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Demirbas M, Hahn-Pedersen JH, Jørgensen HL. Comparison Between Burden of Care Partners of Individuals with Alzheimer's Disease Versus Individuals with Other Chronic Diseases. Neurol Ther 2023; 12:1051-1068. [PMID: 37222859 PMCID: PMC10310688 DOI: 10.1007/s40120-023-00493-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/05/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Caregiving in Alzheimer's disease (AD) is often provided by informal care partners, who spend more hours per week on average than care partners of individuals with conditions other than AD. However, the burden of care in partners of individuals with AD has not been systematically compared to that of other chronic diseases. OBJECTIVE The current study therefore aims to compare the care partner burden of AD to that of other chronic diseases through a systematic literature review. METHODS Data was collected from journal articles published in the last 10 years, using two unique search strings in PubMed and analysed using pre-defined patient-reported outcome measures (PROMs) including the EQ-5D-5L, GAD-7, GHQ-12, PHQ-9, WPAI and the ZBI. The data was grouped according to the included PROMs and the diseases studied. The number of participants in the studies reporting burden of caregiving in AD was adjusted to reflect the number of participants in studies reporting care partner burden in other chronic diseases. RESULTS All results in this study are reported as a mean value and standard deviation (SD). The ZBI measurement was the most frequently used PROM to collect care partner burden (15 studies) and showed a moderate burden (mean 36.80, SD 18.35) on care partners of individuals with AD, higher than most of the other included diseases except for those characterized by psychiatric symptoms (mean scores 55.92 and 59.11). Other PROMs such as PHQ-9 (six studies) and GHQ-12 (four studies) showed a greater burden on care partners of individuals with other chronic diseases such as heart failure, haematopoietic cell transplantations, cancer and depression compared to AD. Likewise, GAD-7 and EQ-5D-5L measurements showed a lesser burden on care partners of individuals with AD compared to care partners of individuals with anxiety, cancer, asthma and chronic obstructive pulmonary disease. The current study suggests that care partners of individuals with AD experience a moderate burden, but with some variations depending on the PROMs used. CONCLUSION The results of this study were mixed with some PROMs indicating a greater burden for care partners of individuals with AD versus other chronic diseases, and other PROMs showing a greater burden for care partners of individuals with other chronic diseases. Psychiatric disorders imposed a greater burden on care partners compared to AD, while somatic diseases in the musculoskeletal system resulted in a significantly smaller burden on care partners compared to AD.
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Affiliation(s)
- Murat Demirbas
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | | | - Henrik L Jørgensen
- Department of Clinical Biochemistry, Copenhagen University Hospital, Hvidovre, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Ellison TS, Cappa SF, Garrett D, Georges J, Iwatsubo T, Kramer JH, Lehmann M, Lyketsos C, Maier AB, Merrilees J, Morris JC, Naismith SL, Nobili F, Pahor M, Pond D, Robinson L, Soysal P, Vandenbulcke M, Weber CJ, Visser PJ, Weiner M, Frisoni GB. Outcome measures for Alzheimer's disease: A global inter-societal Delphi consensus. Alzheimers Dement 2023; 19:2707-2729. [PMID: 36749854 PMCID: PMC11010236 DOI: 10.1002/alz.12945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 12/20/2022] [Indexed: 02/09/2023]
Abstract
INTRODUCTION We aim to provide guidance on outcomes and measures for use in patients with Alzheimer's clinical syndrome. METHODS A consensus group of 20 voting members nominated by 10 professional societies, and a non-voting chair, used a Delphi approach and modified GRADE criteria. RESULTS Consensus was reached on priority outcomes (n = 66), measures (n = 49) and statements (n = 37) across nine domains. A number of outcomes and measurement instruments were ranked for: Cognitive abilities; Functional abilities/dependency; Behavioural and neuropsychiatric symptoms; Patient quality of life (QoL); Caregiver QoL; Healthcare and treatment-related outcomes; Medical investigations; Disease-related life events; and Global outcomes. DISCUSSION This work provides indications on the domains and ideal pertinent measurement instruments that clinicians may wish to use to follow patients with cognitive impairment. More work is needed to develop instruments that are more feasible in the context of the constraints of clinical routine.
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Affiliation(s)
| | - Stefano F. Cappa
- Scuola Universitaria Superiore IUSS Pavia, Pavia, Italy
- Dementia Research Center, IRCCS Mondino Foundation, Pavia, Italy
| | | | | | - Takeshi Iwatsubo
- Unit for Early and Exploratory Clinical Development, The University of Tokyo Hospital, Tokyo, Japan
- Department of Neuropathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Joel H. Kramer
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, California, USA
| | | | - Constantine Lyketsos
- Richman Family Precision Medicine Center of Excellence in Alzheimer’s Disease, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University and Medicine, Baltimore, USA
| | - Andrea B. Maier
- Department of Medicine and Aged Care, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
- Faculty of Behavioural and Movement Sciences, Department of Human Movement Sciences, Vrije Universiteit, Amsterdam Movement Sciences, Amsterdam, Netherlands
- Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Centre for Healthy Longevity, National University Health System, Singapore, Singapore
| | - Jennifer Merrilees
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, California, USA
| | - John C. Morris
- Department of Neurology, Washington University, St. Louis, Missouri, USA
| | - Sharon L. Naismith
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Flavio Nobili
- UO Clinica Neurologica, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Policlinico San Martino, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Child and Mother Health, University of Genoa, Genova, Italy
| | - Marco Pahor
- Department of Aging and Geriatric Research, Institute on Aging, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Dimity Pond
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Louise Robinson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Pinar Soysal
- Department of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
- European Society of Geriatric Medicine, Dementia Special Interest Group
| | - Mathieu Vandenbulcke
- Neuropsychiatry, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Geriatric Psychiatry, University Psychiatric Centre KU Leuven, Leuven, Belgium
| | | | - Pieter Jelle Visser
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, Netherlands
- Alzheimer Center, Department of Neurology, Neuroscience Campus Amsterdam, Amsterdam University Medical Center, VU Medical Center, Amsterdam, Netherlands
- Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institute, Stockholm, Sweden
| | - Michael Weiner
- San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Giovanni B. Frisoni
- Laboratory of Neuroimaging of Aging (LANVIE), University of Geneva, Geneva, Switzerland
- Memory Clinic, Department of Readaptation and Geriatrics, Geneva University and University Hospitals, Geneva, Switzerland
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3
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Domínguez-Vergara J, Santa-Cruz-Espinoza H, Chávez-Ventura G. Zarit Caregiver Burden Interview: Psychometric Properties in Family Caregivers of People with Intellectual Disabilities. Eur J Investig Health Psychol Educ 2023; 13:391-402. [PMID: 36826213 PMCID: PMC9954955 DOI: 10.3390/ejihpe13020029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 01/19/2023] [Accepted: 02/01/2023] [Indexed: 02/09/2023] Open
Abstract
Caregivers of people with intellectual disabilities may feel overburdened in their work and experience negative psychological consequences. The purpose of this instrumental study was to determine the evidence of internal structure and reliability of the Zarit Caregiver Burden Interview scale. A total of 398 family caregivers, including women and men, participated (M = 47.33, SD = 10.44). The structure of the scale was evaluated by factor analysis and the McDonald Omega coefficient was used to estimate reliability. Sixteen models of the scale were tested, differing in number of items and factor structures. A model of 15 items and 4 dimensions (overload, competence, social relationship, and interpersonal relationship) obtained acceptable fit (χ2 = 184.72; p < 0.001; CFI = 0.95; TLI = 0.94; RMSEA = 0.055; SRMR = 0.05) and reliability coefficients above 0.70 in their dimensions. It is concluded that the Zarit scale is valid and reliable for use in caregivers of people with intellectual disabilities.
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Affiliation(s)
| | | | - Gina Chávez-Ventura
- Institute for Research in Science and Technology, Universidad César Vallejo, Trujillo 13009, Peru
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4
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Tu JY, Jin G, Chen JH, Chen YC. Caregiver Burden and Dementia: A Systematic Review of Self-Report Instruments. J Alzheimers Dis 2022; 86:1527-1543. [DOI: 10.3233/jad-215082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: As the demand for dementia care grows rapidly worldwide, heavy “caregiver burden” has been associated with stress and depression. Even so, standard metrics for interdisciplinary research of caregiver burden are limited. Objective: The objective of the present review is to recommend valid, reliable, and comprehensive self-report instruments of caregiver burden. Methods: A systematic review was performed using four databases, searched in April 2021. Articles that established or evaluated self-report instruments for dementia caregiver burden were included, while studies that involved non-dementia caregivers or did not clearly define caregiver burden were excluded. Established guidelines for reliability and agreement studies were used to assess quality and risk of bias. Assessments of self-report instruments were made based on reliability, validity, feasibility, and quality of psychometric evaluations, and comparative evaluations were presented in visual form using radar graphs. Results: Search terms yielded 1,720 articles, and 40 were included in the systematic review after excluding those of low quality. Based on the results of these studies, we recommend the Zarit Burden Interview, Screen for Caregiver Burden, Caregiver Burden Interview, and Burden Scale for Family Caregivers, due to their validity, reliability, and inclusion of multiple subjective and objective dimensions of burden. Conclusion: Targeting specific sources of caregiver burden can help prevent negative outcomes for both dementia patients and caregivers. Future studies should apply self-report instruments to measure and address caregiver burden longitudinally.
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Affiliation(s)
| | | | - Jen-Hau Chen
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yen-Ching Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Public Health, National Taiwan University, Taipei, Taiwan
- Research Center for Genes, Environment and Human Health, College of Public Health, National Taiwan University, Taipei, Taiwan
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5
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Urwin S, Lau YS, Grande G, Sutton M. The Challenges of Measuring Informal Care Time: A Review of the Literature. PHARMACOECONOMICS 2021; 39:1209-1223. [PMID: 34324174 PMCID: PMC8516777 DOI: 10.1007/s40273-021-01053-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/02/2021] [Indexed: 06/13/2023]
Abstract
Economic evaluations increasingly include the value of informal care, for example, in terms of caregiver health effects or time costs. If an economic evaluation uses caregiving time costs, appropriate measurement of caregiving time is an important first step prior to its valuation. There is no comprehensive overview of the measurement challenges for caregiving time. In this literature review, we searched Medline, Embase, Econlit and Scopus to identify measurement issues and associated studies which reported informal care time that addressed them. The search identified 27 studies that addressed nine measurement issues. There is limited evidence on how to address these issues, although some have received relatively more attention, including incremental time (considered in 16 studies), time measurement method comparisons (six studies) and the inclusion of intangible tasks (four studies). Non-response (considered in only one study) and carer and recipient identification (two studies) were the most wide-reaching measurement concerns, as these determine who is identified as carers. There was no evidence on the consequences of these measurement challenges in terms of impacts on cost-effectiveness ratios and on the total cost of health conditions, which would be a crucial next step. Future research on these issues should consider a range of different settings, as informal care is highly heterogeneous. The measurement of informal care is key for its inclusion in economic evaluations but there is little consensus on how to appropriately measure this type of care.
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Affiliation(s)
- Sean Urwin
- Health Organisation, Policy and Economics, School of Health Sciences, University of Manchester, Williamson Building, Oxford Road, Manchester, M13 9PL, UK.
| | - Yiu-Shing Lau
- Health Organisation, Policy and Economics, School of Health Sciences, University of Manchester, Williamson Building, Oxford Road, Manchester, M13 9PL, UK
| | - Gunn Grande
- Division of Nursing, Midwifery and Social Care, University of Manchester, Manchester, UK
| | - Matt Sutton
- Health Organisation, Policy and Economics, School of Health Sciences, University of Manchester, Williamson Building, Oxford Road, Manchester, M13 9PL, UK
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6
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Predictors of the Quality of Life of Informal Carers of Adults on the Autism Spectrum. J Autism Dev Disord 2021; 52:2997-3014. [PMID: 34254220 DOI: 10.1007/s10803-021-05178-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2021] [Indexed: 10/20/2022]
Abstract
Carers of adults on the autism spectrum often experience high levels of stress, worry, and caregiver burden. There are few studies identifying the predictors of carer mental well-being and none have been conducted in Australia. Data from the Autism Cooperative Research Centre for Living with Autism's Australian Longitudinal Study of Autism in Adulthood was used to test the conceptual model by Sonido et al. (Rev J Autism Dev Disord, 2019, https://doi.org/10.1007/s40489-019-00177-8 ) by (a) identifying the predictors of mental well-being for carers of adults on the spectrum, (b) using model selection to determine which predictors contribute to the model of best fit, and (c) testing for mediating relationships between the predictors. Several predictors were directly associated with carer psychological quality of life, including carer age, care recipient intellectual disability, and carer intolerance of uncertainty. Model selection strongly supported the inclusion of most clusters from the conceptual model. Some mediating relationships were found, such as care recipient depressive behaviours mediating the relationships between caregiver burden and psychological quality of life. Future studies of the conceptual model will improve understanding of the predictors of carer mental well-being and enable tailored interventions to improve the psychological health of carers of adults on the autism spectrum.
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Shim YS, Park KH, Chen C, Dominguez JC, Kang K, Kim HJ, Hong Z, Lin YT, Chu LW, Jung S, Kim S. Caregiving, care burden and awareness of caregivers and patients with dementia in Asian locations: a secondary analysis. BMC Geriatr 2021; 21:230. [PMID: 33827446 PMCID: PMC8028783 DOI: 10.1186/s12877-021-02178-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 03/25/2021] [Indexed: 11/15/2022] Open
Abstract
Background This study investigated the differences in caregiver activity, caregiver burden, and awareness of both caregivers and patients with Alzheimer’s disease (AD) across different Asian locations. Methods This was a secondary analysis of a multi-national cohort study that aimed to assess caregiver activity and caregiver burden using the Caregiver Activity Scale (CAS) and Zarit Burden Interview (ZBI), respectively. Patients’ awareness of their dementia diagnosis was assessed by asking the following yes/no question: “Do you have dementia?” Caregivers’ awareness of the patient’s dementia diagnosis was assessed by asking the following yes/no question: “Does your patient have dementia?” Results In total, 524 caregivers of patients with AD from China, Hong Kong, South Korea, the Philippines, Singapore, Thailand, and Taiwan participated. The CAS and ZBI score were significantly different across most locations (p < 0.001 and p = 0.033, respectively). Overall, 56.6% of caregivers and 37.5% of patients had awareness of the dementia diagnosis, and the proportion of patients and caregivers with awareness were also different between each location (all, p < 0.001). Conclusions Caregiving, caregiver burden, and the awareness of caregivers and patients were different across many Asian locations. With understanding of cultural differences, further public education on dementia could help increase the awareness of patients and caregivers and reduce caregiver burden. Trial registration ClinicalTrials.gov, NCT02262975. Registered 13 October 2014,
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Affiliation(s)
- Yong S Shim
- Department of Neurology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kee Hyung Park
- Department of Neurology, College of Medicine, Gachon University Gil Hospital, Incheon, Republic of Korea
| | - Christopher Chen
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Kyunghun Kang
- Department of Neurology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Hee-Jin Kim
- Department of Neurology, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Zhen Hong
- Huashan Hospital Affiliated to Fudan University, Shanghai, China
| | - Yu-Te Lin
- Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Leung-Wing Chu
- Queen Mary Hospital, Department of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - San Jung
- Department of Neurology, Hallym University Kangnam Sacred Heart Hospital, Seoul, Republic of Korea
| | - SangYun Kim
- Department of Neurology, Seoul National University College of Medicine & Clinical Neuroscience Center, Seoul National University Bundang Hospital, 582, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Seoul, Republic of Korea.
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8
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Huang MH, Tsai CF, Lee WJ, Wang WF, Jhang KM, Wang SJ, Fuh JL. Caregivers' willingness to pay for Alzheimer's disease medications in Taiwan. J Chin Med Assoc 2021; 84:446-452. [PMID: 33595992 DOI: 10.1097/jcma.0000000000000504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Alzheimer's disease (AD) exerts significant financial expenses on caregivers, and knowledge of caregivers' support for out-of-pocket payment is of great importance for policymaking on the insurance coverage of future AD medication in Taiwan. We aimed to investigate caregivers' willingness to pay (WTP) for a hypothetical curative AD medication and the effect of different factors on the amount of WTP. METHODS Informal caregivers of patients with AD and informants of patients with amnestic mild cognitive impairment (MCI) were included. An iterative bidding game technique, followed by a dichotomous choice question and a final open-ended question were used to elicit caregivers' maximum WTP. The correlations between the WTP and characteristics of caregiver and patient were analyzed, including sex, educational level, severity of dementia, neuropsychiatric symptoms assessed by Neuropsychiatric Inventory, time needed to support patients assessed by Caregiver Activity Survey, and caregivers' monthly income. RESULTS A total of 1134 informal caregivers of patients with AD or MCI were included. Caregivers of patients with AD were willing to pay for a curative AD medication, and their maximum WTP value was higher than informants of MCI patients. Among patients with AD and patients with MCI, caregivers' monthly income was positively correlated with WTP. Apathy subsyndrome was the only factor correlated with percentage of WTP in caregiver's income in the MCI group. CONCLUSION Support for out-of-pocket WTP for a hypothetical curative AD medication was significantly related to caregiver's income.
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Affiliation(s)
- Mao-Hsuan Huang
- Department of Psychiatry, Division of Geriatric Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Psychiatry, Taipei Veterans General Hospital, Yuanshan and Suao Branch, Ilan, Taiwan, ROC
| | - Chia-Fen Tsai
- Department of Psychiatry, Division of Geriatric Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Wei-Ju Lee
- Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
- Faculty of Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan, ROC
- Dementia and Parkinson's Disease Integrated Center, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
- Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Wen-Fu Wang
- Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan, ROC
- Department of Holistic Wellness, Ming Dao University, Changhua, Taiwan, ROC
| | - Kai-Ming Jhang
- Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan, ROC
| | - Shuu-Jiun Wang
- Faculty of Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan, ROC
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of General Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Jong-Ling Fuh
- Faculty of Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan, ROC
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of General Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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Gonçalves-Pereira M, Zarit SH, Papoila AL, Mateos R. Positive and negative experiences of caregiving in dementia: The role of sense of coherence. Int J Geriatr Psychiatry 2021; 36:360-367. [PMID: 32944997 DOI: 10.1002/gps.5433] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 09/16/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Sense of coherence (SOC) is increasingly recognized as an important health determinant, particularly for mental health. Part of the evidence comes from informal caregivers in diverse clinical conditions. The extent to which SOC influences caregiving outcomes, however, is relatively under-researched in dementia, particularly regarding positive experiences. We analysed the association of SOC with dementia caregivers' subjective burden, psychological distress and positive aspects of care. METHODS/DESIGN This is a secondary analysis of cross-sectional data from the Lisbon study of Families of Persons with Dementia, involving a convenience sample of 99 primary caregivers of community-dwelling patients of neurology and psychiatry services. SOC was assessed with the Orientation for Life Scale. Measures of caregivers' outcomes were: the Zarit Burden Interview, the General Health Questionnaire for psychological distress and the Positive Aspects of Caregiving scale. Analyses controlled for demographics, caregiving arrangements, objective burden, social support, patients' neuropsychiatric symptoms and dementia stage. RESULTS Lower SOC was associated with higher psychological distress (p = 0.001). No significant associations were found for subjective burden (p = 0.081) or positive aspects of caregiving (p = 0.688). Additional analyses showed that lower SOC was associated with less emotional support (p < 0.001) and past psychiatric illness (p = 0.044). CONCLUSIONS These findings support previous research suggesting that SOC is protective for psychological distress, and extend evidence to the positive aspects of care in dementia. The cross-sectional design and small-scale convenience sampling preclude both causality presumptions and generalizability. SOC assessments may be useful to define subgroups of dementia caregivers at risk for anxiety and depression.
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Affiliation(s)
- Manuel Gonçalves-Pereira
- Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal.,Comprehensive Health Research Centre (CHRC), Lisbon, Portugal
| | - Steven H Zarit
- Department of Human Development and Family Studies, Penn State University, University Park, Pennsylvania, USA
| | - Ana L Papoila
- Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal.,Centre of Statistics and its Applications, University of Lisbon (CEAUL), Lisbon, Portugal
| | - Raimundo Mateos
- Department of Psychiatry, University of Santiago de Compostela (USC), Santiago de Compostela, Spain.,Psychogeriatric Unit, CHUS University Hospital, Santiago de Compostela, Spain
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10
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Smith T, Fletcher J, Lister S. Lived experiences of informal caregivers of people with chronic musculoskeletal pain: a systematic review and meta-ethnography. Br J Pain 2020; 15:187-198. [PMID: 34055340 DOI: 10.1177/2049463720925110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background People with chronic pain often seek support from friends and family for everyday tasks. These individuals are termed informal caregivers. There remains uncertainty regarding the lived experiences of these people who care for individuals with chronic musculoskeletal pain. The aim of this article is to synthase the evidence on the lived experiences of informal caregivers providing care to people with chronic musculoskeletal pain. Methods A systematic literature review was undertaken of published and unpublished literature databases including EMBASE, MEDLINE, CINAHL, PubMed, the WHO International Clinical Trial Registry and ClinicalTrials.gov registry (to September 2019). Qualitative studies exploring the lived experiences of informal caregivers of people with chronic musculoskeletal pain were included. Data were synthesised using a meta-ethnography approach. Evidence was evaluated using the Critical Appraisal Skills Programme qualitative appraisal tool. Results From 534 citations, 10 studies were eligible (360 participants: 171 informal caregivers of 189 care recipients). The evidence was moderate quality. Seven themes arose: the relationship of caregivers to healthcare professionals; role reversal with care recipients; acting the confidant to the care recipient; a constant burden in caregiving; legitimising care recipient's condition; knowledge and skills to provide caregiving; and the perception of other family members and wider society to the caregiver/care recipient dyad. Conclusion The lived experiences of caregivers of people with chronic musculoskeletal pain is complex and dynamic. There is an inter-connected relationship between caregivers, care recipients and healthcare professionals. Exploring how these experiences can be modified to improve a caregiving dyad's lived experience is now warranted.
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Affiliation(s)
- Toby Smith
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Jessica Fletcher
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,Physiotherapy Department, Connect Health, Milton Keynes, UK
| | - Sarah Lister
- Physiotherapy Department, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
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11
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Lee AA, Aikens JE, Janevic MR, Rosland AM, Piette JD. Functional support and burden among out-of-home supporters of heart failure patients with and without depression. Health Psychol 2020; 39:29-36. [PMID: 31535879 PMCID: PMC6901712 DOI: 10.1037/hea0000802] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Over 20% of patients with heart failure (HF) experience clinical depression, which is associated with higher rates of mortality, morbidity, and hospitalization. Support from family members or friends (whom we refer to as care partners [CPs]) can lower the risk of these outcomes. We examined whether HF patients with depression received assistance from CPs living outside of their homes. Further, we examined whether patient depression was associated with support-related strain among out-of-home CPs. METHOD We analyzed baseline survey data from 348 HF patients with reduced ejection fraction and their CPs. Patients with scores on the Center for Epidemiological Studies Depression Scale-10 (Kohout, Berkman, Evans, & Cornoni-Huntley, 1993) of ≥10 were classified as having clinically significant depressive symptoms (i.e., depression). Outcomes included CP-reported hr per week helping with health care and talking with patients via telephone and scores on the Modified Caregiver Strain Index. Negative binomial regression models examined differences in the amount of in-person and telephone support for patients with and without depression, controlling for patients' comorbidities, living alone, CP geographic distance, and CP emotional closeness to the patient. RESULTS CPs provided more in-person support to HF patients with depression (M = 3.64 hr) compared with those without depression (M = 2.60 hr per week, incident rate ratio [IRR] = 1.40, p = .019). CPs provided more telephone support to patients with depression (M = 3.02 hr) compared with those without depression (M = 2.09 hr per week, IRR = 1.42, p < .001). Patient depression had no effect on caregiver burden (IRR = 1.00, p = .843). CONCLUSION Patients with clinically significant depressive symptoms receive more in-person assistance and telephonic support from CPs. Despite that additional contact, caregiver burden was not greater among the supporters of depressed patients. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Aaron A Lee
- Veterans Affairs Center for Clinical Management Research
| | - James E Aikens
- Department of Family Medicine, University of Michigan Medical School
| | - Mary R Janevic
- Department of Health Behavior & Health Education, University of Michigan School of Public Health
| | - Ann-Marie Rosland
- Department of Internal Medicine, University of Pittsburgh Medical School
| | - John D Piette
- Veterans Affairs Center for Clinical Management Research
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12
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Ehrhardt S, Porsteinsson AP, Munro CA, Rosenberg PB, Pollock BG, Devanand DP, Mintzer J, Rajji TK, Ismail Z, Schneider LS, Baksh SN, Drye LT, Avramopoulos D, Shade DM, Lyketsos CG. Escitalopram for agitation in Alzheimer's disease (S-CitAD): Methods and design of an investigator-initiated, randomized, controlled, multicenter clinical trial. Alzheimers Dement 2019; 15:1427-1436. [PMID: 31587995 DOI: 10.1016/j.jalz.2019.06.4946] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 06/16/2019] [Accepted: 06/24/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Alzheimer's disease (AD) is a disabling, common cause of dementia, and agitation is one of the most common and distressing symptoms for patients with AD. Escitalopram for agitation in Alzheimer's disease (S-CitAD) tests a novel, clinically derived therapeutic approach to treat agitation in patients with AD. METHODS S-CitAD is a NIH-funded, investigator-initiated, randomized, multicenter clinical trial. Participants receive a structured psychosocial intervention (PSI) as standard of care. Participants without sufficient response to PSI are randomized to receive 15 mg escitalopram/day or a matching placebo in addition to PSI. Primary outcome is the Modified Alzheimer's Disease Cooperative Study - Clinical Global Impression of Change (mADCS-CGIC). DISCUSSION S-CitAD will provide information about a practical, immediately available approach to treating agitation in patients with AD. S-CitAD may become a model of how to evaluate and predict treatment response in patients with AD and agitation as a neuropsychiatric symptom (ClinicalTrials.gov Identifier: NCT03108846).
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Affiliation(s)
- Stephan Ehrhardt
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Anton P Porsteinsson
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Cynthia A Munro
- Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine and Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Paul B Rosenberg
- Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine and Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Bruce G Pollock
- Campbell Family Research Institute and Division of Adult Neurodevelopment and Geriatric Psychiatry, CAMH, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Davangere P Devanand
- Division of Geriatric Psychiatry, New York State Psychiatric Institute and College of Physicians and Surgeons of Columbia University, New York, NY, USA
| | - Jacobo Mintzer
- Roper St. Francis Research and Innovation Center, Charleston, SC, USA; Medical University of South Carolina, College of Health Professionals and Ralph H Johnson VA Medical Center, Charleston, SC, USA
| | - Tarek K Rajji
- Campbell Family Research Institute and Division of Adult Neurodevelopment and Geriatric Psychiatry, CAMH, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Zahinoor Ismail
- Department of Psychiatry, Hotchkiss Brain Institute and O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada; Department of Clinical Neurosciences, Hotchkiss Brain Institute and O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, Hotchkiss Brain Institute and O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Lon S Schneider
- Departments of Psychiatry and the Behavioral Sciences and Neurology, University of Southern California Keck School of Medicine and the University of Southern California Leonard Davis School of Gerontology, Los Angeles, CA, USA; Department of Neurology, University of Southern California Keck School of Medicine and the University of Southern California Leonard Davis School of Gerontology, Los Angeles, CA, USA
| | - Sheriza N Baksh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lea T Drye
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Dimitri Avramopoulos
- Department of Psychiatry and Behavioral Sciences, Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David M Shade
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Constantine G Lyketsos
- Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine and Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
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13
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Becker RE, Greig NH, Lahiri DK, Bledsoe J, Majercik S, Ballard C, Aarsland D, Schneider LS, Flanagan D, Govindarajan R, Sano M, Ferrucci L, Kapogiannis D. (-)-Phenserine and Inhibiting Pre-Programmed Cell Death: In Pursuit of a Novel Intervention for Alzheimer's Disease. Curr Alzheimer Res 2019; 15:883-891. [PMID: 29318971 DOI: 10.2174/1567205015666180110120026] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 01/08/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Concussion (mild) and other moderate traumatic brain injury (TBI) and Alzheimer's disease (AD) share overlapping neuropathologies, including neuronal pre-programmed cell death (PPCD), and clinical impairments and disabilities. Multiple clinical trials targeting mechanisms based on the Amyloid Hypothesis of AD have so far failed, indicating that it is prudent for new drug developments to also pursue mechanisms independent of the Amyloid Hypothesis. To address these issues, we have proposed the use of an animal model of concussion/TBI as a supplement to AD transgenic mice to provide an indication of an AD drug candidate's potential for preventing PPCD and resulting progression towards dementia in AD. METHODS We searched PubMed/Medline and the references of identified articles for background on the neuropathological progression of AD and its implications for drug target identification, for AD clinical trial criteria used to assess disease modification outcomes, for plasma biomarkers associated with AD and concussion/TBI, neuropathologies and especially PPCD, and for methodological critiques of AD and other neuropsychiatric clinical trial methods. RESULTS We identified and address seven issues and highlight the Thal-Sano AD 'Time to Onset of Impairment' Design for possible applications in our clinical trials. Diverse and significant pathological cascades and indications of self-induced neuronal PPCD were found in concussion/TBI, anoxia, and AD animal models. To address the dearth of peripheral markers of AD and concussion/TBI brain pathologies and PPCD we evaluated Extracellular Vesicles (EVs) enriched for neuronal origin, including exosomes. In our concussion/TBI, anoxia and AD animal models we found evidence consistent with the presence of time-dependent PPCD and (-)-phenserine suppression of neuronal self-induced PPCD. We hence developed an extended controlled release formulation of (-)-phenserine to provide individualized dosing and stable therapeutic brain concentrations, to pharmacologically interrogate PPCD as a drug development target. To address the identified problems potentially putting any clinical trial at risk of failure, we developed exploratory AD and concussion/TBI clinical trial designs. CONCLUSIONS Our findings inform the biomarker indication of progression of pathological targets in neurodegenerations and propose a novel approach to these conditions through neuronal protection against self-induced PPCD.
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Affiliation(s)
- Robert E Becker
- Aristea Translational Medicine Corporation, Park City, UT 84098, United States.,Translational Gerontology Branch, Intramural Research Program, National Institute on Aging, Baltimore, MD 21224, United States
| | - Nigel H Greig
- Translational Gerontology Branch, Intramural Research Program, National Institute on Aging, Baltimore, MD 21224, United States
| | - Debomoy K Lahiri
- Department of Psychiatry, Institute of Psychiatric Research, Indiana University School of Medicine, Indianapolis, IN 46202, United States
| | - Joseph Bledsoe
- Surgery-Emergency Medicine, Stanford Medicine and Department of Emergency Medicine, Intermountain Medical Center, Murray, UT 84157, United States
| | - Sarah Majercik
- Trauma and Surgical Critical Care, Intermountain Medical Center, Salt Lake City, UT 84107, United States
| | - Clive Ballard
- Medical School, University of Exeter, Exeter, EX1 2LU, United Kingdom
| | - Dag Aarsland
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology, & Neuroscience, King's College London, London SE5 8AF, United Kingdom
| | - Lon S Schneider
- Departments of Psychiatry, Neurology, and Gerontology, Keck School of Medicine, University of Southern California, Los Angeles, California 90033, United States
| | - Douglas Flanagan
- College of Pharmacy, University of Iowa, Iowa City, IA 52242, United States
| | | | - Mary Sano
- Department of Psychiatry and Alzheimer's Disease Research Center, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, United States
| | - Luigi Ferrucci
- Translational Gerontology Branch, Intramural Research Program, National Institute on Aging, Baltimore, MD 21224, United States
| | - Dimitrios Kapogiannis
- Laboratory of Neurosciences, Intramural Research Program, National Institute on Aging, Baltimore MD, 21224, United States
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14
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Clinical and Demographic Predictors of Adverse Outcomes in Caregivers of Patients with Dementia. Dement Neurocogn Disord 2019; 18:10-18. [PMID: 31097968 PMCID: PMC6494781 DOI: 10.12779/dnd.2019.18.1.10] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/23/2019] [Accepted: 04/10/2019] [Indexed: 01/07/2023] Open
Abstract
Background and Purpose We aimed to elucidate independent predictors of adverse outcomes in caregivers of patients with dementia using readily available clinical and demographic data of patients with dementia and their caregivers. Methods We reviewed patient-caregiver data from the Clinical Research Center for Dementia of South Korea and Caregivers of Alzheimer Disease Research study. The clinical factors of the patients and the demographics of both patients and caregivers were used to predict adverse outcomes for caregivers. Correlation and linear regression analyses were performed. Results We enrolled 454 patients and their caregivers for the present study. The general burden for the caregiver was higher amongst female caregivers, patients with further decreased the level of activities of daily living (ADL), patients with more abnormal behavior, or younger patients. The time spent by the caregivers was more in cases of patients with higher Caregiver Administered Neuropsychiatric Inventory scores, younger patients and for patients with decreased level of ADL. Depression amongst caregivers was more prominent in patients with higher Clinical Dementia Rating Sum of Boxes scores. Physical health-related quality of life (HRQoL) was lower in female caregivers, more physically affected patients, and older caregivers. Lastly, mental HRQoL was lower in younger, more physically affected, and in patients with abnormal behaviors. Conclusions Clinical and demographic characteristics of patients and caregivers predict adverse outcomes for caregivers. Therefore, these factors should be considered to provide support to both patients and their caregivers.
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15
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Carvalho EB, Neri AL. Time use by family caregivers of elderly with dementia: an integrative review. Rev Bras Enferm 2018; 71 Suppl 2:893-904. [PMID: 29791648 DOI: 10.1590/0034-7167-2017-0268] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 10/16/2017] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To describe the development of measures used between 1993 and 2016 to evaluate time use by family caregivers of elderly with dementia and to find out the patterns of time use identified in the literature. METHOD An integrative review of articles was performed, indexed by the following terms: time use management, family caregiver and elderly. RESULTS A total of 17 articles were found, of which seven were methodological. Among these seven articles, five were psychometric. The most frequently used measures were self-reporting (matrices, questionnaires and inventories), validated through objective measures of occurrence and duration. Longitudinal, prospective, clinical and correlational studies showed that care time covaries with the receptors' dependence and that the caregivers' subjective well-being is more affected by the time restriction to free choice activities than the burden resulting from obligatory activities. Final considerations: Valid self-reporting measures are widely used nowadays and they are considered to be effective to assess the objective and subjective costs of health care for dementia.
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16
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Use of FDA approved medications for Alzheimer's disease in mild dementia is associated with reduced informal costs of care. Int Psychogeriatr 2018; 30:1499-1507. [PMID: 29559029 PMCID: PMC6150839 DOI: 10.1017/s104161021800011x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
UNLABELLED ABSTRACTBackground:The use of FDA approved medications for Alzheimer's disease [AD; FDAAMAD; (cholinesterase inhibitors and N-methyl-D-aspartate receptor antagonists)] has been associated with symptomatic benefit with a reduction in formal (paid services) and total costs of care (formal and informal costs). We examined the use of these medications and their association with informal costs in persons with dementia. METHOD Two hundred eighty participants (53% female, 72% AD) from the longitudinal, population-based Dementia Progression Study in Cache County, Utah (USA) were followed up to ten years. Mean (SD) age at baseline was 85.6 (5.5) years. Informal costs (expressed in 2015 dollars) were calculated using the replacement cost method (hours of care multiplied by the median wage in Utah in the visit year) and adjusted for inflation using the Medical Consumer Price Index. Generalized Estimating Equations with a gamma log-link function were used to examine the longitudinal association between use of FDAAMAD and informal costs. RESULTS The daily informal cost for each participant at baseline ranged from $0 to $318.12, with the sample median of $9.40. Within the entire sample, use of FDAAMAD was not significantly associated with informal costs (expβ = 0.73, p = 0.060). In analyses restricted to participants with mild dementia at baseline (N = 222), use of FDAAMAD was associated with 32% lower costs (expβ = 0.68, p = 0.038). CONCLUSIONS Use of FDAAMAD was associated with lower informal care costs in those with mild dementia only.
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17
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Belitskaya-Lévy I, Dysken M, Guarino P, Sano M, Asthana S, Vertrees JE, Pallaki M, Llorente M, Love S, Schellenberg G. Impact of apolipoprotein E genotypes on vitamin E and memantine treatment outcomes in Alzheimer's disease. ALZHEIMERS & DEMENTIA-TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2018; 4:344-349. [PMID: 30175228 PMCID: PMC6118101 DOI: 10.1016/j.trci.2018.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Introduction Because apolipoprotein E (APOE) genotypes are known risk factors for Alzheimer's disease (AD), they have been measured in clinical trial participants to determine their effect on treatment outcome. Methods We determined APOE genotypes in a subset of subjects (N = 415) who participated in a randomized controlled trial of vitamin E and memantine in 613 veterans with mild-to-moderate AD. Results Similar to the primary study, substudy participants receiving vitamin E also had slower functional decline than those receiving placebo. Overall, there was no difference in the rate of functional decline between APOE ε4 allele carriers and noncarriers. A significant interaction was observed between treatment and the APOE genotype on AD progression: ε4 carriers declined faster than noncarriers in the vitamin E plus memantine treatment arm. Discussion APOE genotypes may modulate AD treatment response and should be included in the design of future randomized controlled trials.
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Affiliation(s)
- Ilana Belitskaya-Lévy
- VA Cooperative Studies Program Palo Alto Coordinating Center, VA Palo Alto Healthcare System, Mountain View, CA, USA
| | - Maurice Dysken
- VA Minneapolis Health Care System, Minneapolis, MN, USA.,Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
| | - Peter Guarino
- VA Cooperative Studies Program West Haven Coordinating Center, VA Connecticut Healthcare System, West Haven, CT, USA.,Statistical Center for HIV/AIDS Research and Prevention (SCHARP), Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Mary Sano
- Bronx Veterans Medical Research Center, New York, NY, USA.,Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sanjay Asthana
- William S. Middleton Memorial Veterans Hospital, Madison, WI, USA.,University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Julia E Vertrees
- VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM, USA
| | - Muralidhar Pallaki
- Louis Stokes Cleveland VAMC, Cleveland, OH, USA.,Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Maria Llorente
- Washington DC VA Medical Center, Washington, DC, USA.,Georgetown University School of Medicine, Washington, DC, USA
| | - Susan Love
- VA Minneapolis Health Care System, Minneapolis, MN, USA
| | - Gerard Schellenberg
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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18
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Chen P, Guarino PD, Dysken MW, Pallaki M, Asthana S, Llorente MD, Love S, Vertrees JE, Schellenberg GD, Sano M. Neuropsychiatric Symptoms and Caregiver Burden in Individuals With Alzheimer's Disease: The TEAM-AD VA Cooperative Study. J Geriatr Psychiatry Neurol 2018; 31:177-185. [PMID: 29966477 DOI: 10.1177/0891988718783897] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To assess the prevalence of neuropsychiatric symptoms (NPS) in mild-to-moderate Alzheimer disease (AD) and their association with caregiver burden. METHODS Secondary analyses of baseline data from the Trial of Vitamin E and Memantine in Alzheimer's Disease (TEAM-AD) (N=613). Neuropsychiatric Inventory were used to measure severity of NPS and caregiver activity survey to measure caregiver burden. RESULTS A total of 87% of patients displayed at least 1 NPS; 70% displayed clinically meaningful NPS. The most common symptoms were apathy (47%), irritability (44%), agitation (42%), and depression (40%). Those with moderate AD had more severe NPS than those with mild AD ( P = .03). Neuropsychiatric symptoms were significantly associated with caregiver time after adjusting for age, education, cognitive function, and comorbidity ( P-value < .0001) with every point increase in NPS associated with a 10-minute increase in caregiver time. CONCLUSION Neuropsychiatric symptoms were prevalent in both mild and moderate AD, even in patients receiving treatment with an acetylcholinesterase inhibitors, and were more severe in moderate AD and associated with greater caregiver time.
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Affiliation(s)
- Peijun Chen
- 1 Department of Psychiatry, VISN 10 GRECC, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
- 2 Department of Psychiatry, Geriatric Psychiatry Division, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Peter D Guarino
- 3 Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, CT, USA
- 4 Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Maurice W Dysken
- 5 Minneapolis VA Health Care System, Minneapolis, MN, USA
- 6 Department of Psychiatry, Minneapolis, University of Minnesota School of Medicine, MN, USA
| | - Muralidhar Pallaki
- 7 Department of Medicine, VISN 10 GRECC, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
- 8 Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Sanjay Asthana
- 9 William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
- 10 Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Maria D Llorente
- 11 Washington DC VA Medical Center, Washington, DC, USA
- 12 Department of Psychiatry, Georgetown University School of Medicine, Washington, DC, USA
| | - Susan Love
- 5 Minneapolis VA Health Care System, Minneapolis, MN, USA
- 6 Department of Psychiatry, Minneapolis, University of Minnesota School of Medicine, MN, USA
| | - Julia E Vertrees
- 13 VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, New Mexico VA Health Care System, Albuquerque, NM, USA
| | - Gerard D Schellenberg
- 14 Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Mary Sano
- 15 Bronx Veterans Medical Research Center, New York, NY, USA
- 16 Alzheimer's Disease Research Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Prince MJ, Guerra M, Huang Y, Lloyd-Sherlock P, Sosa AL, Uwakwe R, Acosta I, Ezeah P, Gallardo S, Guerchet MM, Liu Z, Mayston R, Montes de Oca V, Wang H. Health and economic correlates of autonomy among older people in Peru, Mexico and China: The 10/66 INDEP study. Wellcome Open Res 2018. [DOI: 10.12688/wellcomeopenres.14556.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: While autonomy is highlighted as central to older people’s wellbeing, there has been little empirical research to inform a measurement approach, support construct validity, or establish its determinants. We aimed to study the health and economic correlates of self-perceived autonomy among community-dwelling older people in Peru, Mexico and China, using a hypothesis-driven approach. Methods: Cross-sectional household surveys in urban and rural catchment areas in each country, comprising household, informant, and older person interviews, to elicit household income and older residents’ autonomy, unmet needs, and quality of life. Households, all with older residents, were selected from previous waves of the 10/66 Dementia Research Group’s comprehensive surveys of ageing and health. Results: Among 937 older respondents in 754 households, diminished autonomy was associated with older age, marital status, lower education, and lower household income. Physical, cognitive and mental morbidities, functional impairment and dependence were strongly and independently associated with diminished autonomy, explaining the effect of age. Controlling for these variables, an older person’s current total income was inversely associated with diminished autonomy (Count Ratio per fifth of total income 0.86, 95% CI 0.81-0.91). Autonomy was positively correlated with wellbeing and life satisfaction, supporting construct validity. Counter to hypotheses, less autonomy was associated with fewer unmet needs in rural sites. Conclusions: The effects of income insecurity, disability and dependence upon autonomy should be tested prospectively to confirm causal direction. Social pensions, and measures to support the rights of frail and dependent older people may be effective policy instruments for promoting autonomy. While the negative impact of diminished autonomy upon older people’s welfare is supported, the association in rural sites between more autonomy and more unmet needs should be further investigated; efforts to promote autonomy may need careful cultural nuancing, to support rather than subvert traditional family care systems.
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20
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Farina N, Llewellyn D, Isaac MGEKN, Tabet N. Vitamin E for Alzheimer's dementia and mild cognitive impairment. Cochrane Database Syst Rev 2017; 4:CD002854. [PMID: 28418065 PMCID: PMC6478142 DOI: 10.1002/14651858.cd002854.pub5] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Vitamin E occurs naturally in the diet. It has several biological activities, including functioning as an antioxidant to scavenge toxic free radicals. Evidence that free radicals may contribute to the pathological processes behind cognitive impairment has led to interest in the use of vitamin E supplements to treat mild cognitive impairment (MCI) and Alzheimer's disease (AD). This is an update of a Cochrane Review first published in 2000, and previously updated in 2006 and 2012. OBJECTIVES To assess the efficacy of vitamin E in the treatment of MCI and dementia due to AD. SEARCH METHODS We searched the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group (ALOIS), the Cochrane Library, MEDLINE, Embase, PsycINFO, CINAHL, LILACS as well as many trials databases and grey literature sources on 22 April 2016 using the terms: "Vitamin E", vitamin-E, alpha-tocopherol. SELECTION CRITERIA We included all double-blind, randomised trials in which treatment with any dose of vitamin E was compared with placebo in people with AD or MCI. DATA COLLECTION AND ANALYSIS We used standard methodological procedures according to the Cochrane Handbook for Systematic Reviews of Interventions. We rated the quality of the evidence using the GRADE approach. Where appropriate we attempted to contact authors to obtain missing information. MAIN RESULTS Four trials met the inclusion criteria, but we could only extract outcome data in accordance with our protocol from two trials, one in an AD population (n = 304) and one in an MCI population (n = 516). Both trials had an overall low to unclear risk of bias. It was not possible to pool data across studies owing to a lack of comparable outcome measures.In people with AD, we found no evidence of any clinically important effect of vitamin E on cognition, measured with change from baseline in the Alzheimer's Disease Assessment Scale - Cognitive subscale (ADAS-Cog) over six to 48 months (mean difference (MD) -1.81, 95% confidence interval (CI) -3.75 to 0.13, P = 0.07, 1 study, n = 272; moderate quality evidence). There was no evidence of a difference between vitamin E and placebo groups in the risk of experiencing at least one serious adverse event over six to 48 months (risk ratio (RR) 0.86, 95% CI 0.71 to 1.05, P = 0.13, 1 study, n = 304; moderate quality evidence), or in the risk of death (RR 0.84, 95% CI 0.52 to 1.34, P = 0.46, 1 study, n = 304; moderate quality evidence). People with AD receiving vitamin E showed less functional decline on the Alzheimer's Disease Cooperative Study/Activities of Daily Living Inventory than people receiving placebo at six to 48 months (mean difference (MD) 3.15, 95% CI 0.07 to 6.23, P = 0.04, 1 study, n = 280; moderate quality evidence). There was no evidence of any clinically important effect on neuropsychiatric symptoms measured with the Neuropsychiatric Inventory (MD -1.47, 95% CI -4.26 to 1.32, P = 0.30, 1 study, n = 280; moderate quality evidence).We found no evidence that vitamin E affected the probability of progression from MCI to probable dementia due to AD over 36 months (RR 1.03, 95% CI 0.79 to 1.35, P = 0.81, 1 study, n = 516; moderate quality evidence). Five deaths occurred in each of the vitamin E and placebo groups over the 36 months (RR 1.01, 95% CI 0.30 to 3.44, P = 0.99, 1 study, n = 516; moderate quality evidence). We were unable to extract data in accordance with the review protocol for other outcomes. However, the study authors found no evidence that vitamin E differed from placebo in its effect on cognitive function, global severity or activities of daily living . There was also no evidence of a difference between groups in the more commonly reported adverse events. AUTHORS' CONCLUSIONS We found no evidence that the alpha-tocopherol form of vitamin E given to people with MCI prevents progression to dementia, or that it improves cognitive function in people with MCI or dementia due to AD. However, there is moderate quality evidence from a single study that it may slow functional decline in AD. Vitamin E was not associated with an increased risk of serious adverse events or mortality in the trials in this review. These conclusions have changed since the previous update, however they are still based on small numbers of trials and participants and further research is quite likely to affect the results.
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Affiliation(s)
- Nicolas Farina
- Brighton and Sussex Medical SchoolCentre for Dementia StudiesBrightonUKBN1 9QH
| | - David Llewellyn
- University of ExeterMedical SchoolExeterUK+44 (0) 1392 726018
| | | | - Naji Tabet
- Brighton and Sussex Medical SchoolCentre for Dementia StudiesBrightonUKBN1 9QH
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Prina AM, Acosta D, Acosta I, Guerra M, Huang Y, Jotheeswaran A, Jimenez-Velazquez IZ, Liu Z, Llibre Rodriguez JJ, Salas A, Sosa AL, Williams JD, Prince M. Cohort Profile: The 10/66 study. Int J Epidemiol 2017; 46:406-406i. [PMID: 27154633 PMCID: PMC5837706 DOI: 10.1093/ije/dyw056] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2016] [Indexed: 11/13/2022] Open
Affiliation(s)
- A. Matthew Prina
- King’s College London, Centre for Global Mental Health, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Daisy Acosta
- Universidad Nacional Pedro Henriquez Ureña, Internal Medicine Department, GeriatricSection, Santo Domingo, Dominican Republic
| | - Isaac Acosta
- National Institute of Neurology and Neurosurgery of Mexico, National Autonomous University of Mexico, Mexico City, Mexico
| | - Mariella Guerra
- Instituto de la Memoria y Desordenes Relacionados, Lima, Perú
| | - Yueqin Huang
- Peking University, Institute of Mental Health, Beijing, China
| | - A.T. Jotheeswaran
- Department of Ageing and Life Course, World Health Organization, Geneva
| | - Ivonne Z. Jimenez-Velazquez
- Internal Medicine Department, Geriatrics Program, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Zhaorui Liu
- Peking University, Institute of Mental Health, Beijing, China
| | | | - Aquiles Salas
- Medicine Department, Caracas University Hospital, Universidad Central de Venezuela, Caracas, Venezuela and
| | - Ana Luisa Sosa
- National Institute of Neurology and Neurosurgery of Mexico, National Autonomous University of Mexico, Mexico City, Mexico
| | - Joseph D. Williams
- Department of Community Health, Voluntary Health Services, Chennai, India
| | - Martin Prince
- King’s College London, Centre for Global Mental Health, Institute of Psychiatry, Psychology & Neuroscience, London, UK
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Assessment of physical function and participation in chronic pain clinical trials: IMMPACT/OMERACT recommendations. Pain 2017; 157:1836-1850. [PMID: 27058676 DOI: 10.1097/j.pain.0000000000000577] [Citation(s) in RCA: 135] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Although pain reduction is commonly the primary outcome in chronic pain clinical trials, physical functioning is also important. A challenge in designing chronic pain trials to determine efficacy and effectiveness of therapies is obtaining appropriate information about the impact of an intervention on physical function. The Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) and Outcome Measures in Rheumatology (OMERACT) convened a meeting to consider assessment of physical functioning and participation in research on chronic pain. The primary purpose of this article is to synthesize evidence on the scope of physical functioning to inform work on refining physical function outcome measurement. We address issues in assessing this broad construct and provide examples of frequently used measures of relevant concepts. Investigators can assess physical functioning using patient-reported outcome (PRO), performance-based, and objective measures of activity. This article aims to provide support for the use of these measures, covering broad aspects of functioning, including work participation, social participation, and caregiver burden, which researchers should consider when designing chronic pain clinical trials. Investigators should consider the inclusion of both PROs and performance-based measures as they provide different but also important complementary information. The development and use of reliable and valid PROs and performance-based measures of physical functioning may expedite development of treatments, and standardization of these measures has the potential to facilitate comparison across studies. We provide recommendations regarding important domains to stimulate research to develop tools that are more robust, address consistency and standardization, and engage patients early in tool development.
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Abstract
BACKGROUND Vitamin E occurs naturally in the diet. It has several biological activities, including functioning as an antioxidant to scavenge toxic free radicals. Evidence that free radicals may contribute to the pathological processes behind cognitive impairment has led to interest in the use of vitamin E supplements to treat mild cognitive impairment (MCI) and Alzheimer's disease (AD). This is an update of a Cochrane Review first published in 2000, and previously updated in 2006 and 2012. OBJECTIVES To assess the efficacy of vitamin E in the treatment of MCI and dementia due to AD. SEARCH METHODS We searched the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group (ALOIS), the Cochrane Library, MEDLINE, Embase, PsycINFO, CINAHL, LILACS as well as many trials databases and grey literature sources on 22 April 2016 using the terms: "Vitamin E", vitamin-E, alpha-tocopherol. SELECTION CRITERIA We included all double-blind, randomised trials in which treatment with any dose of vitamin E was compared with placebo in people with AD or MCI. DATA COLLECTION AND ANALYSIS We used standard methodological procedures according to the Cochrane Handbook for Systematic Reviews of Interventions. We rated the quality of the evidence using the GRADE approach. Where appropriate we attempted to contact authors to obtain missing information. MAIN RESULTS Four trials met the inclusion criteria, but we could only extract outcome data in accordance with our protocol from two trials, one in an AD population (n = 304) and one in an MCI population (n = 516). Both trials had an overall low to unclear risk of bias. It was not possible to pool data across studies owing to a lack of comparable outcome measures.In people with AD, we found no evidence of any clinically important effect of vitamin E on cognition, measured with change from baseline in the Alzheimer's Disease Assessment Scale - Cognitive subscale (ADAS-Cog) over six to 48 months (mean difference (MD) -1.81, 95% confidence interval (CI) -3.75 to 0.13, P = 0.07, 1 study, n = 272; moderate quality evidence). There was no evidence of a difference between vitamin E and placebo groups in the risk of experiencing at least one serious adverse event over six to 48 months (risk ratio (RR) 0.86, 95% CI 0.71 to 1.05, P = 0.13, 1 study, n = 304; moderate quality evidence), or in the risk of death (RR 0.84, 95% CI 0.52 to 1.34, P = 0.46, 1 study, n = 304; moderate quality evidence). People with AD receiving vitamin E showed less functional decline on the Alzheimer's Disease Cooperative Study/Activities of Daily Living Inventory than people receiving placebo at six to 48 months (mean difference (MD) 3.15, 95% CI 0.07 to 6.23, P = 0.04, 1 study, n = 280; moderate quality evidence). There was no evidence of any clinically important effect on neuropsychiatric symptoms measured with the Neuropsychiatric Inventory (MD -1.47, 95% CI -4.26 to 1.32, P = 0.30, 1 study, n = 280; moderate quality evidence).We found no evidence that vitamin E affected the probability of progression from MCI to probable dementia due to AD over 36 months (RR 1.03, 95% CI 0.79 to 1.35, P = 0.81, 1 study, n = 516; moderate quality evidence). Five deaths occurred in each of the vitamin E and placebo groups over the 36 months (RR 1.01, 95% CI 0.30 to 3.44, P = 0.99, 1 study, n = 516; moderate quality evidence). We were unable to extract data in accordance with the review protocol for other outcomes. However, the study authors found no evidence that vitamin E differed from placebo in its effect on cognitive function, global severity or activities of daily living . There was also no evidence of a difference between groups in the more commonly reported adverse events. AUTHORS' CONCLUSIONS We found no evidence that the alpha-tocopherol form of vitamin E given to people with MCI prevents progression to dementia, or that it improves cognitive function in people with MCI or dementia due to AD. However, there is moderate quality evidence from a single study that it may slow functional decline in AD. Vitamin E was not associated with an increased risk of serious adverse events or mortality in the trials in this review. These conclusions have changed since the previous update, however they are still based on small numbers of trials and participants and further research is quite likely to affect the results.
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Affiliation(s)
- Nicolas Farina
- Brighton and Sussex Medical SchoolCentre for Dementia StudiesBrightonUKBN1 9QH
| | - David Llewellyn
- University of ExeterMedical SchoolExeterUK+44 (0) 1392 726018
| | | | - Naji Tabet
- Brighton and Sussex Medical SchoolCentre for Dementia StudiesBrightonUKBN1 9QH
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Guarino PD, Vertrees JE, Asthana S, Sano M, Llorente MD, Pallaki M, Love S, Schellenberg GD, Dysken MW. Measuring informed consent capacity in an Alzheimer's disease clinical trial. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2016; 2:258-266. [PMID: 29067313 PMCID: PMC5651363 DOI: 10.1016/j.trci.2016.09.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Accurately and efficiently determining a participant's capacity to consent to research is critically important to protect the rights of patients with Alzheimer's disease (AD). METHODS Understanding of the informed consent document was assessed in 613 community-dwelling patients with mild-to-moderate AD enrolled in a randomized, placebo-controlled trial. Associations were examined between clinically determined capacity to consent and (1) patient demographics and clinical characteristics and (2) the Informed Consent Questionnaire (ICQ), an objective measurement of a participant's factual understanding and perceived understanding. RESULTS A total of 453 (74%) participants were determined to have capacity to consent by clinical judgment. ICQ perceived understanding, race, measures of cognitive function, and caregiver time were all significantly associated with the determination of capacity in multivariate analyses. DISCUSSION We found a significant association between capacity and disease severity level, caregiver time, race, and ICQ perceived understanding.
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Affiliation(s)
- Peter D Guarino
- Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, CT, USA
- Statistical Center for HIV/AIDS Research and Prevention (SCHARP), Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Julia E Vertrees
- VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, New Mexico VA Health Care System, Albuquerque, NM, USA
| | - Sanjay Asthana
- William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Mary Sano
- Bronx Veterans Medical Research Center, New York, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Maria D Llorente
- Washington DC VA Medical Center, Washington, DC, USA
- Georgetown University School of Medicine, Washington, DC, USA
| | - Muralidhar Pallaki
- Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Susan Love
- Minneapolis VA Health Care System, Minneapolis, MN, USA
- University of Minnesota, Department of Psychiatry, Minneapolis, MN, USA
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Abstract
The aim of this study was to investigate the amount of time formal caregivers spend addressing activities of day-to-day care activities for persons with Down's syndrome (DS) with and without Alzheimer's dementia (AD). Caregivers completed for 63 persons with DS and AD, and 61 persons with DS without AD, the Caregiving Activity Survey-Intellectual Disability (CAS-ID). Data was also gathered on co-morbid conditions. Regression analysis was used to understand predictors of increased time spent on day-to-day caregiving. Significant differences were found in average time spent in day-to-day caregiving for persons with and without AD. Mid-stage and end-stage AD, and co-morbid conditions were all found to predict increased time spent caregiving. Nature and tasks of day-to-day caregiving appeared to change as AD progressed. The study concluded that staff time to address day-to-day caregiving needs appeared to increase with onset of AD and did so most dramatically for persons with moderate intellectual disability. Equally, while the tasks for staff were different, time demands in caring for persons at both mid-and end-stage AD appeared similar.
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Winblad B, Amouyel P, Andrieu S, Ballard C, Brayne C, Brodaty H, Cedazo-Minguez A, Dubois B, Edvardsson D, Feldman H, Fratiglioni L, Frisoni GB, Gauthier S, Georges J, Graff C, Iqbal K, Jessen F, Johansson G, Jönsson L, Kivipelto M, Knapp M, Mangialasche F, Melis R, Nordberg A, Rikkert MO, Qiu C, Sakmar TP, Scheltens P, Schneider LS, Sperling R, Tjernberg LO, Waldemar G, Wimo A, Zetterberg H. Defeating Alzheimer's disease and other dementias: a priority for European science and society. Lancet Neurol 2016; 15:455-532. [DOI: 10.1016/s1474-4422(16)00062-4] [Citation(s) in RCA: 1001] [Impact Index Per Article: 125.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 10/06/2015] [Accepted: 02/09/2016] [Indexed: 12/15/2022]
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Eifert EK, Adams R, Dudley W, Perko M. Family Caregiver Identity: A Literature Review. AMERICAN JOURNAL OF HEALTH EDUCATION 2015. [DOI: 10.1080/19325037.2015.1099482] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Measuring the impact of informal elderly caregiving: a systematic review of tools. Qual Life Res 2015; 25:1059-92. [PMID: 26475138 DOI: 10.1007/s11136-015-1159-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE To classify and identify the main characteristics of the tools used in practice to assess the impact of elderly caregiving on the informal carers' life. METHODS A systematic review of literature was performed searching in Embase, MEDLINE, PsycINFO, CINAHL, IBECS, LILACS, SiiS, SSCI and Cochrane Library from 2009 to 2013 in English, Spanish, Portuguese and French, and in reference lists of included papers. RESULTS The review included 79 studies, among them several in languages other than English. Their inclusion increased the variety of identified tools to measure this impact (n = 93) and allowed a wider analysis of their geographical use. While confirming their overlapping nature, instruments were classified according to the degree of integration of dimensions they evaluated and their specificity to the caregiving process: caregiver burden (n = 20), quality of life and well-being (n = 11), management and coping (n = 21), emotional and mental health (n = 29), psychosocial impact (n = 10), physical health and healthy habits (n = 2), and other measures. A high use in practice of tools not validated yet and not caregiver-specific was identified. CONCLUSIONS The great variety and characteristics of instruments identified in this review confirm the complexity and multidimensionality of the effects of elderly caregiving on the informal carer's life and explain the difficulties to assess these effects in practice. According to the classification provided, caregiver burden and emotional and mental health are the most evaluated dimensions. However, further work is required to develop integrated and caregiving focused procedures that can appraise this complexity across different countries and cultures.
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Krishna M, Kalyanaraman K, Veena SR, Krishanveni GV, Karat SC, Cox V, Coakley P, Nagaraj K, Stein C, Paul B, Prince M, Osmond C, Fall CH. Cohort Profile: The 1934-66 Mysore Birth Records Cohort in South India. Int J Epidemiol 2015; 44:1833-41. [PMID: 26445965 PMCID: PMC4690000 DOI: 10.1093/ije/dyv176] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2015] [Indexed: 11/14/2022] Open
Affiliation(s)
- Murali Krishna
- Early Career Research Fellow, Wellcome DBT India Alliance, India, Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, India,
| | | | - S R Veena
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, India
| | - G V Krishanveni
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, India
| | - S C Karat
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, India
| | - Vanessa Cox
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Patsy Coakley
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Kiran Nagaraj
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, India
| | - Claudia Stein
- Division of Information, Evidence, Research and Innovation at WHO/Europe, Copenhagen, Denmark and
| | - Bdr Paul
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, India
| | | | - Clive Osmond
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Caroline Hd Fall
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
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Vitlic A, Lord JM, Taylor AE, Arlt W, Bartlett DB, Rossi A, Arora-Duggal N, Welham A, Heald M, Oliver C, Carroll D, Phillips AC. Neutrophil function in young and old caregivers. Br J Health Psychol 2015; 21:173-89. [DOI: 10.1111/bjhp.12156] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 07/17/2015] [Indexed: 12/14/2022]
Affiliation(s)
- Ana Vitlic
- School of Sport, Exercise and Rehabilitation Sciences; University of Birmingham; UK
- MRC-Arthritis Research UK Centre for Musculoskeletal Ageing Research; University of Birmingham; UK
| | - Janet M. Lord
- MRC-Arthritis Research UK Centre for Musculoskeletal Ageing Research; University of Birmingham; UK
- School of Immunity and Infection; University of Birmingham; UK
| | - Angela E. Taylor
- Centre for Endocrinology Diabetes and Metabolism (CEDAM); University of Birmingham; UK
| | - Wiebke Arlt
- Centre for Endocrinology Diabetes and Metabolism (CEDAM); University of Birmingham; UK
| | - David B. Bartlett
- MRC-Arthritis Research UK Centre for Musculoskeletal Ageing Research; University of Birmingham; UK
- School of Immunity and Infection; University of Birmingham; UK
| | - Alessandra Rossi
- MRC-Arthritis Research UK Centre for Musculoskeletal Ageing Research; University of Birmingham; UK
- School of Immunity and Infection; University of Birmingham; UK
| | - Niharika Arora-Duggal
- MRC-Arthritis Research UK Centre for Musculoskeletal Ageing Research; University of Birmingham; UK
- School of Immunity and Infection; University of Birmingham; UK
| | - Alice Welham
- School of Psychology; University of Birmingham; UK
| | - Mary Heald
- School of Psychology; University of Birmingham; UK
| | - Chris Oliver
- School of Psychology; University of Birmingham; UK
| | - Douglas Carroll
- School of Sport, Exercise and Rehabilitation Sciences; University of Birmingham; UK
| | - Anna C. Phillips
- School of Sport, Exercise and Rehabilitation Sciences; University of Birmingham; UK
- MRC-Arthritis Research UK Centre for Musculoskeletal Ageing Research; University of Birmingham; UK
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Piette JD, Striplin D, Marinec N, Chen J, Aikens JE. A randomized trial of mobile health support for heart failure patients and their informal caregivers: impacts on caregiver-reported outcomes. Med Care 2015; 53:692-9. [PMID: 26125415 PMCID: PMC4503477 DOI: 10.1097/mlr.0000000000000378] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Mobile health services may improve chronic illness care, but interventions rarely support informal caregivers' efforts. OBJECTIVES To determine whether automated feedback to caregivers of chronic heart failure patients impacts caregiving burden and assistance with self-management. RESEARCH DESIGN Randomized comparative effectiveness trial. SUBJECTS A total of 369 heart failure patients were recruited from a Veterans Health Administration health care system. All patients participated with a "CarePartner" or informal caregiver outside their household. INTERVENTION Patients randomized to "standard mHealth" received weekly automated self-care support calls for 12 months with notifications about problems sent to clinicians. "mobile health+CarePartner" (mHealth+CP) patients received identical services, plus email summaries and suggestions for self-care assistance automatically sent to their CarePartners. MEASURES At baseline, 6, and 12 months, CarePartners completed assessments of caregiving strain, depressive symptoms, and participation in self-care support. RESULTS mHealth+CP CarePartners reported less caregiving strain than controls at both 6 and 12 months (both P≤0.03). That effect as well as improvements in depressive symptoms were seen primarily among CarePartners reporting greater burden at baseline (P≤0.03 for interactions between arm and baseline strain/depression at both endpoints). Although most mHealth+CP CarePartners increased the amount of time spent in self-care support, those with the highest time commitment at baseline reported decreases at both follow-ups (all P<0.05). mHealth+CP CarePartners reported more frequently attending patients' medical visits at 6 months (P=0.049) and greater involvement in medication adherence at both endpoints (both P≤0.032). CONCLUSIONS When CarePartners experienced significant caregiving strain and depression, systematic feedback about their patient-partner decreased those symptoms. Feedback also increased most CarePartners' engagement in self-care.
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Affiliation(s)
- John D. Piette
- Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan, USA
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
- Department of Internal Medicine, School of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Dana Striplin
- Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan, USA
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Nicolle Marinec
- Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan, USA
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Jenny Chen
- Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan, USA
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - James E. Aikens
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
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Gage H, Cheynel J, Williams P, Mitchell K, Stinton C, Katz J, Holland C, Sheehan B. Service utilisation and family support of people with dementia: a cohort study in England. Int J Geriatr Psychiatry 2015; 30:166-77. [PMID: 24838443 DOI: 10.1002/gps.4118] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 03/05/2014] [Accepted: 03/07/2014] [Indexed: 11/12/2022]
Abstract
OBJECTIVES This study aimed to compare costs of caring for people with dementia in domiciliary and residential settings, central England. METHODS A cohort of people with dementia was recruited during a hospital stay 2008-2010. Data were collected by interview at baseline, and 6- and 12-month follow-up, covering living situation (own home with or without co-resident carer, care home); cognition, health status and functioning of person with dementia; carer stress; utilisation of health and social services; and informal (unpaid) caring input. Costs of formal services and informal caring (replacement cost method) were calculated. Costs of residential and domiciliary care packages were compared. RESULTS Data for 109 people with dementia were collected at baseline; 95 (87.2%) entered hospital from their own homes. By 12 months, 40 (36.7%) had died and 85% of the survivors were living in care homes. Over one-half of people with dementia reported social care packages at baseline; those living alone had larger packages than those living with others. Median caring time for co-resident carers was 400 min/day and 10 h/week for non co-resident carers. Residential care was more costly than domiciliary social care for most people. When the value of informal caring was included, the total cost of domiciliary care was higher than residential care, but not significantly so. Carer stress reduced significantly after the person with dementia entered a care home. CONCLUSIONS Caring for people with dementia at home may be more expensive, and more stressful for carers, than care in residential settings.
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Abstract
BACKGROUND Social support programs for dementia caregivers were widely used in order to reduce care burden. We investigated which types of social supports can reduce psychological and non-psychological burdens of dementia caregivers, and explored the mechanism of those social supports. METHODS We evaluated 731 community-dwelling dementia patients and their caregivers from the National Survey of Dementia Care in South Korea. We investigated the five types of social supports (emotional support, informational support, tangible support, positive social interaction, affectionate support) using the Medical Outcomes Study Social Support Survey in each caregiver. The mechanisms of specific types of social support on psychological/non-psychological burden were examined using path analysis. RESULTS Positive social interaction and affectionate support reduced psychological burden via direct and indirect paths. Tangible support reduced the non-psychological burden via direct and indirect paths. Informational support and emotional support were not helpful for reducing psychological or non-psychological burden. A maximum of 20% of psychological burden could be relieved by positive social interaction and 10.3% of that could be reduced by affectionate support. Tangible support was associated with a 15.1% maximal improvement in non-psychological burden. CONCLUSIONS In order to reduce caregiver burden in dementia effectively, psychosocial interventions should be tailored to target type of caregiver burden.
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Rosenthal Gelman C, Sokoloff T, Graziani N, Arias E, Peralta A. Individually-tailored support for ethnically-diverse caregivers: enhancing our understanding of what is needed and what works. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2014; 57:662-680. [PMID: 24621198 DOI: 10.1080/01634372.2014.881451] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Family caregivers play a crucial role in maintaining older adults in the community, often at great cost to themselves. We discuss a program serving ethnically-diverse caregivers in New York, offering, on average, 11 case-management hr per client. Participants reported statistically significantly reduced stress and burden. Respite was the most requested service, belying an assumption underlying policies and services that families, particularly among minority populations, can and will care for their older members. Thus, services must be carefully tailored to meet actual caregiver needs, including provision of alternatives that reduce caregiver involvement. We discuss practice and policy implications.
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Affiliation(s)
- Caroline Rosenthal Gelman
- a Silberman School of Social Work and Hartford Silberman Center of Excellence in Aging and Diversity, Hunter College , New York , New York , USA
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Cost and burden of informal caregiving of dependent older people in a rural Indian community. BMC Health Serv Res 2014; 14:207. [PMID: 24886051 PMCID: PMC4022434 DOI: 10.1186/1472-6963-14-207] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 04/25/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lack of state supported care services begets the informal caregiving by family members as the mainstay of care provided to the dependent older people in many Low and Middle Income Countries (LMICs), including India. Little is known about the time spent on caregiving, its cost and the burden experienced by these informal caregivers. We aimed to estimate the costs of informal caregiving and to evaluate the nature as well as correlates of caregivers' burden in a rural Indian community. METHODS We assessed 1000 people aged above 65 years, among whom 85 were dependent. We assessed their socioeconomic profiles, disability, health status and health expenditures. Their caregivers' socio-demographic profiles, mental health, and the time spent on caregiving were assessed using standard instruments. Caregiver's burden was evaluated using Zarit Burden Scale. We valued the annual informal caregiving costs using proxy good method. We employed appropriate non-parametric multivariate statistics to evaluate the correlates of caregivers' burden. RESULTS Average time spent on informal caregiving was 38.6 (95% CI 35.3-41.9) hours/week. Estimated annual cost of informal caregiving using proxy good method was 119,210 US$ in this rural community. Mean total score of Zarit burden scale, measuring caregivers' burden, was 17.9 (95% CI 15.6-20.2). Prevalence of depression among the caregivers was 10.6% (95% CI 4.1-17.1%). Cerebrovascular disease, Parkinson's disease, higher disability, insomnia and incontinence of the dependent older people as well as the time spent on helping Activities of Daily Living and on supervision increased caregiver's burden significantly. CONCLUSIONS Cost and burden of informal caregiving are high in this rural Indian community. Many correlates of burden, experienced by caregivers, are modifiable. We discuss potential strategies to reduce this burden in LMICs. Need for support to informal caregivers and for management of dependent older people with chronic disabling diseases by multidisciplinary community teams are highlighted.
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Vitlic A, Phillips AC, Gallagher S, Oliver C, Lord JM, Moss P. Anticytomegalovirus antibody titres are not associated with caregiving burden in younger caregivers. Br J Health Psychol 2014; 20:68-84. [DOI: 10.1111/bjhp.12092] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 12/02/2013] [Indexed: 12/31/2022]
Affiliation(s)
- Ana Vitlic
- School of Sport and Exercise Sciences; University of Birmingham; UK
- MRC-Arthritis Research UK Centre for Musculoskeletal Ageing Research; University of Birmingham; UK
| | - Anna C. Phillips
- School of Sport and Exercise Sciences; University of Birmingham; UK
- MRC-Arthritis Research UK Centre for Musculoskeletal Ageing Research; University of Birmingham; UK
| | | | - Chris Oliver
- School of Psychology; University of Birmingham; UK
| | - Janet M. Lord
- MRC-Arthritis Research UK Centre for Musculoskeletal Ageing Research; University of Birmingham; UK
- School of Immunity and Infection; University of Birmingham; UK
| | - Paul Moss
- School of Cancer Sciences; University of Birmingham; UK
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Black BS, Johnston D, Rabins PV, Morrison A, Lyketsos C, Samus QM. Unmet needs of community-residing persons with dementia and their informal caregivers: findings from the maximizing independence at home study. J Am Geriatr Soc 2014; 61:2087-2095. [PMID: 24479141 DOI: 10.1111/jgs.12549] [Citation(s) in RCA: 209] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine the prevalence and correlates of unmet needs in a sample of community-residing persons with dementia (PWD) and their informal caregivers. DESIGN Analysis of cross-sectional, baseline participant characteristics before randomization in a care coordination intervention trial. SETTING Baltimore, Maryland. PARTICIPANTS Community-residing PWD (n=254) and their informal caregivers (n=246). MEASUREMENTS In-home assessments of dementia-related needs based on the Johns Hopkins Dementia Care Needs Assessment. Bivariate and multivariate regression analyses were conducted to identify demographic, socioeconomic, clinical, functional, and quality-of-life correlates of unmet needs. RESULTS The mean number of unmet needs was 7.7±4.8 in PWD and 4.6±2.3 in caregivers, with almost all PWD (99%) and caregivers (97%) having one or more unmet needs. Unmet needs in PWD were significantly greater in those with higher cognitive function. Ninety percent of PWD had unmet safety needs, more than half had unmet needs for meaningful activities, and almost one-third had not received a prior evaluation or diagnosis. Higher unmet needs in PWD was significantly associated with nonwhite race, lower income, less impairment in activities of daily living, and more symptoms of depression. For caregivers, more than 85% had unmet needs for resource referrals and caregiver education. Higher unmet caregiver needs was significantly associated with nonwhite race, less education, and more symptoms of depression. CONCLUSION Many community-residing PWD and their caregivers have unmet dementia-related needs for care, services, and support. Providers should be aware that unmet needs may be higher in minority and low-income community residents, caregivers with lower education, and individuals with early-stage dementia. Identifying and treating symptoms of depression in PWD and caregivers may enable them to address their other unmet needs.
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Affiliation(s)
- Betty S Black
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Deirdre Johnston
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Peter V Rabins
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Ann Morrison
- Morrison and Associates, LLC, Baltimore, Maryland
| | - Constantine Lyketsos
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, Maryland.,Johns Hopkins Bayview Medical Center, Baltimore, Maryland
| | - Quincy M Samus
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, Maryland.,Johns Hopkins Bayview Medical Center, Baltimore, Maryland
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Dysken MW, Sano M, Asthana S, Vertrees JE, Pallaki M, Llorente M, Love S, Schellenberg GD, McCarten JR, Malphurs J, Prieto S, Chen P, Loreck DJ, Trapp G, Bakshi RS, Mintzer JE, Heidebrink JL, Vidal-Cardona A, Arroyo LM, Cruz AR, Zachariah S, Kowall NW, Chopra MP, Craft S, Thielke S, Turvey CL, Woodman C, Monnell KA, Gordon K, Tomaska J, Segal Y, Peduzzi PN, Guarino PD. Effect of vitamin E and memantine on functional decline in Alzheimer disease: the TEAM-AD VA cooperative randomized trial. JAMA 2014; 311:33-44. [PMID: 24381967 PMCID: PMC4109898 DOI: 10.1001/jama.2013.282834] [Citation(s) in RCA: 349] [Impact Index Per Article: 34.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Although vitamin E and memantine have been shown to have beneficial effects in moderately severe Alzheimer disease (AD), evidence is limited in mild to moderate AD. OBJECTIVE To determine if vitamin E (alpha tocopherol), memantine, or both slow progression of mild to moderate AD in patients taking an acetylcholinesterase inhibitor. DESIGN, SETTING, AND PARTICIPANTS Double-blind, placebo-controlled, parallel-group, randomized clinical trial involving 613 patients with mild to moderate AD initiated in August 2007 and concluded in September 2012 at 14 Veterans Affairs medical centers. INTERVENTIONS Participants received either 2000 IU/d of alpha tocopherol (n = 152), 20 mg/d of memantine (n = 155), the combination (n = 154), or placebo (n = 152). MAIN OUTCOMES AND MEASURES Alzheimer's Disease Cooperative Study/Activities of Daily Living (ADCS-ADL) Inventory score (range, 0-78). Secondary outcomes included cognitive, neuropsychiatric, functional, and caregiver measures. RESULTS Data from 561 participants were analyzed (alpha tocopherol = 140, memantine = 142, combination = 139, placebo = 140), with 52 excluded because of a lack of any follow-up data. Over the mean (SD) follow-up of 2.27 (1.22) years, ADCS-ADL Inventory scores declined by 3.15 units (95% CI, 0.92 to 5.39; adjusted P = .03) less in the alpha tocopherol group compared with the placebo group. In the memantine group, these scores declined 1.98 units less (95% CI, -0.24 to 4.20; adjusted P = .40) than the placebo group's decline. This change in the alpha tocopherol group translates into a delay in clinical progression of 19% per year compared with placebo or a delay of approximately 6.2 months over the follow-up period. Caregiver time increased least in the alpha tocopherol group. All-cause mortality and safety analyses showed a difference only on the serious adverse event of "infections or infestations," with greater frequencies in the memantine (31 events in 23 participants) and combination groups (44 events in 31 participants) compared with placebo (13 events in 11 participants). CONCLUSIONS AND RELEVANCE Among patients with mild to moderate AD, 2000 IU/d of alpha tocopherol compared with placebo resulted in slower functional decline. There were no significant differences in the groups receiving memantine alone or memantine plus alpha tocopherol. These findings suggest benefit of alpha tocopherol in mild to moderate AD by slowing functional decline and decreasing caregiver burden. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00235716.
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Affiliation(s)
| | - Mary Sano
- James J. Peters VA Medical Research Center, New York, New York
| | - Sanjay Asthana
- William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin
| | - Julia E Vertrees
- Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, New Mexico
| | - Muralidhar Pallaki
- Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio6Case Western Reserve University School of Medicine, Cleveland, Ohio
| | | | - Susan Love
- Minneapolis VA Health Care System, Minneapolis, Minnesota
| | | | | | | | | | - Peijun Chen
- Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio6Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - David J Loreck
- VA Maryland Healthcare System, Baltimore11University of Maryland Medical School, Department of Psychiatry, Baltimore
| | | | | | - Jacobo E Mintzer
- Ralph H. Johnson VA Medical Center, Charleston, South Carolina14Department of Health Studies, Medical University of South Carolina, Charleston15Roper St Francis Healthcare, Charleston, South Carolina
| | | | | | | | - Angel R Cruz
- Bay Pines VA Healthcare System, Bay Pines, Florida
| | | | | | | | - Suzanne Craft
- VA Puget Sound Health Care System, Seattle, Washington21Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle
| | - Stephen Thielke
- VA Puget Sound Health Care System, Seattle, Washington21Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle
| | - Carolyn L Turvey
- Iowa City VA Medical Center, Iowa City, Iowa23University of Iowa, Iowa City
| | - Catherine Woodman
- Iowa City VA Medical Center, Iowa City, Iowa23University of Iowa, Iowa City
| | | | - Kimberly Gordon
- W. G. (Bill) Hefner VA Medical Center, Salisbury, North Carolina
| | - Julie Tomaska
- Minneapolis VA Health Care System, Minneapolis, Minnesota
| | - Yoav Segal
- Minneapolis VA Health Care System, Minneapolis, Minnesota
| | - Peter N Peduzzi
- Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven26Yale University School of Public Health, New Haven, Connecticut
| | - Peter D Guarino
- Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven26Yale University School of Public Health, New Haven, Connecticut
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Dysken MW, Guarino PD, Vertrees JE, Asthana S, Sano M, Llorente M, Pallaki M, Love S, Schellenberg GD, McCarten JR, Malphurs J, Prieto S, Chen P, Loreck DJ, Carney S, Trapp G, Bakshi RS, Mintzer JE, Heidebrink JL, Vidal-Cardona A, Arroyo LM, Cruz AR, Kowall NW, Chopra MP, Craft S, Thielke S, Turvey CL, Woodman C, Monnell KA, Gordon K, Tomaska J, Vatassery G. Vitamin E and memantine in Alzheimer's disease: clinical trial methods and baseline data. Alzheimers Dement 2014; 10:36-44. [PMID: 23583234 PMCID: PMC4128187 DOI: 10.1016/j.jalz.2013.01.014] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Revised: 01/06/2013] [Accepted: 01/21/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Alzheimer's disease (AD) has been associated with both oxidative stress and excessive glutamate activity. A clinical trial was designed to compare the effectiveness of (i) alpha-tocopherol, a vitamin E antioxidant; (ii) memantine (Namenda), an N-methyl-D-aspartate antagonist; (iii) their combination; and (iv) placebo in delaying clinical progression in AD. METHODS The Veterans Affairs Cooperative Studies Program initiated a multicenter, randomized, double-blind, placebo-controlled trial in August 2007, with enrollment through March 2012 and follow-up continuing through September 2012. Participants with mild-to-moderate AD who were taking an acetylcholinesterase inhibitor were assigned randomly to 2000 IU/day of alpha-tocopherol, 20 mg/day memantine, 2000 IU/day alpha-tocopherol plus 20 mg/day memantine, or placebo. The primary outcome for the study is the Alzheimer's Disease Cooperative Study/Activities of Daily Living Inventory. Secondary outcome measures include the Mini-Mental State Examination; the Alzheimer's Disease Assessment Scale, cognitive portion; the Dependence Scale; the Neuropsychiatric Inventory; and the Caregiver Activity Survey. Patient follow-up ranged from 6 months to 4 years. RESULTS A total of 613 participants were randomized. The majority of the patients were male (97%) and white (86%), with a mean age of 79 years. The mean Alzheimer's Disease Cooperative Study/Activities of Daily Living Inventory score at entry was 57 and the mean Mini-Mental State Examination score at entry was 21. CONCLUSION This large multicenter trial will address the unanswered question of the long-term safety and effectiveness of alpha-tocopherol, memantine, and their combination in patients with mild-to-moderate AD taking an acetylcholinesterase inhibitor. The results are expected in early 2013.
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Affiliation(s)
| | - Peter D Guarino
- Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Julia E Vertrees
- VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM, USA
| | - Sanjay Asthana
- William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Mary Sano
- Bronx Veterans Medical Research Center, New York, NY, USA
| | | | | | - Susan Love
- VA Minneapolis Health Care System, Minneapolis, MN, USA
| | | | | | | | | | - Peijun Chen
- Louis Stokes Cleveland VAMC, Cleveland, OH, USA
| | - David J Loreck
- VA Maryland Healthcare System, University of Maryland Medical School, Department of Psychiatry, Baltimore, MD, USA
| | - Sara Carney
- VA Maryland Healthcare System, Baltimore, MD, USA
| | - George Trapp
- VA North Texas Healthcare System, Dallas, TX, USA
| | | | - Jacobo E Mintzer
- Ralph H. Johnson VAMC, Medical University of South Carolina, Charleston, SC, USA
| | | | | | | | - Angel R Cruz
- Bay Pines VA Healthcare System, Bay Pines, FL, USA
| | | | | | - Suzanne Craft
- VA Puget Sound Healthcare System, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Stephen Thielke
- VA Puget Sound Healthcare System, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | | | | | | | | | - Julie Tomaska
- VA Minneapolis Health Care System, Minneapolis, MN, USA
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Mack J, Peterson A, Quinn J. Assessing Outcomes in Dementia Care. DEMENTIA 2013. [DOI: 10.1002/9781118656082.ch11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Martín-Carrasco M, Domínguez-Panchón AI, Muñoz-Hermoso P, González-Fraile E, Ballesteros-Rodríguez J. [Assessment tools to measure burden in the informal caregiver of patients with dementia]. Rev Esp Geriatr Gerontol 2013; 48:276-84. [PMID: 24161356 DOI: 10.1016/j.regg.2013.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 06/14/2013] [Accepted: 06/20/2013] [Indexed: 10/26/2022]
Abstract
UNLABELLED The complexity of dementia caregiver burden concept has led to a significant number of assessment tests using various approaches. For this reason, a review of these measurementss could be useful for clinical or research purposes. OBJECTIVE The objective of the study is to perform an updated review on the tools available, classifying them according to the burden criterion by studying their characteristics and psychometric properties, and providing those most relevant for application. METHOD The method applied consisted of a database search -Pubmed, PsycINFO, Embase and Psicodoc (1980-2012). RESULTS A total of 31 assessment tools were selected, grouped on the basis of the burden concept evaluated: objective/subjective burden, burden from a multidimensional approach, and as distress associated with patient impairment. CONCLUSIONS This study provides a suitable tool for using caregiver burden assessment tools accurately. A marked conclusion is the need to establish agreements in the assessment methods, in order to develop standard knowledge and application to healthcare practice.
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Affiliation(s)
- Manuel Martín-Carrasco
- Instituto de Investigaciones Psiquiátricas (IIP), Fundación M. Josefa Recio, CIBERSAM, G10, Bilbao, España.
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The impact of complex chronic diseases on care utilization among assisted living residents. Geriatr Nurs 2013; 35:26-30. [PMID: 24139207 DOI: 10.1016/j.gerinurse.2013.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 08/28/2013] [Accepted: 09/01/2013] [Indexed: 11/21/2022]
Abstract
PURPOSE Many residents of assisted living (AL) have chronic diseases that are difficult to manage, including congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD) and diabetes mellitus (DM). We estimated the amount and intensity of care delivered by the staff for residents with these conditions. METHODS We performed a secondary data analysis from the Maryland Assisted Living (MDAL) Study (399 residents, 29 facilities). In-person assessments included measures of cognition, function, depression, and general medical health. Diagnosis of CHF, COPD, and DM, as well as current medications was abstracted from AL medical charts. Measures of care utilization were operationalized at the resident level as: 1) minutes per day of direct care (caregiver activity scale [CAS]), 2) subjective staff ratings of care burden, and 3) assigned AL "level of care" (based on state regulatory criteria). RESULTS In best fit regression models, CHF and DM were not significant predictors of the evaluated care utilization measures; however, COPD was independently associated with increased minutes per day of direct care - 34% of the variance in the caregiver activity scale was explained by degree of functional dependency, cognitive impairment, age, and presence of COPD. Functional dependency, depressive symptoms, and age explained almost a quarter (23%) of the variance of staff care burden rating. For the AL level of care intensity rating, degree of functional dependency, level of cognition, and age were significant correlates, together explaining about 28% of the variance. CONCLUSION The presence of COPD was a significant predictor of time per day of direct care. However, CHF and DM were not correlates of care utilization measures. Functional and cognitive impairment was associated with measures of care utilization, reiterating the importance of these characteristics in the utilization and intensity of care consumed by AL residents. Further study of this population could reveal other forms and amounts of care utilization.
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Carrillo-González GM, Sánchez-Herrera B, Barrera-Ortiz L, Chaparro-Díaz OL. The Burden of Care in Instances of Chronic Non-communicable Disease. AQUICHAN 2013. [DOI: 10.5294/aqui.2013.13.2.10] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objetivo: analizar los diferentes enfoques para abordar la carga del cuidado en la enfermedad crónica no transmisible (ECNT). Materiales y métodos: con base en una revisión de literatura en las bases de datos: CINAHL, Ovid, Scielo, Medline y Psychoinfo, bajo los descriptores carga, impacto, costos, en combinación con enfermedad crónica y cuidado, con su respectiva traducción al inglés, se identificaron y analizaron los elementos estudiados como carga del cuidado de la ECNT. Resultados: la carga del cuidado en la ECNT es un constructo multidimensional que incluye la perspectiva epidemiológica (relación con la frecuencia y valoración de consecuencias en años de vida y pérdidas funcionales), la económica (impacto sobre consumo, ahorro, oferta de mano de obra, productividad y acumulación de capital humano) y la social (factores de desgaste, estrés, impacto familiar, limitación social y aspectos positivos de la experiencia), con múltiples interrelaciones entre sí. Conclusión: se requiere una mirada integral para examinar la carga del cuidado en la ECNT que incluya los actores sociales afectados: pacientes, cuidadores familiares, familias, profesionales e instituciones de salud.
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12-month incidence, prevalence, persistence, and treatment of mental disorders among individuals recently admitted to assisted living facilities in Maryland. Int Psychogeriatr 2013; 25:721-31. [PMID: 23290818 PMCID: PMC3648853 DOI: 10.1017/s1041610212002244] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND To estimate the 12-month incidence, prevalence, and persistence of mental disorders among recently admitted assisted living (AL) residents and to describe the recognition and treatment of these disorders. METHODS Two hundred recently admitted AL residents in 21 randomly selected AL facilities in Maryland received comprehensive physician-based cognitive and neuropsychiatric evaluations at baseline and 12 months later. An expert consensus panel adjudicated psychiatric diagnoses (using DSM-IV-TR criteria) and completeness of workup and treatment. Incidence, prevalence, and persistence were derived from the panel's assessment. Family and direct care staff recognition of mental disorders was also assessed. RESULTS At baseline, three-quarters suffered from a cognitive disorder (56% dementia, 19% Cognitive Disorders Not Otherwise Specified) and 15% from an active non-cognitive mental disorder. Twelve-month incidence rates for dementia and non-cognitive psychiatric disorders were 17% and 3% respectively, and persistence rates were 89% and 41% respectively. Staff recognition rates for persistent dementias increased over the 12-month period but 25% of cases were still unrecognized at 12 months. Treatment was complete at 12 months for 71% of persistent dementia cases and 43% of persistent non-cognitive psychiatric disorder cases. CONCLUSIONS Individuals recently admitted to AL are at high risk for having or developing mental disorders and a high proportion of cases, both persistent and incident, go unrecognized or untreated. Routine dementia and psychiatric screening and reassessment should be considered a standard care practice. Further study is needed to determine the longitudinal impact of psychiatric care on resident outcomes and use of facility resources.
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Predictive factors for the objective burden of informal care in people with dementia: a systematic review. Alzheimer Dis Assoc Disord 2013; 26:197-204. [PMID: 22075941 DOI: 10.1097/wad.0b013e31823a6108] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Informal care plays a substantial role in the provision of total care in dementia. Several reviews have been published on the predictive factors of subjective burden; however, such a review lacks information on objective burden, which refers to the amount and/or costs of informal care. OBJECTIVES The objectives of this study were to (1) give an overview of the predictive factors that are associated with the objective burden of informal care; (2) discuss whether these factors are similar to the predictive factors of subjective burden; and (3) examine whether they are modifiable. DESIGN The literature in a number of international databases was systematically searched. Methodological quality and level of certainty were assessed. RESULTS Ten studies were identified as relevant for the purpose of this review, describing a total of 39 predictive factors. Three factors (behavioral problems and impairments regarding daily functioning and cognition) were considered to be predictors of objective burden. Three factors were not related; 12 were potential predictors; and the results of the remaining 22 factors were inconclusive. CONCLUSIONS Many factors were found to be (potential) predictors of objective burden, reflecting its complex nature. Objective and subjective burdens are 2 different relevant aspects of informal care. Interventions aimed at countering behavioral problems and impairments regarding daily functioning could reduce objective burden.
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Costa N, Ferlicoq L, Derumeaux-Burel H, Rapp T, Garnault V, Gillette-Guyonnet S, Andrieu S, Vellas B, Lamure M, Grand A, Molinier L. Comparison of informal care time and costs in different age-related dementias: a review. BIOMED RESEARCH INTERNATIONAL 2012; 2013:852368. [PMID: 23509789 PMCID: PMC3591240 DOI: 10.1155/2013/852368] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Revised: 10/25/2012] [Accepted: 10/25/2012] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Age-related dementia is a progressive degenerative brain syndrome whose prevalence increases with age. Dementias cause a substantial burden on society and on families who provide informal care. This study aims to review the relevant papers to compare informal care time and costs in different dementias. METHODS A bibliographic search was performed on an international medical literature database (MEDLINE). All studies which assessed the social economic burden of different dementias were selected. Informal care time and costs were analyzed in three care settings by disease stages. RESULTS 21 studies met our criteria. Mean informal care time was 55.73 h per week for Alzheimer disease and 15.8 h per week for Parkinson disease (P = 0.0076), and the associated mean annual informal costs were $17,492 versus $3,284, respectively (P = 0.0393). CONCLUSION There is a lack of data about informal care time and costs among other dementias than AD or PD. Globally, AD is the most costly in terms of informal care costs than PD, $17,492 versus $3,284, respectively.
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Wimo A, Gustavsson A, Jönsson L, Winblad B, Hsu MA, Gannon B. Application of Resource Utilization in Dementia (RUD) instrument in a global setting. Alzheimers Dement 2012; 9:429-435.e17. [PMID: 23142433 DOI: 10.1016/j.jalz.2012.06.008] [Citation(s) in RCA: 124] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Revised: 04/23/2012] [Accepted: 06/13/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND The Resource Utilization in Dementia (RUD) questionnaire is the most widely used instrument for resource use data collection in dementia, enabling comparison of costs of care across countries with differing health care provisions. Recent feedback from payers questioned its face validity given that health care provisions have changed since the initial development of the RUD in 1998. The aim of this study was to update the RUD to improve its face validity in Alzheimer's disease (AD) clinical research and its utility for health care resource allocation. METHODS An extensive PubMed review was conducted of current relevant resource items in AD in 15 countries. The findings were complemented by interviews with local care providers and experts in dementia care and health economics. Their proposed revisions were discussed with five leading dementia experts in North and South America, northern and southern Europe, and Asia. A new version of the RUD was developed based on their recommendations. RESULTS RUD users identified a need for more information relevant to coverage decisions. Proposed revisions included changes to existing questions (e.g., to capture more accurately the number and type of health care visits) and the addition of new questions (e.g., on informal caregiver hours and the primary caregiver's hours of sleep). CONCLUSION Several minor changes were made to the RUD instrument to improve the accuracy and precision of the data while maintaining comparability with the original version and reflecting current medical practice. The RUD Complete Version 4.0 is now available for use in future AD clinical trials.
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Affiliation(s)
- Anders Wimo
- KI-Alzheimer Disease Research Centre, Karolinska Institutet, Sweden.
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Costa N, Derumeaux H, Rapp T, Garnault V, Ferlicoq L, Gillette S, Andrieu S, Vellas B, Lamure M, Grand A, Molinier L. Methodological considerations in cost of illness studies on Alzheimer disease. HEALTH ECONOMICS REVIEW 2012; 2:18. [PMID: 22963680 PMCID: PMC3563616 DOI: 10.1186/2191-1991-2-18] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Accepted: 08/27/2012] [Indexed: 05/18/2023]
Abstract
Cost-of-illness studies (COI) can identify and measure all the costs of a particular disease, including the direct, indirect and intangible dimensions. They are intended to provide estimates about the economic impact of costly disease. Alzheimer disease (AD) is a relevant example to review cost of illness studies because of its costliness.The aim of this study was to review relevant published cost studies of AD to analyze the method used and to identify which dimension had to be improved from a methodological perspective. First, we described the key points of cost study methodology. Secondly, cost studies relating to AD were systematically reviewed, focussing on an analysis of the different methods used. The methodological choices of the studies were analysed using an analytical grid which contains the main methodological items of COI studies. Seventeen articles were retained. Depending on the studies, annual total costs per patient vary from $2,935 to $52, 954. The methods, data sources, and estimated cost categories in each study varied widely. The review showed that cost studies adopted different approaches to estimate costs of AD, reflecting a lack of consensus on the methodology of cost studies. To increase its credibility, closer agreement among researchers on the methodological principles of cost studies would be desirable.
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Affiliation(s)
- Nagede Costa
- Department of Medical Information, University Hospital of Toulouse, Toulouse, F-31059, France
- UMR 1027, INSERM, Toulouse, F-31059, France
| | - Helene Derumeaux
- Department of Medical Information, University Hospital of Toulouse, Toulouse, F-31059, France
| | - Thomas Rapp
- Universty of Paris Descartes, Paris, 75016, France
| | - Valérie Garnault
- Department of Medical Information, University Hospital of Toulouse, Toulouse, F-31059, France
| | - Laura Ferlicoq
- Department of Medical Information, University Hospital of Toulouse, Toulouse, F-31059, France
| | - Sophie Gillette
- UMR 1027, INSERM, Toulouse, F-31059, France
- UMR 1027, University of Toulouse III, Toulouse, F-31059, France
- Universty of Paris Descartes, Paris, 75016, France
| | - Sandrine Andrieu
- UMR 1027, INSERM, Toulouse, F-31059, France
- UMR 1027, University of Toulouse III, Toulouse, F-31059, France
- Department of Epidemiology and Public Health, University Hospital of Toulouse, Toulouse, F-31059, France
| | - Bruno Vellas
- UMR 1027, INSERM, Toulouse, F-31059, France
- UMR 1027, University of Toulouse III, Toulouse, F-31059, France
- Department of geriatric medicine, University hospital of Toulouse, Toulouse, F-31073, France
| | - Michel Lamure
- EDISS, University of Lyon I, Villeurbanne, F-69100, France
| | - Alain Grand
- UMR 1027, INSERM, Toulouse, F-31059, France
- UMR 1027, University of Toulouse III, Toulouse, F-31059, France
- Department of Epidemiology and Public Health, University Hospital of Toulouse, Toulouse, F-31059, France
| | - Laurent Molinier
- Department of Medical Information, University Hospital of Toulouse, Toulouse, F-31059, France
- UMR 1027, INSERM, Toulouse, F-31059, France
- UMR 1027, University of Toulouse III, Toulouse, F-31059, France
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Prince M, Brodaty H, Uwakwe R, Acosta D, Ferri CP, Guerra M, Huang Y, Jacob KS, Llibre Rodriguez JJ, Salas A, Sosa AL, Williams JD, Jotheeswaran AT, Liu Z. Strain and its correlates among carers of people with dementia in low-income and middle-income countries. A 10/66 Dementia Research Group population-based survey. Int J Geriatr Psychiatry 2012; 27:670-82. [PMID: 22460403 PMCID: PMC3504977 DOI: 10.1002/gps.2727] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Accepted: 03/08/2011] [Indexed: 12/01/2022]
Abstract
OBJECTIVES In a multi-site population-based study in several middle-income countries, we aimed to investigate relative contributions of care arrangements and characteristics of carers and care recipients to strain among carers of people with dementia. Based on previous research, hypotheses focused on carer sex, care inputs, behavioural and psychological symptoms (BPSD) and socioeconomic status, together with potential buffering effects of informal support and employing paid carers. METHODS In population-based catchment area surveys in 11 sites in Latin America, India and China, we analysed data collected from people with dementia and care needs, and their carers. Carer strain was assessed with the Zarit Burden Interview. RESULTS With 673 care recipient/carer dyads interviewed (99% of those eligible), mean Zarit Burden Interview scores ranged between 17.1 and 27.9 by site. Women carers reported more strain than men. The most substantial correlates of carer strain were primary stressors BPSD, dementia severity, needs for care and time spent caring. Socioeconomic status was not associated with carer strain. Those cutting back on work experienced higher strain. There was tentative evidence for a protective effect of having additional informal or paid support. CONCLUSIONS Our findings underline the global impact of caring for a person with dementia and support the need for scaling up carer support, education and training. That giving up work to care was prevalent and associated with substantial increased strain emphasizes the economic impact of caring on the household. Carer benefits, disability benefits for people with dementia and respite care should all be considered.
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Affiliation(s)
- Martin Prince
- King's College London, (Institute of Psychiatry, Centre for Global Mental Health, Health Service and Population Research Department), London, UK.
| | - Henry Brodaty
- Dementia Collaborative Research Centre, School of Psychiatry, Faculty of Medicine, The University of New South WalesSydney, NSW, Australia
| | - Richard Uwakwe
- Nnamdi Azikiwe University Teaching HospitalNnewi, Anambra State, Nigeria
| | - Daisy Acosta
- Universidad Nacional Pedro Henriquez Ureña (UNPHU), Internal Medicine DepartmentGeriatric Section, Santo Domingo, Dominican Republic
| | - Cleusa P Ferri
- King's College London, (Institute of Psychiatry, Centre for Global Mental Health, Health Service and Population Research Department)London, UK
| | - Mariella Guerra
- Universidad Peruana Cayetano Heredia and Instituto de la Memoria y Desordenes RelacionadosLima, Perú
| | - Yueqin Huang
- Peking University Institute of Mental Health, Key Laboratory of Mental Health, Ministry of Health (Peking University)Beijing, China
| | - KS Jacob
- Christian Medical CollegeVellore, India
| | | | - Aquiles Salas
- Medicine Department, Caracas University Hospital, Faculty of Medicine, Universidad Central de VenezuelaCaracas, Venezuela
| | - Ana Luisa Sosa
- The Cognition and Behavior Unit, National Institute of Neurology and Neurosurgery of Mexico, Autonomous National University of MexicoDelegacion Tlalpan, Mexico City, Mexico
| | | | | | - Zhaorui Liu
- Peking University Institute of Mental Health, Key Laboratory of Mental Health, Ministry of Health (Peking University)Beijing, China
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Miller EA, Rosenheck RA, Schneider LS. Caregiver burden, health utilities, and institutional service use in Alzheimer's disease. Int J Geriatr Psychiatry 2012; 27:382-93. [PMID: 21560160 PMCID: PMC3204397 DOI: 10.1002/gps.2730] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Accepted: 03/08/2011] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This study examined the moderating effect of caregiver burden on the relationship between the health status of Alzheimer's disease (AD) patients and their use of institutional services (i.e., hospitalization, nursing home, and residential care). METHODS Data were obtained at baseline and at 3, 6, and 9 months following study entry on 421 community-dwelling patients with AD in the Clinical Antipsychotic Trials of Intervention Effectiveness for AD. The outcome variable includes use of any institutional services. Logistic regression was employed to estimate the interaction between Health Utility Index Mark III score (a general health status measure) and four concurrent caregiver burden measures at outcome. Marginal effects were calculated and plotted using random effects models for observations at multiple time points per individual. Average effects were calculated across all observations using models without random effects. RESULTS Random effects results suggest that caregiver burden weakens the inverse relationship between health utilities and institutional service use, leading to greater likelihood of institutional use than would be expected at a given level of health. This is indicated by positive and significant signs on the Health Utility Index Mark III*caregiver burden interaction when burden is measured using the Caregiver Distress Scale, Beck Depression Inventory, and Caregiver Assessment Survey (all p < 0.05). It is reinforced by positive and significant average effects deriving from Caregiver Distress and Beck Depression Inventory models without random effects (both p < 0.10). Results derived from the Burden Interview Scale, although positive, were non-significant and weak by comparison. CONCLUSION Caregiver support interventions should be offered to individuals caring for less-advanced AD patients. Otherwise, healthy patients may be at increased risk for institutionalization when caregivers experience high levels of burden.
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Affiliation(s)
- Edward Alan Miller
- Department of Gerontology and Gerontology Institute, McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston, Boston, MA, USA.
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