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Zheng J, Gresham M, Phillipson L, Hall D, Jeon YH, Brodaty H, Low LF. Exploring the usability, user experience and usefulness of a supportive website for people with dementia and carers. Disabil Rehabil Assist Technol 2024; 19:1369-1381. [PMID: 37086036 DOI: 10.1080/17483107.2023.2180546] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 02/08/2023] [Indexed: 04/23/2023]
Abstract
PURPOSE This study explores the usability, usefulness and user experience of the Forward with Dementia website for people with dementia and family carers, and identifies strategies to improve web design for this population. METHODS The website was iteratively user-tested by 12 participants (five people with dementia, seven carers) using the Zoom platform. Data collection involved observations, semi-structured interviews and questionnaires. Integrative mixed-method data analysis was used, informed by inductive thematic qualitative analysis. RESULTS Users of Version 1 of the website experienced web functionality, navigation and legibility issues. Strategies for desirable web design were identified as simplifying functions, streamlining navigation and decluttering page layouts. Implementation of strategies produced improvements in usability, user experience and usefulness in Version 2, with mean System Usability Scale scores improving from 15 to 84, and mean task completion improving from 55% to 89%. The user journey for people with dementia and carers overlapped, but each group had their own unique needs in the context of web design. CONCLUSIONS The interplay between a website's content, functionality, navigation and legibility can profoundly influence user perceptions of a website. Dementia-related websites play an important role in informing audiences of management strategies, service availability and planning for the progression of dementia. Findings of this study may assist in guiding future web development targeting this population.
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Affiliation(s)
- Jacky Zheng
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Meredith Gresham
- Discipline of Psychiatry and Mental Health, Centre for Healthy Brain Ageing, UNSW Sydney, Sydney, Australia
| | - Lyn Phillipson
- School of Health and Society, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia
| | - Danika Hall
- Discipline of Psychiatry and Mental Health, Centre for Healthy Brain Ageing, UNSW Sydney, Sydney, Australia
| | - Yun-Hee Jeon
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Henry Brodaty
- Discipline of Psychiatry and Mental Health, Centre for Healthy Brain Ageing, UNSW Sydney, Sydney, Australia
| | - Lee-Fay Low
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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Mohamad MA, Leong Bin Abdullah MFI, Shari NI. Similarities and differences in the prevalence and risk factors of suicidal behavior between caregivers and people with dementia: a systematic review. BMC Geriatr 2024; 24:254. [PMID: 38486186 PMCID: PMC10941364 DOI: 10.1186/s12877-024-04753-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 01/27/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND People with dementia and their caregivers are prone to suicidal behaviors due to difficulty adjusting to their initial caregiving role and due to emotional disturbances resulting from deterioration of functioning. The present systematic review (1) explored the prevalence of and risk factors for suicidal behavior and (2) assessed the similarities and differences in the prevalence and risk factors for suicidal behavior between people with dementia and their caregivers. METHODS A comprehensive literature search for research articles published between 1950 and 2023 was carried out using major databases, such as Google Scholar, Web of Science, PubMed, Scopus, PsycINFO, EMBASE, the Cochrane Library, and Medline. RESULTS A total of 40 research articles were selected for review. A total of 12 research articles revealed that the prevalence of suicidal behavior among caregivers ranged from 4.7% to 26%. However, the risk of suicidal behavior among people with dementia was inconsistent, as only 17 out of 28 selected studies reported the risk of suicidal behavior among people with dementia. The risk factors associated with suicidal behavior among caregivers of people with dementia could be both self-related and care receiver-related factors, whereas risk factors in people with dementia were self-related factors. Notably, greater cognitive decline, which impairs individuals' ability to carry out complex acts and planning, may lower their suicidal risk. Finally, assessment of the risk of bias indicated that 95% of the selected studies had unclear risk. CONCLUSION Self-related and care receiver-related factors should be assessed among caregivers of people with dementia to evaluate the risk of suicidal behavior. In addition, we recommend evaluating suicidal risk in people with dementia in the early phase of dementia when cognitive decline is less severe. However, as the majority of the selected studies had unclear risk of bias, future studies with improved methodologies are warranted to confirm our study findings.
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Affiliation(s)
- Mohd Afifuddin Mohamad
- Department of Community Health, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Kepala Batas, Pulau Pinang, 13200, Malaysia
| | | | - Nurul Izzah Shari
- School of Human Resource Development and Psychology, Faculty of Social Sciences and Humanities (FSSH), Universiti Teknologi Malaysia, Skudai, Johor, 81310, Malaysia
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Miyamae F, Sugiyama M, Taga T, Okamura T. Peer support meeting of people with dementia: a qualitative descriptive analysis of the discussions. BMC Geriatr 2023; 23:637. [PMID: 37814249 PMCID: PMC10563253 DOI: 10.1186/s12877-023-04329-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 09/18/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Dementia cafés for people with dementia and their caregivers are promoted in national dementia policies. The effect of dementia cafés on people with dementia has been reported through narratives of caregivers who participated the dementia cafés. However, evidence derived from the data, which included only people with dementia, is sparse. The aim of this study is to analyze the narratives of people with dementia in peer support meetings in Tokyo where only people with dementia participate, i.e., caregivers were not present. METHODS People with dementia and older people with subjective cognitive impairment were recruited in our community-based participatory research centre. Based on the qualitative descriptive approach, we conducted a thematic analysis of the field notes, which was made through ethnographical observation of the meetings. RESULTS Twenty-five meetings were held from November 2018 to March 2020. The cumulative total number of participants was 196. First, the symptomatic problems related to living with dementia were mentioned, which were collectively named under the overarching category of 'Experience of living with dementia.' Second, questions and solutions to the various symptoms were discussed, which were named the 'Quest of Symptoms.' Third, we noted the narrative that reflected on daily life, feelings, and the life that one has led, which were named 'Life story.' Fourth, we noted narratives of how symptoms have improved and their world has expanded, which were named 'Hope.' Fifth and most importantly, narratives about compassion for people with dementia in the past and future, as well as for people of the same generation, were discussed, which were named 'Compassion.' CONCLUSIONS The lived experiences of people with dementia were revealed. Participants noted they were not just being cared for but exchanging information and exploring the symptoms; in other words, they were resilient. Furthermore, more positive aspects concerning living with dementia were discussed, such as 'Hope' and 'Compassion.' Further research concerning the discourse of people around the participants is necessary to evaluate the situation from multiple perspectives.
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Affiliation(s)
- Fumiko Miyamae
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-Cho, Itabashi-ku, Tokyo, 173-0015, Japan.
| | - Mika Sugiyama
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-Cho, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Tsutomu Taga
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-Cho, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Tsuyoshi Okamura
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-Cho, Itabashi-ku, Tokyo, 173-0015, Japan
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Mishra PK, Iaboni A, Ye B, Newman K, Mihailidis A, Khan SS. Privacy-protecting behaviours of risk detection in people with dementia using videos. Biomed Eng Online 2023; 22:4. [PMID: 36681841 PMCID: PMC9863094 DOI: 10.1186/s12938-023-01065-3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 01/09/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND People living with dementia often exhibit behavioural and psychological symptoms of dementia that can put their and others' safety at risk. Existing video surveillance systems in long-term care facilities can be used to monitor such behaviours of risk to alert the staff to prevent potential injuries or death in some cases. However, these behaviours of risk events are heterogeneous and infrequent in comparison to normal events. Moreover, analysing raw videos can also raise privacy concerns. PURPOSE In this paper, we present two novel privacy-protecting video-based anomaly detection approaches to detect behaviours of risks in people with dementia. METHODS We either extracted body pose information as skeletons or used semantic segmentation masks to replace multiple humans in the scene with their semantic boundaries. Our work differs from most existing approaches for video anomaly detection that focus on appearance-based features, which can put the privacy of a person at risk and is also susceptible to pixel-based noise, including illumination and viewing direction. We used anonymized videos of normal activities to train customized spatio-temporal convolutional autoencoders and identify behaviours of risk as anomalies. RESULTS We showed our results on a real-world study conducted in a dementia care unit with patients with dementia, containing approximately 21 h of normal activities data for training and 9 h of data containing normal and behaviours of risk events for testing. We compared our approaches with the original RGB videos and obtained a similar area under the receiver operating characteristic curve performance of 0.807 for the skeleton-based approach and 0.823 for the segmentation mask-based approach. CONCLUSIONS This is one of the first studies to incorporate privacy for the detection of behaviours of risks in people with dementia. Our research opens up new avenues to reduce injuries in long-term care homes, improve the quality of life of residents, and design privacy-aware approaches for people living in the community.
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Affiliation(s)
- Pratik K. Mishra
- grid.17063.330000 0001 2157 2938Institute of Biomedical Engineering, University of Toronto, Toronto, Canada ,grid.231844.80000 0004 0474 0428KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Andrea Iaboni
- grid.231844.80000 0004 0474 0428KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Bing Ye
- grid.231844.80000 0004 0474 0428KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Kristine Newman
- grid.68312.3e0000 0004 1936 9422Daphne Cockwell School of Nursing, Ryerson University, Toronto, Canada
| | - Alex Mihailidis
- grid.17063.330000 0001 2157 2938Institute of Biomedical Engineering, University of Toronto, Toronto, Canada ,grid.231844.80000 0004 0474 0428KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Shehroz S. Khan
- grid.17063.330000 0001 2157 2938Institute of Biomedical Engineering, University of Toronto, Toronto, Canada ,grid.231844.80000 0004 0474 0428KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
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Chen J, Gramegna SM, Biamonti A. A sense of home for people with dementia in a long-term care facility: A design perspective. Health Place 2023; 79:102957. [PMID: 36565539 DOI: 10.1016/j.healthplace.2022.102957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 11/22/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022]
Abstract
The study aims to provide new insights into the approach to the spatial design of homelike dementia care facilities. This paper builds on Molony's (2010) findings that home meaning in care facilities is a process of people-place integration, and then proposes that people living with dementia can accomplish this process through their bodily habit. This research adopted an ethnographic case study approach. Three cases from a long-term care facility were studied by using semi-structured interviews and observations. According to the findings, having a sense of home for people living with dementia can be understood as a process of re-establishing people-place integration through their bodily habits in a long-term care facility. As a result, designers can consider which design features can assist people living with dementia in re-establishing this integration through bodily habit to create home feelings in a dementia care facility.
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Affiliation(s)
- Jing Chen
- LABIRINT Research Atelier, Department of Design, Politecnico di Milano, Milano, Italy.
| | - Silvia Maria Gramegna
- LABIRINT Research Atelier, Department of Design, Politecnico di Milano, Milano, Italy
| | - Alessandro Biamonti
- LABIRINT Research Atelier, Department of Design, Politecnico di Milano, Milano, Italy
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Spichiger F, Volken T, Bosshard G, Zigan N, Blanc G, Büscher A, Nagl-Cupal M, Bernard M, Rubli Truchard E, Larkin P, Koppitz A. Pain Interventions for people with dementia: a quasi-experimental study. BMC Palliat Care 2022; 21:228. [PMID: 36581883 PMCID: PMC9798691 DOI: 10.1186/s12904-022-01118-9] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 12/06/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Due to the complexity of the provision of care for people with dementia, pain assessment and management is still considered to be lacking. An optimal way to support frontline staff in providing pain assessment and management for people with dementia living in nursing homes has not yet been identified. The success of supporting interventions seems dependent on contextual factors in the nursing homes. This study, therefore, analyzes the feasibility of a nurse-led training intervention, using repeated on-site case studies, in modifying pain intensity and frequency in people with dementia. METHODS Using a quasi-experimental design, we undertook a multi-center study of nurse-led training in pain management, with subsequent on-site case studies. Healthcare workers from 3 nursing homes assessed pain in 164 residents with dementia over 147 days. We used mixed-effect growth curve models with spline regression to analyze the data. RESULTS We found that on-site case studies support frontline staff with pain management and assessment. Repeated reflection in case studies led to significantly longer pain free intervals (from 4.7 at baseline to 37.1 days at second follow-up) and decreased frequency of pain events (OR 0.54 at first follow-up and 0.43 at second follow-up). However no trends regarding pain intensity could be found. Therefore, on-site case studies may be valuable for improving pain frequency and pain-free intervals over time. CONCLUSION This feasibility study shows the potential of on-site support for frontline nursing home staff. On-site case studies may also affect health outcomes in people with dementia. However, the complexity of dementia care necessitates the management of a broader range of needs. TRIAL REGISTRATION The study was retrospectively registered on the tenth of January 2017 with the German registry of clinical trials (DRKS00009726).
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Affiliation(s)
- Frank Spichiger
- HES-SO, School of Health Sciences Fribourg, Institute of Applied Health Research, Route des Arsenaux 16a, 1700 Fribourg, Switzerland ,grid.8515.90000 0001 0423 4662Lausanne University Hospital and University of Lausanne, Institute of Higher Education and Research in Healthcare, Route de la Corniche 10, Lausanne, 1010 Switzerland
| | - Thomas Volken
- grid.19739.350000000122291644ZHAW School of Health Sciences, Katharina-Sulzer-Platz 9, 8400 Winterthur, Switzerland
| | - Georg Bosshard
- Alters- und Pflegezentrum Bruggwiesen, Märtplatz 19, 8307 Effretikon, Switzerland
| | - Nicole Zigan
- grid.19739.350000000122291644ZHAW School of Health Sciences, Katharina-Sulzer-Platz 9, 8400 Winterthur, Switzerland
| | - Geneviève Blanc
- Berner Bildungszentrum Pflege, Freiburgstrasse 133, 3008 Bern, Switzerland
| | - Andreas Büscher
- grid.434095.f0000 0001 1864 9826Osnabrück University of Applied Sciences, Faculty of Business Management and Social Sciences, Caprivistraße 30A, 49076 Osnabrück, Germany
| | - Martin Nagl-Cupal
- grid.10420.370000 0001 2286 1424University of Vienna, Institute of Nursing Science, Alser Strasse 23, 1080 Vienna, Austria
| | - Mathieu Bernard
- grid.8515.90000 0001 0423 4662Lausanne University Hospital and University of Lausanne, Palliative and Supportive Care Service, Avenue Pierre-Decker 5, 1011 Lausanne, Switzerland
| | - Eve Rubli Truchard
- grid.8515.90000 0001 0423 4662Lausanne University Hospital and University of Lausanne, Palliative and Supportive Care Service, Avenue Pierre-Decker 5, 1011 Lausanne, Switzerland ,grid.8515.90000 0001 0423 4662Lausanne University Hospital and University of Lausanne, Service of Geriatric Medicine and Geriatric Rehabilitation, Avenue Pierr-Decker 5, 1011 Lausanne, Switzerland
| | - Philip Larkin
- grid.8515.90000 0001 0423 4662Lausanne University Hospital and University of Lausanne, Institute of Higher Education and Research in Healthcare, Route de la Corniche 10, Lausanne, 1010 Switzerland ,grid.8515.90000 0001 0423 4662Lausanne University Hospital and University of Lausanne, Palliative and Supportive Care Service, Avenue Pierre-Decker 5, 1011 Lausanne, Switzerland
| | - Andrea Koppitz
- HES-SO, School of Health Sciences Fribourg, Institute of Applied Health Research, Route des Arsenaux 16a, 1700 Fribourg, Switzerland
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Saragih ID, Everard G, Lee BO. A systematic review and meta-analysis of randomized controlled trials on the effect of serious games on people with dementia. Ageing Res Rev 2022; 82:101740. [PMID: 36191740 DOI: 10.1016/j.arr.2022.101740] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/09/2022] [Accepted: 09/27/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND An increase in dementia prevalence has been accompanied by increasing interest in new rehabilitation methods, such as serious games. Serious games hold the potential to postpone functional and cognitive declines in people with dementia by increasing their independence and engagement; however, the efficacy of serious games remains underexplored. This review was conducted to quantify the effects of serious games in people with dementia, including several newly published trials, with the hopes of contributing to evidence-based practice by offering support for clinical decision-making. METHODS Only randomized controlled trials (RCTs) assessing the impacts of game-based intervention programs compared with conventional therapy on cognitive function, instrumental and non-instrumental activities of daily living, or depression among people with dementia were included in this review. Meta-analyses were performed to determine the pooled standardized mean difference (SMD) of each outcome using a random-effects model. RESULTS The final search identified 12 studies that met our criteria. Overall, serious games were found to improve cognitive function (pooled SMD: 0.34; 95% CI: 0.07-0.61) and alleviated depression (pooled SMD: -0.131; 95% CI: -1.85 to -0.77) in people with dementia. CONCLUSIONS Serious games improve cognitive function and reduce depression in people with dementia. Future studies in this field should aim to evaluate and determine the long-term effect of these games.
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Wittek M, Voß H, Kiefer A, Wiloth S, Schmitt E. Community support for caring relatives of people with dementia: qualitative analysis using the Theoretical Domains Framework. Z Gesundh Wiss 2022; 31:1-11. [PMID: 35975189 PMCID: PMC9371957 DOI: 10.1007/s10389-022-01744-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/20/2022] [Indexed: 11/28/2022]
Abstract
Aim Although caring relatives of people with dementia are a mainstay of many care systems, the availability of support services for them within the municipal community shows deficiencies. Adopting the Theoretical Domains Framework (TDF) this study aims to investigate 1) which of the TDF domains adapted to gerontology show up in public dialogue, and 2) the results that public dialogues produce in terms of support services for caring relatives. Subject and methods The data consists of town hall meetings and focus groups from 14 municipal communities in Germany. Participants were caring relatives and stakeholders of the communities. A qualitative content analysis was conducted, focusing on the assessment of three TDF domains, namely knowledge, goals, and sociopolitical context as well as outcomes of care optimisation. Results With regard to domain knowledge, it was evident that in every community there were actors aware of the situation and relevance of carers and their relatives. Only some actors mentioned goals for optimising the care of the target group. The sociopolitical context is often addressed through statements about incomplete requirements. Conclusion Overall, a relation between the discussion about the domains in public dialogues and changes in supporting carers of people with dementia can be assumed. The results indicate that an increased discussion about the domains within town hall meetings influences the actors and their statements with regard to the improvement of support services for caring relatives of people with dementia. Since the domains were not developed exclusively for the outlined context, this approach can also be applied to other areas of care. Supplementary information The online version contains supplementary material available at 10.1007/s10389-022-01744-w.
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Affiliation(s)
- Maren Wittek
- Institute of Gerontology, Ruprecht-Karls-University of Heidelberg, Bergheimer Straße 20, 69115 Heidelberg, Germany
| | - Henrike Voß
- Institute of Gerontology, Ruprecht-Karls-University of Heidelberg, Bergheimer Straße 20, 69115 Heidelberg, Germany
| | - Anna Kiefer
- Institute of Gerontology, Ruprecht-Karls-University of Heidelberg, Bergheimer Straße 20, 69115 Heidelberg, Germany
| | - Stefanie Wiloth
- Institute of Gerontology, Ruprecht-Karls-University of Heidelberg, Bergheimer Straße 20, 69115 Heidelberg, Germany
| | - Eric Schmitt
- Institute of Gerontology, Ruprecht-Karls-University of Heidelberg, Bergheimer Straße 20, 69115 Heidelberg, Germany
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Wang Y, Xiao LD, Yu Y, Huang R, You H, Liu M. An individualized telephone-based care support program for rural family caregivers of people with dementia: study protocol for a cluster randomized controlled trial. BMC Geriatr 2021; 21:629. [PMID: 34736394 PMCID: PMC8567341 DOI: 10.1186/s12877-021-02575-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 10/22/2021] [Indexed: 11/25/2022] Open
Abstract
Background There are about 9.5 million people with dementia in China. Up to 99% of them are cared for by their family caregivers. Family caregivers are confronted with considerable difficulties and challenges while providing care. They often experience high levels of emotional, physical, financial, and social burdens. Caregivers in rural areas experience an even higher level of burden compared to their counterparts in urban areas due to fewer health resources for dementia care. However, so far, no intervention study has been conducted to support family caregivers in rural areas of China. The aim of this proposed study is to adapt and evaluate an evidence-based and culturally-tailored individualized telephone-based care support (ITBCS) program for family caregivers of people with dementia in rural China. Methods A cluster randomized controlled trial (RCT) will be conducted to evaluate the effectiveness of the ITBCS compared with usual care for Chinese rural family caregivers of people with dementia. A total sample of 168 rural family caregivers will be recruited. The intervention components consist of a 3-month intensive telephone-based care support intervention followed by telephone-based follow-up consultations for 6 months. The control group will receive usual care services available for them. Outcome measures include carers’ subjective burden, depressive symptoms, health-related quality of life, social support, caregiving self-efficacy, and care recipients’ difficult behaviours and competence in activities of daily living at 3, 9 and 15 months after baseline. The potential cost-effectiveness of the ITBCS compared with usual care will be assessed as well. Discussion If effective, the ITBCS program can be adapted and used in rural areas of China as a blueprint to improve the quality of home-based care for people with dementia. Findings from the present study are significant for developing evidence-based dementia care policy in rural China. Trial registration Chinese Clinical Trial Registry, ChiCTR2000038821, Registered 4 April 2020, http://www.chictr.org.cn/showprojen.aspx?proj=62268.
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Affiliation(s)
- Yao Wang
- Xiang Ya School of Nursing, Central South University, Changsha, Hunan Province, China.
| | - Lily Dongxia Xiao
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Yu Yu
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Rong Huang
- Xiang Ya School of Nursing, Central South University, Changsha, Hunan Province, China
| | - Hui You
- Xiang Ya School of Nursing, Central South University, Changsha, Hunan Province, China
| | - Minhui Liu
- Xiang Ya School of Nursing, Central South University, Changsha, Hunan Province, China
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Hoel KA, Rokstad AMM, Feiring IH, Lichtwarck B, Selbæk G, Bergh S. Person-centered dementia care in home care services - highly recommended but still challenging to obtain: a qualitative interview study. BMC Health Serv Res 2021; 21:723. [PMID: 34294078 PMCID: PMC8299610 DOI: 10.1186/s12913-021-06722-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dementia is one of the main causes of disability and dependence in older people, and people with dementia need comprehensive healthcare services, preferably in their own homes. A well-organized home care service designed for people with dementia is necessary to meet their needs for health- and social care. Therefore, it is important to gain knowledge about how people with dementia experience the home care service and if the service responds to their wishes and needs. The aim of this study was to explore the experience of home care services among people with dementia, to understand the continuity in services, how the service was adapted to people with dementia, and how the patient experienced person-centered care and shared decision-making. METHODS We used a qualitative, exploratory design based on a phenomenological-hermeneutic approach and performed individual in-depth interviews with persons with dementia. A convenience sample of 12 persons with moderate to severe degrees of dementia from four Norwegian municipalities participated in the study. The interviews were conducted in February 2019. RESULTS The findings identified that the participants appreciated the possibility to stay safely in their own homes and mostly experienced good support from staff. They expressed various views and understanding of the service and experienced limited opportunities for user involvement and individualized, tailored service. The overall theme summarizing the findings was: "It is difficult for people with dementia to understand and influence home care services, but the services facilitate the possibility to stay at home and feel safe with support from staff." CONCLUSION The participants did not fully understand the organization of the care and support they received from the home care services, but they adapted to the service without asking for changes based on their needs or desires. Although person-centered care is recommended both nationally and internationally, the participants experienced little inclusion in defining the service they received, and it was perceived as unclear how they could participate in shared decision-making.
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Affiliation(s)
- Kari-Anne Hoel
- The Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Brumunddal, Norway.
- Faculty of Health and Social Sciences, Molde University College, Molde, Norway.
| | - Anne Marie Mork Rokstad
- The Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ingvild Hjorth Feiring
- The Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Brumunddal, Norway
| | - Bjørn Lichtwarck
- The Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Brumunddal, Norway
| | - Geir Selbæk
- Faculty of Health and Social Sciences, Molde University College, Molde, Norway
- The Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Sverre Bergh
- The Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Brumunddal, Norway
- Faculty of Health and Social Sciences, Molde University College, Molde, Norway
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Stephan A, Marques MJ, Bieber A, Machado AS, Balsinha C, Handels R, Makai P, Gonçalves-Pereira M, Dichter MN. Self- and proxy-rating of the ICECAP-O for people with dementia: A cross-sectional linguistic validation study in Germany and Portugal. Z Evid Fortbild Qual Gesundhwes 2021; 162:24-31. [PMID: 33811016 DOI: 10.1016/j.zefq.2021.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 01/05/2021] [Accepted: 02/25/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND The capability concept became a recognized approach to the measurement of quality of life. The ICECAP-O for older people aims to measure capabilities and has recently been used in people with dementia (self-rating) and informal carers (substituted judgement). However, linguistic validation studies have so far been lacking. METHODS A cross-sectional cognitive interview study with 15 people with dementia (PwD) and 23 informal carers (ICs) was conducted in Germany and Portugal. Respondents were asked to reveal their understanding of the ICECAP-O and the capability approach as well as the response process. A summarising content analysis was performed. RESULTS Despite the small sample, our linguistic validation of the German and Portuguese translations detected considerable difficulties or deviations in item comprehension when compared with the intended meaning. In some cases, the item interpretations did not reflect the entire scope of the associated capability dimension, though they were basically correct. Moreover, participants were not able to differentiate some items appropriately from one another, and some misinterpretations occurred. ICs relied mainly on observable behaviour, emotions, or verbal expressions of the PwD. Therefore, ICs found items that ask about the achievement of individual expectations or thoughts about the future difficult to assess. Only very few PwD clearly indicated that they understood the capability approach. ICs in Germany had more difficulties in understanding the capability concept than in ICs Portugal. DISCUSSION This linguistic validation study in Germany and Portugal indicates a need for some rephrasing and refinements of the ICECAP-O translated items in both countries to fully encompass some dimensions and avoid misinterpretations. Further studies with larger samples are necessary. Based on our findings, the current German version for ICs' substituted judgement cannot be recommended for this kind of respondents without further advancements.
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Lee EC, Wright J, Walters SJ, Cooper CL, Mountain GA. Estimating the minimum important difference in the DEMQOL instrument in people with dementia. Qual Life Res 2021; 30:2995-3005. [PMID: 34114132 PMCID: PMC8481142 DOI: 10.1007/s11136-021-02900-7] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE The Dementia-Related Quality of Life (DEMQOL) measure and the DEMQOL-Utility Score (DEMQOL-U) are validated tools for measuring quality of life (QOL) in people with dementia. What score changes translate to a clinically significant impact on patients' lives was unknown. This study establishes the minimal important differences (MID) for these two instruments. METHODS Anchor-based and distribution-based methods were used to estimate the MID scores from patients enrolled in a randomised controlled trial. For the anchor-based method, the global QOL (Q29) item from the DEMQOL was chosen as the anchor for DEMQOL and both Q29 and EQ-5D for DEMQOL-U. A one category difference in Q29, and a 0.07 point difference in EQ-5D score, were used to classify improvement and deterioration, and the MID scores were calculated for each category. These results were compared with scores obtained by the distribution-based methods. RESULTS A total of 490 people with dementia had baseline DEMQOL data, of these 386 had 8-month data, and 344 had 12-month DEMQOL data. The absolute change in DEMQOL for a combined 1-point increase or decrease in the Q29 anchor was 5.2 at 8 months and 6.0 at 12 months. For the DEMQOL-U, the average absolute change at 8 and 12 months was 0.032 and 0.046 for the Q29 anchor and 0.020 and 0.024 for EQ-5D anchor. CONCLUSION We present MID scores for the DEMQOL and DEMQOL-U instruments obtained from a large cohort of patients with dementia. An anchored-based estimate of the MID for the DEMQOL is around 5 to 6 points; and 0.02 to 0.05 points for the DEMQOL-U. The results of this study can guide clinicians and researchers in the interpretation of these instruments comparisons between groups or within groups of people with dementia. TRIAL REGISTRATION NUMBER AND DATE OF REGISTRATION ISRCTN17993825 on 11th October 2016.
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Affiliation(s)
- Ellen C. Lee
- grid.11835.3e0000 0004 1936 9262Sheffield Clinical Trials Research Unit, School of Health and Related Research, The University of Sheffield, Regent’s Court, 30 Regent St, Sheffield, S1 4DA UK
| | - Jessica Wright
- grid.11835.3e0000 0004 1936 9262Sheffield Clinical Trials Research Unit, School of Health and Related Research, The University of Sheffield, Regent’s Court, 30 Regent St, Sheffield, S1 4DA UK
| | - Stephen J. Walters
- grid.11835.3e0000 0004 1936 9262Sheffield Clinical Trials Research Unit, School of Health and Related Research, The University of Sheffield, Regent’s Court, 30 Regent St, Sheffield, S1 4DA UK
| | - Cindy L. Cooper
- grid.11835.3e0000 0004 1936 9262Sheffield Clinical Trials Research Unit, School of Health and Related Research, The University of Sheffield, Regent’s Court, 30 Regent St, Sheffield, S1 4DA UK
| | - Gail A. Mountain
- grid.6268.a0000 0004 0379 5283Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
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Wu YT, Clare L, Jones IR, Nelis SM, Quinn C, Martyr A, Victor CR, Lamont RA, Rippon I, Matthews FE. Perceived and objective availability of green and blue spaces and quality of life in people with dementia: results from the IDEAL programme. Soc Psychiatry Psychiatr Epidemiol 2021; 56:1601-1610. [PMID: 33484297 PMCID: PMC8429369 DOI: 10.1007/s00127-021-02030-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 01/06/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim of this study was to investigate the associations between quality of life and both perceived and objective availability of local green and blue spaces in people with dementia, including potential variation across rural/urban settings and those with/without opportunities to go outdoors. METHODS This study was based on 1540 community-dwelling people with dementia in the Improving the experience of Dementia and Enhancing Active Life (IDEAL) programme. Quality of life was measured by the Quality of Life in Alzheimer's Disease (QoL-AD) scale. A list of 12 types of green and blue spaces was used to measure perceived availability while objective availability was estimated using geographic information system data. Regression modelling was employed to investigate the associations of quality of life with perceived and objective availability of green and blue spaces, adjusting for individual factors and deprivation level. Interaction terms with rural/urban areas or opportunities to go outdoors were fitted to test whether the associations differed across these subgroups. RESULTS Higher QoL-AD scores were associated with higher perceived availability of local green and blue spaces (0.82; 95% CI 0.06, 1.58) but not objective availability. The positive association between perceived availability and quality of life was stronger for urban (1.50; 95% CI 0.52, 2.48) than rural residents but did not differ between participants with and without opportunities to go outdoors. CONCLUSIONS Only perceived availability was related to quality of life in people with dementia. Future research may investigate how people with dementia utilise green and blue spaces and improve dementia-friendliness of these spaces.
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Affiliation(s)
- Yu-Tzu Wu
- Social Epidemiology Research Group, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK. .,Population Health Sciences Institute, Newcastle University, The Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE4 5PL, UK.
| | - Linda Clare
- College of Medicine and Health, University of Exeter, St Luke’s Campus, Exeter, EX1 2LU UK
| | - Ian Rees Jones
- Wales Institute of Social and Economic Research and Data, Cardiff University, Cardiff, CF10 3BB UK
| | - Sharon M. Nelis
- College of Medicine and Health, University of Exeter, St Luke’s Campus, Exeter, EX1 2LU UK
| | - Catherine Quinn
- Centre for Applied Dementia Studies, University of Bradford, Bradford, BD7 1DP UK
| | - Anthony Martyr
- College of Medicine and Health, University of Exeter, St Luke’s Campus, Exeter, EX1 2LU UK
| | - Christina R. Victor
- Department of Clinical Sciences, College of Health and Life Sciences, Brunel University London, Uxbridge, UB8 3PH UK
| | - Ruth A. Lamont
- College of Medicine and Health, University of Exeter, St Luke’s Campus, Exeter, EX1 2LU UK
| | - Isla Rippon
- Department of Clinical Sciences, College of Health and Life Sciences, Brunel University London, Uxbridge, UB8 3PH UK
| | - Fiona E. Matthews
- Population Health Sciences Institute, Newcastle University, The Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE4 5PL UK
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Casey D, Gallagher N, Devane D, Woods B, Murphy K, Smyth S, Newell J, Murphy AW, Clarke C, Foley T, Timmons F, Dröes RM, O’Halloran M, Windle G, Irving Lupton K, Domegan C, O’Shea E, Dolan P, Doyle P. The feasibility of a Comprehensive Resilience-building psychosocial Intervention (CREST) for people with dementia in the community: protocol for a non-randomised feasibility study. Pilot Feasibility Stud 2020; 6:177. [PMID: 33292667 PMCID: PMC7667740 DOI: 10.1186/s40814-020-00701-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 10/05/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A dementia diagnosis can prevent people from participating in society, leading to a further decline in cognitive, social and physical health. However, it may be possible for people with dementia to continue to live meaningful lives and continue to participate actively in society if a supportive psychosocial environment exists. Resilience theory, which focuses on strengthening personal attributes and external assets in the face of serious challenges, may provide a scaffold on which an inclusive multifaceted psychosocial supportive environment can be built. This protocol paper describes a study to determine the feasibility of conducting a multifaceted complex resilience building psychosocial intervention for people with dementia and their caregivers living in the community. METHODS This is a non-randomised feasibility study. Ten participants with dementia and their primary caregivers living in the community will be recruited and receive the CREST intervention. The intervention provides (a) a 7-week cognitive stimulation programme followed by an 8-week physical exercise programme for people with dementia and (b) a 6-week educational programme for caregivers. Members of the wider community will be invited to a dementia awareness programme and GP practices to a dementia training workshop. Trained professionals will deliver all intervention components. Outcomes will assess the feasibility and acceptability of all study processes. The feasibility and acceptability of a range of outcomes to be collected in a future definitive trial, including economic measurements, will also be explored. Finally, social marketing will be used to map a route toward stigma change in dementia for use in a subsequent trial. Quantitative feasibility outcome assessments will be completed at baseline and after completion of the 15-week intervention while qualitative data will be collected at recruitment, baseline, during and post-intervention delivery. CONCLUSION This feasibility study will provide evidence regarding the feasibility and acceptability of a comprehensive multifaceted psychosocial intervention programme for people with dementia and their caregivers (CREST). The results will be used to inform the development and implementation of a subsequent RCT, should the findings support feasibility. TRIAL REGISTRATION ISRCTN25294519 Retrospectively registered 07.10.2019.
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Affiliation(s)
- Dympna Casey
- School of Nursing & Midwifery, National University of Ireland Galway, Aras Moyola, Galway, Ireland
| | - Niamh Gallagher
- School of Nursing & Midwifery, National University of Ireland Galway, Aras Moyola, Galway, Ireland
| | - Declan Devane
- School of Nursing & Midwifery, National University of Ireland Galway, Aras Moyola, Galway, Ireland
| | - Bob Woods
- Dementia Services Development Centre, Bangor University, Bangor, Wales
| | - Kathy Murphy
- School of Nursing & Midwifery, National University of Ireland Galway, Aras Moyola, Galway, Ireland
| | - Siobhán Smyth
- School of Nursing & Midwifery, National University of Ireland Galway, Aras Moyola, Galway, Ireland
| | - John Newell
- School of Mathematics, Statistics & Applied Mathematics, National University of Ireland Galway, Galway, Ireland
| | - Andrew W. Murphy
- Department of General Practice, School of Medicine, National University of Ireland Galway, Galway, Ireland
| | | | - Tony Foley
- Department of General Practice, University College Cork, Cork, Ireland
| | - Fergus Timmons
- The Alzheimer Society of Ireland, Temple Road, Blackrock, Co. Dublin Ireland
| | - Rose-Marie Dröes
- Department of Psychiatry, VU University Medical Center, A.J. Ernststraat 1187 (kamer D0.03), Amsterdam, The Netherlands
| | - Martin O’Halloran
- College of Engineering & Informatics, National University of Ireland Galway, Galway, Ireland
| | - Gill Windle
- School of Health Sciences, Bangor University, Bangor, Wales
| | - Kate Irving Lupton
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
| | - Christine Domegan
- J.E. Cairnes School of Business & Economics, National University of Ireland Galway, Galway, Ireland
| | - Eamon O’Shea
- Centre for Economic & Social Research on Dementia, ILAS Building, National University of Ireland, Galway, Ireland
| | - Pat Dolan
- UNESCO Child and Family Research Centre, School of Political Science and Sociology, National University of Ireland, Galway, Ireland
| | - Priscilla Doyle
- School of Nursing & Midwifery, National University of Ireland Galway, Aras Moyola, Galway, Ireland
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Abstract
BACKGROUND Socially assistive robots (SARs) have the potential to assist nonpharmacological interventions based on verbal communication to support the care of persons with dementia (PwDs). However, establishing verbal communication with a PwD is challenging. Thus, several authors have proposed strategies to converse with PwDs. While these strategies have proved effective at enhancing communication between PwDs and their caregivers, they have not been used or tested in the domain of human-robot interaction. OBJECTIVES This study aimed to assess the effectiveness of incorporating conversational strategies proposed in the literature for caregivers, during PwD-robot interactions. METHODS We conducted a total of 23 group sessions based on music and conversation therapy, where a SAR interacted with 12 PwDs (mean = 80.25 years) diagnosed with mild to moderate-stage dementia. Using a single subject research approach, we designed an AB study to assess the effectiveness of the conversational strategies in the PwD-robot interaction. Our analysis focuses on the direct communication between the PwDs and the robot, and the perceived enjoyment of PwDs. RESULTS The number of utterances made from a PwD to the robot increased significantly when the conversational strategies were included in the robot. In addition, PwDs engaged in more sustained conversations. Additionally, PwDs enjoyed conversing with the robot Eva, as much as listening to music. These results indicate that the use of these conversational strategies is -effective at increasing the interaction between PwD and a SAR. CONCLUSIONS PwDs who participated in the study engaged and enjoyed the interaction with the SAR. The results provide evidence of the importance of incorporating appropriate conversational strategies in SARs that support interventions for the care and social stimulation of PwDs.
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Affiliation(s)
| | - Jesus Favela
- Computer Science Department, CICESE, Ensenada, Mexico
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Rababa M, Aldalaykeh M. Responding to Varying Levels of Certainty about Pain in People with Dementia after Initial Pain Assessment. Dement Geriatr Cogn Dis Extra 2019; 9:271-280. [PMID: 31572423 PMCID: PMC6751429 DOI: 10.1159/000501030] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 05/15/2019] [Indexed: 01/14/2023] Open
Abstract
Introduction Pain is still inadequately treated in people with dementia (PWD) due to the complexity of assessing it. Pain assessment in PWD is still challenging because of patient-related or nurse-related factors. The patient-related factors have been studied extensively. However, the nurse-related factors, e.g., nurses' certainty regarding suspected pain in PWD, have been given little attention by researchers. Purpose This study aims to investigate how the degree of nurses' certainty is compromised after pain assessment and how this affects levels of pain and agitation in PWD. Method A descriptive, correlational design was used, and a convenience sample of 104 nursing home residents with dementia were recruited. Results This study found that nurses' certainty after the pain assessment mediates the relationship between the type of pain assessment and patient outcomes when the nurses had a high initial certainty. When nurses had a low initial certainty, their certainty after the assessment and the type of assessment predicted the levels of pain and agitation in PWD. Conclusion Understanding how nurses' certainty can be compromising after pain assessment and how this relates to pain management in PWD is crucial.
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Renehan E, Goeman D, Koch S. Development of an optimised key worker framework for people with dementia, their family and caring unit living in the community. BMC Health Serv Res 2017; 17:501. [PMID: 28728578 PMCID: PMC5520382 DOI: 10.1186/s12913-017-2448-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 07/13/2017] [Indexed: 11/17/2022] Open
Abstract
Background In Australia, dementia is a national health priority. With the rising number of people living with dementia and shortage of formal and informal carers predicted in the near future, developing approaches to coordinating services in quality-focused ways is considered an urgent priority. Key worker support models are one approach that have been used to assist people living with dementia and their caring unit coordinate services and navigate service systems; however, there is limited literature outlining comprehensive frameworks for the implementation of community dementia key worker roles in practice. In this paper an optimised key worker framework for people with dementia, their family and caring unit living in the community is developed and presented. Methods A number of processes were undertaken to inform the development of a co-designed optimised key worker framework: an expert working and reference group; a systematic review of the literature; and a qualitative evaluation of 14 dementia key worker models operating in Australia involving 14 interviews with organisation managers, 19 with key workers and 15 with people living with dementia and/or their caring unit. Data from the systematic review and evaluation of dementia key worker models were analysed by the researchers and the expert working and reference group using a constant comparative approach to define the essential components of the optimised framework. Results The developed framework consisted of four main components: overarching philosophies; organisational context; role definition; and key worker competencies. A number of more clearly defined sub-themes sat under each component. Reflected in the framework is the complexity of the dementia journey and the difficulty in trying to develop a ‘one size fits all’ approach. Conclusions This co-designed study led to the development of an evidence based framework which outlines a comprehensive synthesis of components viewed as being essential to the implementation of a dementia key worker model of care in the community. The framework was informed and endorsed by people living with dementia and their caring unit, key workers, managers, Australian industry experts, policy makers and researchers. An evaluation of its effectiveness and relevance for practice within the dementia care space is required. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2448-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Emma Renehan
- RDNS Institute, Royal District Nursing Service Ltd, 31 Alma Rd, St Kilda, Vic, 3182, Australia.
| | - Dianne Goeman
- RDNS Institute, Royal District Nursing Service Ltd, 31 Alma Rd, St Kilda, Vic, 3182, Australia.,Central Clinical School, Medicine, Nursing & Health Sciences, Monash University, Melbourne, Australia.,School of Medicine & Public Health, The University of Newcastle, Callaghan, Australia
| | - Susan Koch
- RDNS Institute, Royal District Nursing Service Ltd, 31 Alma Rd, St Kilda, Vic, 3182, Australia.,School of Medicine & Public Health, The University of Newcastle, Callaghan, Australia
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Orgeta V, Orrell M, Edwards RT, Hounsome B, Woods B. Self- and Carer-Rated Pain in People With Dementia: Influences of Pain in Carers. J Pain Symptom Manage 2015; 49:1042-9. [PMID: 25542551 DOI: 10.1016/j.jpainsymman.2014.10.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 04/10/2014] [Revised: 10/28/2014] [Accepted: 11/13/2014] [Indexed: 12/24/2022]
Abstract
CONTEXT Although pain is frequent in people with dementia (PwD), evidence on the prevalence and factors influencing ratings of pain in dementia is limited. Carer variables are often associated with bias in proxy ratings of pain, but few studies have examined the role of caregiver pain in influencing these ratings. OBJECTIVES This study explored the prevalence of pain in PwD in a large U.K. SAMPLE A secondary aim was to identify factors influencing ratings of pain in people with mild to moderate dementia and whether carer pain systematically influences proxy ratings. METHODS This was a cross-sectional study of 488 caregiving dyads living in the community. Self- and carer-rated pain was assessed as part of the EuroQoL-5D (EQ-5D). Depression and anxiety for the PwD were measured by the Cornell Scale for Depression in Dementia and the Rating of Anxiety in Dementia Scale. The Hospital Anxiety and Depression Scale was used to measure anxiety and depressive symptoms in carers. Using logistic regression modeling, we examined the relationship between self- and carer-rated (proxy) pain in PwD and psychological distress, functional ability, and health status. Carer variables included self-rated health, strain, anxiety, depression, and caregiver pain. RESULTS A total of 45% of PwD reported pain, whereas carer-rated pain was higher (59%). Self-rated pain was more frequent in those with lower self-rated health (adjusted odds ratio [AOR] 0.97; 95% CI 0.96-0.99, P ≤ 0.001) and higher anxiety (AOR 1.07; 95% CI 1.01-1.12, P = 0.013). Carer-rated (proxy) pain was additionally predicted by poor proxy-rated health in the PwD (AOR 0.98; 95% CI 0.96-0.99, P = 0.006) and carers' own experience of pain (AOR 0.36; 95% CI 0.21-0.63, P ≤ 0.001). CONCLUSION Our results indicate that pain is very frequently reported in PwD and that the presence of pain is associated with high levels of anxiety. Caregiver pain affects carers' perceptions of pain in PwD.
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Affiliation(s)
- Vasiliki Orgeta
- Division of Psychiatry, University College London, London, United Kingdom.
| | - Martin Orrell
- Division of Psychiatry, University College London, London, United Kingdom
| | - Rhiannon Tudor Edwards
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, Gwynedd, United Kingdom
| | - Barry Hounsome
- Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Bob Woods
- Dementia Services Development Centre Wales, Bangor University, Bangor, Gwynedd, United Kingdom
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