska Institutet, Department for Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Solna, Sweden
| | - Manuel Gonçalves-Pereira
- CEDOC, Chronic Diseases Research Centre NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Kate Irving
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
| | - Gabriele Meyer
- Medical Faculty, Institute for Health and Nursing Science, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany
| | - Geir Selbæk
- Norwegian National Advisory Unit ON Ageing and Health, Vestfold Health Trust, Tønsberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Bob Woods
- Dementia Services Development Centre Wales (DSDC), Bangor University, Bangor, UK
| | - Orazio Zanetti
- IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Frans Verhey
- Alzheimer Center Limburg, Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University Medical Center +, Maastricht, The Netherlands
| | - Anders Wimo
- Karolinska Institutet, Department for Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Solna, Sweden.,Centre for Research & Development, Uppsala University/County Council of Gävleborg, Gävle, Sweden
| | - Ron L H Handels
- Karolinska Institutet, Department for Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Solna, Sweden.,Alzheimer Center Limburg, Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University Medical Center +, Maastricht, The Netherlands
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21
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Gonçalves-Pereira M, Marques MJ, Balsinha C, Fernandes A, Machado AS, Verdelho A, Barahona-Corrêa B, Bárrios H, Guimarães J, Grave J, Alves L, Almeida MC, Reis TA, Orrell M, Woods B, De Vugt M, Verhey F. [Needs for Care and Service Use in Dementia: Baseline Assessment of Portuguese Participants in the Actifcare Cohort Study]. ACTA MEDICA PORT 2019; 32:355-367. [PMID: 31166896 DOI: 10.20344/amp.11136] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 12/10/2018] [Indexed: 11/20/2022]
Abstract
INTRODUCTION People with dementia and their relatives should have timely access to formal care in the community. The EU-Actifcare project analysed access to and use of formal services, as related to unmet needs for care. We describe the cohort study implementation and baseline results in Portugal, with a focus on needs for care and service use assessments. MATERIAL AND METHODS Our convenience sample consisted of 66 dyads of community-dwelling people with mild to moderate dementia and no significant use of formal services, and their informal carers. Measures included the Camberwell Assessment of Need for the Elderly and Resources Utilization in Dementia. RESULTS People with dementia had unmet needs (mean 1.1; SD 1.7), mainly regarding company (23%), psychological distress (20%), and daily activities (14%). Family caregivers spent 150 minutes/day (median) providing support, and 44% had psychological distress unmet needs. Problems with access to or use of formal services, when present, were frequently due to attitudes or lack of knowledge of any or both members of the dyad. DISCUSSION The recruitment process was challenging, since the inclusion criteria were restrictive. Not claiming generalizability, we recruited a typical sample of Portuguese people with mild to moderate dementia and no significant formal community support. Levels and type of unmet needs found in some participants would call for formal support, were it not for problems regarding access or use. CONCLUSION There are difficulties regarding timely access and effective use of formal care in dementia, along with relevant unmet needs.
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Affiliation(s)
- Manuel Gonçalves-Pereira
- Centro de Estudos de Doenças Crónicas - CEDOC. Faculdade de Ciências Médicas / NOVA Medical School. Universidade NOVA de Lisboa. Lisboa. Portugal
| | - Maria J Marques
- Centro de Estudos de Doenças Crónicas - CEDOC. Faculdade de Ciências Médicas / NOVA Medical School. Universidade NOVA de Lisboa. Lisboa. Portugal
| | - Conceição Balsinha
- 1. Centro de Estudos de Doenças Crónicas - CEDOC. Faculdade de Ciências Médicas / NOVA Medical School. Universidade NOVA de Lisboa. Lisboa. Unidade de Saúde Familiar Marginal. Agrupamento dos Centros de Saúde de Cascais. Cascais. Portugal
| | - Alexandra Fernandes
- Unidade de Saúde Familiar Fernão Ferro Mais. Agrupamento dos Centros de Saúde de Almada-Seixal. Seixal. Portugal
| | - Ana Sá Machado
- Centro de Estudos de Doenças Crónicas - CEDOC. Faculdade de Ciências Médicas / NOVA Medical School. Universidade NOVA de Lisboa. Lisboa. Portugal
| | - Ana Verdelho
- Instituto de Saúde Ambiental. Faculdade de Medicina. Centro Hospitalar e Universitário de Lisboa. Lisboa. Portugal
| | - Bernardo Barahona-Corrêa
- Faculdade de Ciências Médicas / NOVA Medical School. Universidade NOVA de Lisboa. Lisboa. Hospital de Egas Moniz. Centro Hospitalar de Lisboa Ocidental. Lisboa. Portugal
| | - Helena Bárrios
- Faculdade de Ciências Médicas / NOVA Medical School. Universidade NOVA de Lisboa. Lisboa. Portugal
| | - João Guimarães
- Faculdade de Ciências Médicas / NOVA Medical School. Universidade NOVA de Lisboa. Lisboa. Portugal
| | - Joana Grave
- Faculdade de Ciências Médicas / NOVA Medical School. Universidade NOVA de Lisboa. Lisboa. Portugal
| | - Luísa Alves
- Centro de Estudos de Doenças Crónicas - CEDOC. Faculdade de Ciências Médicas / NOVA Medical School. Universidade NOVA de Lisboa. Lisboa. Hospital de Egas Moniz. Centro Hospitalar de Lisboa Ocidental. Lisboa. Portugal
| | - Manuel Caldas Almeida
- Faculdade de Ciências Médicas / NOVA Medical School. Universidade NOVA de Lisboa. Lisboa. Portugal
| | - Teresa Alves Reis
- Centro de Estudos de Doenças Crónicas - CEDOC. Faculdade de Ciências Médicas / NOVA Medical School. Universidade NOVA de Lisboa. Lisboa. Portugal
| | - Martin Orrell
- Nottingham Institute of Mental Health. Nothingham. United Kingdom; Director - Institute of Mental Health / Head, Division of Psychiatry and Applied Psychology, Faculty of Medicine and Health Sciences, United Kingdom
| | - Bob Woods
- Bangor University. Bangor. United Kingdom; Emeritus Professor - Bangor University, United Kingdom
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Marques MJ, Woods B, Hopper L, Jelley H, Irving K, Kerpershoek L, Meyer G, Bieber A, Stephan A, Sköldunger A, Sjölund BM, Selbaek G, Rosvik J, Zanetti O, Portolani E, de Vugt M, Verhey F, Gonçalves-Pereira M. Relationship quality and sense of coherence in dementia: Results of a European cohort study. Int J Geriatr Psychiatry 2019; 34:745-755. [PMID: 30729572 DOI: 10.1002/gps.5082] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 08/08/2018] [Accepted: 02/03/2019] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Quality of life of people with dementia and their family carers is strongly influenced by interpersonal issues and personal resources. In this context, relationship quality (RQ) and sense of coherence (SOC) potentially protect and promote health. We aimed to identify what influences RQ in dyads of people with dementia and their carers and to examine differences in their perspectives. METHODS Cross-sectional data were used from the Actifcare cohort study of 451 community-dwelling people with dementia and their primary carers in eight European countries. Comprehensive assessments included the Positive Affect Index (RQ) and the Orientation to Life Questionnaire (SOC). RESULTS Regression analyses revealed that RQ as perceived by people with dementia was associated with carer education, stress, and spouse caregiving. RQ as perceived by carers was associated with carer stress, depression, being a spouse, social support, reported neuropsychiatric symptoms of dementia, and carer SOC. Neuropsychiatric symptoms and carer stress contributed to discrepancies in RQ ratings within the dyad. The only factor associated with both individual RQ ratings and discrepancies was carer stress (negative feelings subscore). No significant differences in the overall perception of RQ were evident between spouses and adult children carers, but RQ determinants differed between the two. CONCLUSIONS In this European sample, carer SOC was associated with carer-reported RQ. RQ determinants differed according to the perspective considered (person with dementia or carer) and carer subgroup. A deeper understanding of RQ and its determinants will help to tailor interventions that address these distinct perspectives and potentially improve dementia outcomes.
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Affiliation(s)
- Maria J Marques
- CEDOC, NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Bob Woods
- Dementia Services Development Centre (DSDC) Wales, Bangor University, Bangor, UK
| | - Louise Hopper
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
| | - Hannah Jelley
- Dementia Services Development Centre (DSDC) Wales, Bangor University, Bangor, UK
| | - Kate Irving
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
| | - Liselot Kerpershoek
- Alzheimer Centre Limburg, School for Mental Health and Neurosciences, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Gabriele Meyer
- Institute for Health and Nursing Science, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Anja Bieber
- Institute for Health and Nursing Science, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Astrid Stephan
- Institute for Health and Nursing Science, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Anders Sköldunger
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Britt-Marie Sjölund
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Department of Health and Caring Sciences, University of Gävle, Gävle, Sweden
| | - Geir Selbaek
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway.,Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway
| | - Janne Rosvik
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Orazio Zanetti
- IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Elisa Portolani
- IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Marjolein de Vugt
- Alzheimer Centre Limburg, School for Mental Health and Neurosciences, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Frans Verhey
- Alzheimer Centre Limburg, School for Mental Health and Neurosciences, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Manuel Gonçalves-Pereira
- CEDOC, NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
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Gonçalves-Pereira M, Prina AM, Cardoso AM, da Silva JA, Prince M, Xavier M. The prevalence of late-life depression in a Portuguese community sample: A 10/66 Dementia Research Group study. J Affect Disord 2019; 246:674-681. [PMID: 30611911 DOI: 10.1016/j.jad.2018.12.067] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 06/05/2018] [Revised: 11/20/2018] [Accepted: 12/20/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Late life depression is associated with a significant burden of disease. Estimating depression in older adults can be difficult and requires different methodological approaches from those fitting younger adults. As community prevalence data is scarce in Portugal, we estimated the prevalence of depression in a sample of older Portuguese adults. Moreover, we investigated the association between depression and disability. METHODS A cross-sectional comprehensive one-phase survey was conducted of all residents aged 65 and over of one urban and one rural catchment area in Southern Portugal. Standardized 10/66 assessments include a comprehensive cognitive module and the Geriatric Mental State (GMS)-AGECAT. Information on demographics, non-communicable disease risk factors and disability/functioning (WHODAS 2.0) was also recorded. Depression was assessed using both ICD-10 and EURO-D criteria. RESULTS We interviewed 1405 older people (mean age 74.9, SD = 6.7 years; 55.5% women) after 313 (18.2%) refusals to participate. The prevalence rate for ICD-10 depression was 4.4 (95% CI 3.5-5.6) and 18.0 (95% CI 16.0-20.1) using the EURO-D case definition. As compared with having no depression, ICD-10 depression was associated with a higher level of disability, even after adjusting for confounders (4.8, 95% CI 2.8-8.1). The same happened with subsyndromal depression ('EURO-D only') cases (2.2, 95% CI 1.4-3.5). LIMITATIONS Non-generalisability of findings outside of catchment areas. CONCLUSIONS In this sample of older Portuguese people, the prevalence of depression was high and so were the associated levels of disability. EURO-D diagnoses may provide a better picture of clinically significant old age depression as a basis for health and social service planning.
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Affiliation(s)
- Manuel Gonçalves-Pereira
- CEDOC, Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal.
| | - A Matthew Prina
- King's College London, Social Epidemiology Research Group, Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London SE5 8AF, UK.
| | - Ana M Cardoso
- CEDOC, Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal.
| | - Joaquim Alves da Silva
- Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa; Champalimaud Clinical Centre, Champalimaud Centre for the Unknown, Lisboa, Portugal.
| | - Martin Prince
- King's College London, Centre for Global Mental Health, Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London SE5 8AF, UK.
| | - Miguel Xavier
- CEDOC, Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal; Directorate General of Health, Min. Health, Portugal.
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Verdelho A, Madureira S, Correia M, Ferro JM, Rodrigues M, Gonçalves-Pereira M, Gonçalves M, Santos AC, Vilela P, Bárrios H, Borges M, Santa-Clara H. Impact of physical activity in vascular cognitive impairment (AFIVASC): study protocol for a randomised controlled trial. Trials 2019; 20:114. [PMID: 30744681 PMCID: PMC6371566 DOI: 10.1186/s13063-019-3174-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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] [Received: 03/27/2018] [Accepted: 01/02/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Cognitive impairment and cerebrovascular pathology are both frequent with ageing. Cognitive impairment due to vascular pathology of the brain, termed vascular cognitive impairment (VCI), is one of the most frequent causes of cognitive impairment in elderly subjects. Thus far, VCI has no specific pharmacological treatment. Recent observational studies have suggested a protective effect of physical activity in cognition, but adequate randomised controlled trials (RCT) are lacking. METHODS AFIVASC is a multi-centre randomised controlled trial, with a 6-month intervention treatment and an additional follow-up of 6 months, that aims to estimate the impact of 6 months of moderate intensity physical activity on cognition (the primary outcome) at 6 and 12 months in subjects with VCI. Participants are community dwellers with criteria for VCI without dementia or who have had previous stroke or transient ischaemic attack (TIA). Patients may be self-referred or referred from a medical appointment. After confirming the inclusion criteria, a run-in period of 1 month is conducted to access adherence; only after that are subjects randomly assigned (using a computerised program blinded to clinical details) to two groups (intervention group and best practice usual care group). The intervention consists of three physical activity sessions of 60 min each (two supervised and one unsupervised) per week. The primary outcome is measured by the presence or absence of decline in cognitive status. Secondary outcomes include changes in neuro-cognitive measures, quality of life, and functional and motor status. Primary and secondary outcomes are evaluated at 6 and 12 months by investigators blinded to both intervention and randomisation. A required sample size of 280 subjects was estimated. Statistical analyses will include regression analysis with repeated measures. The study was approved by the Ethics Committee for Health of Centro Hospitalar de Lisboa Norte (ref. no. 1063/13) and by the Ethics Committee for Health of Centro Hospitalar do Porto CHP (ref. no. 2016.055(049-DEFI/048-CES)). DISCUSSION We aim to show whether or not moderate physical activity has a beneficial impact on cognition, quality of life, motor, and functional status in people with vascular cognitive impairment, and to generate new insights on the applicability of implementing physical activity in this specific population. TRIAL REGISTRATION ClinicalTrials.gov, NCT03578614 July 6, 2018.
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Affiliation(s)
- Ana Verdelho
- Department of Neurosciences and Mental Health, Faculdade de Medicina, Centro Hospitalar Universitário Lisboa Norte Hospital de Santa Maria, Instituto de Medicina Molecular (IMM) and Instituto de Saúde Ambiental (ISAMB), Universidade de Lisboa, Avenida Professor Egas Moniz, 1649035 Lisbon, Portugal
| | - Sofia Madureira
- Department of Psychology, ISCTE-IUL, NOVA Medical School / Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Instituto de Medicina Molecular (IMM), Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Manuel Correia
- Neurology Service, Hospital de Santo António, Centro Hospitalar do Porto and Instituto de Ciências Biomédicas Abel Salazar (ICBAS), University of Porto, Porto, Portugal
| | - José Manuel Ferro
- Instituto de Medicina Molecular (IMM), Faculdade de Medicina, Universidade de Lisboa and Department of Neuroscience, Hospital de Santa Maria-CHLN, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Mário Rodrigues
- Instituto de Medicina Molecular (IMM), Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Manuel Gonçalves-Pereira
- CEDOC, Chronic Diseases Research Center, NOVA Medical School /Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Mafalda Gonçalves
- Instituto de Medicina Molecular (IMM), Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Ana Catarina Santos
- Instituto de Medicina Molecular (IMM), Faculdade de Medicina, Universidade de Lisboa and Dementia Unit, Hospital do Mar, Lisbon, Portugal
| | - Pedro Vilela
- Neuroradiology - Imaging Department, Hospital da Luz, Lisbon, Portugal
| | - Helena Bárrios
- NOVA Medical School, Universidade Nova de Lisboa, Portugal and Instituto de Medicina Molecular (IMM), Hospital do Mar Lisboa, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Mariana Borges
- Instituto de Medicina Molecular (IMM), Faculdade de Medicina, Universidade de Lisboa and Faculdade de Motricidade Humana,Universidade de Lisboa, Lisbon, Portugal
| | - Helena Santa-Clara
- Faculdade de Motricidade Humana, Universidade de Lisboa, CIPER – Centro Interdisciplinar de Estudo da Performance Humana, Lisbon, Portugal
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Janssen N, Handels RL, Sköldunger A, Woods B, Jelley H, Edwards RT, Orrell M, Selbæk G, Røsvik J, Gonçalves-Pereira M, Marques MJ, Zanetti O, Portolani E, Irving K, Hopper L, Meyer G, Bieber A, Stephan A, Kerpershoek L, Wolfs CA, de Vugt ME, Verhey FR, Wimo A. Impact of Untimely Access to Formal Care on Costs and Quality of Life in Community Dwelling People with Dementia. J Alzheimers Dis 2018; 66:1165-1174. [DOI: 10.3233/jad-180531] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Niels Janssen
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ron L. Handels
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Neurobiology, Care sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Anders Sköldunger
- Department of Neurobiology, Care sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Bob Woods
- Dementia Services Development Centre, Bangor University, Bangor, UK
| | - Hannah Jelley
- Dementia Services Development Centre, Bangor University, Bangor, UK
| | - Rhiannon Tudor Edwards
- Centre for Health Economics and Medicines Evaluation (CHEME), Bangor University, Bangor, UK
| | - Martin Orrell
- Nottingham University, Institute of Mental Health, Nottingham, UK
| | - Geir Selbæk
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, T—nsberg, Norway
| | - Janne Røsvik
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, T—nsberg, Norway
| | - Manuel Gonçalves-Pereira
- CEDOC, Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Maria J. Marques
- CEDOC, Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Orazio Zanetti
- Alzheimer’s Research Unit – Memory Clinic – IRCCS Centro S.Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Elisa Portolani
- Alzheimer’s Research Unit – Memory Clinic – IRCCS Centro S.Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Kate Irving
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
| | - Louise Hopper
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
| | - Gabriele Meyer
- Martin Luther University Halle-Wittenberg, Medical Faculty, Institute of Health and Nursing Sciences, Halle, Germany
| | - Anja Bieber
- Martin Luther University Halle-Wittenberg, Medical Faculty, Institute of Health and Nursing Sciences, Halle, Germany
| | - Astrid Stephan
- Martin Luther University Halle-Wittenberg, Medical Faculty, Institute of Health and Nursing Sciences, Halle, Germany
| | - Liselot Kerpershoek
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Claire A.G. Wolfs
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marjolein E. de Vugt
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Frans R.J. Verhey
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Anders Wimo
- Department of Neurobiology, Care sciences and Society, Karolinska Institutet, Stockholm, Sweden
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26
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Handels RL, Sköldunger A, Bieber A, Edwards RT, Gonçalves-Pereira M, Hopper L, Irving K, Jelley H, Kerpershoek L, Marques MJ, Meyer G, Michelet M, Portolani E, Røsvik J, Selbaek G, Stephan A, de Vugt M, Wolfs C, Woods B, Zanetti O, Verhey F, Wimo A. Quality of Life, Care Resource Use, and Costs of Dementia in 8 European Countries in a Cross-Sectional Cohort of the Actifcare Study. J Alzheimers Dis 2018; 66:1027-1040. [DOI: 10.3233/jad-180275] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Ron L.H. Handels
- Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg, School for Mental Health and Neurosciences, Maastricht University, Maastricht, The Netherlands
- Department of Neurobiology, Care Science and Society, Division of Neurogeriatrics, Karolinska Institute, Stockholm, Sweden
| | - Anders Sköldunger
- Department of Neurobiology, Care Science and Society, Division of Neurogeriatrics, Karolinska Institute, Stockholm, Sweden
| | - Anja Bieber
- Martin Luther University Halle-Wittenberg, Medical Faculty, Institute for Health and Nursing Science, Halle (Saale), Germany
| | - Rhiannon Tudor Edwards
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, United Kingdom
| | - Manuel Gonçalves-Pereira
- CEDOC, Chronic Diseases Research Centre, NOVA Medical School/Faculdade de Ci—-ncias Médicas, Universidade Nova de Lisboa, Portugal
| | - Louise Hopper
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
| | - Kate Irving
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
| | - Hannah Jelley
- Dementia Services Development Centre Wales (DSDC), Bangor University, Bangor, United Kingdom
| | - Liselot Kerpershoek
- Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg, School for Mental Health and Neurosciences, Maastricht University, Maastricht, The Netherlands
| | - Maria J. Marques
- CEDOC, Chronic Diseases Research Centre, NOVA Medical School/Faculdade de Ci—-ncias Médicas, Universidade Nova de Lisboa, Portugal
| | - Gabriele Meyer
- Martin Luther University Halle-Wittenberg, Medical Faculty, Institute for Health and Nursing Science, Halle (Saale), Germany
| | - Mona Michelet
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Health Trust, T—–nsberg, Norway
- Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Norway
| | - Elisa Portolani
- Alzheimer’s Unit - Memory Clinic, IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Janne Røsvik
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Health Trust, T—–nsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Norway
| | - Geir Selbaek
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Health Trust, T—–nsberg, Norway
- Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway
- Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Astrid Stephan
- Martin Luther University Halle-Wittenberg, Medical Faculty, Institute for Health and Nursing Science, Halle (Saale), Germany
| | - Marjolein de Vugt
- Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg, School for Mental Health and Neurosciences, Maastricht University, Maastricht, The Netherlands
| | - Claire Wolfs
- Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg, School for Mental Health and Neurosciences, Maastricht University, Maastricht, The Netherlands
| | - Bob Woods
- Dementia Services Development Centre Wales (DSDC), Bangor University, Bangor, United Kingdom
| | - Orazio Zanetti
- Alzheimer’s Unit - Memory Clinic, IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Frans Verhey
- Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg, School for Mental Health and Neurosciences, Maastricht University, Maastricht, The Netherlands
| | - Anders Wimo
- Department of Neurobiology, Care Science and Society, Division of Neurogeriatrics, Karolinska Institute, Stockholm, Sweden
- Centre for Research & Development, Uppsala University/County Council of Gävleborg, Gävle, Sweden
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27
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Kerpershoek L, de Vugt M, Wolfs C, Woods B, Jelley H, Orrell M, Stephan A, Bieber A, Meyer G, Selbaek G, Handels R, Wimo A, Hopper L, Irving K, Marques M, Gonçalves-Pereira M, Portolani E, Zanetti O, Verhey F. Needs and quality of life of people with middle-stage dementia and their family carers from the European Actifcare study. When informal care alone may not suffice. Aging Ment Health 2018; 22:897-902. [PMID: 29068697 DOI: 10.1080/13607863.2017.1390732] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [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: 01/02/2023]
Abstract
OBJECTIVE The Actifcare (Access to timely formal care) study investigated needs of people with dementia and their families during the phase in which formal care is being considered, and examined whether higher need levels are related to lower quality of life (QOL). METHOD From eight European countries 451 people with dementia and their carers participated. Needs were measured with the Camberwell Assessment of Need for the Elderly. QOL was measured with the QOL-AD, and carer quality of life was measured with the CarerQol. The relationship between needs and QOL was analysed with multiple regression analyses. RESULTS Needs were expressed in the domains of psychological distress, daytime activities, company and information. People with dementia rated their unmet needs significantly lower than their carers: the mean number of self-rated unmet needs was 0.95, whereas the mean proxy ratings were 1.66. For met needs, the self-rated mean was 5.5 and was 8 when proxy-rated. The level of needs reported was negatively associated with QOL for both. CONCLUSION The study results show that informal carers reported almost twice as many needs as people with dementia. The domains in which needs are expressed should be the primary focus for interventions to support QOL. The perspectives of people with dementia are informative when identifying needs.
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Affiliation(s)
- Liselot Kerpershoek
- a Alzheimer Centrum Limburg , Maastricht University , Maastricht , The Netherlands
| | - Marjolein de Vugt
- a Alzheimer Centrum Limburg , Maastricht University , Maastricht , The Netherlands
| | - Claire Wolfs
- a Alzheimer Centrum Limburg , Maastricht University , Maastricht , The Netherlands
| | | | | | | | - Astrid Stephan
- c Martin Luther University Halle-Wittenberg (DE) , Institute of Health and Nursing sciences , Halle , Germany
| | - Anja Bieber
- c Martin Luther University Halle-Wittenberg (DE) , Institute of Health and Nursing sciences , Halle , Germany
| | - Gabriele Meyer
- c Martin Luther University Halle-Wittenberg (DE) , Institute of Health and Nursing sciences , Halle , Germany
| | - Geir Selbaek
- d Department of Geriatric Medicine , Oslo University Hospital , Oslo , Norway
| | - Ron Handels
- a Alzheimer Centrum Limburg , Maastricht University , Maastricht , The Netherlands.,e Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics , Karolinska Institutet , Stockholm , Sweden
| | - Anders Wimo
- e Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics , Karolinska Institutet , Stockholm , Sweden.,f Centre for Research & Development Uppsala University / City Council of Gävleborg , Gävle , Sweden
| | - Louise Hopper
- g School of Nursing and Human Sciences , Dublin City University , Dublin , Ireland
| | - Kate Irving
- g School of Nursing and Human Sciences , Dublin City University , Dublin , Ireland
| | - Maria Marques
- h CEDOC, Nova Medical School, Faculdade De Ciências Médicas , Universidade Nova De Lisboa , Lisbon , Portugal
| | - Manuel Gonçalves-Pereira
- h CEDOC, Nova Medical School, Faculdade De Ciências Médicas , Universidade Nova De Lisboa , Lisbon , Portugal
| | - Elisa Portolani
- i Alzheimer's Research Unit-Memory Clinic , IRCCS Centro S. Giovanni di Dio , Milano , Italy
| | - Orazio Zanetti
- i Alzheimer's Research Unit-Memory Clinic , IRCCS Centro S. Giovanni di Dio , Milano , Italy
| | - Frans Verhey
- a Alzheimer Centrum Limburg , Maastricht University , Maastricht , The Netherlands
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28
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Stephan A, Bieber A, Hopper L, Joyce R, Irving K, Zanetti O, Portolani E, Kerpershoek L, Verhey F, de Vugt M, Wolfs C, Eriksen S, Røsvik J, Marques MJ, Gonçalves-Pereira M, Sjölund BM, Jelley H, Woods B, Meyer G. Barriers and facilitators to the access to and use of formal dementia care: findings of a focus group study with people with dementia, informal carers and health and social care professionals in eight European countries. BMC Geriatr 2018; 18:131. [PMID: 29866102 PMCID: PMC5987478 DOI: 10.1186/s12877-018-0816-1] [Citation(s) in RCA: 119] [Impact Index Per Article: 19.8] [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: 03/19/2017] [Accepted: 05/14/2018] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND People with dementia and informal carers often access formal care late in the process of dementia. The barriers and facilitators to service use from the perspectives of different stakeholders involved are not well understood. Thus, we aimed to explore the barriers and facilitators of access to and utilisation of formal care from the perspectives of people with dementia, their informal carers and health and social care professionals. METHOD Focus groups with people with dementia, informal carers and professionals were conducted in eight European countries. Recruitment targeted people with dementia, informal carers with experience of formal care and professionals involved in providing (access to) formal care. Qualitative content analysis using open coding was used on a national level. Cross-national synthesis was based on the translated national reports. RESULTS Overall, 55 focus groups with 261 participants were conducted, involving 51 people with dementia, 96 informal carers and 114 professionals. Sixteen categories describing barriers and facilitators were identified, referring to three global themes: Aspects related to 1) individuals involved, 2) the system or 3) overarching aspects. The attitudes and beliefs of people with dementia and their carers may have a major impact, and they often serve as barriers. Formal care was perceived as a threat to the individual independence of people with dementia and was thus avoided as long as possible. A healthcare professional serving as a constant key contact person could be an essential facilitator to overcome these barriers. Contact should be initiated proactively, as early as possible, and a trusting and consistent relationship needs to be established. Beyond that, the findings largely confirm former research and show that barriers to accessing and using formal care still exist across Europe despite a number of national and European initiatives. CONCLUSION Further investigations are needed to elaborate how the concept of a key contact person could be integrated with existing case management approaches and how the independence and autonomy of people with dementia can be strengthened when formal care needs to be accessed and used. These may be meaningful facilitators regarding enhanced access to formal care for people with dementia and their families.
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Affiliation(s)
- Astrid Stephan
- Institute for Health and Nursing Science, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany.
| | - Anja Bieber
- Institute for Health and Nursing Science, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany
| | - Louise Hopper
- School of Nursing and Human Sciences, Dublin City University, Glasnevin, Dublin 9, Ireland
| | - Rachael Joyce
- School of Nursing and Human Sciences, Dublin City University, Glasnevin, Dublin 9, Ireland
| | - Kate Irving
- School of Nursing and Human Sciences, Dublin City University, Glasnevin, Dublin 9, Ireland
| | - Orazio Zanetti
- Alzheimer Unit, IRCCS S. Centro Giovanni di Dio "Fatebenefratelli", Via Pilastroni 4, Brescia (BS), Italy
| | - Elisa Portolani
- Alzheimer Unit, IRCCS S. Centro Giovanni di Dio "Fatebenefratelli", Via Pilastroni 4, Brescia (BS), Italy
| | - Liselot Kerpershoek
- Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands
| | - Frans Verhey
- Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands
| | - Marjolein de Vugt
- Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands
| | - Claire Wolfs
- Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands
| | - Siren Eriksen
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - Janne Røsvik
- Department of Geriatric Medicine, Oslo University Hospital, Aldring og Helse, Oslo, Norway
| | - Maria J Marques
- Chronic Diseases Research Center, Nova Medical School
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo Mártires da Pátria, 130, 1169-056, Lisbon, Portugal
| | - Manuel Gonçalves-Pereira
- Chronic Diseases Research Center, Nova Medical School
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo Mártires da Pátria, 130, 1169-056, Lisbon, Portugal
| | - Britt-Marie Sjölund
- Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, University of Gävle, Gävle, Sweden
| | - Hannah Jelley
- Dementia Services Development Centre Wales, Bangor University, Bangor, LL57 2PZ, UK
| | - Bob Woods
- Dementia Services Development Centre Wales, Bangor University, Bangor, LL57 2PZ, UK
| | - Gabriele Meyer
- Institute for Health and Nursing Science, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany.
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Abstract
Schizophrenia is a complex biopsychosocial condition in which expressed emotion in family members is a robust predictor of relapse. Not surprisingly, family interventions are remarkably effective and thus recommended in current treatment guidelines. Their key elements seem to be common therapeutic factors, followed by education and coping skills training. However, few studies have explored these key elements and the process of the intervention itself. We conducted a qualitative and quantitative analysis of the records from a pioneering family intervention trial addressing expressed emotion, published by Leff and colleagues four decades ago. Records were analyzed into categories and data explored using descriptive statistics. This was complemented by a narrative evaluation using an inductive approach based on emotional markers and markers of change. The most used strategies in the intervention were addressing needs, followed by coping skills enhancement, advice, and emotional support. Dealing with overinvolvement and reframing were the next most frequent. Single-family home sessions seemed to augment the therapeutic work conducted in family groups. Overall the intervention seemed to promote cognitive and emotional change in the participants, and therapists were sensitive to the emotional trajectory of each subject. On the basis of our findings, we developed a longitudinal framework for better understanding the process of this treatment approach.
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Affiliation(s)
- Jaime Grácio
- Chronic Diseases Research Center (CEDOC), Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
- Clínica Psiquiátrica de S. José, Sisters Hospitallers, Lisbon, Portugal
| | - Manuel Gonçalves-Pereira
- Chronic Diseases Research Center (CEDOC), Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Julian Leff
- King's College London, London, UK
- University College London, London, UK
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Palha J, Palha F, Dias P, Gonçalves-Pereira M. Portuguese Adaptation and Input for the Validation of the Views on Inpatient Care (VOICE) Outcome Measure to Assess Service Users'Perceptions of Inpatient Psychiatric Care. ACTA MEDICA PORT 2017; 30:790-795. [PMID: 29279071 DOI: 10.20344/amp.8596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 06/20/2017] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Patient satisfaction is an important measure of health care quality. Patients' views have seldom been considered in the construction of measures addressing satisfaction with inpatient facilities in psychiatry. The Views on Inpatient Care - VOICE - is a first service-user generated outcome measure relying solely on their perceptions of acute care, representing a valuable indicator of service users' perceived quality of care. The present study aimed to contribute to the validation of the Portuguese version of VOICE. MATERIAL AND METHODS The questionnaire was translated into Portuguese and applied to a sample of eighty-five female inpatients of a psychiatric institution. Data analysis focused on assessing reliability and exploring the impact of demographic and clinical variables on participants' satisfaction. RESULTS Internal consistency of the questionnaire was high (α = 0.87). Participants' age and marital status were associated with differences in scores, with older patients and patients who were married or involved in a close relationship presenting higher satisfaction levels. DISCUSSION The questionnaire demonstrated good internal consistency and acceptability, as well as construct validity. Further studies should expand the analysis of the psychometric properties of this measure e.g., test-retest reliability. CONCLUSION The Portuguese version of VOICE is a promising tool to assess service users' perceptions of inpatient psychiatric care in Portugal.
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Affiliation(s)
- João Palha
- Serviços Locais de Saúde Mental. Centro Hospitalar Póvoa de Varzim - Vila do Conde. Póvoa de Varzim. Portugal; ENCONTRAR+SE: Associação para a Promoção da Saúde Mental. Porto. Portugal
| | - Filipa Palha
- ENCONTRAR+SE: Associação para a Promoção da Saúde Mental. Porto. Portugal; Centro de Estudos em Desenvolvimento Humano. Faculdade de Educação e Psicologia. Universidade Católica Portuguesa. Porto. Portugal
| | - Pedro Dias
- Centro de Estudos em Desenvolvimento Humano. Faculdade de Educação e Psicologia. Universidade Católica Portuguesa. Porto. Portugal
| | - Manuel Gonçalves-Pereira
- CEDOC - Centro de Estudos de Doenças Crónicas. NOVA Medical School/Faculdade de Ciências Médicas. Universidade Nova de Lisboa. Lisboa. Portugal
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Gonçalves-Pereira M, Cardoso A, Verdelho A, Alves da Silva J, Caldas de Almeida M, Fernandes A, Raminhos C, Ferri CP, Prina AM, Prince M, Xavier M. The prevalence of dementia in a Portuguese community sample: a 10/66 Dementia Research Group study. BMC Geriatr 2017; 17:261. [PMID: 29115922 PMCID: PMC5688818 DOI: 10.1186/s12877-017-0647-5] [Citation(s) in RCA: 14] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 10/19/2017] [Indexed: 11/22/2022] Open
Abstract
Background Dementia imposes a high burden of disease worldwide. Recent epidemiological studies in European community samples are scarce. In Portugal, community prevalence data is very limited. The 10/66 Dementia Research Group (DRG) population-based research programmes are focused in low and middle income countries, where the assessments proved to be culture and education fair. We applied the 10/66 DRG prevalence survey methodology in Portugal, where levels of illiteracy in older populations are still high. Methods A cross-sectional comprehensive one-phase survey was conducted of all residents aged 65 and over of two geographically defined catchment areas in Southern Portugal (one urban and one rural site). Nursing home residents were not included in the present study. Standardized 10/66 DRG assessments include a cognitive module, an informant interview and the Geriatric Mental State-AGECAT, providing data on dementia diagnosis and subtypes, mental disorders including depression, physical health, anthropometry, demographics, disability/functioning, health service utilization, care arrangements and caregiver strain. Results We interviewed 1405 old age participants (mean age 74.9, SD = 6.7 years; 55.5% women) after 313 (18.2%) refusals to participate. The prevalence rate for dementia in community-dwellers was 9.23% (95% CI 7.80–10.90) using the 10/66 DRG algorithm and 3.65% (95% CI 2.97–4.97) using DSM-IV criteria. Pure Alzheimer’s disease was the most prevalent dementia subtype (41.9%). The prevalence of dementia was strongly age-dependent for both criteria, but there was no association with sex. Conclusions Dementia prevalence was higher than previously reported in Portugal. The discrepancy between prevalence according to the 10/66 DRG algorithm and the DSM-IV criteria is consistent with that observed in less developed countries; this suggests potential underestimation using the latter approach, although relative validity of these two approaches remains to be confirmed in the European context. We improved the evidence base to raise awareness and empower advocacy about dementia in Portugal, so that the complex needs of frail older people may be met in better ways.
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Affiliation(s)
- Manuel Gonçalves-Pereira
- Chronic Diseases Research Center (CEDOC), Nova Medical School
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo Mártires da Pátria 130, 1169-056, Lisbon, Portugal.
| | - Ana Cardoso
- Chronic Diseases Research Center (CEDOC), Nova Medical School
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo Mártires da Pátria 130, 1169-056, Lisbon, Portugal
| | - Ana Verdelho
- Department of Neurosciences, H. Santa Maria/CHLN; IMM and ISAMB, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Joaquim Alves da Silva
- Chronic Diseases Research Center (CEDOC), Nova Medical School
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo Mártires da Pátria 130, 1169-056, Lisbon, Portugal.,Champalimaud Neuroscience Programme, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Manuel Caldas de Almeida
- Chronic Diseases Research Center (CEDOC), Nova Medical School
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo Mártires da Pátria 130, 1169-056, Lisbon, Portugal.,Santa Casa da Misericórdia de Mora, União das Misericórdias Portuguesas, Mora, Portugal
| | | | - Cátia Raminhos
- Chronic Diseases Research Center (CEDOC), Nova Medical School
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo Mártires da Pátria 130, 1169-056, Lisbon, Portugal
| | - Cleusa P Ferri
- King's College London, Centre for Global Mental Health, Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF, UK.,Universidade Federal de São Paulo, Department of Psychobiology, São Paulo, Brasil
| | - A Matthew Prina
- King's College London, Centre for Global Mental Health, Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF, UK
| | - Martin Prince
- King's College London, Centre for Global Mental Health, Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF, UK
| | - Miguel Xavier
- Chronic Diseases Research Center (CEDOC), Nova Medical School
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo Mártires da Pátria 130, 1169-056, Lisbon, Portugal
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Broda A, Bieber A, Meyer G, Hopper L, Joyce R, Irving K, Zanetti O, Portolani E, Kerpershoek L, Verhey F, Vugt MD, Wolfs C, Eriksen S, Røsvik J, Marques MJ, Gonçalves-Pereira M, Sjölund BM, Woods B, Jelley H, Orrell M, Stephan A. Perspectives of policy and political decision makers on access to formal dementia care: expert interviews in eight European countries. BMC Health Serv Res 2017; 17:518. [PMID: 28774307 PMCID: PMC5543593 DOI: 10.1186/s12913-017-2456-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [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: 03/08/2017] [Accepted: 07/18/2017] [Indexed: 11/10/2022] Open
Abstract
Background As part of the ActifCare (ACcess to Timely Formal Care) project, we conducted expert interviews in eight European countries with policy and political decision makers, or representatives of relevant institutions, to determine their perspectives on access to formal care for people with dementia and their carers. Methods Each ActifCare country (Germany, Ireland, Italy, The Netherlands, Norway, Portugal, Sweden, United Kingdom) conducted semi-structured interviews with 4–7 experts (total N = 38). The interview guide addressed the topics “Complexity and Continuity of Care”, “Formal Services”, and “Public Awareness”. Country-specific analysis of interview transcripts used an inductive qualitative content analysis. Cross-national synthesis focused on similarities in themes across the ActifCare countries. Results The analysis revealed ten common themes and two additional sub-themes across countries. Among others, the experts highlighted the need for a coordinating role and the necessity of information to address issues of complexity and continuity of care, demanded person-centred, tailored, and multidisciplinary formal services, and referred to education, mass media and campaigns as means to raise public awareness. Conclusions Policy and political decision makers appear well acquainted with current discussions among both researchers and practitioners of possible approaches to improve access to dementia care. Experts described pragmatic, realistic strategies to influence dementia care. Suggested innovations concerned how to achieve improved dementia care, rather than transforming the nature of the services provided. Knowledge gained in these expert interviews may be useful to national decision makers when they consider reshaping the organisation of dementia care, and may thus help to develop best-practice strategies and recommendations. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2456-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anja Broda
- Martin Luther University Halle-Wittenberg, Institute of Health and Nursing Sciences, Magdeburger Straße 8, D-06112, Halle (Saale), Germany.
| | - Anja Bieber
- Martin Luther University Halle-Wittenberg, Institute of Health and Nursing Sciences, Magdeburger Straße 8, D-06112, Halle (Saale), Germany
| | - Gabriele Meyer
- Martin Luther University Halle-Wittenberg, Institute of Health and Nursing Sciences, Magdeburger Straße 8, D-06112, Halle (Saale), Germany
| | - Louise Hopper
- Dublin City University, School of Nursing and Human Sciences, Dublin, Ireland
| | - Rachael Joyce
- Dublin City University, School of Nursing and Human Sciences, Dublin, Ireland
| | - Kate Irving
- Dublin City University, School of Nursing and Human Sciences, Dublin, Ireland
| | - Orazio Zanetti
- IRCCS S. Giovanni di Dio "Fatebenefratelli", Brescia, Italy
| | | | - Liselot Kerpershoek
- Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands
| | - Frans Verhey
- Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands
| | - Marjolein de Vugt
- Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands
| | - Claire Wolfs
- Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands
| | - Siren Eriksen
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Oslo, Norway
| | - Janne Røsvik
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Oslo, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Maria J Marques
- CEDOC, Chronic Diseases Research Center, Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Manuel Gonçalves-Pereira
- CEDOC, Chronic Diseases Research Center, Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Britt-Marie Sjölund
- Aging Research Center (ARC), Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet and Stockholm University, Stockholm, Sweden.,Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, University of Gävle, Gävle, Sweden
| | - Bob Woods
- Bangor University, Dementia Services Development Centre, Bangor, UK
| | - Hannah Jelley
- Bangor University, Dementia Services Development Centre, Bangor, UK
| | - Martin Orrell
- Nottingham University, Institute of Mental Health, Nottingham, UK
| | - Astrid Stephan
- Martin Luther University Halle-Wittenberg, Institute of Health and Nursing Sciences, Magdeburger Straße 8, D-06112, Halle (Saale), Germany
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Bieber A, Stephan A, Verbeek H, Verhey F, Kerpershoek L, Wolfs C, de Vugt M, Woods RT, Røsvik J, Selbaek G, Sjölund BM, Wimo A, Hopper L, Irving K, Marques MJ, Gonçalves-Pereira M, Portolani E, Zanetti O, Meyer G. Access to community care for people with dementia and their informal carers : Case vignettes for a European comparison of structures and common pathways to formal care. Z Gerontol Geriatr 2017; 51:530-536. [PMID: 28616816 DOI: 10.1007/s00391-017-1266-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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: 01/23/2017] [Revised: 04/12/2017] [Accepted: 05/29/2017] [Indexed: 01/16/2023]
Abstract
BACKGROUND People with dementia and their informal carers often do not receive appropriate professional support or it is not received at the right time. OBJECTIVES Description and comparison of common pathways to formal community dementia care in eight European countries as a part of the transnational Actifcare project. MATERIALS AND METHODS The German team was responsible for creating an individual case scenario as a starting point. The research teams in Ireland, Italy, the Netherlands, Norway, Portugal, Sweden, and the United Kingdom were then asked to describe a common pathway to formal dementia care by writing their own vignette using the provided individual case scenario. RESULTS A transnational qualitative content analysis was used to identify the following categories as being the most important: involved professionals, dementia-specific and team-based approaches, proactive roles, and financial aspects. General practitioners (GPs) are described as being the most important profession supporting the access to formal care in all the involved countries. In some countries other professionals take over responsibility for the access procedure. Dementia-specific approaches are rarely part of standard care; team-based approaches have differing significances in each of the countries. Informal carers are mainly proactive in seeking formal care. The Nordic countries demonstrate how financial support enhances access to the professional system. CONCLUSION Enhanced cooperation between GPs and other professions might optimize access to formal dementia care. Team-based approaches focusing on dementia care should be developed further. Informal carers should be supported and relieved in their role. Financial barriers remain which should be further investigated and reduced.
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Affiliation(s)
- A Bieber
- Medical Faculty, Institute for Health and Nursing Science, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany
| | - A Stephan
- Medical Faculty, Institute for Health and Nursing Science, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany
| | - H Verbeek
- School for Mental Health and Neuroscience, Alzheimer Center Limburg, Department of Psychiatry and Neuropsychology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - F Verhey
- School for Mental Health and Neuroscience, Alzheimer Center Limburg, Department of Psychiatry and Neuropsychology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - L Kerpershoek
- School for Mental Health and Neuroscience, Alzheimer Center Limburg, Department of Psychiatry and Neuropsychology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - C Wolfs
- School for Mental Health and Neuroscience, Alzheimer Center Limburg, Department of Psychiatry and Neuropsychology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - M de Vugt
- School for Mental Health and Neuroscience, Alzheimer Center Limburg, Department of Psychiatry and Neuropsychology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - R T Woods
- Dementia Services Development Centre Wales, Bangor University, Bangor, UK
| | - J Røsvik
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, and Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - G Selbaek
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, and Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - B M Sjölund
- Department of Neurobiology, Care sciences and Society, Karolinska Institut, Stockholm, Sweden.,Department of Health and Caring Services, University of Gävle, Gävle, Sweden
| | - A Wimo
- Department of Neurobiology, Care sciences and Society, Karolinska Institut, Stockholm, Sweden
| | - L Hopper
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
| | - K Irving
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
| | - M J Marques
- CEDOC, Chronic Diseases Research Centre, Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - M Gonçalves-Pereira
- CEDOC, Chronic Diseases Research Centre, Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - E Portolani
- Alzheimer's Research Unit-Memory Clinic, Brescia, Italy
| | - O Zanetti
- Alzheimer's Research Unit-Memory Clinic, Brescia, Italy
| | - G Meyer
- Medical Faculty, Institute for Health and Nursing Science, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany.
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Gonçalves-Pereira M, González-Fraile E, Santos-Zorrozúa B, Martín-Carrasco M, Fernández-Catalina P, Domínguez-Panchón AI, Muñoz-Hermoso P, Ballesteros J. Assessment of the consequences of caregiving in psychosis: a psychometric comparison of the Zarit Burden Interview (ZBI) and the Involvement Evaluation Questionnaire (IEQ). Health Qual Life Outcomes 2017; 15:63. [PMID: 28381222 PMCID: PMC5382493 DOI: 10.1186/s12955-017-0626-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 12/09/2016] [Accepted: 03/13/2017] [Indexed: 01/27/2023] Open
Abstract
Background The Zarit Burden Interview (ZBI) was originally developed to assess the level of subjective burden in caregivers of people with dementia. The Involvement Evaluation Questionnaire (IEQ) is amongst the leading scales to assess caregiving consequences in severe mental illness. We aimed to compare the psychometric properties of the ZBI, a generic tool, and of the IEQ, a more specific tool to assess the consequences of caregiving in schizophrenia and related disorders. Methods Secondary analyses of a 16-week, randomized controlled trial of a psychoeducational intervention in 223 primary caregivers of patients with schizophrenia or schizoaffective disorder. Psychometric properties (internal consistency, convergent and discriminative validity, and sensitivity to change) were evaluated for both ZBI and IEQ. Results Internal consistency was good and similar for both scales (ZBI: 0.91, 95% CI: 0.89, 0.94; IEQ: 0.86, 95% CI: 0.83, 0.89). Convergent validity was relevant for similar domains (e.g. ZBI total score vs IEQ-tension r = 0.69, 95% CI: 0.61, 0.75) and at least moderate for the rest of domains (ZBI total score, personal strain and role strain vs IEQ-urging and supervision). Discriminative validity against psychological distress and depressive symptoms was good (Area Under the Curve [AUC]: 0.77, 95% CI: 0.71, 0.83; and 0.69, 95% CI: 0.63, 0.78 – for ZBI against GHQ-28 and CES-D respectively; and AUC: 0.72, 95% CI: 0.65, 0.78; and 0.69, 95% CI: 0.62, 0.77 – for IEQ against GHQ-28 and CES-D respectively). AUCs against the reference criteria did not differ significantly between the two scales. After the intervention, both scales showed a significant decrease at endpoint (p-values < 0.001) with similar standardised effect sizes for change (-0.36, 95% CI: -0.58, -0.15 – for ZBI; -0.39, 95% CI: -0.60, -0.18 – for IEQ). Conclusions Both ZBI and IEQ have shown satisfactory psychometric properties to assess caregiver burden in this sample. We provided further evidence on the performance of the ZBI as a general measure of subjective burden. Trial registration (ISRCTN32545295).
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Affiliation(s)
- Manuel Gonçalves-Pereira
- CEDOC, NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal.,Clínica Psiquiátrica de S. José (Sisters Hospitallers), Lisboa, Portugal
| | - Eduardo González-Fraile
- Institute of Psychiatric Research (Sisters Hospitallers), Bilbao, Spain. .,Universidad Internacional de La Rioja, Logroño, Spain.
| | | | - Manuel Martín-Carrasco
- Institute of Psychiatric Research (Sisters Hospitallers), Bilbao, Spain.,Padre Menni Psychiatric Clinic (Sisters Hospitallers), Pamplona, Spain.,CIBER Mental Health, Vitoria, Spain
| | | | | | | | - Javier Ballesteros
- University of the Basque Country, UPV/EHU, Leioa, Spain.,CIBER Mental Health, Leioa, Spain
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Janssen EPCJ, de Vugt M, Köhler S, Wolfs C, Kerpershoek L, Handels RLH, Orrell M, Woods B, Jelley H, Stephan A, Bieber A, Meyer G, Engedal K, Selbaek G, Wimo A, Irving K, Hopper L, Gonçalves-Pereira M, Portolani E, Zanetti O, Verhey FR. Caregiver profiles in dementia related to quality of life, depression and perseverance time in the European Actifcare study: the importance of social health. Aging Ment Health 2017; 21:49-57. [PMID: 27869480 DOI: 10.1080/13607863.2016.1255716] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [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] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To identify caregiver profiles of persons with mild to moderate dementia and to investigate differences between identified caregiver profiles, using baseline data of the international prospective cohort study Actifcare. METHODS A latent class analysis was used to discover different caregiver profiles based on disease related characteristics of 453 persons with dementia and their 453 informal caregivers. These profiles were compared with regard to quality of life (CarerQoL score), depressive symptoms (HADS-D score) and perseverance time. RESULTS A 5-class model was identified, with the best Bayesian Information Criterion value, significant likelihood ratio test (p < 0.001), high entropy score (0.88) and substantive interpretability. The classes could be differentiated on two axes: (i) caregivers' age, relationship with persons with dementia, severity of dementia, and (ii) tendency towards stress and difficulty adapting to stress. Classes showed significant differences with all dependent variables, and were labelled 'older low strain', 'older intermediate strain', 'older high strain', 'younger low strain' and 'younger high strain'. CONCLUSION Differences exist between types of caregivers that explain variability in quality of life, depressive symptoms and perseverance time. Our findings may give direction for tailored interventions for caregivers of persons with dementia, which may improve social health and reduce health care costs.
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Affiliation(s)
- Eveline P C J Janssen
- a Department of Psychiatry and Neuropsychology , School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University Medical Center , Maastricht , The Netherlands.,b Department of Old Age Psychiatry , Mondriaan , Heerlen , The Netherlands
| | - Marjolein de Vugt
- a Department of Psychiatry and Neuropsychology , School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University Medical Center , Maastricht , The Netherlands
| | - Sebastian Köhler
- a Department of Psychiatry and Neuropsychology , School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University Medical Center , Maastricht , The Netherlands
| | - Claire Wolfs
- a Department of Psychiatry and Neuropsychology , School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University Medical Center , Maastricht , The Netherlands
| | - Liselot Kerpershoek
- a Department of Psychiatry and Neuropsychology , School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University Medical Center , Maastricht , The Netherlands
| | - Ron L H Handels
- a Department of Psychiatry and Neuropsychology , School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University Medical Center , Maastricht , The Netherlands
| | - Martin Orrell
- c Department of Psychiatry and Applied Psychology, Faculty of Medicine & Health Sciences , Institute of Mental Health, University of Nottingham , Nottingham , United Kingdom
| | - Bob Woods
- d Dementia Services Development Centre Wales , Bangor University , Bango , United Kingdom
| | - Hannah Jelley
- d Dementia Services Development Centre Wales , Bangor University , Bango , United Kingdom
| | - Astrid Stephan
- e Medical Faculty , Institute for Health and Nursing Science , Halle-Wittenberg , Germany
| | - Anja Bieber
- e Medical Faculty , Institute for Health and Nursing Science , Halle-Wittenberg , Germany
| | - Gabriele Meyer
- e Medical Faculty , Institute for Health and Nursing Science , Halle-Wittenberg , Germany
| | - Knut Engedal
- f Norwegian National Advisory Unit on Ageing and Health , Vestfold Hospital Trust , Tønsberg , Norway
| | - Geir Selbaek
- f Norwegian National Advisory Unit on Ageing and Health , Vestfold Hospital Trust , Tønsberg , Norway
| | - Anders Wimo
- g Department of Neurobiology, Care sciences and Society , Karolinska Institut , Stockholm , Sweden
| | - Kate Irving
- h School of Nursing and Human Sciences, Dublin City University , Dublin , Ireland
| | - Louise Hopper
- h School of Nursing and Human Sciences, Dublin City University , Dublin , Ireland
| | - Manuel Gonçalves-Pereira
- i CEDOC - Chronic Diseases Research Center , Nova Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa , Lisbon , Portugal
| | - Elisa Portolani
- j Alzheimer Unit , IRCCS Centro San Giovanni di Dio, Fatebenefratelli , Brescia , Italy
| | - Orazio Zanetti
- j Alzheimer Unit , IRCCS Centro San Giovanni di Dio, Fatebenefratelli , Brescia , Italy
| | - Frans R Verhey
- a Department of Psychiatry and Neuropsychology , School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University Medical Center , Maastricht , The Netherlands
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Kerpershoek L, de Vugt M, Wolfs C, Jelley H, Orrell M, Woods B, Stephan A, Bieber A, Meyer G, Engedal K, Selbaek G, Handels R, Wimo A, Hopper L, Irving K, Marques M, Gonçalves-Pereira M, Portolani E, Zanetti O, Verhey F. Erratum to: Access to timely formal dementia care in Europe: protocol of the Actifcare (ACcess to Timely Formal Care) study. BMC Health Serv Res 2016; 16:620. [PMID: 27793151 PMCID: PMC5086073 DOI: 10.1186/s12913-016-1877-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 10/25/2016] [Indexed: 11/22/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Astrid Stephan
- Martin-Luther University Halle-Wittenberg, Halle, Germany
| | - Anja Bieber
- Martin-Luther University Halle-Wittenberg, Halle, Germany
| | - Gabriele Meyer
- Martin-Luther University Halle-Wittenberg, Halle, Germany
| | | | | | - Ron Handels
- Maastricht University, Maastricht, Netherlands.,Karolinska Institutet, Solna, Sweden
| | | | | | | | - Maria Marques
- CEDOC, Nova Medical School
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Manuel Gonçalves-Pereira
- CEDOC, Nova Medical School
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Elisa Portolani
- Alzheimer's Research Unit-Memory Clinic, IRCCS "Centro S.Giovanni di Dio, Brescia, Italy
| | - Orazio Zanetti
- Alzheimer's Research Unit-Memory Clinic, IRCCS "Centro S.Giovanni di Dio, Brescia, Italy
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Kerpershoek L, de Vugt M, Wolfs C, Jelley H, Orrell M, Woods B, Stephan A, Bieber A, Meyer G, Engedal K, Selbaek G, Handels R, Wimo A, Hopper L, Irving K, Marques M, Gonçalves-Pereira M, Portolani E, Zanetti O, Verhey F. Access to timely formal dementia care in Europe: protocol of the Actifcare (ACcess to Timely Formal Care) study. BMC Health Serv Res 2016; 16:423. [PMID: 27550084 PMCID: PMC4994155 DOI: 10.1186/s12913-016-1672-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [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: 01/29/2016] [Accepted: 08/15/2016] [Indexed: 11/16/2022] Open
Abstract
Background Previous findings indicate that people with dementia and their informal carers experience difficulties accessing and using formal care services due to a mismatch between needs and service use. This mismatch causes overall dissatisfaction and is a waste of the scarce financial care resources. This article presents the background and methods of the Actifcare (ACcess to Timely Formal Care) project. This is a European study aiming at best-practice development in finding timely access to formal care for community-dwelling people with dementia and their informal carers. There are five main objectives: 1) Explore predisposing and enabling factors associated with the use of formal care, 2) Explore the association between the use of formal care, needs and quality of life and 3) Compare these across European countries, 4) Understand the costs and consequences of formal care services utilization in people with unmet needs, 5) Determine the major costs and quality of life drivers and their relationship with formal care services across European countries. Methods In a longitudinal cohort study conducted in eight European countries approximately 450 people with dementia and informal carers will be assessed three times in 1 year (baseline, 6 and 12 months). In this year we will closely monitor the process of finding access to formal care. Data on service use, quality of life and needs will be collected. Discussion The results of Actifcare are expected to reveal best-practices in organizing formal care. Knowledge about enabling and predisposing factors regarding access to care services, as well as its costs and consequences, can advance the state of the art in health systems research into pathways to dementia care, in order to benefit people with dementia and their informal carers.
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Affiliation(s)
| | | | | | | | | | | | - Astrid Stephan
- Martin-Luther University Halle-Wittenberg, Halle, Germany
| | - Anja Bieber
- Martin-Luther University Halle-Wittenberg, Halle, Germany
| | - Gabriele Meyer
- Martin-Luther University Halle-Wittenberg, Halle, Germany
| | | | | | - Ron Handels
- Maastricht University, Maastricht, Netherlands.,Karolinska Institutet, Solna, Sweden
| | | | | | | | - Maria Marques
- CEDOC, Nova Medical School
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Manuel Gonçalves-Pereira
- CEDOC, Nova Medical School
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Elisa Portolani
- Alzheimer's Research Unit-Memory Clinic, IRCCS "Centro S.Giovanni di Dio, Brescia, Italy
| | - Orazio Zanetti
- Alzheimer's Research Unit-Memory Clinic, IRCCS "Centro S.Giovanni di Dio, Brescia, Italy
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Grácio J, Gonçalves-Pereira M, Leff J. What do We Know about Family Interventions for Psychosis at the Process Level? A Systematic Review. Fam Process 2016; 55:79-90. [PMID: 25900627 DOI: 10.1111/famp.12155] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The evidence regarding effectiveness of family interventions for psychosis (FIP) is strong and consistent. However, there is a gap in the research on the process of these interventions, and little is known about their active ingredients. This review aims to identify the active ingredients of FIP. We conducted a systematic literature review, focusing on qualitative research, and analyzed 22 papers in total. We found a single study comprehensively exploring the process of FIP. All other studies focused on particular aspects of process-related variables. The key elements of FIP seem to be the so-called "common therapeutic factors", followed by education about the illness and coping skills training. This review supports the value of a stepped model of intervention according to the needs of the families. However, the evidence reviewed also reveals a gap in the research findings based on the limited research available. FIP are complex, psychosocial interventions with multiple components, and more intensive, qualitative research is needed to establish linkages between process and outcome.
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Affiliation(s)
- Jaime Grácio
- Clínica Psiquiátrica de S. José, Sisters Hospitallers, Lisbon, Portugal
- Department of Mental Health and Centro de Estudos de Doenças Crónicas, NOVA Medical School / Faculdade de Ciências Médicas (NMS/FCM), CEDOC, Lisbon, Portugal
| | - Manuel Gonçalves-Pereira
- Department of Mental Health and Centro de Estudos de Doenças Crónicas, NOVA Medical School / Faculdade de Ciências Médicas (NMS/FCM), CEDOC, Lisbon, Portugal
| | - Julian Leff
- Department of Mental Health Sciences, University College London, London, UK
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Martín-Carrasco M, Fernández-Catalina P, Domínguez-Panchón AI, Gonçalves-Pereira M, González-Fraile E, Muñoz-Hermoso P, Ballesteros J. A randomized trial to assess the efficacy of a psychoeducational intervention on caregiver burden in schizophrenia. Eur Psychiatry 2016; 33:9-17. [PMID: 26852375 DOI: 10.1016/j.eurpsy.2016.01.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [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: 08/27/2015] [Revised: 12/23/2015] [Accepted: 01/03/2016] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Patient's relatives usually care for patients with schizophrenia, and as informal caregivers they experience negative consequences. The aim of the EDUCA-III trial is to test the efficacy of a psychoeducational intervention program (PIP) versus standard care to reduce the caregiver burden at post-intervention (4 months), and at follow-up (8 months). METHOD A two-arm, evaluator blind, multicentre, randomized controlled trial. The PIP group had 12 weekly group sessions. The control intervention group had the usual support and standard care. Primary outcomes were change scores since baseline on the Zarit Burden Interview (ZBI) and the Involvement Evaluation Questionnaire (IEQ). RESULTS One hundred and nine caregivers were randomized to PIP and 114 to control condition from 23 research sites. The decrease of ZBI scores was significantly higher on the PIP arm at 4 months (mean difference [MD]=-4.33; 95% CI -7.96, -0.71), and at 8 months (MD=-4.46; 95% CI -7.79, -1.13). There were no significant decreases in the IEQ scores (MD at 4 months=-2.80; 95% CI -6.27, 0.67; MD at 8 months=-2.85; 95% CI -6.51, 0.81). CONCLUSIONS The PIP condition seems to reduce caregiver burden. TRIAL REGISTRATION ISRCTN32545295.
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Affiliation(s)
- M Martín-Carrasco
- Institute of Psychiatric Research, Bilbao, Spain; Padre Menni Psychiatric Centre, Pamplona, Spain; CIBER Mental Health, Spain
| | | | | | - M Gonçalves-Pereira
- Clínica Psiquiátrica de S. José (Sisters Hospitallers), Lisboa, Portugal; CEDOC, NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Lisboa, Portugal
| | | | | | - J Ballesteros
- University of the Basque Country, UPV/EHU, Leioa, Spain; CIBER Mental Health, Spain
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González-Fraile E, Domínguez-Panchón AI, Fernández-Catalina P, Gonçalves-Pereira M. [The different versions of the State-Trait Anxiety Inventory]. Rev Psiquiatr Salud Ment 2014; 7:151-2. [PMID: 24704395 DOI: 10.1016/j.rpsm.2014.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 01/03/2014] [Accepted: 01/09/2014] [Indexed: 12/18/2022]
Affiliation(s)
- Eduardo González-Fraile
- Instituto de Investigaciones Psiquiátricas, Fundación M. Josefa Recio, Bilbao, Vizcaya, España.
| | | | - Paola Fernández-Catalina
- Línea de Rehabilitación Psicosocial, Centro de Día y Equipo de Apoyo Social Comunitario de Puente de Vallecas, Madrid, España
| | - Manuel Gonçalves-Pereira
- Clínica Psiquiátrica de S. José, Irmãs Hospitaleiras, Lisboa, Portugal; Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
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Gonçalves-Pereira M, Zarit SH. The Zarit Burden Interview in Portugal: Validity and recommendations in dementia and palliative care. ACTA MEDICA PORT 2014; 27:163-5. [PMID: 24813483 DOI: 10.20344/amp.5107] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Accepted: 03/17/2014] [Indexed: 11/20/2022]
Abstract
The impact of dementia on informal or family caregivers became a public health issue. One well-established tool for the assessment of emotional, physical and social impact on caregivers is the Zarit Burden Interview. Worldwide, it is widely used in epidemiological studies, drug or psychosocial clinical trials, and health services research. The original focus on burden among dementia caregivers has spread to other clinical contexts, mostly in old age and palliative care. Given these diverse applications, issues around the validity and reliability of national translations are crucial to assure that all evidence gathered is indeed of high quality. Moreover, caution is needed on the use of cut-offs for categorizing levels of caregiver strain or of subscales derived from recurrent exploratory factor analyses in small-scale local studies. As with other translations of measures in the health field, researchers and clinicians in Portugal must be aware of how to address bias in using the Zarit Burden Interview and interpreting findings.
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Affiliation(s)
- Manuel Gonçalves-Pereira
- Departamento de Saúde Mental e Centro de Estudo de Doenças Crónicas. Faculdade de Ciências Médicas. Universidade Nova de Lisboa. Lisboa. Portugal..
| | - Steven H Zarit
- Department of Human Development and Family Studies. Penn State University. University Park. United States of America
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Gonçalves-Pereira M, Barreiros F, Cardoso A, Verdelho A, Alves da Silva J, Raminhos C, Fernandes A, Xavier M. EPA-0420 – Unmet needs in portuguese elderly people: data from services research and the 10/66 prevalence surveys on dementia and depression. Eur Psychiatry 2014. [DOI: 10.1016/s0924-9338(14)77842-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Xavier M, Cardoso A, Raminhos C, Alves da Silva J, Verdelho A, Fernandes A, Ferri C, Prince M, Gonçalves-Pereira M. EPA-0485 - Evaluating the somatic impairments in the elderly: preliminary results of the 10/66-dementia research group prevalence study in Portugal. Eur Psychiatry 2014. [DOI: 10.1016/s0924-9338(14)77892-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Gonçalves-Pereira M. EPA-0980 – Key-relatives versus other relatives of people with psychiatric disorders: implications for practice and research. Eur Psychiatry 2014. [DOI: 10.1016/s0924-9338(14)78281-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Xavier M, Raminhos C, Cardoso A, Alves da Silva J, Verdelho A, Fernandes A, Ferri C, Prince M, Gonçalves-Pereira M. EPA-0607 – Patterns of service use in the elderly: preliminary results of the 10/66-dementia research group prevalence study in portugal. Eur Psychiatry 2014. [DOI: 10.1016/s0924-9338(14)77991-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Gonçalves-Pereira M, Trancas B, Loureiro J, Papoila A, Caldas-de-Almeida JM. Empathy as related to motivations for medicine in a sample of first-year medical students. Psychol Rep 2013; 112:73-88. [PMID: 23654028 DOI: 10.2466/17.13.pr0.112.1.73-88] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Professionalism and empathy are crucial in clinical settings. An association would be expected between empathic attitudes and altruistic motivations for a medical education. However, data is scarce in first-year students, and a previous small-scale study did not fully confirm the hypothesis that person-oriented motives would have a strong relationship to empathy. The present study tested this association in a larger sample. 202 first-year medical students (M age = 19.0 yr., SD = 2.7; 67.3% women) were assessed cross-sectionally, using the Vaglum and colleagues' indexes on motives for choosing medicine (security/status, person-orientation, and interest in the natural sciences) and the Jefferson Scale of Physician Empathy for students. There was a weak association between empathy and person-orientation, but the evidence regarding links between empathy and the three motivation scores was low overall. In this Portuguese sample there was not a clear-cut association between empathy and motivations for medical school.
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Affiliation(s)
- Manuel Gonçalves-Pereira
- Department of Mental Health, CEDOC Faculdade de Ciências Médicas, FCM, Universidade Nova de Lisboa, Portugal.
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Abstract
BACKGROUND Affective disorders are associated with cognitive disturbances but their role as risk factors for dementia is still not fully investigated. AIMS To evaluate the risk of developing dementia in individuals with a history of affective disorder. METHOD We conducted a systematic review of case-control and cohort studies addressing the risk of developing dementia in people with affective disorders. To the best of our knowledge, this is the first systematic review that has included studies evaluating this risk specifically in people with bipolar disorder. RESULTS Fifty-one studies were included. Most of the studies found an increased risk for developing dementia in individuals with depression. Greater frequency and severity of depressive episodes seem to increase this risk. The evidence is contradictory regarding whether there is a difference in risk in people with early- or late-onset depression. The few available risk estimates for dementia in people with bipolar disorder suggest an even higher risk than for those with depression. CONCLUSIONS Affective disorders appear to be associated with an increased risk of developing dementia, and one that is dependent on clinical and demographic variables. Depression may be both a prodrome and a risk factor for dementia. Future research should aim to elucidate the mechanisms that mediate these links.
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Affiliation(s)
- Joaquim da Silva
- Department of Mental Health and CEDOC, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, FCM, UNL, Campo Mártires da Pátria, 130, 1169-056 Lisbon, Portugal.
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Gonçalves-Pereira M, van Wijngaarden B, Xavier M, Papoila AL, Caldas-de-Almeida JM, Schene AH. Caregiving in severe mental illness: the psychometric properties of the Involvement Evaluation Questionnaire in Portugal. Ann Gen Psychiatry 2012; 11:8. [PMID: 22455541 PMCID: PMC3364850 DOI: 10.1186/1744-859x-11-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [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: 02/01/2012] [Accepted: 03/28/2012] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Despite the achievements of previous research, caregiving assessments in severe mental illness should be crossculturally validated in order to define risk groups or to evaluate family work. This study reports on the psychometric properties of the European version of the Involvement Evaluation Questionnaire (IEQ-EU) in Portugal. METHODS A Portuguese translation of the IEQ-EU was developed according to the 'European Psychiatric Services: Inputs Linked to Outcome Domains and Needs' (EPSILON) group guidelines. We then studied 194 caregivers who were related to patients with schizophrenia spectrum disorders in psychiatric outpatient services. All relatives were assessed using the IEQ-EU. In order to describe the corresponding patients' sample, the majority (n = 162) was evaluated with the World Health Organization Disability Assessment Schedule (WHO-DAS II); 108 patients were also assessed with the Brief Psychiatric Rating Scale (BPRS) and the Global Assessment of Functioning (GAF). RESULTS The factor structure of the Portuguese version of the questionnaire was similar to the original; internal consistency was good, with Cronbach's α ranging from 0.71 to 0.87 in the IEQ-EU scales (total score and domains: tension, supervision, worrying, urging); test-retest reliability yielded intraclass correlation coefficients (ICCs) from 0.80 to 0.94, concerning the same scores. Ecological validity was confirmed. Most caregiving consequences were reported on the worrying domain of the IEQ-EU. CONCLUSIONS Validity and reliability of the Portuguese IEQ-EU translation were established. Specifically the four IEQ-EU subscale domains seem to be valid in Portugal.
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Affiliation(s)
- Manuel Gonçalves-Pereira
- Department of Mental Health, CEDOC, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal.
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Gonçalves-Pereira M, Sampaio D. [Family work in geriatric psychiatry]. ACTA MEDICA PORT 2011; 24 Suppl 4:819-826. [PMID: 22863489] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Dementia and other late-life conditions in neuropsychiatry impose a heavy burden on society as a whole and in families in particular. A number of clinical presentations involving family aspects may be seen in clinical practice in a range of diagnoses (Alzheimer's disease, other dementias, depression or any other psychiatric disorder in the elderly). As a consequence, there is a growing trend towards working with families in geriatric psychiatry. Marital issues are not a frequent target for specific clinical intervention, but couple therapy may be useful regardless of age. The effectiveness of family systems therapy has not been widely evaluated in psychogeriatrics, so far. However, it may be a powerful resource when family dynamics must be addressed, mostly in families where dysfunctional circularities precede the outburst of severe clinical problems. More often, family psychoeducation will be the first indication, in different formats, settings and levels of intensity. However, context reading and systemically-informed work are not restricted to classical family therapy and do not imply it. Is has been suggested that family psychoeducation should sometimes include a stronger family systems perspective. Structured and feasible family assessments should always precede interventions. Indeed, they are a first step of the intervention itself, while necessarily reviewed through the course of family work. Ageism perhaps still influences to some extent health professionals' attitudes, including the ones of family therapists, leading to the underutilization of family approaches in the elderly. However, working with families remains a core process in geriatric psychiatry and family therapy may be a powerful resource in particular cases.
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Affiliation(s)
- Manuel Gonçalves-Pereira
- Departamento de Saúde Mental e CEDOC, Faculdade de Ciências Médicas/Universidade Nova de Lisboa, Lisboa, Portugal
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Loureiro J, Gonçalves-Pereira M, Trancas B, Caldas-de-Almeida JM, Castro-Caldas A. [Empathy in the doctor-patient relationship as viewed by first-year medical students: data on validity and sensibility to change of the Jefferson Measure in Portugal]. ACTA MEDICA PORT 2011; 24 Suppl 2:431-442. [PMID: 22849932] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND AND AIMS Empathy is a key feature of the doctor-patient relationship. Several studies have shown a link between empathic relationships and clinical outcomes. However, reports of a decline in empathy over the course of undergraduate medical education and medical practice have raised concern among medical educators. Our study focuses on the exploration of the temporal stability of attitudes towards empathy in first-year medical students. We also aimed to characterise this sample regarding attitudes towards empathy and its associations with socio-demographic determinants, motives for entering Medicine and professional expectations. Finally, we wanted to contribute to the preliminary validation in Portugal of the Jefferson Scale of Physician Empathy, students' version (JSPE-S), following Hojat's definition of empathy as a predominantly cognitive concept. METHODS We selected a non-randomized sample of 81 first-year medical students, in Lisbon. For the evaluation of the motives for choosing Medicine as a career, we adapted a questionnaire based on the items reported by Vaglum and associates. For self-report assessment of attitudes towards empathy, we used a Portuguese translation of the JSPE- -S. Finally, we analysed the evolution of empathy-related attitudes through a six-month period that included Medical Psychology teaching (given that the curriculum would be expected to raise empathy-driven attitudes and skills). RESULTS The JSPE-S total score increased from baseline to follow-up assessments (p=0.001). At the baseline, we found a negative correlation between the "status/security" motivation index and the JSPE-S "standing in patient shoes" component, while there was a positive correlation between the "people oriented" motivation index and the JSPE-S "compassionate care" factor. Psychometric properties were acceptable for both the JSPE-S and the motivation questionnaire. DISCUSSION In general, our findings support the idea that empathy can be learnt in medical schools. This study also provides evidence for the validation of the JSPE-S and for the acceptability of an instrument assessing motivation for medical school, in Portugal. Albeit weak, the correlations between motivational factors and empathy components deserve further exploration in research.
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Affiliation(s)
- José Loureiro
- Serviço de Cardiologia, Hospital Fernando Fonseca, Amadora, Portugal
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