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Smith-MacDonald L, Venturato L, Hunter P, Kaasalainen S, Sussman T, McCleary L, Thompson G, Wickson-Griffiths A, Sinclair S. Perspectives and experiences of compassion in long-term care facilities within Canada: a qualitative study of patients, family members and health care providers. BMC Geriatr 2019; 19:128. [PMID: 31060500 PMCID: PMC6503362 DOI: 10.1186/s12877-019-1135-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 04/11/2019] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION This paper details a subset of the findings from a participatory action research project exploring a palliative intervention in long-term care sites across Canada. The findings presented in this paper relate to understanding compassion within the context of a palliative approach to long-term care. METHODS Findings presented are drawn from qualitative interviews and focus groups with residents, family members, healthcare providers, and managers from 4 long-term care sites across 4 provinces in Canada. In total, there were 117 individuals (20 residents, 16 family members, 72 healthcare providers, and 9 managers) who participated in one of 19 focus groups. Data was analyzed by multiple members of the research team in accordance with thematic analysis. Individual concepts were organized into themes across the different focus groups and the results were used to build a conceptual understanding of compassion within Long Term Care . FINDINGS Two themes, each comprised of 5 sub-themes, emerged from the data. The first theme 'Conceptualizing Compassion in Long-Term Care generated a multidimensional understanding of compassion that was congruent with previous theoretical models. 'Organizational Compassion: resources and staffing', the second major theme, focused on the operationalization of compassion within the practice setting and organizational culture. Organizational Compassion subthemes focused on how compassion could support staff to enact care for the residents, the families, one another, and at times, recognizing their pain and supporting it through grief and mourning. CONCLUSIONS Results suggest that compassion is an essential part of care and relationships within long-term care, though it is shaped by personal and professional relational aspects of care and bound by organizational and systemic issues. Findings suggest that compassion may be an under-recognised, but essential element in meeting the promise of person-centred care within long-term care environments.
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Affiliation(s)
- Lorraine Smith-MacDonald
- Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
| | - Lorraine Venturato
- Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada.,Dementia and Cognitive Impairment NeuroTeam, Hotchkiss Brain Institute, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
| | - Paulette Hunter
- St. Thomas More College, University of Saskatchewan, 1437 College Drive, Saskatoon, SK, S7N 0W6, Canada
| | - Sharon Kaasalainen
- School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Tamara Sussman
- School of Social Work, McGill University, 845 Sherbrooke Street West, Montreal, QC, H3A 0G4, Canada
| | - Lynn McCleary
- Department of Nursing, Brock University, 1812 Sir Isaac Brock Way, St. Catharines, ON, L2S 3A1, Canada
| | - Genevieve Thompson
- College of Nursing, Max Rady Faculty of Health Sciences, University of Manitoba, Helen Glass Centre for Nursing, 89 Curry Place, Winnipeg, MB, R3T 2N2, Canada
| | | | - Shane Sinclair
- Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada. .,Division of Palliative Medicine, Department of Oncology, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada. .,Compassion Research Lab, Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N1N4, Canada.
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Uniacke B, Wang Y, Biezonski D, Sussman T, Lee S, Posner J, Steinglass J. Resting-state connectivity within and across neural circuits in anorexia nervosa. Brain Behav 2019; 9:e01205. [PMID: 30590873 PMCID: PMC6373651 DOI: 10.1002/brb3.1205] [Citation(s) in RCA: 15] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 11/29/2018] [Accepted: 11/30/2018] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Obsessional thoughts and ritualized eating behaviors are characteristic of Anorexia Nervosa (AN), leading to the common suggestion that the illness shares neurobiology with obsessive-compulsive disorder (OCD). Resting-state functional connectivity MRI (rs-fcMRI) is a measure of functional neural architecture. This longitudinal study examined functional connectivity in AN within the limbic cortico-striato-thalamo-cortical (CSTC) loop, as well as in the salience network, the default mode network, and the executive control network (components of the triple network model of psychopathology). METHODS Resting-state functional connectivity MRI scans were collected in unmedicated female inpatients with AN (n = 25) and healthy controls (HC; n = 24). Individuals with AN were scanned before and after weight restoration and followed for one month after hospital discharge. HC were scanned twice over the same timeframe. RESULTS Using a seed-based correlation approach, individuals with AN had increased connectivity within the limbic CSTC loop when underweight, only. There was no significant association between limbic CSTC connectivity and obsessive-compulsive symptoms or prognosis. Exploratory analyses of functional network connectivity within the triple network model showed reduced connectivity between the salience network and left executive control network among AN relative to HC. These abnormalities persisted following weight restoration. CONCLUSIONS The CSTC findings suggest that the neural underpinnings of obsessive-compulsive symptoms may differ from those of OCD. The inter-network abnormalities warrant examination in relation to illness-specific behaviors, namely abnormal eating behavior. This longitudinal study highlights the complexity of the neural underpinnings of AN.
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Affiliation(s)
- Blair Uniacke
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York.,Department of Psychiatry, New York State Psychiatric Institute, New York, New York
| | - Yun Wang
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York.,Department of Psychiatry, New York State Psychiatric Institute, New York, New York
| | | | - Tamara Sussman
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York.,Department of Psychiatry, New York State Psychiatric Institute, New York, New York
| | - Seonjoo Lee
- Division of Mental Health Data Science, New York State Psychiatric Institute, New York, New York.,Department of Biostatistics, Columbia University Irving Medical Center, New York, New York
| | - Jonathan Posner
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York.,Department of Psychiatry, New York State Psychiatric Institute, New York, New York
| | - Joanna Steinglass
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York.,Department of Psychiatry, New York State Psychiatric Institute, New York, New York
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Sussman T, Kaasalainen S, Lee E, Akhtar-Danesh N, Strachan PH, Brazil K, Bonifas R, Bourgeois-Guérin V, Durivage P, Papaioannou A, Young L. Condition-Specific Pamphlets to Improve End-of-life Communication in Long-term Care: Staff Perceptions on Usability and Use. J Am Med Dir Assoc 2018; 20:262-267. [PMID: 30583908 DOI: 10.1016/j.jamda.2018.11.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 10/31/2018] [Accepted: 11/06/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES This article reports findings on the usability and staff use of 5 condition- specific pamphlets of high prevalence in long-term care (LTC): dementia, heart failure, chronic obstructive pulmonary disease, renal failure, and frailty. The pamphlets were created in response to residents', families', and staff's recommendations for activating early reflections and communication about end-of-life care. DESIGN A mixed-method (qualitative and quantitative) survey design was used. Step 1 collected survey data on the usability of the pamphlets. Step 2 collected survey data on pamphlet use. SETTINGS AND PARTICIPANTS Two nurses with specialized palliative care training, 2 resident/family representatives, 10 condition-specific specialists, and 33 LTC palliative leads reviewed the pamphlets for usability prior to distribution. A total of 178 LTC home staff in 4 participating LTC homes reported on pamphlet use. MEASURES Specialists and resident/family representatives were asked to provide open comments and LTC home palliative leads were asked to complete a survey on the accuracy, readability, and relevance of the pamphlets. After 6 months of distribution, all staff in participating LTC homes were asked to complete a survey on pamphlet use, usefulness, and comfort with distribution. RESULTS The pamphlets were reportedly accurate, relevant, and easy to understand. Following 6 months of availability, most staff in LTC had read the pamphlets, found the information useful, and planned to share them. However, half of the staff questioned their role in pamphlet distribution and most had not distributed them. Regulated staff (ie, staff affiliated with a regulated profession) expressed more comfort sharing the pamphlets than care aides and support staff. CONCLUSIONS/IMPLICATIONS Condition-specific pamphlets appear to hold promise in providing residents and families with relevant information that may activate early reflections and conversations about end-of-life care. However, structured implementation strategies, training, and discussions are required to improve staff comfort with distribution and explore roles in distribution and follow-up.
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Affiliation(s)
| | | | - Eunyoung Lee
- School of Social Work, McGill University, Canada
| | | | | | - Kevin Brazil
- School of Nursing and Midwifery, Queens University Belfast, United Kingdom
| | | | | | - Patrick Durivage
- Montreal Central West University Affiliated Health and Social Service Network, Canada
| | | | - Laurel Young
- Creative Arts Therapies Department, Concordia University, Canada
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Durepos P, Sussman T, Ploeg J, Akhtar-Danesh N, Punia H, Kaasalainen S. What Does Death Preparedness Mean for Family Caregivers of Persons With Dementia? Am J Hosp Palliat Care 2018; 36:436-446. [DOI: 10.1177/1049909118814240] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Purpose: The purpose of this study was to clarify the concept of death preparedness for family caregivers in dementia. Conceptualization was required to support the assessment, promotion, and operationalization (ie, measurement) of death preparedness through palliative care interventions such as advance care planning. Methods: Rodgers evolutionary method of concept analysis was selected to guide this study because of the dynamic nature of death preparedness influenced by context, setting, and time. A comprehensive literature search was conducted. Authors performed constant comparative analysis to identify and interpret surrogate/related concepts, attributes, antecedents, and consequences of death preparedness. Results: Most importantly attributes included (1) knowing and recognizing the symptoms of decline in dementia and what dying looks like; (2) understanding emotions and grief responses; (3) accessing and appraising supports needed to manage and care for dying; (4) organizing affairs and completing tasks in advance; (5) accepting that losses are inevitable and imminent; (6) reflecting on caregiving and finding meaning, “a silver-lining”; and (7) closing, reconciling, and renewing relationship bonds and completing the family member’s life. Discussion: This study contributed a full definition of death preparedness in dementia. Findings aligned with/expanded upon Hebert et al Theoretical Framework of Preparedness for End-of-Life. The use of problem- and emotion-based coping strategies by caregivers with support from health-care providers to promote feelings of death preparedness (including self-efficacy and control) and minimize uncertainty was the implication of this study. Development of a holistic preparedness instrument is underway.
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Affiliation(s)
- Pamela Durepos
- Faculty of Health Sciences, School of Nursing, McMaster University, Hamilton, Ontario, Canada
- Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada
| | - Tamara Sussman
- Department of Social Work, McGill University, Hamilton, Ontario, Canada
| | - Jenny Ploeg
- Faculty of Health Sciences, School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Noori Akhtar-Danesh
- Faculty of Health Sciences, School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Harveer Punia
- Faculty of Health Sciences, School of Nursing, McMaster University, Hamilton, Ontario, Canada
- Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada
| | - Sharon Kaasalainen
- Faculty of Health Sciences, School of Nursing, McMaster University, Hamilton, Ontario, Canada
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McCleary L, Thompson GN, Venturato L, Wickson-Griffiths A, Hunter P, Sussman T, Kaasalainen S. Meaningful connections in dementia end of life care in long term care homes. BMC Psychiatry 2018; 18:307. [PMID: 30249213 PMCID: PMC6154884 DOI: 10.1186/s12888-018-1882-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 09/11/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Most persons with dementia die in long term care (LTC) homes, where palliative approaches are appropriate. However, palliative approaches have not been widely implemented and there is limited understanding of staff and family experiences of dying and bereavement in this context. METHOD This descriptive qualitative study explored family and staff experiences of end of life and end of life care for persons with dementia in LTC homes. Eighteen focus groups were conducted with 77 staff members and 19 relatives of persons with dementia at four LTC homes in four Canadian provinces. RESULTS Three themes emerged: knowing the resident, the understanding that they are all human beings, and the long slow decline and death of residents with dementia. DISCUSSION Intimate knowledge of the person with dementia, obtained through longstanding relationships, was foundational for person-centred end of life care. Health care aides need to be included in end of life care planning to take advantage of their knowledge of residents with dementia. There were unmet bereavement support needs among staff, particularly health care aides. Persons with dementia were affected by death around them and existing rituals for marking deaths in LTC homes may not fit their needs. Staff were uncomfortable answering relatives' questions about end of life. CONCLUSIONS Longstanding intimate relationships enhanced end of life care but left health care aides with unmet bereavement support needs. Staff in LTC homes should be supported to answer questions about the trajectory of decline of dementia and death. Further research about residents' experiences of deaths of other residents is needed.
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Affiliation(s)
- Lynn McCleary
- Department of Nursing, Brock University, St. Catharines, Canada.
| | - Genevieve N Thompson
- 0000 0004 1936 9609grid.21613.37College of Nursing, University of Manitoba, Winnipeg, Canada
| | - Lorraine Venturato
- 0000 0004 1936 7697grid.22072.35Faculty of Nursing, University of Calgary, Calgary, Canada
| | | | - Paulette Hunter
- 0000 0001 2154 235Xgrid.25152.31Department of Psychology, St. Thomas More College, University of Saskatchewan, Saskatoon, Canada
| | - Tamara Sussman
- 0000 0004 1936 8649grid.14709.3bSchool of Social Work, McGill University, Montreal, Canada
| | - Sharon Kaasalainen
- 0000 0004 1936 8227grid.25073.33School of Nursing, McMaster University, Hamilton, Canada
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Thompson G, Shindruk C, Wickson-Griffiths A, Sussman T, Hunter P, McClement S, Chochinov H, McCleary L, Kaasalainen S, Venturato L. "Who would want to die like that?" Perspectives on dying alone in a long-term care setting. Death Stud 2018; 43:509-520. [PMID: 30207512 DOI: 10.1080/07481187.2018.1491484] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 04/09/2018] [Accepted: 05/03/2018] [Indexed: 06/08/2023]
Abstract
The discourse of dying alone is negatively weighted and models of a good death identify not dying alone as a key outcome. Understanding why dying alone is viewed negatively and its effects on care is a priority. In separate focus groups with long-term care residents, family caregivers, and staff, we identified evidence for four different perspectives on the importance of presence at the time of death. However, while each individual had their own unique perspective on dying alone, the predominant view expressed across respondent groups was that having human connection near the end of one's life was important.
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Affiliation(s)
- Genevieve Thompson
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba , Winnipeg , Manitoba , Canada
| | - Chloe Shindruk
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba , Winnipeg , Manitoba , Canada
| | | | - Tamara Sussman
- Faculty of Arts, School of Social Work, McGill University , Montreal , Quebec , Canada
| | - Paulette Hunter
- St. Thomas More College, University of Saskatchewan , Saskatoon , Saskatchewan , Canada
| | - Susan McClement
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba , Winnipeg , Manitoba , Canada
| | - Harvey Chochinov
- Department of Psychiatry, College of Medicine, Rady Faculty of Health Sciences, University of Manitoba , Winnipeg , Manitoba , Canada
| | - Lynn McCleary
- Department of Nursing, Faculty of Applied Health Sciences, Brock University , Saint Catharines , Ontario , Canada
| | - Sharon Kaasalainen
- School of Nursing, Faculty of Health Sciences, McMaster University , Hamilton , Ontario , Canada
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Tiwari SR, Sussman T, Kota K, Moore HC, Montero AJ, Budd GT, Puhalha S, Abraham J. Abstract P5-21-26: T-DM1 activity in metastatic HER2-positive breast cancer patients who have received prior trastuzumab and pertuzumab: NSABP B-005. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p5-21-26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background :
The pivotal phase III EMILIA trial reported a progression free survival (PFS) rate of 9.6 months and an objective response rate of 43% with T-DM1 in patients with HER2-positive metastatic breast cancer previously treated with trastuzumab and a taxane. However, there is very limited data on the efficacy of T-DM1 in patients who have received prior pertuzumab either neoadjuvantly or as first line therapy in the metastatic setting. The primary goal of this study was to assess the clinical efficacy (tumor response rates and median duration on therapy) of T-DM1 in patients previously treated with pertuzumab and trastuzumab.
Methods:
After IRB approval, a cancer data registry and electronic pharmacy database were utilized to identify breast cancer patients receiving treatment with T-DM1 at Cleveland Clinic and University of Pittsburgh. Patients that received trastuzumab and pertuzumab, in either the neoadjuvant or metastatic setting, with baseline and follow up imaging available for review were identified. Patient charts were reviewed to collect accurate information about the treatment sequencing and outcomes. RECIST version 1.1 was utilized for tumor assessment and patients with measurable disease and non measurable disease were included in the study.
Results:
We identified a total of 23 patients with a median age of 55 years that met the inclusion criteria. 69% percent of patients received T-DM1 as first line or second line therapy and 31% received it as third line or later. All patients had at least 1 measurable lesion. Best overall response showed rates of complete response, partial response and stable disease of 17%, 26% and 22% respectively. 35% patients progressed on first assessment after start of treatment. The median duration on therapy was 5.3 months (range 3 weeks to 33 months) with 43% of patients receiving T-DM1 for greater than 6 months.
Conclusion:
Our results were comparable to those reported by EMILIA trial. T-DM1 has reasonable clinical efficacy in patients who have received prior treatment with pertuzumab and trastuzumab with an overall response rate of 43% and median duration on therapy of 5.3 months.
Citation Format: Tiwari SR, Sussman T, Kota K, Moore HC, Montero AJ, Budd GT, Puhalha S, Abraham J. T-DM1 activity in metastatic HER2-positive breast cancer patients who have received prior trastuzumab and pertuzumab: NSABP B-005 [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-21-26.
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Affiliation(s)
- SR Tiwari
- Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; University of Pittsburgh, Pittsburgh, PA
| | - T Sussman
- Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; University of Pittsburgh, Pittsburgh, PA
| | - K Kota
- Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; University of Pittsburgh, Pittsburgh, PA
| | - HC Moore
- Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; University of Pittsburgh, Pittsburgh, PA
| | - AJ Montero
- Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; University of Pittsburgh, Pittsburgh, PA
| | - GT Budd
- Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; University of Pittsburgh, Pittsburgh, PA
| | - S Puhalha
- Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; University of Pittsburgh, Pittsburgh, PA
| | - J Abraham
- Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; University of Pittsburgh, Pittsburgh, PA
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Burns VF, Sussman T. Homeless for the First Time in Later Life: Uncovering More Than One Pathway. The Gerontologist 2018; 59:251-259. [DOI: 10.1093/geront/gnx212] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Tamara Sussman
- School of Social Work, McGill University, Montreal, Québec, Canada
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Kaasalainen S, Sussman T, Durepos P, McCleary L, Ploeg J, Thompson G. What Are Staff Perceptions About Their Current Use of Emergency Departments for Long-Term Care Residents at End of Life? Clin Nurs Res 2017; 28:692-707. [PMID: 29271241 PMCID: PMC7328671 DOI: 10.1177/1054773817749125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The goal of this study was to examine current rates of resident deaths, Emergency Department (ED) use within the last year of life, and hospital deaths for long-term care (LTC) residents. Using a mixed-methods approach, we compared these rates across four LTC homes in Ontario, Canada, and explored potential explanations of variations across homes to stimulate staff reflections and improve performance based on a quality improvement approach. Chart audits revealed that 59% of residents across sites visited EDs during the last month of life and 26% of resident deaths occurred in hospital. Staff expressed surprise at the amount of hospital use during end of life (EOL). Reflections suggested that clinical expertise, comfort with EOL communication, clinical resources (i.e., equipment), and family availability for EOL decision making could all affect nondesirable hospital transfers at EOL. Staff appeared motivated to address these areas of practice following this reflective process.
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Affiliation(s)
- Sharon Kaasalainen
- McMaster University, Hamilton, Ontario, Canada
- Sharon Kaasalainen, Faculty of Health Sciences, 3N25F, McMaster University, 1280 Main Street West, Hamilton, Ontario, Canada L8N 3Z5.
| | | | | | | | - Jenny Ploeg
- McMaster University, Hamilton, Ontario, Canada
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Sussman T, Kaasalainen S, Bui M, Akhtar-Danesh N, Mintzberg S, Strachan P. "Now I Don't Have to Guess": Using Pamphlets to Encourage Residents and Families/Friends to Engage in Advance Care Planning in Long-Term Care. Gerontol Geriatr Med 2017; 3:2333721417747323. [PMID: 29308424 PMCID: PMC5751914 DOI: 10.1177/2333721417747323] [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: 09/08/2017] [Accepted: 10/27/2017] [Indexed: 11/24/2022] Open
Abstract
Objective: This article explores whether access to illness trajectory pamphlets for five conditions with high prevalence in long-term care (LTC) can encourage residents and families/friends to openly engage in advance care planning (ACP) discussions with one another and with health providers. Method: In all, 57 residents and families/friends in LTC completed surveys and 56 participated in seven focus groups that explored whether the pamphlets supported ACP engagement. Results: Survey results suggested that access to pamphlets encouraged residents and families/friends to reflect on future care (48/57, 84%), clarified what questions to ask (40/57, 70%), and increased comfort in talking about end of life (EOL) care (36/57, 63%). Discussions between relatives and friends/families (32/57, 56%) or with health providers (21/57, 37%) were less common. Focus group deliberations illuminated that while reading illness-specific information was validating, a tendency to protect one another from an emotional topic, prevented residents and families/friends from conversing with one another about EOL issues. Discussion: Having access to pamphlets with information about EOL care provides important and welcome opportunities for reflection for both residents in LTC and their families/friends. Moving residents and families/friends from reflecting on issues to discussing them together could require staff support through planned care conferences or staff initiated conversations at the bedside.
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Affiliation(s)
| | | | - Matthew Bui
- McMaster University, Hamilton, Ontario, Canada
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Abstract
To understand individuals' financial behaviors, it is important to understand the financial knowledge gap - the distance between one's objective and subjective financial knowledge. Overestimating one's financial knowledge can lead to risky financial behaviors. To date, limited empirical work has examined how financial knowledge gap varies across age groups. We analyze the size and nature of the financial knowledge gap and its variation across age groups. Using nationally representative data, we find robust evidence that older adults overestimate their financial knowledge. Social workers can assess the financial knowledge gap and educate their clients to protect from financial fraud, exploitation, and abuse.
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Affiliation(s)
| | - David W Rothwell
- b Human Development and Family Sciences, Oregon State University, College of Public Health , Corvallis , Oregon , USA
| | - Katrina Cherney
- a School of Social Work, McGill University , Montreal , Québec , Canada
| | - Tamara Sussman
- a School of Social Work, McGill University , Montreal , Québec , Canada
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Kaasalainen S, Sussman T, Durepos P, Ploeg J, Venturato L, McCleary L, Hunter P. REDUCING EMERGENCY ROOM VISITS AND HOSPITAL DEATHS AT END-OF-LIFE FOR LONG-TERM CARE RESIDENTS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.1804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - T. Sussman
- McGill University, Montreal, Quebec, Canada,
| | - P. Durepos
- McMaster University, Hamilton, Ontario, Canada,
| | - J. Ploeg
- McMaster University, Hamilton, Ontario, Canada,
| | - L. Venturato
- University of Calgary, Calgary, Alberta, Canada,
| | - L. McCleary
- Brock University, St Catharines, Ontario, Canada,
| | - P.V. Hunter
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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McCusker J, Yaffe M, Sussman T, Cole M, Sewitch M, Strumpf E, Freeman E, Lambert S, de Raad M. La gestion de la dépression chez les aînés et leurs aidants naturels : résultats d’un programme de recherche au Québec. smq 2017. [DOI: 10.7202/1040254ar] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
La dépression est un problème répandu, sérieux, et souvent chronique chez les aînés, qui sont souvent atteints de maladies physiques chroniques, et affecte de façon négative leurs traitements et leurs soins. Malheureusement, le taux de détection et de suivi adéquat de la dépression est faible dans cette population. Au cours des deux dernières décennies, notre équipe a mené une série d’études pour mieux comprendre et améliorer la gestion de la dépression chez les aînés. Nous présentons une revue narrative et synthèse de 25 articles qui incluent : 4 revues systématiques, 10 études observationnelles, 9 essais d’interventions, et 2 conférences de consensus. Nous proposons en conclusion nos recommandations pour 1) la détection de la dépression dans les soins de santé primaires ; 2) les soins collaboratifs de la dépression ; 3) des interventions d’autogestion de la dépression ; 4) le rôle des aidants naturels dans les interventions d’autogestion de la dépression.
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Affiliation(s)
- Jane McCusker
- Centre de recherche de St. Mary, Montréal, Canada
- Département d’épidémiologie, biostatistique et santé au travail, Université McGill, Montréal, Canada
| | - Mark Yaffe
- Département de médecine familiale, Centre hospitalier de St. Mary, Montréal, Canada
- Département de médecine de famille, Université McGill, Montréal, Canada
| | - Tamara Sussman
- École de travail social, Université McGill, Montréal, Canada
| | - Martin Cole
- Centre de recherche de St. Mary, Montréal, Canada
- Département de psychiatrie, Centre hospitalier de St. Mary, Montréal, Canada
- Département de psychiatrie, Université McGill, Montréal, Canada
| | - Maida Sewitch
- Département d’épidémiologie, biostatistique et santé au travail, Université McGill, Montréal, Canada
- Institut de recherche du Centre universitaire de santé McGill, Montréal, Canada
- Centre universitaire de santé McGill, Divisions de gastroentérologie et d’épidémiologie clinique, Montréal, Canada
| | - Erin Strumpf
- Département d’économie, Université McGill, Montréal, Canada
| | - Ellen Freeman
- Centre de recherche, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Canada
| | - Sylvie Lambert
- Centre de recherche de St. Mary, Montréal, Canada
- École des sciences infirmières Ingram, Université McGill, Montréal, Canada
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Kaasalainen S, Sussman T, Bui M, Akhtar-Danesh N, Laporte RD, McCleary L, Wickson Griffiths A, Brazil K, Parker D, Dal Bello-Haas V, Papaioannou A, O'Leary J. What are the differences among occupational groups related to their palliative care-specific educational needs and intensity of interprofessional collaboration in long-term care homes? BMC Palliat Care 2017; 16:33. [PMID: 28521799 PMCID: PMC5437548 DOI: 10.1186/s12904-017-0207-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 08/09/2016] [Accepted: 05/03/2017] [Indexed: 11/27/2022] Open
Abstract
Background The purpose of this study was to compare the differences across occupational groups related to their end-of-life care-specific educational needs and reported intensity of interprofessional collaboration in long-term care (LTC) homes. Methods A cross-sectional survey, based on two questionnaires, was administered at four LTC homes in Ontario, Canada using a modified Dilman’s approach. The first questionnaire, End of Life Professional Caregiver Survey, included three domains: patients and family-centered communication, cultural and ethical values, effective care delivery. The Intensity of Interprofessional Collaboration Scale included two subscales: care sharing activities, and interprofessional coordination. In total, 697 LTC staff were given surveys, including personal support workers, support staff (housekeeping, kitchen, recreation, laundry, dietician aids, office staff), and registered staff (licensed nurses, physiotherapists, social workers, pharmacists, physicians). Results A total of 317 participants completed the survey (126 personal support workers, 109 support staff, 82 registered staff) for a response rate of 45%. Significant differences emerged among occupational groups across all scales and subscales. Specifically, support staff rated their comfort of working with dying patients significantly lower than both nurses and PSWs. Support staff also reported significantly lower ratings of care sharing activities and interprofessional coordination compared to both registered staff and personal support workers. Conclusions These study findings suggest there are differing educational needs and sense of interprofessional collaboration among LTC staff, specific to discipline group. Both the personal support workers and support staff groups appeared to have higher needs for education; support staff also reported higher needs related to integration on the interdisciplinary team. Efforts to build capacity within support staff related to working with dying residents and their families are needed. Optimal palliative care may require resources to increase the availability of support for all staff involved in the care of patients.
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Affiliation(s)
- S Kaasalainen
- Faculty of Health Sciences, 3N25F, McMaster University, 1280 Main Street West, Hamilton, ON, L8N 3Z5, Canada. .,Queen's University Belfast, Belfast, UK.
| | - T Sussman
- McGill University, Montreal, QC, Canada
| | - M Bui
- Faculty of Health Sciences, 3N25F, McMaster University, 1280 Main Street West, Hamilton, ON, L8N 3Z5, Canada
| | - N Akhtar-Danesh
- Faculty of Health Sciences, 3N25F, McMaster University, 1280 Main Street West, Hamilton, ON, L8N 3Z5, Canada
| | | | - L McCleary
- Brock University, St. Catharines, ON, Canada
| | | | - K Brazil
- Queen's University Belfast, Belfast, UK
| | - D Parker
- Deborah Parker, University of Western Sydney, Sydney, Australia
| | - V Dal Bello-Haas
- Faculty of Health Sciences, 3N25F, McMaster University, 1280 Main Street West, Hamilton, ON, L8N 3Z5, Canada
| | - A Papaioannou
- Faculty of Health Sciences, 3N25F, McMaster University, 1280 Main Street West, Hamilton, ON, L8N 3Z5, Canada
| | - J O'Leary
- Faculty of Health Sciences, 3N25F, McMaster University, 1280 Main Street West, Hamilton, ON, L8N 3Z5, Canada
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Kamga H, McCusker J, Yaffe M, Sewitch M, Sussman T, Strumpf E, Olivier S, Wittich W, Moghadaszadeh S, Freeman EE. Self-care tools to treat depressive symptoms in patients with age-related eye disease: a randomized controlled clinical trial. Clin Exp Ophthalmol 2017; 45:371-378. [DOI: 10.1111/ceo.12890] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 11/24/2016] [Accepted: 11/26/2016] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Mark Yaffe
- McGill University; Montreal Quebec Canada
| | | | | | | | - Sébastien Olivier
- Maisonneuve-Rosemont Hospital; Montreal Quebec Canada
- Department of Ophthalmology; University of Montreal; Montreal Quebec Canada
| | - Walter Wittich
- School of Optometry; University of Montreal; Montreal Quebec Canada
| | | | - Ellen E Freeman
- Maisonneuve-Rosemont Hospital; Montreal Quebec Canada
- Department of Ophthalmology; University of Montreal; Montreal Quebec Canada
- School of Epidemiology, Public Health, and Preventive Medicine; University of Ottawa; Ottawa Ontario Canada
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McCusker J, Yaffe M, Sussman T, Cole M, Sewitch M, Strumpf E, Freeman E, Lambert S, de Raad M. [The Management of Depression in Older Adults and Their Family Caregivers: Findings from a Research Program in Quebec]. Sante Ment Que 2017; 42:273-288. [PMID: 28792572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Objectives A research group based at St. Mary's Research Centre, St. Mary's Hospital, Montreal, has conducted a research program over the past two decades that aims to inform improvements in the management of depression in primary care and general medical settings, among older adults. This paper reviews the findings from this research program, discusses the findings in the context of other research, and highlights the implications for practice and health policy.Methods Narrative review and synthesis of 25 published articles, that included: 4 systematic reviews, 10 observational studies, 9 intervention trials, and 2 consensus conference reports.Results The results pertain to 4 research areas: detection of depression in primary care and general medical settings; collaborative care of depression; depression self-care interventions; and the role of family and friends in supporting depression self-care interventions.Conclusions We propose six recommendations for improving the management of depression in the target population. 1) Depression detection and treatment can be improved through collaborative care models that involve primary care physicians, mental health specialists and non-physician mental health workers who are trained to assist with the detection of depression, with the delivery of brief, low-intensity psychological interventions and with self-care support. More research and evaluation are necessary to determine the factors that enhance the effectiveness, cost-efficiency, and consumer-centeredness of these interventions. 2) Supported depression self-care (and other low-intensity interventions such as short problem-solving therapy) offered by telephone or via internet, either as part of collaborative or usual care are feasible treatment options but more research is necessary to determine their effectiveness in different clinical populations. Some populations (e.g., those aged 75 and over, with visual and/or mild cognitive impairment) are likely to need greater or face-to-face support. 3) As most family physicians are unlikely to have the necessary time or interest to support depression self-care interventions, other sustainable programmatic contexts are needed for delivery of these interventions. Options include: nurses or other mental health workers in multidisciplinary family medicine groups; regional mental health programs; and voluntary organizations dedicated to assisting in the management of chronic illnesses. Research is needed on the feasibility and effectiveness of using peer support workers or volunteers to provide coaching of depression self-care interventions. 4) Involvement of family or friends in depression self-care may improve outcomes (e.g., dyadic interventions) but further research is necessary. 5) Further research should explore the potential of depression self-care interventions to prevent major depression and in depression relapse prevention in this population.
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Affiliation(s)
- Jane McCusker
- Centre de recherche de St. Mary, Montréal, Canada ; Département d'épidémiologie, biostatistique et santé au travail, Université McGill, Montréal, Canada
| | - Mark Yaffe
- Département de médecine familiale, Centre hospitalier de St. Mary, Montréal, Canada ; Département de médecine de famille, Université McGill, Montréal, Canada
| | - Tamara Sussman
- École de travail social, Université McGill, Montréal, Canada
| | - Martin Cole
- Centre de recherche de St. Mary, Montréal, Canada ; Département de psychiatrie, Centre hospitalier de St. Mary, Montréal, Canada ; Département de psychiatrie, Université McGill, Montréal, Canada
| | - Maida Sewitch
- Département d'épidémiologie, biostatistique et santé au travail, Université McGill, Montréal, Canada ; Institut de recherche du Centre universitaire de santé McGill, Montréal, Canada ; Centre universitaire de santé McGill, Divisions de gastroentérologie et d'épidémiologie clinique, Montréal, Canada
| | - Erin Strumpf
- Département d'économie, Université McGill, Montréal, Canada
| | - Ellen Freeman
- Centre de recherche, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Canada
| | - Sylvie Lambert
- Centre de recherche de St. Mary, Montréal, Canada ; École des sciences infirmières Ingram, Université McGill, Montréal, Canada
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George NR, Kryworuchko J, Hunold KM, Ouchi K, Berman A, Wright R, Grudzen CR, Kovalerchik O, LeFebvre EM, Lindor RA, Quest TE, Schmidt TA, Sussman T, Vandenbroucke A, Volandes AE, Platts-Mills TF. Shared Decision Making to Support the Provision of Palliative and End-of-Life Care in the Emergency Department: A Consensus Statement and Research Agenda. Acad Emerg Med 2016; 23:1394-1402. [PMID: 27611892 DOI: 10.1111/acem.13083] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 08/29/2016] [Accepted: 09/07/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Little is known about the optimal use of shared decision making (SDM) to guide palliative and end-of-life decisions in the emergency department (ED). OBJECTIVE The objective was to convene a working group to develop a set of research questions that, when answered, will substantially advance the ability of clinicians to use SDM to guide palliative and end-of-life care decisions in the ED. METHODS Participants were identified based on expertise in emergency, palliative, or geriatrics care; policy or patient-advocacy; and spanned physician, nursing, social work, legal, and patient perspectives. Input from the group was elicited using a time-staggered Delphi process including three teleconferences, an open platform for asynchronous input, and an in-person meeting to obtain a final round of input from all members and to identify and resolve or describe areas of disagreement. CONCLUSION Key research questions identified by the group related to which ED patients are likely to benefit from palliative care (PC), what interventions can most effectively promote PC in the ED, what outcomes are most appropriate to assess the impact of these interventions, what is the potential for initiating advance care planning in the ED to help patients define long-term goals of care, and what policies influence palliative and end-of-life care decision making in the ED. Answers to these questions have the potential to substantially improve the quality of care for ED patients with advanced illness.
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Affiliation(s)
- Naomi R. George
- Department of Emergency Medicine; Brown University; Providence RI
| | | | | | - Kei Ouchi
- Department of Emergency Medicine; Brigham and Women's Hospital; Boston MA
| | - Amy Berman
- Hartford Program Officer/Patient Representative; New York NY
| | - Rebecca Wright
- Department of Emergency Medicine; NYU School of Medicine; New York NY
| | - Corita R. Grudzen
- Department of Emergency Medicine; NYU School of Medicine; New York NY
| | | | - Eric M. LeFebvre
- Department of Emergency Medicine, Geriatric Fellow; University of North Carolina-Chapel Hill; Chapel Hill NC
| | | | - Tammie E. Quest
- Department of Emergency Medicine; Emory University; Atlanta GA
| | - Terri A. Schmidt
- Departments of Emergency Medicine and Hematology/Oncology; Oregon Health and Science University; Portland OR
| | - Tamara Sussman
- School of Social Work; McGill University; Montreal Quebec Canada
| | | | | | - Timothy F. Platts-Mills
- Department of Emergency Medicine and Department of Anesthesiology; University of North Carolina-Chapel Hill; Chapel Hill NC
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68
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Brotman S, Drummond J, Silverman M, Sussman T, Orzeck P, Barylak L, Wallach I, Billette V. Talking about Sexuality and Intimacy with Women Spousal Caregivers: Perspectives of Service Providers. Health Soc Work 2016; 41:263-270. [PMID: 29206976 DOI: 10.1093/hsw/hlw040] [Citation(s) in RCA: 2] [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: 08/27/2015] [Accepted: 01/14/2016] [Indexed: 06/07/2023]
Abstract
This article reports the findings of an exploratory study examining service provider perceptions and experiences of addressing sexuality and intimacy with women spousal caregivers. The caregiver-provider encounter is examined, and challenges faced by service providers in addressing sexuality are considered. Themes identified include ambivalence and discomfort, personal and institutional barriers, meanings attributed to sexuality and intimacy, and lack of opportunities to discuss experiences. Strategies to overcome silence and invisibility on the part of service providers in the health and social services system are considered.
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Affiliation(s)
- Shari Brotman
- School of Work, McGill University, 3506 University Street, Montreal, Quebec, Canada
| | | | | | | | - Pam Orzeck
- Leading Practices in Caregiving, CIUSSS West-Central Montreal Health/CLSC René Cassin Centre for Research and Expertise in Social Gerontology
| | - Lucy Barylak
- Leading Practices in Social Gerontology, CIUSSS West-Central Montreal Health/CLSC René Cassin Centre for Research and Expertise in Social Gerontology
| | | | - Veronique Billette
- Equipe VIES, Institut national de la recherche scientifique, INRS Urbanisation Culture Société, Quebec, Montreal
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69
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Earl M, Sussman T, Kaasalainen S. Resident and Staff Experiences with Palliative Care Services Provided in Nursing Homes: Qualitative Content Analysis of Focus Group Transcripts. Arch Phys Med Rehabil 2016. [DOI: 10.1016/j.apmr.2016.08.210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sussman T, Mccusker J, Yaffe M, Belzile E, Sewitch M, Cole M, Strumpf E. Family members' or friends' involvement in self-care for patients with depressive symptoms and co-morbid chronic conditions. Chronic Illn 2016; 12:182-98. [PMID: 26935233 DOI: 10.1177/1742395316633510] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 11/30/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To describe the support that patients reported receiving from family or friends (F/F) while participating in a self-care intervention for depressive symptoms; examine associations between patient-reported F/F support and use of self-care materials; and describe F/F perceptions of involvement in a subsample of F/F. METHODS One hundred eighty-nine of 223 (85%) patients aged 40+ with chronic physical conditions and co-morbid depressive symptoms participating in a randomized self-care intervention trial, completed structured telephone surveys at three months about the F/F support received. Ten F/F participated in post study qualitative interviews on the support provided. RESULTS 30%, 44%, and 91% of patients reported overall F/F support with self-care, F/F involvement with the self-care intervention and emotional support, respectively. 61% felt positively and 10% felt negatively or conflicted with F/F support. F/F involvement in the self-care intervention was the only variable associated with patient use of self-care materials when examined alongside all F/F support variables (Proportional Odds Ratio = 1.21; 95% C.I. = 1.01, 1.45). F/F perceived less involvement in the self-care intervention than patients. DISCUSSION Patients engaged in a self-care intervention for depressive symptoms use more self-care materials when they perceive F/F involvement in the intervention. Patients and F/F may perceive involvement differently and benefit from discussions about potential F/F roles.
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Affiliation(s)
- Tamara Sussman
- School of Social Work, McGill University, Montreal, QC, Canada
| | - Jane Mccusker
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University St Mary's Research Centre, Montreal, QC, Canada
| | - Mark Yaffe
- Department of Family Medicine, McGill University, Montreal, QC, Canada Department of Family Medicine, St. Mary's Hospital Centre, St. Mary's Hospital Centre, Montreal, QC, Canada
| | | | - Maida Sewitch
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University Department of Medicine, McGill University, Montreal, QC, Canada Divisions of Gastroenterology and Clinical Epidemiology, McGill University Health Centre, Montreal, QC, Canada
| | - Martin Cole
- St Mary's Research Centre, Montreal, QC, Canada Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Erin Strumpf
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University Department of Economics, McGill University, Montreal, QC, Canada
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71
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Grenier A, Sussman T, Barken R, Bourgeois-Guérin V, Rothwell D. 'Growing Old' in Shelters and 'On the Street': Experiences of Older Homeless People. J Gerontol Soc Work 2016; 59:458-477. [PMID: 27653853 DOI: 10.1080/01634372.2016.1235067] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Homelessness among older people in Canada is both a growing concern, and an emerging field of study. This article reports thematic results of qualitative interviews with 40 people aged 46 to 75, carried out as part of a mixed-methods study of older people who are homeless in Montreal, Quebec, Canada. Our participants included people with histories of homelessness (n = 14) and persons new to homelessness in later life (n = 26). Interviews focused on experiences at the intersections of aging and homelessness including social relationships, the challenges of living on the streets and in shelters in later life, and the future. This article outlines the 5 main themes that capture the experience of homelessness for our participants: age exacerbates worries; exclusion and isolation; managing significant challenges; shifting needs and realities; and resilience, strength, and hope. Together, these findings underscore the need for specific programs geared to the unique needs of older people who are homeless.
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Affiliation(s)
- Amanda Grenier
- a Health, Aging, and Society , McMaster University , Hamilton , Canada
| | - Tamara Sussman
- b School of Social Work , McGill University , Montreal , Canada
| | - Rachel Barken
- c Postdoctoral fellow , York University , Toronto , Canada
| | | | - David Rothwell
- e Public Health and Human Services , Oregon State University , Corvallis , Oregon , USA
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72
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Rothwell DW, Sussman T, Grenier A, Mott S, Bourgeois-Guérin V. Patterns of Shelter Use Among Men New to Homelessness in Later Life. J Appl Gerontol 2016; 36:71-93. [PMID: 26769822 DOI: 10.1177/0733464815624154] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 10/06/2015] [Accepted: 11/22/2015] [Indexed: 11/17/2022] Open
Abstract
People who become homeless for the first time in late life are a growing but understudied population. This study draws on administrative data from one shelter ( N = 1,214 first-time homeless) to assess the extent to which age is related to shelter stay and, to examine psychosocial factors that may be associated with shelter departure. Our bivariate and survival analysis results suggest that older homeless men stay in the shelter 2 weeks longer than younger clients. Older men with pending legal issues and mobility concerns were more likely to leave the shelter than those without such concerns. Findings highlight the impact of age and other psychosocial variables on shelter stay, and provide direction from which to address homelessness among men who are new to homelessness in later life.
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McCusker J, Cole MG, Yaffe M, Strumpf E, Sewitch M, Sussman T, Ciampi A, Lavoie K, Platt RW, Belzile E. A randomized trial of a depression self-care toolkit with or without lay telephone coaching for primary care patients with chronic physical conditions. Gen Hosp Psychiatry 2016; 40:75-83. [PMID: 27067224 DOI: 10.1016/j.genhosppsych.2016.02.004] [Citation(s) in RCA: 4] [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] [Received: 10/09/2014] [Revised: 03/11/2015] [Accepted: 03/12/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The aim of this study was to compare outcomes of use of a depression self-care toolkit with and without lay telephone coaching among primary care patients 40 years and older with depressive symptoms and comorbid chronic physical conditions. METHOD A single blind, individually randomized, pragmatic trial of a depression self-care toolkit (Toolkit) with or without lay telephone coaching was conducted among primary care adults with depressive symptoms and comorbid chronic physical conditions. Eligible patients were randomized to receive the Toolkit with (intervention) or without (control) telephone coaching provided by trained lay coaches. The primary outcome was depression severity [Patient Health Questionnaire (PHQ-9)] at 6 months. Secondary outcomes were self-efficacy, satisfaction, and use of health services at 6 months. RESULTS A total of 223 patients were randomized, and 172 (77.1%) completed 6-month follow-ups. PHQ-9 scores improved significantly in both groups over the 6-month follow-up; the differences in PHQ-9 scores between intervention and control groups were statistically significant at 3 months [effect size = 0.43; 95% confidence interval (CI) = 0.15-0.70] but not at 6 months (effect size = 0.23; 95% CI = -0.04-0.59). Patients with moderate depression severity (PHQ-9 10-19) and high self-efficacy at baseline were most likely to benefit from the intervention. There was no significant effect of the intervention on the secondary outcomes. CONCLUSIONS The incremental value of lay telephone coaching of a Toolkit appears short-lived. Targeting of coaching to those with moderate depression severity may be indicated.
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Affiliation(s)
- Jane McCusker
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada; St Mary's Research Centre, Montreal, Quebec, Canada.
| | - Martin G Cole
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada; Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Mark Yaffe
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada; Family Medicine Centre, St. Mary's Hospital Center, Montreal, Quebec, Canada
| | - Erin Strumpf
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada; Department of Economics, McGill University, Montreal, Quebec, Canada
| | - Maida Sewitch
- Department of Medicine, McGill University, McGill University Health Centre, Montreal, Quebec, Canada; Divisions of Gastroenterology and Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Tamara Sussman
- School of Social Work, McGill University, Montreal, Quebec, Canada
| | - Antonio Ciampi
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada; St Mary's Research Centre, Montreal, Quebec, Canada
| | - Kim Lavoie
- Department of Psychology, Montreal Behavioural Medicine Centre, Montreal, Quebec, Canada; Research Center, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
| | - Robert W Platt
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Eric Belzile
- St Mary's Research Centre, Montreal, Quebec, Canada
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Kaasalainen S, Kaasalainen S, Sussman T, Neves P, Papaioannou A. Strengthening a Palliative Approach in Long-Term Care (SPA-LTC): A New Program to Improve Quality of Living and Dying for Residents and their Family Members. J Am Med Dir Assoc 2016. [DOI: 10.1016/j.jamda.2015.12.067] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Sahin D, Yaffe MJ, Sussman T, McCusker J. A mixed studies literature review of family physicians' participation in research. Fam Med 2014; 46:503-514. [PMID: 25058542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND AND OBJECTIVES Family physicians' recruitment and adherence in research are challenging. This mixed studies literature review sought to identify the extent of family physicians' participation in primary health care research, as well as facilitators and inhibitors of their recruitment and subsequent protocol adherence in research projects. METHODS We searched Medline, Embase, PsycINFO, SCOPUS, Google Scholar, and BioMed Central Medical Research Methodology by using an explicit strategy. Sixty-two articles met predetermined selection criteria. Using a mixed method approach, we performed a content analysis of the results published in these articles to synthesize factors affecting family physicians' participation in research. RESULTS Recruitment rates varied between 2% and 81%. The most frequent types of participation requested were completion of questionnaires (48%) and recruitment of patients (37%). We found that family physicians' personal/professional factors mainly affected recruitment, practice/patient-related issues mainly affected adherence, and study protocol characteristics facilitated both recruitment and adherence of family physicians in research. CONCLUSIONS This review provides a synthesis of knowledge about factors mediating family physicians' roles in research. Our findings offer material for researchers to create checklists to help create and operationalize protocols that respect local clinical and research realities.
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Affiliation(s)
- Deniz Sahin
- Department of Family Medicine and St. Mary's Research Centre, McGill University, Montreal, Quebec
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Abstract
This interpretive grounded theory study explores 10 residents' retrospective accounts of the relocation process, including the decision to move into a long-term care home, the pre-move preparations, the moving day circumstances, and the initial adjustment period following the move. Analysis of the data revealed a complex intersection of conditions at multiple layers that shaped residents' experiences of the transitional process. Recommendations to enhance circumstances at individual, interpersonal, and systemic layers, for each temporal stage of the relocation process are proposed. Implications for social work practice across the continuum of care are also discussed.
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Affiliation(s)
- Tamara Sussman
- a School of Social Work , McGill University , Montreal , Canada
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Sussman T, Yaffe M, Mccusker J, Burns V, Strumpf E, Sewitch M, Belzile E. A mixed methods exploration of family members'/friends' roles in a self-care intervention for depressive symptoms. Chronic Illn 2014; 10:93-106. [PMID: 23986084 DOI: 10.1177/1742395313500359] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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: 11/16/2022]
Abstract
OBJECTIVES The aims of this exploratory study were to examine the: (1) family and friend (F/F) support patients reported receiving and F/F reported providing to patients while participating in a self-care intervention (SCI) for depressive symptoms and (2) associations between different types of F/F support and patients' use of the self-care tools in the SCI. METHODS Fifty-seven patients aged 40 + participating in an uncontrolled feasibility study of an SCI, completed structured telephone interviews about the support they received from F/F while participating in the SCI. Eighteen F/F completed questionnaires on the support they provided to patients during the SCI. Seven F/F participated in a post-study qualitative interview on their involvement in the SCI. RESULTS About 35% of patients reported receiving F/F support with the SCI. Patients' use of the behavioral tools was positively associated with patients' report of F/F support, and with F/F's report of instrumental support provided. F/F reported uncertainty about the type of support they should offer to patients in the SCI. DISCUSSION F/F involvement in SCIs for depressive symptoms may be helpful to patients and may foster adherence to these interventions. More research is warranted on the nature of such involvement from the perspective of patients and F/F.
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Affiliation(s)
- Tamara Sussman
- 1School of Social Work, McGill University, Montreal, Canada
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McCusker J, Yaffe M, Sussman T, Kates N, Mulvale G, Jayabarathan A, Law S, Haggerty J. Developing an evaluation framework for consumer-centred collaborative care of depression using input from stakeholders. Can J Psychiatry 2013; 58:160-8. [PMID: 23461887 DOI: 10.1177/070674371305800306] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To develop a framework for research and evaluation of collaborative mental health care for depression, which includes attributes or domains of care that are important to consumers. METHODS A literature review on collaborative mental health care for depression was completed and used to guide discussion at an interactive workshop with pan-Canadian participants comprising people treated for depression with collaborative mental health care, as well as their family members; primary care and mental health practitioners; decision makers; and researchers. Thematic analysis of qualitative data from the workshop identified key attributes of collaborative care that are important to consumers and family members, as well as factors that may contribute to improved consumer experiences. RESULTS The workshop identified an overarching theme of partnership between consumers and practitioners involved in collaborative care. Eight attributes of collaborative care were considered to be essential or very important to consumers and family members: respectfulness; involvement of consumers in treatment decisions; accessibility; provision of information; coordination; whole-person care; responsiveness to changing needs; and comprehensiveness. Three inter-related groups of factors may affect the consumer experience of collaborative care, namely, organizational aspects of care; consumer characteristics and personal resources; and community resources. CONCLUSION A preliminary evaluation framework was developed and is presented here to guide further evaluation and research on consumer-centred collaborative mental health care for depression.
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Affiliation(s)
- Jane McCusker
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.
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McCusker J, Cole M, Yaffe M, Sussman T, Lavoie KL, Strumpf E, Sewitch M, Sahin D, de Raad M. A feasibility study of a telephone-supported self-care intervention for depression among adults with a comorbid chronic physical illness in primary care. Ment Health Fam Med 2012; 9:257-273. [PMID: 24294301 PMCID: PMC3721920] [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] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Objective We assessed the feasibility and acceptability to patients of a telephone-supported self-care intervention for depression among adults aged 40 years or over with one of six targeted chronic physical illnesses and comorbid depressive symptoms in family practice settings. Methods An open, uncontrolled trial (feasibility study) was conducted among patients treated in Montreal family practices. Eligible patients were aged 40 years or over, had one or more of the targeted chronic physical illnesses for at least 6 months (arthritis, hypertension, diabetes, heart disease, asthma and chronic obstructive pulmonary disease) and were evaluated as having at least mild depressive symptoms (a score of ≥ 5 on the 9-item Patient Health Questionnaire, PHQ-9). Participants received a package of six self-care tools (information booklet, video, Internet programme, action plan, workbook and mood-monitoring tool) with telephone support by a lay coach for up to 6 months. Results In total, 63 eligible patients provided written consent and completed the baseline interview; 57 (90%) and 55 (87%) patients completed 2-month and 6-month follow-up interviews, respectively. The mean number of telephone calls made by coaches to participants was 10.5 (SD 4.0), and the average length of these calls was 10.6 minutes. At the 6-month follow-up, 83.6% of the participants reported that one or more of the tools were helpful. Clinically significant improvements were seen in depressive symptoms (as assessed by the PHQ-9) at 6 months, with an effect size of 0.88 (95% CI, 0.55, 1.14). Conclusion A telephone-supported self-care intervention for depression was feasible, was acceptable to patients, and was associated with a significant 6-month improvement in depressive symptoms. A randomised trial of this intervention is justified.
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Affiliation(s)
- Jane McCusker
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University; St Mary's Research Centre, Montreal, Canada
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Burns V, Grenier A, Lavoie JP, Rothwell D, Sussman T. Les personnes âgées itinérantes — invisibles et exclues. Une analyse de trois stratégies pour contrer l’itinérance. ACTA ACUST UNITED AC 2012. [DOI: 10.7202/1018230ar] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Sussman T, Yaffe M, McCusker J, Parry D, Sewitch M, Van Bussel L, Ferrer I. Improving the management of late-life depression in primary care: barriers and facilitators. Depress Res Treat 2011; 2011:326307. [PMID: 21738868 PMCID: PMC3123847 DOI: 10.1155/2011/326307] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Accepted: 03/01/2011] [Indexed: 11/18/2022]
Abstract
The objectives of this study were to elicit Canadian health professionals' views on the barriers to identifying and treating late-life depression in primary care settings and on the solutions felt to be most important and feasible to implement. A consensus development process was used to generate, rank, and discuss solutions. Twenty-three health professionals participated in the consensus process. Results were analysed using quantitative and qualitative methods. Participants generated 12 solutions. One solution, developing mechanisms to increase family physicians' awareness of resources, was highly ranked for importance and feasibility by most participants. Another solution, providing family physicians with direct mental health support, was highly ranked as important but not as feasible by most participants. Deliberations emphasized the importance of case specific, as needed support based on the principles of shared care. The results suggest that practitioners highly value collaborative care but question the feasibility of implementing these principles in current Canadian primary care contexts.
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Affiliation(s)
- Tamara Sussman
- School of Social Work, McGill University, 3506 University Street, Room 300, Montreal, QC, Canada H3A 2A7
| | - Mark Yaffe
- Family Medicine, St. Mary's Hospital Center, McGill University, 3830 Lacombe Avenue, Montreal, QC, Canada H3T 1M5
| | - Jane McCusker
- Epidemiology, Biostatistics and Occupational Health, St. Mary's Hospital Center, McGill University, 3830 Lacombe Avenue, Montreal, QC, Canada H3T 1M5
| | - David Parry
- Department of Clinical Epidemiology and Community Studies, St. Mary's Hospital Center, Faculty of Law, McGill University, 3830 Lacombe Avenue, Montreal, QC, Canada H3T 1M5
| | - Maida Sewitch
- Department of Medicine, McGill University, 3830 Lacombe Avenue, Montreal, QC, Canada H3T 1M5
| | - Lisa Van Bussel
- Division of Geriatric Psychiatry, Department of Psychiatry, St. Joseph's Health Centre, The University of Western Ontario, 850 Highbury Avenue, London, ON, Canada N6A 4G5
| | - Ilyan Ferrer
- School of Social Work, McGill University, 3506 University Street, Montreal, QC, Canada H3A 2A7
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Abstract
The literature clearly denotes that spouses differ from other family members in their reactions to caregiving, their patterns of service use and their assessment of specific services. Yet, despite their prevalence as caregivers, little is known about their unique perceptions of community services and the factors that impact their experiences with the service system. The purpose of this study was to explore the relative influence of (a) spouses' personal factors (e.g., gender, family support) and (b) service factors (e.g., one-on-one professional support), on spousal caregivers' perceptions of community services. The study employed a survey design with a sample of 73 spousal caregivers caring for their partners with dementia at home. This study found that spousal caregivers have more negative perceptions of the service system when their in-home workers are not informed about their spouses' likes, dislikes and routines. This service factor was the most significant predictor of caregivers' service perceptions. The study further found that most spousal caregivers receive fewer than five consultations from a non-medical professional over a one year period. While spouses longed for more professional support, this service factor was not uniquely associated with service related stress. The policy and practice implications of these findings are discussed.
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Affiliation(s)
- Tamara Sussman
- School of Social Work, McGill University, Montreal, Quebec, Canada.
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Sussman T, Regehr C. The influence of community-based services on the burden of spouses caring for their partners with dementia. Health Soc Work 2009; 34:29-39. [PMID: 19281100 DOI: 10.1093/hsw/34.1.29] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Despite the vast literature on caregiver stress, few studies have explored how community services affect the stress process for spousal caregivers. The current study explores the differential effects of emotional and tangible support provided by family and friends and by formal services, and caregivers' perceptions of community services on spousal caregivers' burden. The study used a survey design with a sample of 85 spousal caregivers caring for their partners with dementia in the community. The study found that in-home services, as they are currently offered, do little to reduce the burden of spouses caring for their partners with dementia. Rather the most effective service is the provision of adult day programs, which provide not only respite for the spousal caregiver, but also opportunities for social interaction for their partners with dementia. This study further found that spousal caregivers experience a relatively high level of service-related stress. However, when examined alongside care recipient behavioral challenges and frequency of day program use, caregivers' perceptions of and experiences with the service system did not uniquely explain their burden. Implications of the findings for policy, research, and practice are discussed.
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Affiliation(s)
- Tamara Sussman
- School of Social Work, McGill University, Montreal, Canada.
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Appleyard J, Armstrong M, Bassett JB, Bowte JC, Bradley KF, Brown RAG, Campbell-Fergusson J, Campbell-Smith S, Dunlop J, Enoch BA, Fagan D, Farewell T, Forrest RD, Gordon NH, Hole R, Hore BD, Lawlor T, Low RAL, Lye M, Modowal KK, Sheppard H, Sperryn P, Stewart AJ, Sussman T, Tidmarsh D, Wilson P, Winwood RS, Woodyard JE. Vote of thanks. West J Med 1969. [DOI: 10.1136/bmj.4.5681.498-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Sussman T. Transperitoneal ureterolithotomy. Proc R Soc Med 1969; 62:861. [PMID: 5810322 PMCID: PMC1811163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Sussman T. Alkaptonuria. Proc R Soc Med 1969; 62:485. [PMID: 5770593 PMCID: PMC1810987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Affiliation(s)
- T Sussman
- Amersham and High Wycombe General Hospitals
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Kirk RM, Sussman T. Colonic air insufflation in abdominal diagnosis. Br J Clin Pract 1968; 22:281-3. [PMID: 5659793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Sussman T. Unfilled Posts in the North. West J Med 1968. [DOI: 10.1136/bmj.2.5599.246-d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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