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Giebel C, Halpin K, O'Connell L, Carton J. The legalities of managing finances and paying for future care in dementia: a UK-based qualitative study. Aging Ment Health 2023; 27:2403-2409. [PMID: 37132486 DOI: 10.1080/13607863.2023.2209035] [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: 11/08/2022] [Accepted: 04/25/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND Managing finances in dementia and on someone else's behalf can be difficult, especially with navigating the legalities surrounding this activity. With a lack of previous evidence, the aim of this qualitative study was to explore how people living with dementia and unpaid carers are planning the financing of dementia care and deal with legal issues surrounding finances. METHODS We recruited people living with dementia and unpaid carers from across the UK between February and May 2022. The topic guide was developed with two unpaid carers as advisers, and both contributed to the analysis and interpretation of findings, as well as dissemination. Participants were interviewed remotely, and transcripts analysed using inductive thematic analysis. RESULTS Thirty unpaid carers and people with dementia participated. We generated three themes: Changes to family dynamics; Barriers to implementing legal arrangements in practice; Planning to pay for future care. Arranging financial management involved difficult family dynamics for some, including strained relationships between the carer and person cared for, and among carers. There was little to no guidance on how finances should be handled, causing difficulties in the implementation even when legal agreements were in place. The lack of guidance was equally experienced for information about how to pay for care and plan for paying for future care. CONCLUSIONS Post-diagnostic support needs to include legal and financial advice, with clearer guidance on how to access financial support to pay for care. Future quantitative research should explore the link between economic background and access to financial support.
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Affiliation(s)
- Clarissa Giebel
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
- NIHR ARC NWC, Liverpool, UK
| | | | - Lena O'Connell
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
- NIHR ARC NWC, Liverpool, UK
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2
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Eikelboom WS, Koch J, Beattie E, Lautenschlager NT, Doyle C, van den Berg E, Papma JM, Anstey KJ, Mortby ME. Residential aged care staff perceptions and responses towards neuropsychiatric symptoms: a mixed methods analysis of electronic healthcare records. Aging Ment Health 2023; 27:243-250. [PMID: 35100918 DOI: 10.1080/13607863.2022.2032597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To investigate electronic care notes to better understand reporting and management of neuropsychiatric symptoms (NPS) by residential aged care (RAC) staff. METHODS We examined semi-structured care notes from electronic healthcare notes of 77 residents (67% female; aged 67-101; 79% with formal dementia diagnosis) across three RAC facilities. As part of standard clinical practice, staff documented the NPS presentation and subsequent management amongst residents. Using a mixed-method approach, we analyzed the type of NPS reported and explored care staff responses to NPS using inductive thematic analysis. RESULTS 465 electronic care notes were recorded during the 18-month period. Agitation-related behaviors were most frequently reported across residents (48.1%), while psychosis (15.6%), affective symptoms (14.3%), and apathy (1.3%) were less often reported. Only 27.5% of the notes contained information on potential causes underlying NPS. When faced with NPS, care staff responded by either providing emotional support, meeting resident's needs, removing identified triggers, or distracting. CONCLUSION Results suggest that RAC staff primarily detected and responded to those NPS they perceived as distressing. Findings highlight a potential under-recognition of specific NPS types, and lack of routine examination of NPS causes or systematic assessment and management of NPS. These observations are needed to inform the development and implementation of non-pharmacological interventions and care programs targeting NPS in RAC. UNLABELLED Supplemental data for this article is available online at https://doi.org/10.1080/13607863.2022.2032597 .
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Affiliation(s)
- Willem S Eikelboom
- Neuroscience Research Australia, Randwick Sydney, NSW, Australia.,Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Jana Koch
- Neuroscience Research Australia, Randwick Sydney, NSW, Australia.,School of Psychology, University of New South Wales, Kensington Sydney, NSW, Australia
| | - Elizabeth Beattie
- Dementia Centre for Research Collaboration, School of Nursing, Queensland University of Technology, QLD, Australia
| | - Nicola T Lautenschlager
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia.,NorthWestern Mental Health, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Colleen Doyle
- National Aging Research Institute, Parkville, VIC, Australia
| | - Esther van den Berg
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Janne M Papma
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Kaarin J Anstey
- Neuroscience Research Australia, Randwick Sydney, NSW, Australia.,School of Psychology, University of New South Wales, Kensington Sydney, NSW, Australia
| | - Moyra E Mortby
- Neuroscience Research Australia, Randwick Sydney, NSW, Australia.,School of Psychology, University of New South Wales, Kensington Sydney, NSW, Australia
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3
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Ferreira AR, Gonçalves-Pinho M, Simões MR, Freitas A, Fernandes L. Dementia-related agitation: a 6-year nationwide characterization and analysis of hospitalization outcomes. Aging Ment Health 2023; 27:380-388. [PMID: 35466829 DOI: 10.1080/13607863.2022.2065663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To characterize all hospitalizations held in mainland Portugal (2010-2015) with dementia-related agitation based on International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) coding, and to investigate whether there is a relationship between agitation and hospitalization outcomes. METHODS A retrospective observational study was conducted using an administrative dataset containing data from all mainland Portuguese public hospitals. Only hospitalization episodes for patients aged over 65 years who have received a dementia diagnosis ascertained by an ICD-9-CM code of dementia with behavioral disturbance (294.11 and 294.21) and dementia without behavioral disturbance (294.10 and 294.20) were selected. Episodes were further grouped according to the presence of an agitation code. For each episode, demographic data and hospitalization outcomes, including length of stay (LoS), in-hospital mortality, discharge destination and all-cause hospital readmissions, were sourced from the dataset. Comparative analyses were performed and multivariable logistic methods were used to estimate the adjusted associations between agitation (exposure) and outcomes. RESULTS Overall, 53,156 episodes were selected, of which 6,586 had an agitation code. These were mostly related to male, younger inpatients (mean 81.19 vs. 83.29 years, p < 0.001), had a higher comorbidity burden, stayed longer at the hospital (median 9.00 vs. 8.00 days, p < 0.001) and frequently ended being transferred to another facility with inpatient care. Agitation was shown to independently increase LoS (aOR = 1.385; 95%CI:1.314-1.461), but not the risk of a fatal outcome (aOR = 0.648; 95%CI:0.600-0.700). CONCLUSION These results support the importance of detecting and managing agitation early on admission, since its prompt management may prevent lengthy disruptive hospitalizations.
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Affiliation(s)
- Ana Rita Ferreira
- Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal.,CINTESIS@RISE, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Manuel Gonçalves-Pinho
- CINTESIS@RISE, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Psychiatry and Mental Health, Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - Mário R Simões
- University of Coimbra, CINEICC, PsyAssessmentLab, Faculty of Psychology and Educational Sciences, Coimbra, Portugal
| | - Alberto Freitas
- CINTESIS@RISE, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Lia Fernandes
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal.,CINTESIS@RISE, Faculty of Medicine, University of Porto, Porto, Portugal.,Psychiatry Service, Centro Hospitalar Universitário de São João, Porto, Portugal
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4
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Nguyen TA, Tran KV, Hinton L, Roughead EE, Esterman A, Dang TH, Kim GB, Pham DB, Nguyen HTD, Crotty M, Kurrle S, Pham T, Pham TL, Hoang P, Brodaty H. Experiences and perceptions of dementia in Vietnam and among the Vietnamese diaspora: a systematic review of qualitative studies. Aging Ment Health 2023; 27:301-316. [PMID: 35549573 DOI: 10.1080/13607863.2022.2056136] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Objectives: This paper aimed to review and synthesise the qualitative research evidence on the experiences and perceptions of dementia in Vietnam and among the Vietnamese diaspora.Methods: Systematic searches were conducted in June 2019 using Medline, Embase, Emcare, PsycINFO and Cochrane electronic databases, as well as grey literature. Keywords and Medical Subject Headings [MeSH terms] for dementia and associated terms were combined with keywords for Vietnam and its provinces. Qualitative research articles published in English or Vietnamese were included to examine evidence on the life experiences of Vietnamese people with dementia using thematic analysis.Results: Our searches resulted in 3,940 papers, from which 21 qualitative research studies were included for final analysis. The majority of research has not been undertaken in Vietnam but with the Vietnamese diaspora in Western countries and has taken a cultural perspective to analyses. Research in Western countries has focused on the need for culturally adapted and culturally sensitive models of care. Emerging themes about the life experiences of Vietnamese people with dementia identified from the studies included: many people do not have diagnostic terms for dementia but use the descriptive language of symptoms; stigma was a reported problem and on occasions can be observed in the descriptive language used for people with dementia; cultural and traditional values create both an opportunity and a barrier, supporting compassion, family care and relaxation, but creating barriers to accessing health services or long-term residential care.Conclusions: This is the first systematic review reporting qualitative evidence on the life experiences of people with dementia in Vietnam and among the Vietnamese diaspora. Future research is needed on the voice of people with dementia themselves and their caregivers particularly in Vietnam, and low and middle-income countries with regards to living with dementia, pathways to care from diagnosis, treatment, care and support, additional social care and preparedness for end of life care for people with dementia.
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Affiliation(s)
- Tuan Anh Nguyen
- Social Gerontology Division, National Ageing Research Institute, Melbourne, VIC, Australia.,UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, Australia.,School of Health Sciences, Swinburne University of Technology, Melbourne, VIC, Australia.,Health Strategy and Policy Institute, Ministry of Health of Vietnam, Hanoi, Vietnam
| | - Kham Van Tran
- Social Gerontology Division, National Ageing Research Institute, Melbourne, VIC, Australia.,UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, Australia
| | - Ladson Hinton
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, Davis, Sacramento, CA, USA
| | - Elizabeth E Roughead
- UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, Australia
| | - Adrian Esterman
- UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, Australia
| | - Thu Ha Dang
- Social Gerontology Division, National Ageing Research Institute, Melbourne, VIC, Australia.,School of Health Sciences, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Giang Bao Kim
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Diep Bich Pham
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Huong Thi Diem Nguyen
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Maria Crotty
- College of Medicine and Public Health, Rehabilitation, Aged & Extended Care, Flinders University, Adelaide, Australia
| | - Susan Kurrle
- Faculty of Medicine, The University of Sydney, Sydney, Australia
| | - Thang Pham
- National Geriatric Hospital of Vietnam, Hanoi, Vietnam
| | - Tuan Le Pham
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Phuong Hoang
- UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, Australia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing, The University of New South Wales, Sydney, NSW, Australia
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Parker GJ, Haslam C, Stuart J, Shum DHK, Ownsworth T. Health practitioner beliefs regarding the impact of age-based stereotype threat on performance in the cognitive assessment of older adults. Aging Ment Health 2022:1-14. [PMID: 36038552 DOI: 10.1080/13607863.2022.2116399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVES Health practitioners' understanding of the impact of age-based stereotype threat (ABST) on the cognitive test performance of older adults is not well understood. This study aimed to investigate health practitioners' ability to recognize the influence of ABST in the cognitive assessment of older adults and their perceptions of its impact in practice. METHODS One-hundred and twenty-nine health practitioners (86% female; M age = 39.75, SD = 11.50) with experience in conducting cognitive assessments with older adults (mainly psychologists and occupational therapists) completed an online survey assessing demographic and practice characteristics, aging beliefs, a hypothetical cognitive assessment scenario, and perceived impact of ABST on practice. RESULTS Overall, health practitioners rated ABST factors in the assessment scenario as less detrimental to cognitive performance than internal and external factors. In a hierarchical regression model, lower recognition of ABST and negative aging beliefs significantly accounted for lower perceived impact of ABST on older adults' cognitive test performance in practice (R2 = .37, p < .001). CONCLUSION Health practitioners may not recognize the influence of ABST on assessment findings, especially if they hold negative aging beliefs. The findings highlight the need to improve health practitioners' knowledge of ABST to increase the validity of cognitive testing in older adults.
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Affiliation(s)
- Giverny J Parker
- School of Applied Psychology, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Catherine Haslam
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Jaimee Stuart
- School of Applied Psychology, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - David H K Shum
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, Hong Kong
| | - Tamara Ownsworth
- School of Applied Psychology, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
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Prendergast L, Toms G, Seddon D, Tudor Edwards R, Anthony B, Jones C. 'It was just - everything was normal': outcomes for people living with dementia, their unpaid carers, and paid carers in a Shared Lives day support service. Aging Ment Health 2022:1-9. [PMID: 35848206 DOI: 10.1080/13607863.2022.2098921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Short breaks support the wellbeing of people living with dementia (PLWD) and their unpaid carers. However, little is known about the benefits of community-based short breaks. The objective of this study was to conduct interviews with stakeholders of a Shared Lives (SL) day support service to explore mechanisms and outcomes for the service. The aim of the study was to refine a logic model for a SL day support service for PLWD, their unpaid carers, and paid carers. This logic model shall form the basis for a Social Return on Investment evaluation to identify the social value contributed by the service. METHODS Thirteen interviews were conducted with service stakeholders including PLWD, unpaid carers and paid carers. Framework analysis assisted in the synthesis of the findings into a logic model. RESULTS The logic model refined through the interviews, detailed service mechanisms (inputs, activities, outputs) and outcomes. An overarching theme from the interviews concerned the importance of triadic caring relationships, which conferred benefits for those involved in the service. CONCLUSION SL day support fosters triadic caring relationships, and interview data suggests that these relationships are associated with meaningful outcomes for PLWD, their unpaid carers, and paid carers. We highlight the implications for policy, practice, and future research.
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Affiliation(s)
- Louise Prendergast
- School of Medical and Health Sciences, Bangor University, Bangor, Wales, UK
| | - Gill Toms
- School of Medical and Health Sciences, Bangor University, Bangor, Wales, UK
| | - Diane Seddon
- Centre for Ageing and Dementia Research (CADR), Dementia Services Development Centre (DSDC) Wales Research Centre, School of Medical and Health Sciences, Bangor University, Bangor, Wales, UK
| | - Rhiannon Tudor Edwards
- Centre for Health Economics and Medicines Evaluation (CHEME), Bangor University, Bangor, Wales, UK
| | - Bethany Anthony
- Centre for Health Economics and Medicines Evaluation (CHEME), Bangor University, Bangor, Wales, UK
| | - Carys Jones
- School of Medical and Health Sciences, Bangor University, Bangor, Wales, UK
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Rosi A, Govoni S, Del Signore F, Tassorelli C, Cappa S, Allegri N. Italian Dementia-Friendly Hospital Trial (IDENTITÀ): efficacy of a dementia care intervention for hospital staff. Aging Ment Health 2022; 27:921-929. [PMID: 35773241 DOI: 10.1080/13607863.2022.2084507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
This study investigated the short-term impact and the retention of a dementia care intervention for healthcare staff working in an Italian acute hospital setting. Additionally, we identified the predictors of improvement across the intervention. Sixty-two healthcare staff from an Italian public hospital participated in a dementia care intervention consisting of 5 modules delivered in a 5-hour training program focusing on dementia management, knowledge, and care. A pre-test/post-test and six-months follow-up design was used to evaluate participants' changes in knowledge, attitudes, and confidence in dementia. The intervention significantly improved healthcare staff's dementia knowledge and confidence immediately after the end of the intervention. No significant changes were observed from post-test to follow-up, indicating retention of these outcomes over six months. Regarding attitude to dementia, we found an immediate improvement only in the Recognition of Personhood scale. Looking at the predictors of improvement, healthcare staff with lower levels of knowledge, attitudes, and confidence in dementia at pre-test were those who improved more following the intervention. These findings provide further evidence that dementia care interventions are suitable initiatives to promote knowledge and skills required to manage the needs of people with dementia in an acute hospital setting.
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Affiliation(s)
- Alessia Rosi
- Brain and Behavioral Sciences Department, University of Pavia, Pavia, Italy
| | - Stefano Govoni
- Drug Sciences Department, University of Pavia, Pavia, Italy.,CEFAT (Center of Pharmaceuticals Economics and Medical Technologies Evaluation), University of Pavia, Pavia, Italy
| | - Federica Del Signore
- CEFAT (Center of Pharmaceuticals Economics and Medical Technologies Evaluation), University of Pavia, Pavia, Italy
| | - Cristina Tassorelli
- Brain and Behavioral Sciences Department, University of Pavia, Pavia, Italy.,IRCCS Mondino Foundation, Pavia, Italy
| | - Stefano Cappa
- IRCCS Mondino Foundation, Pavia, Italy.,University School for Advanced Studies, IUSS, Pavia, Italy
| | - Nicola Allegri
- CEFAT (Center of Pharmaceuticals Economics and Medical Technologies Evaluation), University of Pavia, Pavia, Italy
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8
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Linden I, Hevink M, Wolfs C, Perry M, Dirksen C, Ponds R. Understanding patients' and significant others' preferences on starting a diagnostic trajectory for dementia: An integrative review. Aging Ment Health 2022; 27:862-875. [PMID: 35763442 PMCID: PMC10166060 DOI: 10.1080/13607863.2022.2084505] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To explore the preferences of people with memory complaints (PwMC) and their significant others regarding starting a diagnostic trajectory for dementia. METHODS A systematic literature search was conducted in PubMed, PsycINFO, CINAHL, Web of Science, and Embase. Selection of abstracts and papers was performed independently by two researchers. Methodological quality was assessed with the Mixed Method Appraisal Tool. Result sections of the selected papers were thematically synthesized. RESULTS From 2497 citations, seven qualitative studies and two mixed methods studies published between 2010 and 2020 were included. Overall quality of the studies was high to moderate. A thematic synthesis showed that preferences for starting a diagnostic trajectory arose from the feeling of needing to do something about the symptoms, beliefs on the necessity and expected outcomes of starting a diagnostic trajectory. These views were influenced by normalization or validation of symptoms, the support or wishes of the social network, interactions with health care professionals, the health status of the PwMC, and societal factors such as stigma and socioeconomic status. CONCLUSION A variety of considerations with regard to decision-making on starting a diagnostic trajectory for dementia were identified. This emphasizes the need to explore individual preferences to facilitate a timely dementia diagnosis.
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Affiliation(s)
- Iris Linden
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands
| | - Maud Hevink
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands
| | - Claire Wolfs
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands
| | - Marieke Perry
- Department of Geriatric Medicine, Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Primary and Community care, Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Carmen Dirksen
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Rudolf Ponds
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands.,Department of Medical Psychology, Amsterdam University Medical Center, Amsterdam, The Netherlands
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9
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Henderson C, Rehill A, Brooker D, Evans SC, Evans SB, Bray J, Saibene FL, Scorolli C, Szcześniak D, d'Arma A, Lion K, Atkinson T, Farina E, Rymaszewska J, Chattat R, Meiland F, Dröes RM, Knapp M. Costs and cost-effectiveness of the meeting centres support programme for people living with dementia and carers in Italy, Poland and the UK: The MEETINGDEM study. Health Soc Care Community 2021; 29:1756-1768. [PMID: 33506538 DOI: 10.1111/hsc.13281] [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] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 11/08/2020] [Accepted: 11/25/2020] [Indexed: 06/12/2023]
Abstract
We examined the costs and cost-effectiveness of the Meeting Centre Support Programme (MCSP) implemented and piloted in the UK, Poland and Italy, replicating the Dutch Meeting Centre model. Dutch Meeting Centres combine day services for people with dementia with carer support. Data were collected over 2015-2016 from MCSP and usual care (UC) participants (people with dementia-carer dyads) at baseline and 6 months. We examined participants' health and social care (HSC), and societal costs, including Meeting Centre (MC) attendances. Costs and outcomes in MCSP and UC groups were compared. Primary outcomes: Persons with dementia: quality-adjusted life years (EQ-5D-5L-derived); QOL-AD. DQoL was examined as a secondary outcome. Carers: Short Sense of Competence Questionnaire (SSCQ). Incremental cost-effectiveness ratios (ICER) and cost-effectiveness acceptability curves were obtained by bootstrapping outcome and cost regression estimates. Eighty-three MCSP and 69 UC dyads were analysed. The 6-month cost of providing MCSP was €4,703; participants with dementia attended MC a mean of 45 times and carers 15 times. Including intervention costs, adjusted 6-month HSC costs were €5,941higher in MCSP than in UC. From the HSC perspective: in terms of QALY, the probability of cost-effectiveness was zero over willingness-to-pay (WTP) ranging from €0 to €350,000. On QOL-AD, the probability of cost-effectiveness of MCSP was 50% at WTP of €5,000 for a one-point increase. A one-point gain in the DQoL positive affect subscale had a probability of cost-effectiveness of 99% at WTP over €8,000. On SSCQ, no significant difference was found between MCSP and UC. Evidence for cost-effectiveness of MCSP was mixed but suggests that it may be cost-effective in relation to gains in dementia-specific quality of life measures. MCs offer effective tailored post-diagnostic support services to both people with dementia and carers in a context where few evidence-based alternatives to formal home-based social services may be available.
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Affiliation(s)
- Catherine Henderson
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Amritpal Rehill
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Dawn Brooker
- Association for Dementia Studies, University of Worcester, Worcester, UK
| | - Simon C Evans
- Association for Dementia Studies, University of Worcester, Worcester, UK
| | - Shirley B Evans
- Association for Dementia Studies, University of Worcester, Worcester, UK
| | - Jennifer Bray
- Association for Dementia Studies, University of Worcester, Worcester, UK
| | | | | | | | | | | | - Teresa Atkinson
- Association for Dementia Studies, University of Worcester, Worcester, UK
| | | | | | | | - Franka Meiland
- Amsterdam University Medical Centres, VU University Medical Centre, Amsterdam, The Netherlands
| | - Rose-Marie Dröes
- Amsterdam University Medical Centres, VU University Medical Centre, Amsterdam, The Netherlands
| | - Martin Knapp
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
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10
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Abstract
METHODS A systematic search and narrative synthesis of original research was conducted. Searches in Pubmed, Web of Science, PsychINFO and CINAHL followed PRISMA Guidelines. The review focused on people with dementia involved in advocacy. There were no restrictions based on study design or date. Language was limited to English. RESULTS Seven papers were identified, with predominantly qualitative methodologies. Four overarching themes were identified: threats, fighting back, evolving identities and making a difference. Threats ranged from those arising from dementia as an illness, to exposure to stigma. Fighting back represented advocates' response to these threats, often described using martial metaphors. Evolving identities captured advocates' journeys through diagnosis to involvement in advocacy and subsequent impact upon identity. Making a difference represented the impact of dementia advocacy at an individual, community and societal level. CONCLUSIONS This review confirms that the threats associated with dementia extend beyond the symptoms of illness. Dementia advocacy offers potential improvements in well-being for those involved, through the activity itself and via extended social networks. There is little research on broader aspects of advocates' identity, including ethnicity, gender, and age. There has been little attempt to quantify the impact of dementia advocacy.
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Affiliation(s)
- Jason Weetch
- Centre for Research in Aging and Cognitive Health (REACH), University of Exeter Medical School, Exeter, UK
| | - Siobhan O'Dwyer
- College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Linda Clare
- Centre for Research in Aging and Cognitive Health (REACH), University of Exeter Medical School, Exeter, UK
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11
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Dovi E, Bier JC, Fantini-Hauwel C. Evolution of lived experience of dementia caregivers after a psycho-educational group: an interpretative phenomenological analysis. Scand J Caring Sci 2020; 35:1134-1142. [PMID: 33164253 DOI: 10.1111/scs.12929] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 10/19/2020] [Indexed: 11/29/2022]
Abstract
The 'Help and Support for Caregivers and Patients' psycho-education group aims to educate and support dementia caregivers. Fourteen spousal caregivers were interviewed before (T1) and after (T2) psycho-education participation. Intrapersonal processes and the potential evolution of lived experience were explored using longitudinal interpretative phenomenological analysis. Three trajectory groups were identified at T1: proactive help-seekers, passive but hopeful caregivers and ambivalent caregivers. T2 interviews revealed that caregivers experienced growth in their role, benefitted from peer interactions, feelings of guilt were addressed and they were using out-of-home dementia-specific services. Identifying beliefs or attitudes that might prevent caregivers from getting help or support is important. Caregiver well-being remains a public health priority and furthering our knowledge about their complex and changing needs is paramount to provide well-designed and tailored resources.
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Affiliation(s)
- Eliane Dovi
- Research Center of Clinical psychology, psychopathology and psychosomatics, Université libre de Bruxelles, Brussels, Belgium
| | | | - Carole Fantini-Hauwel
- Research Center of Clinical psychology, psychopathology and psychosomatics, Université libre de Bruxelles, Brussels, Belgium
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Sperling SA, Brown DS, Jensen C, Inker J, Mittelman MS, Manning CA. FAMILIES: an effective healthcare intervention for caregivers of community dwelling people living with dementia. Aging Ment Health 2020; 24:1700-1708. [PMID: 31364866 DOI: 10.1080/13607863.2019.1647141] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Objectives: Caregiving for a person with dementia (PWD) carries increased risk of poorer health and quality of life. Non-pharmacological interventions improve outcomes for caregivers of PWDs. We evaluated the efficacy of a modified New York University Caregiver Intervention (NYUCI), named FAMILIES, delivered to spousal and non-spousal caregivers of PWDs from diverse etiologies in a reduced number of sessions.Methods: Participants were 122 primary caregivers for community dwelling PWDs in Virginia. The intervention included two individual and four family/group counseling sessions that integrated dementia education, coping skills and behavioral management training, emotional support, and identification of family and community resources. Assessment of depression, caregiver well-being and burden, and caregiver reactions to the behavioral symptoms of dementia (BSD) were completed at baseline, the sixth session, and 6-month follow-up.Results: Symptoms of depression (p < .001) and caregiver burden (p = .001) and caregivers' capacity to effectively manage their reactions to BSD (p = .003), significantly improved at the sixth session. Benefits were maintained at 6-month follow-up. Being married and female predicted improvement in caregiver burden; being male and living in a rural area predicted reduced risk of depression. Caregivers reported that the intervention was helpful and had a positive impact on the PWD.Conclusions: Modifications to the NYUCI did not diminish its efficacy. Caregivers in FAMILIES experienced improvements in depressive symptoms, caregiver burden, and their ability to effectively manage their reactions to BSD. Systemic support for implementing FAMILIES could have a broad impact on caregivers, PWDs, and the healthcare system.
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Affiliation(s)
- Scott A Sperling
- Department of Neurology, University of Virginia, Charlottesville, VA, USA
| | - Daniel S Brown
- Department of Neurology, University of Virginia, Charlottesville, VA, USA
| | - Christine Jensen
- Riverside Center for Excellence in Aging and Lifelong Health, Williamsburg, VA, USA
| | - Jenny Inker
- Department of Gerontology, Virginia Commonwealth University, Richmond, VA, USA
| | - Mary S Mittelman
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA
| | - Carol A Manning
- Department of Neurology, University of Virginia, Charlottesville, VA, USA
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Costlow K, Parmelee PA. The impact of relocation stress on cognitively impaired and cognitively unimpaired long-term care residents. Aging Ment Health 2020; 24:1589-1595. [PMID: 31468988 PMCID: PMC7048638 DOI: 10.1080/13607863.2019.1660855] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 08/23/2019] [Indexed: 10/26/2022]
Abstract
Objectives: The current aims were to explore the effects of relocation stress on depression and anxiety in long-term care residents and to investigate the moderating effect of cognitive status.Methods: The study used existing data from nursing home and congregate apartment residents. Self-reported measures of relocation stress, cognitive status, depression, and anxiety were examined. Exploratory analyses examined group differences in depression and anxiety within the full sample (n = 568) and the sample of first-year residents (n = 347). Main analyses were conducted in a subsample of 107 first-year residents who completed the measure of relocation stress.Results: Residents who had moved in the past year reported more anxiety but not depression than longer-term residents. Relocation stress significantly predicted depression but not anxiety in the subsample of first-year residents. There was no significant effect of cognitive status or the interaction of cognitive status and relocation stress on depression and anxiety.Conclusion: Findings suggest that cognitively impaired older adults are no more vulnerable to the negative effects of relocation stress than cognitively unimpaired older adults. Relocation stress should be regarded as a risk factor for depression in long-term care residents, regardless of cognitive status, in the first year after relocation.
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Affiliation(s)
- Kyrsten Costlow
- Alabama Research Institute on Aging and Department of Psychology, University of Alabama, Tuscaloosa, USA
| | - Patricia A. Parmelee
- Alabama Research Institute on Aging and Department of Psychology, University of Alabama, Tuscaloosa, USA
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14
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Abstract
Objectives: Death preparedness amongst family caregivers (CG) is a valuable and measurable concept. Preparedness predicts CG outcomes in bereavement and is modifiable through a palliative approach which includes advance care planning (ACP) interventions. Improving death preparedness is important for CGs of persons with dementia (PwD) whom are more likely to develop negative outcomes in bereavement, and experience less than adequate palliative care. However, the adequacy of existing tools to measure death preparedness in CGs of PwD is unknown, which limits intervention design and prospective evaluation of ACP effectiveness.Methods: We conducted a review and evaluation of existing tools measuring the attribute domains and traits of CG death preparedness. Literature was searched for articles describing caregiving at end of life (EOL). Measurement tools were extracted, screened for inclusion criteria, and data extracted regarding: conceptual basis, population of development, and psychometrics. Tool content was compared to preparedness domains/traits to assess congruency and evaluate the adequacy of tools as measures of death preparedness for CGs of PwD.Results: Authors extracted 569 tools from articles, retaining seven tools for evaluation. The majority of tools, n = 5 (70%) did not sample all preparedness domains/traits. Few tools had items specific to EOL; only one tool had a specific item questioning CG preparedness for death, and only one tool had items specific to dementia.Conclusion: Limitations in existing tools suggest they are not adequate measures of death preparedness for CGs of PwD. Consequently, the authors are currently developing a questionnaire to be titled, 'Caring Ahead' for this purpose.
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Affiliation(s)
- Pamela Durepos
- McMaster University, Faculty of Health Sciences, School of Nursing, Hamilton, Ontario, Canada.,Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada
| | - Jenny Ploeg
- McMaster University, Faculty of Health Sciences, School of Nursing, Hamilton, Ontario, Canada.,Aging, Community and Health Research Unit, Hamilton, Ontario, Canada
| | - Noori Akhtar-Danesh
- McMaster University, Faculty of Health Sciences, School of Nursing, Hamilton, Ontario, Canada
| | - Tamara Sussman
- Department of Social Work, McGill University, Montreal, Quebec, Canada
| | - Elizabeth Orr
- McMaster University, Faculty of Health Sciences, School of Nursing, Hamilton, Ontario, Canada
| | - Sharon Kaasalainen
- McMaster University, Faculty of Health Sciences, School of Nursing, Hamilton, Ontario, Canada
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15
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Birt L, Poland F, Charlesworth G, Leung P, Higgs P. Relational experiences of people seeking help and assessment for subjective cognitive concern and memory loss. Aging Ment Health 2020; 24:1356-1364. [PMID: 30917667 DOI: 10.1080/13607863.2019.1592111] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: To understand the experience of people who seek help for subjective cognitive concern and memory loss, including people not referred for further assessment. To understand the patients' perspective of the medical process of receiving a cognitive assessment. This work is situated within the context of policy priorities for dementia diagnosis.Methods: Participants with and without dementia were recruited through NHS trusts and community organisations in four regional areas in England. Data were collected using longitudinal qualitative interviews. Transcript data were thematically analysed.Results: Sample of 41 people (mean 75 years, 25 dementia diagnoses). Interpretative thematic analyses focused on the presence or absence of trust in relational experiences. There were three transition points where trust could be specifically developed or undermined: (1) deciding to seek help; (2) healthcare practitioners' response to help-seeking; (3) process and outcome of assessment. Triggers for help-seeking for subjective cognitive concern were being prompted by family and knowing a relative with dementia. When participants perceived healthcare practitioners' behaviour as dismissive, they had less trust in the outcome of the healthcare encounter. Misunderstandings and absence of trust in assessment processes led to participants stating they did not fully agree with the outcomes of the assessment.Conclusions: Healthcare practitioners have an important role in supporting people with subjective cognitive concern ensuring patients have trust in assessment outcomes. Where the validity of the assessment process is seen as ambiguous, people can be left dealing with uncertainty, rather than being clear about ways they can manage their condition, situation or status.
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Affiliation(s)
- Linda Birt
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Fiona Poland
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Georgina Charlesworth
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.,Research and Development Department, North East London NHS Foundation Trust, London, UK
| | - Phuong Leung
- Division of Psychiatry, University College London, London, UK
| | - Paul Higgs
- Division of Psychiatry, University College London, London, UK
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McCrae N, Penhallow J, Rees O, Norman I. The Specialized Early Care for Alzheimer's method of caring for people with dementia: an investigation of what works and how. Scand J Caring Sci 2019; 34:736-744. [PMID: 31830310 DOI: 10.1111/scs.12778] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 09/20/2019] [Accepted: 09/24/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND RATIONALE SPECAL is a model of care for people with dementia based on a novel conceptualisation of memory and how this changes in dementia. Carers adapt their communication style to prevent distress and promote well-being for the person with dementia. However, there is limited scientific evidence on the effectiveness of SPECAL. AIM This study explored mechanisms of SPECAL through a qualitative enquiry with family carers. METHOD Semi-structured interviews were conducted with family carers who had been coached in SPECAL and applied its principles and practices. Thematic analysis was applied. FINDINGS All participants had found SPECAL helpful in caring for a person with dementia. The core themes of this positive experience were empathy, harmony and resilience. Synthesis of these themes contributes to a proposed model of the mechanisms of SPECAL. CONCLUSION In applying SPECAL, carers gained an empathetic insight to the feelings of the person with dementia. This empathy leads to a more harmonious environment, which enhances the carer's resilience.
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Affiliation(s)
- Niall McCrae
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Jessica Penhallow
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Olivia Rees
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Ian Norman
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
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17
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Egilstrod B, Ravn MB, Petersen KS. Living with a partner with dementia: a systematic review and thematic synthesis of spouses' lived experiences of changes in their everyday lives. Aging Ment Health 2019; 23:541-550. [PMID: 29405735 DOI: 10.1080/13607863.2018.1433634] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [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: 12/16/2022]
Abstract
OBJECTIVES Dementia causes dramatic changes in everyday-living for spouses. Occured changes in marital relationship, force spouses to perform more both mentally and physically. Leading to a spousal perceived burden. To improve understanding of spouses' needs, spouses lived experiences is needed. The aim was to identify and synthesise qualitative studies on spouses' lived experiences of living with a partner with dementia. METHODS A systematic search was undertaken in January 2017. Six databases (CINAHL, Cochrane Library, Embase, PubMed, PsycINFO and Sociological Abstracts) were searched, using search terms in accordance with PICo. A descriptive synthesis and a thematic synthesis were undertaken. FINDINGS Fifteen studies met the inclusion criteria. Three themes derived from the analysis 1) Noticing changes in everyday life 2) Transformation to a new marital relation in everyday life, with corresponding sub-themes; changes in marital relationship, management of the transitioned marital relation in everyday life 3) Planning the future. CONCLUSION Findings provide an overview of how spouses notice changes and transform their marital relationships in everyday-life. Findings offer a deeper understanding of changes that occurs over time while the partner is living at home. Findings contribute with knowledge on spouses' experiences of changes in early-stages of dementia. Interventions supporting spouses are needed.
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Affiliation(s)
- Barbara Egilstrod
- a Department of Health Science and Technology, Faculty of Medicine , Aalborg University , Denmark
| | - Maiken Bay Ravn
- a Department of Health Science and Technology, Faculty of Medicine , Aalborg University , Denmark
| | - Kirsten Schultz Petersen
- a Department of Health Science and Technology, Faculty of Medicine , Aalborg University , Denmark
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18
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Davis JD, Hill BD, Pillemer S, Taylor J, Tremont G. Guilt after placement questionnaire: a new instrument to assess caregiver emotional functioning following nursing home placement. Aging Ment Health 2019; 23:352-356. [PMID: 29309201 DOI: 10.1080/13607863.2017.1423029] [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] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Guilt is a core feature of dementia caregivers' experiences following placement. This study describes and validates a new assessment tool for monitoring caregiver adjustment after placement. METHODS Forty-six items addressing ambivalence and guilt about placement were tested with 170 dementia caregivers (M age = 56.79, SD = 13.19; 69.4% female; 54.7% adult child). RESULTS Using principal axis factor analysis, 10 items were retained that showed acceptable internal consistency (Cronbach's alpha of 0.92). Construct validity was established in a subset of the sample (n = 53) with measures of depression (r = 0.53), burden (r = 0.48), conflict with staff (r = 0.47), and well-being (r = -0.30). CONCLUSIONS This scale may be used to identify caregivers at risk for adjustment problems following placement and to monitor adjustment over time.
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Affiliation(s)
- Jennifer Duncan Davis
- a Department of Psychiatry , Rhode Island Hospital , Providence , RI , USA.,b Department of Psychiatry & Human Behavior , Alpert Medical School of Brown University , Providence , RI , USA
| | - Benjamin D Hill
- c Department of Psychology , University of South Alabama , Mobile , AL , USA
| | - Sarah Pillemer
- a Department of Psychiatry , Rhode Island Hospital , Providence , RI , USA.,b Department of Psychiatry & Human Behavior , Alpert Medical School of Brown University , Providence , RI , USA
| | - Joshua Taylor
- c Department of Psychology , University of South Alabama , Mobile , AL , USA
| | - Geoffrey Tremont
- a Department of Psychiatry , Rhode Island Hospital , Providence , RI , USA.,b Department of Psychiatry & Human Behavior , Alpert Medical School of Brown University , Providence , RI , USA
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Jeon DW, Ju HB, Jung DU, Kim SJ, Shim JC, Moon JJ, Kim YN. Usefulness of the University of California San Diego Performance-Based Skills Assessment for the evaluation of cognitive function and activities of daily living function in patients with cognitive impairment. Aging Ment Health 2019; 23:46-52. [PMID: 29068696 DOI: 10.1080/13607863.2017.1393796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To assess the usefulness of the University of California San Diego Performance-Based Skills Assessment (UPSA) as a new diagnostic method and tool for the assessment of cognitive function and activities of daily living function in patients with cognitive impairment. METHOD In total, 35 patients with cognitive impairment and 35 healthy controls were recruited for this study. The Mini-Mental State Examination (MMSE), Clinical Dementia Rating (CDR), and Global Deterioration Scale (GDS) were used for the evaluation of cognitive function, while the Barthel Activities of Daily Living Index (BADL), Instrumental Activities of Daily Living Index (IADL), and UPSA were used for the evaluation of activities of daily living function. RESULTS UPSA scores were significantly lower in patients with cognitive impairment than in controls. The UPSA total score was significantly correlated with MMSE, CDR, GDS, and IADL scores. With regard to the detection of cognitive impairment, UPSA exhibited a greater determination power (R2 = 0.593) compared with BADL (R2 = 0.149) and IADL (R2 = 0.423) and higher sensitivity and specificity compared with IADL. CONCLUSION Our results suggest that UPSA is a useful tool for the evaluation of cognitive function and activities of daily living function in patients with cognitive impairment.
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Affiliation(s)
- Dong-Wook Jeon
- a Department of Psychiatry , Busan Paik Hospital, Inje University College of Medicine , Busan , Korea
| | - Hyun-Bin Ju
- a Department of Psychiatry , Busan Paik Hospital, Inje University College of Medicine , Busan , Korea
| | - Do-Un Jung
- a Department of Psychiatry , Busan Paik Hospital, Inje University College of Medicine , Busan , Korea
| | - Sung-Jin Kim
- a Department of Psychiatry , Busan Paik Hospital, Inje University College of Medicine , Busan , Korea
| | | | - Jung-Joon Moon
- a Department of Psychiatry , Busan Paik Hospital, Inje University College of Medicine , Busan , Korea
| | - You-Na Kim
- a Department of Psychiatry , Busan Paik Hospital, Inje University College of Medicine , Busan , Korea
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Abstract
OBJECTIVES Pre-death grief plays a significant role in dementia caregiving, and has adverse impacts on caregivers. It was the purpose of the present study to examine whether a cognitive-behavioral intervention including a grief intervention module could increase caregivers' coping with pre-death grief and whether these effects could be maintained as of a six-month follow-up assessment. METHOD In a randomized-controlled trial examining the effectiveness of a cognitive-behavioral intervention, 273 caregivers were allocated to either an intervention or control group. Intervention group participants received 12 therapy sessions over six months; all participants completed a measure of pre-death grief. The analysis was conducted using latent change models. In the first model, study group was included as a predictor of change in pre-death grief; subsequent models also included care situation and sociodemographic variables. RESULTS The burden due to pre-death grief was reduced for intervention but not control group participants at the time of the six-month follow-up assessment (Cohen's d = -0.361). When controlling for changes in the care situation and sociodemographic variables, the treatment effect was also found in the assessment completed post intervention (Cohen's d = -0.248). CONCLUSION Results indicate that a cognitive-behavioral intervention including grief-specific strategies can successfully foster caregivers' coping with loss and reduce burden of pre-death grief.
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Affiliation(s)
- Franziska Meichsner
- a Department of Counseling and Clinical Psychology, Institute of Psychology , Friedrich Schiller University Jena , Jena , Germany
| | - Gabriele Wilz
- a Department of Counseling and Clinical Psychology, Institute of Psychology , Friedrich Schiller University Jena , Jena , Germany
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21
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Abstract
OBJECTIVES Caring for a patient with dementia is a real challenge and can have considerable psychological consequences in the long run. Many caregivers, mostly relatives, feel highly burdened. To develop effective caregiver support to prevent caregivers from getting overburdened, insight is needed into the determinants of burden. The objective of this study is to explore which patient and caregiver characteristics determine the different kinds of caregiver burden over time, both in the short and in the long run. METHOD The study was longitudinal. Data on patients and caregivers, general burden and emotional distress were collected at three times: at baseline, at the end of treatment and at nine months. The study was conducted in a psychiatric skilled nursing home with a unit for integrative reactivation and rehabilitation (IRR) and at different sites of home-/day care, assisted living arrangements and nursing home wards (usual care). RESULTS General burden is shown to be determined by severity of patient's neuropsychiatric symptoms, caregiver's sense of competence, health-related quality of life. Emotional distress is determined by severity of patient's neuropsychiatric symptoms, caregiver's sense of competence, high affiliation and patient gender. CONCLUSION In preventing or treating caregiver burden, professional interventions need to aim specifically at diminishing the neuropsychiatric symptoms in dementia patients and improving the sense of competence in caregivers.
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Affiliation(s)
- Jacqueline van der Lee
- a Psychiatric Skilled Nursing Home 'DrieMaasStede', Argos Zorggroep, Schiedam/VU Department of General Practice & Elderly Care Medicine , EMGO Institute for Health and Care Research VU University Amsterdam/VU University Medical Centre , Amsterdam , The Netherlands
| | - Ton J E M Bakker
- b Stichting Wetenschap Balans (Foundation for Scientific Research Geriatric Health Care), Rotterdam/VU Department of General Practice & Elderly Care Medicine , EMGO Institute for Health and Care Research VU University Amsterdam/VU University Medical Centre , Amsterdam , The Netherlands
| | - Hugo J Duivenvoorden
- c Stichting Wetenschap Balans (Foundation for Scientific Research Geriatric Health Care) , Rotterdam , The Netherlands
| | - Rose-Marie Dröes
- d VU Department of General Practice & Elderly Care Medicine , EMGO Institute for Health and Care Research VU University Amsterdam/VU University Medical Centre, Amsterdam/GGZ Ingeest , Amsterdam , The Netherlands
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Tang JYM, Ho AHY, Luo H, Wong GHY, Lau BHP, Lum TYS, Cheung KSL. Validating a Cantonese short version of the Zarit Burden Interview (CZBI-Short) for dementia caregivers. Aging Ment Health 2016; 20:996-1001. [PMID: 26016419 DOI: 10.1080/13607863.2015.1047323] [Citation(s) in RCA: 24] [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: 10/23/2022]
Abstract
OBJECTIVES The present study aimed to develop and validate a Cantonese short version of the Zarit Burden Interview (CZBI-Short) for Hong Kong Chinese dementia caregivers. METHODS The 12-item Zarit Burden Interview (ZBI) was translated into spoken Cantonese and back-translated by two bilingual research assistants and face validated by a panel of experts. Five hundred Chinese dementia caregivers showing signs of stress reported their burden using the translated ZBI and rated their depressive symptoms, overall health, and care recipients' physical functioning and behavioral problems. The factor structure of the translated scale was identified using principal component analysis and confirmatory factor analysis; internal consistency and item-total correlations were assessed; and concurrent validity was tested by correlating the ZBI with depressive symptoms, self-rated health, and care recipients' physical functioning and behavioral problems. RESULTS The principal component analysis resulted in 11 items loading on a three-factor model comprised role strain, self-criticism, and negative emotion, which accounted for 59% of the variance. The confirmatory factor analysis supported the three-factor model (CZBI-Short) that explained 61% of the total variance. Cronbach's alpha (0.84) and item-total correlations (rho = 0.39-0.71) indicated CZBI-Short had good reliability. CZBI-Short showed correlations with depressive symptoms (r = 0.50), self-rated health (r = -0.26) and care recipients' physical functioning (r = 0.18-0.26) and disruptive behaviors (r = 0.36). CONCLUSIONS The 12-item CZBI-Short is a concise, reliable, and valid instrument to assess burden in Chinese dementia caregivers in clinical and social care settings.
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Affiliation(s)
| | - Andy Hau-Yan Ho
- a Sau Po Centre on Ageing , The University of Hong Kong , Hong Kong , China.,b Division of Psychology, School of Humanities and Social Sciences , Nanyang Technological University , Singapore
| | - Hao Luo
- a Sau Po Centre on Ageing , The University of Hong Kong , Hong Kong , China.,c Department of Sociology , Tsinghua University , Beijing , China
| | - Gloria Hoi-Yan Wong
- a Sau Po Centre on Ageing , The University of Hong Kong , Hong Kong , China.,d Department of Psychiatry , The University of Hong Kong , Hong Kong , China
| | - Bobo Hi-Po Lau
- e Department of Psychology , The University of Hong Kong , Hong Kong , China
| | - Terry Yat-Sang Lum
- a Sau Po Centre on Ageing , The University of Hong Kong , Hong Kong , China.,f Department of Social Work and Social Administration , The University of Hong Kong , Hong Kong , China
| | - Karen Siu-Lan Cheung
- a Sau Po Centre on Ageing , The University of Hong Kong , Hong Kong , China.,f Department of Social Work and Social Administration , The University of Hong Kong , Hong Kong , China
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Abstract
OBJECTIVES To develop the Person-Environment Apathy Rating (PEAR) scale that measures environmental stimulation and apathy in persons with dementia and to evaluate its psychometrics. METHOD The PEAR scale consists of the PEAR-Environment subscale and PEAR-Apathy subscales. The items were developed via literature review, field testing, expert review, and pilot testing. The construct validity and reliability were examined through video observation. The parent study enrolled 185 institutionalized residents with dementia. For this study, 96 videos were selected from 24 participants. The PEAR-Environment subscale was validated using the Ambiance Scale and the Crowding Index. The PEAR-Apathy subscale was validated using the Neuropsychiatric Inventory (NPI)-Apathy, Passivity in Dementia Scale (PDS), and NPI-Depression. RESULTS The PEAR-Environment subscale and PEAR-Apathy subscales each consists of six items rated on a 1-4 scale. For validity, the Crowding Index slightly, yet significantly, correlated with the PEAR-Environment subscale total score and three of the individual scores. Ambiance Scale scores, both engaging and soothing, did not correlate with the PEAR-Environment subscale. The PEAR-Apathy highly correlated with the PDS and NPI-Apathy and moderately correlated with the NPI-Depression, suggesting good convergent validity and moderate discriminant validity. For reliability, both environment and apathy subscales demonstrated excellent internal consistency. Although facial expression and eye contact showed moderate inter-rater reliability, all other items showed good to excellent inter-rater and intra-rater reliability. CONCLUSION This study has successfully developed the PEAR scale and established its psychometrics based on the compatible scales available. The PEAR scale is the first scale that concurrently assesses apathy and environmental stimulation, and is recommended for use in persons with dementia.
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Affiliation(s)
- Ying-Ling Jao
- a College of Nursing , The Pennsylvania State University , 201 Health and Human Development East, State College , PA , USA.,b College of Nursing , The University of Iowa , Iowa City , IA , USA
| | - Donna L Algase
- c School of Nursing , University of Michigan , Ann Arbor , MI , USA
| | - Janet K Specht
- b College of Nursing , The University of Iowa , Iowa City , IA , USA.,d John A. Hartford Center for Geriatric Nursing Excellence , Iowa City , IA , USA
| | - Kristine Williams
- b College of Nursing , The University of Iowa , Iowa City , IA , USA.,d John A. Hartford Center for Geriatric Nursing Excellence , Iowa City , IA , USA
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Abstract
OBJECTIVES This study describes the development of the Music Engagement Questionnaire (MusEQ), a 35-item scale to measure engagement with music in daily life. Music has implications for well-being and for therapy, notably for individuals living with dementia. A number of excellent scales or questionnaires are now available to measure music engagement. Unlike these scales, the MusEQ may be completed by either the participant or an informant. METHOD Study 1 drew on a community-based sample of 391 participants. Exploratory factor analysis revealed six interpretable factors, which formed the basis for construction of six subscales. Study 2 applied the MusEQ to a group of participants with Alzheimer's disease (AD; n = 16) as well as a group of neurotypical older adults (OA; n = 16). Informants completed the MusEQ, and the OA group also completed the self-report version of the MusEQ. Both groups had an interview in which they described the place music had in their lives. These interviews were scored by three independent raters. RESULTS The MusEQ showed excellent internal consistency. Five of the factor-derived subscales showed good or excellent internal consistency. MusEQ scores were moderately correlated with a global rating of 'musicality' and with music education. There was strong agreement between self-report and informant-report data. MusEQ scores showed a significant positive relationship to independent ratings of music engagement. CONCLUSION The MusEQ provides a meaningful and reliable option for measuring music engagement among participants who are unable to complete a self-report questionnaire.
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Affiliation(s)
- Ashley D Vanstone
- a Department of Psychology , Queen's University at Kingston , Kingston , Canada
| | - Michael Wolf
- a Department of Psychology , Queen's University at Kingston , Kingston , Canada
| | - Tina Poon
- a Department of Psychology , Queen's University at Kingston , Kingston , Canada
| | - Lola L Cuddy
- a Department of Psychology , Queen's University at Kingston , Kingston , Canada
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Abstract
OBJECTIVES Care of patients with dementia raises challenging ethical issues, including the use of deception in clinical practice. This study aimed to determine the extent to which medical students agree that ethical arguments for and against deceiving patients in general apply to patients with dementia. METHOD Qualitative study using six focus groups (n = 21) and 10 interviews (n = 10) with undergraduate students in years 1, 3 and 5 at a UK medical school. Analysis using initial coding followed by comparison of data with a pre-existing framework concerning deception in clinical practice. RESULTS Arguments for and against deceiving patients with dementia overlapped with those previously described in relation to clinical practice in general. However, the majority of participants highlighted issues unique to dementia care that warranted additional consideration. Three key dementia-specific considerations identified were capacity (understanding, retaining and emotional processing), perceived vulnerability and family dynamics. Students expressed uncertainty as to their ability to make judgements about honest communication with patients with dementia and their families. CONCLUSION Dementia adds additional complexity to clinical judgements about the acceptability of deception in practice. Medical students have a number of unmet learning needs with regard to communicating with patients with dementia and their families. Existing ethical frameworks may provide a helpful starting point for education about dementia care.
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Affiliation(s)
- Ellen StClair Tullo
- a Institute for Ageing and Health, Biomedical Research Building, Campus for Ageing and Vitality , Newcastle University , Newcastle-upon-Tyne , UK
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Bantry White E, Montgomery P. Dementia, walking outdoors and getting lost: incidence, risk factors and consequences from dementia-related police missing-person reports. Aging Ment Health 2015; 19:224-30. [PMID: 24912376 DOI: 10.1080/13607863.2014.924091] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To estimate incidence, identify consequences and potential risk factors for harm in people with dementia who got lost in one UK policing region. METHODS In a retrospective observational study, data were extracted from missing-person records over a four-year period in one UK policing region (population of 2.1 million). RESULTS Two hundred and eighty-one incidents of getting lost were identified. Incidence of getting lost was estimated at 0.5% of the regional dementia population. Fifty-nine percent of reports came from domestic settings, 29% from care homes/hospitals, and 12% on excursions from home. Five percent (n = 15) sustained significant harm, including two deaths. Average age was 78 years (SD 8.3). Harm was associated with older age (mean difference 6.16 years, CI 1.86 to 10.46, p = 0.005, t = 2.82), length of time missing (Mdn time 2.48 hours; IQR 0.97 to 9.45, p = 0.02), and season (9% winter, 2% summer, p = 0.006). The length of time missing increased with delays in reporting to police (r = 0.15, p = 0.018), getting lost at night (Mdn time 1.70 hours, IQR 0.52-3.32, p = 0.028), driving themselves (Mdn time 2.45 hours, IQR 0.42-2.00, p = 0.001), and using public transport (Mdn 1.78 hours, IQR 1.07-3.92, p = 0.001). CONCLUSION Incidence in this study suggests getting lost is a low-frequency event for people with dementia but for a small minority, the risks are considerable. Exploratory analyses suggest individual and environmental factors increase the risk of harm. Suitable methods need to be developed to replicate these findings in larger prospective samples. A focus on the predictors of harm may aid development of assessment protocols to ensure intervention is proportionate.
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Abstract
The aging process is marked by a series of transitions that influence multiple domains of well-being. One important transition for older adults is the process of driving cessation. Numerous studies have examined risk factors for driving cessation among older adults to identify at-risk older drivers for road safety. Recent research has focused on the consequences of driving cessation in later life for health and well-being. However, these reports have been largely empirical and are not drawn from a defined conceptual framework. Establishing a theoretical model of 'how driving cessation interacts with other processes and domains of aging' will promote synthesis of seemingly disparate findings and also link the empirical research on cessation to the broader field of gerontology. This article describes a conceptual model for articulating and examining the components of the driving cessation process based on the stress-coping paradigm. This model situates driving cessation within the context of exogenous stressors, individual vulnerabilities and coping strategies, and environmental hazards and buffers over the lifespan. This model could assist in guiding intervention strategies aimed at reducing premature driving cessation in older drivers with ameliorable impairments while assisting at-risk older drivers to reduce or stop driving in a less stressful way.
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Affiliation(s)
- Moon Choi
- Department of Epidemiology and Community Health, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA.
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