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Grenier A, O'Connor D, James K, Imahori D, Minchopoulos D, Velev N, Tamblyn-Watts L, Mann J. Consent and Inclusion of People Living with Dementia (PLWD) in Research: Establishing a Canadian Agenda for Inclusive Rights-Based Practices. Can J Aging 2024:1-8. [PMID: 38764147 DOI: 10.1017/s0714980824000217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2024] Open
Abstract
BACKGROUND People living with dementia (PLWD) may want to participate in research, but the guidelines and processes enacted across various contexts may prohibit this from happening. OBJECTIVE Understanding the experiences of people with lived experiences of dementia requires meaningful inclusion in research, as is consistent with rights-based perspectives. Currently, the inclusion of PLWD in Canadian research is complex, and guidelines and conceptual frameworks have not been fully developed. METHODS This research note outlines a three-year proof-of-concept grant on the inclusion and consent of PLWD in research. FINDINGS It presents a brief report on some of the contradictions and challenges that exist in legislation, research guidelines, and research practices and raises a series of questions as part of an agenda on rights and inclusion of PLWD in research. DISCUSSION It suggests conceptual, legal, and policy issues that need to be addressed and invites Canadian researchers to re-envision research practices and to advocate for law and policy reform that enables dementia research to align and respect the rights and personhood of PLWD.
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Affiliation(s)
- Amanda Grenier
- Factor Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
- Rotman Research Institute, Baycrest Centre for Geriatric Care, Toronto, Ontario, Canada
| | - Deborah O'Connor
- School of Social Work, University of British Columbia, Vancouver, BC, Canada
| | - Krista James
- Peter A. Allard School of Law, University of British Columbia, Vancouver, BC, Canada
| | - Daphne Imahori
- Factor Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Daniella Minchopoulos
- Factor Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
- Rotman Research Institute, Baycrest Centre for Geriatric Care, Toronto, Ontario, Canada
| | - Nicole Velev
- Factor Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
- Rotman Research Institute, Baycrest Centre for Geriatric Care, Toronto, Ontario, Canada
| | - Laura Tamblyn-Watts
- Factor Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
- CanAge, Toronto, ON, Canada
| | - Jim Mann
- University of British Columbia, Vancouver, BC, Canada (Honorary doctorate)
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Komatsu A, Nakagawa T, Noguchi T, Jin X, Okahashi S, Saito T. Decision-making involvement and onset of cognitive impairment in community-dwelling older care recipients: a 2-year longitudinal study. Psychogeriatrics 2024; 24:195-203. [PMID: 38111132 DOI: 10.1111/psyg.13061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/24/2023] [Accepted: 12/04/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND The decision-making of older adults and people with dementia is attracting more attention among healthcare professionals. While cognitive impairment has been examined as a factor related to decision-making, it can also be assumed that involvement in decision-making leads to the maintenance of cognitive function. This study examined the association of the decision-making process with the onset of cognitive impairment. METHODS We analyzed data from a 2-year longitudinal panel survey of community-dwelling care recipients aged ≥65 years in Japan. The sample included 406 participants who responded to both baseline and follow-up surveys, were cognitively intact at baseline, and had no missing cognitive impairment data regarding onset at follow-up. The status of decision-making involvement was assessed using a single item and classified into four categories: 'very involved,' 'less involved,' 'unclear about desired care,' and 'having no one to share the decision.' RESULTS Among the participants (women, 65.0%; ≥75 years old: 68.2%), the incidence of cognitive impairment during the follow-up was 26.6%. Multivariable logistic regression showed that, compared with highly involved participants, those who lacked clarity about desired care were more likely to develop an onset of cognitive impairment (odds ratio: 5.49; 95% confidence interval: 1.63-18.54; P = 0.006). CONCLUSION Even among cognitively intact care recipients, those who are not able to formulate their desired care may be at risk of cognitive decline. Therefore, support for the decision-making process, not limited to the final decision, is essential to improving the prognosis of community-dwelling care recipients.
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Affiliation(s)
- Ayane Komatsu
- Department of Social Science, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Takeshi Nakagawa
- Department of Social Science, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Taiji Noguchi
- Department of Social Science, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Xueying Jin
- Department of Social Science, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Sayaka Okahashi
- Department of Social Science, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Tami Saito
- Department of Social Science, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
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Le TD, Lin SC, Huang MC, Fan SY, Kao CY. Factors impacting the demonstration of relational autonomy in medical decision-making: A meta-synthesis. Nurs Ethics 2023:9697330231200570. [PMID: 37818823 DOI: 10.1177/09697330231200570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
BACKGROUND Relational autonomy is an alternative concept of autonomy in which an individual is recognized as embedded into society and influenced by relational factors. Social context, including social location, political structure, and social forces, significantly influence an agent to develop and exercise autonomy skills. The relational approach has been applied in clinical practice to identify relational factors impacting patient autonomy and decision-making, yet there is a knowledge gap in how these factors influence the demonstration of relational autonomy in the context of medical decisions of adults. OBJECTIVE The present study targeted the existing knowledge of what and how relational factors impact individuals making medical decisions using the theoretical framework of relational autonomy. METHODS A meta-synthesis study was utilized. Four electronic databases, including Embase, OVID Medline, CINAHL, and PubMed, were searched, along with gray literature and reference lists, to identify relevant studies. RESULTS 23 studies reporting 21 qualitative and two mixed-method studies were reviewed. Four themes emerged from the qualitative findings: (1) supportive relationships facilitate an individual's relational autonomy; (2) obtaining comprehensive information from broader sources helps individuals exercise relational autonomy; (3) undue family pressure impedes the exercising of patient relational autonomy; and (4) healthcare providers' dominant voice hampers the demonstration of relational autonomy. CONCLUSIONS Applying relational autonomy to assist adults in making well-considered decisions is essential. The meta-synthesis suggests establishing a supportive relationship between individuals, healthcare providers, and family. A supportive relationship will allow healthcare providers to make judgments in line with an individual's values and wishes with the aim of promoting relational autonomy. Advance care planning was proposed as the effective solution to obtain a consensus between individuals and their families while respecting an individual's values and preferences. Furthermore, it is considered crucial for healthcare providers to appreciate an individual's values and incorporate their preferences into recommendations.
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Affiliation(s)
| | | | - Mei-Chih Huang
- National Cheng Kung University, Taiwan
- National Tainan Junior College of Nursing, Taiwan
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4
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Lauridsen S, Schou-Juul F, Folker AP, Simonsen P, Phil ME, Skov SS. Developing the CARE intervention to enhance ethical self-efficacy in dementia care through the use of literary texts. BMC Med Ethics 2023; 24:45. [PMID: 37386381 PMCID: PMC10311821 DOI: 10.1186/s12910-023-00926-9] [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: 01/31/2023] [Accepted: 06/22/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Dementia care is essential to promote the well-being of patients but remains a difficult task prone to ethical issues. These issues include questions like whether manipulating a person with dementia is ethically permissible if it promotes her best interest or how to engage with a person who is unwilling to recognize that she has dementia. To help people living with dementia and their carers manage ethical issues in dementia care, we developed the CARE intervention. This is an intervention focused on promoting the ethical self-efficacy of people living with dementia and carers, i.e., their confidence that they can manage ethical issues when they occur. The purpose of this paper is to explain and discuss how we have developed the CARE intervention to promote the ethical self-efficacy of people living with dementia, their family, and professional carers through a specific and, we believe, new use of literary texts. METHODS The CARE intervention has been developed in two phases: First, we conducted a needs assessment of the occurrence of ethical issues in dementia care and the need for an intervention to support people living with dementia and their carers in managing such issues. Second, in a design phase, we developed the CARE intervention to meet identified needs. RESULTS To address identified ethical issues in dementia care we designed the CARE intervention as a workshop format where people living with dementia and carers can meet, discuss literary texts, and deliberate on how to solve such issues. The workshop is structured by the following elements: An agenda of ethical issues, a collection of literary cases exemplifying ethical issues, a moderator with an understanding of dementia care, and an overview of the ethical principles relevant to the discussion of ethical issues. >This workshop concept is operationalized in three applications tailored to meet the specific ethical issues of each of the study´s three target groups: people living with dementia and family carers, professional and family carers, and professional carers. CONCLUSION We conclude the paper by stating that it is possible to develop an intervention that promotes the ethical self-efficacy of people living with dementia and family and professional carers.
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Affiliation(s)
- Sigurd Lauridsen
- The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
| | - Frederik Schou-Juul
- The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Anna Paldam Folker
- The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Peter Simonsen
- Department Department of Language, Culture, History and Communication, University of Southern Denmark, Odense, Denmark
| | - Marie-Elisabeth Phil
- Department Department of Language, Culture, History and Communication, University of Southern Denmark, Odense, Denmark
| | - Sofie Smedegaard Skov
- The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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5
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Brennan F, Chapman M, Gardiner MD, Narasimhan M, Cohen J. Our dementia challenge: arise palliative care. Intern Med J 2023; 53:186-193. [PMID: 36822608 DOI: 10.1111/imj.16011] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 12/13/2022] [Indexed: 02/25/2023]
Abstract
While many of the maladies of the 20th century are steadily coming under control, the march of neurodegenerative disorders continues largely unchecked. Dementias are an exemplar of such disorders; their incidence and prevalence continue to rise, in large part due to a steadily ageing population worldwide. They represent a group of chronic, progressive and, ultimately, fatal neurodegenerative diseases. Dementia has remained therapeutically recalcitrant. It is not a single disease, and because of that, we cannot expect a single panacea. While primary prevention rightly gains prominence, those with established disease currently require a shift in focus from curative intent towards improved quality of life. Enter palliative care. The sheer number and complexity of needs of patients with dementia, from the physical to the psychosocial and spiritual, necessitates the engagement of a wide range of medical disciplines, nursing and allied health professionals. One of those disciplines, as highlighted in the recent Australian Royal Commission into Aged Care Quality and Safety, is palliative care. This paper shall expand upon that role in the overall context of care for those with dementia.
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Affiliation(s)
- Frank Brennan
- Department of Palliative Care, Calvary Hospital, Kogarah, New South Wales, Australia.,Department of Palliative Care, The St George Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine, The University of NSW Sydney, Sydney, New South Wales, Australia
| | - Michael Chapman
- Department of Palliative Care, Canberra Hospital, ACT, Canberra, Australian Capital Territory, Australia.,Medical School, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Matthew D Gardiner
- Department of Palliative Care, Calvary Hospital, Kogarah, New South Wales, Australia.,Faculty of Medicine, The University of NSW Sydney, Sydney, New South Wales, Australia
| | - Manisha Narasimhan
- Department of Neurology, The Sutherland Hospital, Sydney, New South Wales, Australia.,Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Joshua Cohen
- Department of Palliative Care, Calvary Hospital, Kogarah, New South Wales, Australia
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6
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Meyer C, Dickins M, O’Keefe F, Hall K, Lowthian J. Risk Negotiation With People With Dementia: From Co-designed Paper Version to Implementation Preparation of an Electronic Conversation Tool. Gerontol Geriatr Med 2023; 9:23337214221149772. [PMID: 36726412 PMCID: PMC9885029 DOI: 10.1177/23337214221149772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/11/2022] [Accepted: 12/14/2022] [Indexed: 01/28/2023] Open
Abstract
The home care workforce provides essential support for older people with dementia to live a life of fulfillment. "Enabling Choices," an evidence-informed conversation tool, aims to negotiate risk around everyday activities between home care workers, people with dementia and their informal carers. This paper describes tool conversion into electronic format and preparation for implementation throughout a large Australian health and aged care service provider, utilizing the Implementation Framework for Aged Care (IFAC). Using codesign principles, the tool was converted from paper-based to electronic format involving frontline, operational and Information Management Services staff, and people with dementia/carers. Focus groups and interviews identified tool acceptability, feasibility, and appropriateness. For implementation preparation, the wider socio-cultural-political context was mapped, and key questions of the IFAC addressed. Environment, workflow, and training requirements were determined, and strategies for behavior change ascertained. Numerous opportunities and challenges exist for the widespread upscale of an evidence-informed tool into practice.
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Affiliation(s)
- Claudia Meyer
- Bolton Clarke Research Institute,
Forest Hill, VIC, Australia,La Trobe University, Bundoora, VIC,
Australia,Monash University, Frankston, VIC,
Australia,Flinders University, Adelaide, SA,
Australia,Claudia Meyer, Bolton Clarke Research
Institute, Level 1, 347 Burwood Highway, Forest Hill, VIC 3131, Australia.
| | - Marissa Dickins
- Bolton Clarke Research Institute,
Forest Hill, VIC, Australia,Monash University, Clayton, VIC,
Australia
| | - Fleur O’Keefe
- Bolton Clarke Research Institute,
Forest Hill, VIC, Australia
| | - Kylie Hall
- Bolton Clarke Research Institute,
Forest Hill, VIC, Australia
| | - Judy Lowthian
- Bolton Clarke Research Institute,
Forest Hill, VIC, Australia,Monash University, Clayton, VIC,
Australia,University of Queensland, St Lucia,
Australia
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7
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O'Connor CMC, Liddle J, O'Reilly M, Meyer C, Cartwright J, Chisholm M, Conway E, Fielding E, Fox A, MacAndrew M, Schnitker L, Travers C, Watson K, While C, Bail K. Advocating the rights of people with dementia to contribute to research: Considerations for researchers and ethics committees. Australas J Ageing 2021; 41:309-313. [PMID: 34821448 DOI: 10.1111/ajag.13023] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 10/12/2021] [Accepted: 10/14/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Research involving people with dementia is vital to appropriately inform policy and practice decisions affecting this population. As dementia-care researchers, we frequently advocate to Human Research Ethics Committees for the right of people with dementia to choose whether to participate in research. This brief report provides some considerations for researchers and ethics committees. METHOD Descriptive summary of principles that argue for inclusion of people with dementia in research studies. RESULTS Specifically excluding people living with dementia from research because of perceived cognitive impairment is inappropriate in light of human rights principles and the right to contribute to evidence-based care. CONCLUSION There is a difference between capacity to provide informed consent and ability to provide perspectives that are valid for each individual. Providing the opportunity for a person with dementia to participate in research and offering support to do this is a matter of human rights.
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Affiliation(s)
- Claire M C O'Connor
- HammondCare, Centre for Positive Ageing, Sydney, New South Wales, Australia.,School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Jacki Liddle
- The University of Queensland, Brisbane, Queensland, Australia
| | - Maria O'Reilly
- Central Queensland University, Bundaberg, Queensland, Australia
| | - Claudia Meyer
- Bolton Clarke Research Institute, Melbourne, Victoria, Australia.,Rehabilitation, Ageing and Independent Living Research Centre, Monash University, Melbourne, Victoria, Australia
| | | | | | - Erin Conway
- Faculty of Health Sciences, Australian Catholic University, Brisbane, Queensland, Australia
| | - Elaine Fielding
- Queensland University of Technology, Brisbane, Queensland, Australia
| | - Amanda Fox
- Queensland University of Technology, Brisbane, Queensland, Australia
| | | | - Linda Schnitker
- Bolton Clarke Research Institute, Brisbane, Queensland, Australia
| | - Catherine Travers
- The University of Queensland, Brisbane, Queensland, Australia.,Queensland University of Technology, Brisbane, Queensland, Australia
| | - Karen Watson
- The University of Sydney, Sydney, New South Wales, Australia
| | - Christine While
- Dementia Training Australia, La Trobe University, Melbourne, Victoria, Australia
| | - Kasia Bail
- Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
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8
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Toyokawa N, Darling N, Toyokawa T. Monitoring, Scaffolding, Intervening, and Overriding: Adult Children's Perspectives on Supporting Older Parents. JOURNAL OF ADULT DEVELOPMENT 2021; 29:53-65. [PMID: 34658615 PMCID: PMC8503870 DOI: 10.1007/s10804-021-09389-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2021] [Indexed: 10/27/2022]
Abstract
When older parents experience age-related functional limitations, adult children may begin to monitor and try to control their parents' behavior. This shift can lead to tension due to differences in values both generations share, with parents prioritizing autonomy and self-sufficiency and adult children prioritizing safety and convention. Although a great deal of research on the transition from adolescence to adulthood focuses on governance transfer and changing boundaries of autonomy, monitoring, and control, less is known about how this happens in later life. The current study used qualitative methodology to explore the dynamic balance of autonomy, safety, and care between older parents and adult children who provide assistance in their daily lives. It focused on which areas adult children were most likely to monitor and try to control and how they did so, how parents respond to those efforts, and the dynamics of information management. Sixteen adult children who had at least one living parent (M age = 53, SD = 6.1) discussed the challenges of managing two conflicting caregiving goals: respecting parents' autonomy and ensuring parents' moral well-being, health, and safety. Data were analyzed using directive content analysis. Although participants were concerned about the negative consequences of their parents' current behaviors and health conditions, they rarely impinged on their parents' autonomy until they were prompted by an authority figure or had clear evidence that their parents' health or safety were threatened. Parents often kept information about their activities and well-being from their children in order to protect their autonomy. Implications for balancing parents and adult children's goals of governance transfer are discussed.
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Affiliation(s)
- Noriko Toyokawa
- Psychology, Southern Oregon University, 1250 Siskiyou Blvd, Ashland, OR 97520 USA
| | - Nancy Darling
- Psychology, Oberlin College and Conservatory, Oberlin, OH USA
| | - Teru Toyokawa
- Human Development, California State University San Marcos, San Marcos, CA USA
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9
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Peisah C, Sampson EL, Rabheru K, Wand A, Lapid M. The Human Rights of Older People With Mental Health Conditions and Psychosocial Disability to a Good Death and Dying Well. Am J Geriatr Psychiatry 2021; 29:1041-1046. [PMID: 34175232 DOI: 10.1016/j.jagp.2021.05.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 05/22/2021] [Indexed: 12/17/2022]
Abstract
The human right to a good death and dying well is as important as the right to life. At stake at the end of life are human rights to dignity, autonomy, self-determination and respect for will and preferences, equitable access to quality health care that is needs-based, and respect for family and relationships. Older people with dementia, those with serious mental illness, and those with intellectual disability are vulnerable to "bad deaths" due to violations of these rights. In this paper we explore why this is so and examine existing and potential solutions. A human rights-approach to end-of-life care and policy for older persons with mental health conditions and psychosocial disability is one that is needs-based, encompassing physical and mental health, palliative care, social, and spiritual support services provided in the context of inclusive living. Most importantly, end of life care must be self-determined, and not "one size fits all." An important remedy to existing violations is to strengthen human rights frameworks to cater specifically to older persons' needs with a UN convention on the rights of older persons. Finally, as health professionals we have important contributions to make at the coalface by accepting our responsibilities in the area of death and dying. With the concept of the palliative psychiatrist gaining traction and recognition that death is our business, we add that human rights is also our business.
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Affiliation(s)
- Carmelle Peisah
- School of Psychiatry, Faculty Medicine & Ageing Futures Institute, University of New South Wales, Capacity Australia (CP), Sydney, Australia.
| | - Elizabeth L Sampson
- Marie Curie Palliative Care Research Unit, Division of Psychiatry, University College London (ELS), London, United Kingdom
| | | | - Anne Wand
- Specialty of Psychiatry, Faculty Medicine and Health, University of Sydney (AW), Sydney, Australia; Discipline of Psychiatry, Faculty of Medicine, University of New South Wales (AW), New South Wales, Australia
| | - Maria Lapid
- Department of Psychiatry and Psychology, Mayo Clinic (ML), Rochester, MN
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10
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Friz AM, Benson C, Mullen S, Block L, Gilmore-Bykovskyi A. Tailoring Research Recruitment for Acute Care Settings: Recommendations from People with Dementia and their Caregivers. Alzheimer Dis Assoc Disord 2021; 35:191-199. [PMID: 33044305 PMCID: PMC8032819 DOI: 10.1097/wad.0000000000000419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 09/10/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is a pressing need to increase enrollment and representation in Alzheimer's disease and related dementia (ADRD) research. Current recruitment approaches focus largely on clinic and community settings, with minimal engagement of acute care environments despite their broad use across diverse populations. The objectives of this study were to examine views, preferences, and recommendations regarding acute care-based ADRD research recruitment among persons with dementia and their caregivers. METHODS The authors conducted semistructured interviews with recently hospitalized persons with dementia (N=3) and family caregivers (N=28). Interviews were analyzed using thematic analysis. FINDINGS All participants endorsed acute care as an appropriate time for recruitment into ADRD research studies and identified important elements of an appropriately tailored recruitment approach and an interpersonally effective research staff. Participants emphasized that this approach should consider the acute care context with respect to participant situation, uncertainty, and timing. Participant suggestions informed the design of a 5-step process to guide ADRD research recruitment in the context of acute care. DISCUSSION Findings provide valuable insights from people with dementia and their caregivers regarding opportunities for research engagement surrounding acute care and can inform expanded recruitment in these settings.
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Affiliation(s)
- Amanda M. Friz
- University of Wisconsin-Madison School of Nursing, Madison, Wisconsin, USA
| | - Clark Benson
- University of Wisconsin-Madison School of Nursing, Madison, Wisconsin, USA
| | - Shannon Mullen
- University of Wisconsin-Madison School of Nursing, Madison, Wisconsin, USA
| | - Laura Block
- University of Wisconsin-Madison School of Nursing, Madison, Wisconsin, USA
| | - Andrea Gilmore-Bykovskyi
- University of Wisconsin-Madison School of Nursing, Madison, Wisconsin, USA
- Division of Geriatrics, Department of Medicine, University of Wisconsin-Madison School of Medicine & Public Health, Madison, Wisconsin, USA
- William S. Middleton Memorial Veterans Hospital, Geriatric Research Education and Clinical Center, Madison, Wisconsin, USA
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11
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Todd JA, Lawson C, Grealish L. Making clinical care decisions with people living with dementia in hospital: An integrative literature review. Int J Nurs Stud 2021; 120:103979. [PMID: 34087525 DOI: 10.1016/j.ijnurstu.2021.103979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 04/29/2021] [Accepted: 05/04/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND As our population ages, the percentage of hospitalised patients diagnosed with dementia is expected to rise. However, there is emerging evidence that people living with dementia may experience discrimination and exclusion from decisions about their clinical care. Although dementia affects cognition, many patients living with dementia want to participate in decision-making processes relating to their clinical care in hospital. OBJECTIVE Identify the processes associated with making decisions about clinical care with people living with dementia in hospital. DESIGN An integrative literature review. DATA SOURCES Cumulative Index of Nursing and Allied Health Literature (CINAHL), Scopus, EMBASE (Ovid), MEDLINE (PubMED), PsycINFO and HeinOnline. REVIEW METHOD One author conducted the initial screening of titles, and two authors screened in subsequent rounds for abstracts and full text. The process of making clinical decisions was the outcome of interest. Articles about people with cognitive impairment that did not include dementia, or decisions such as discharge planning or end of life care were excluded. An inductive synthesis of the findings was undertaken. RESULTS Nine articles were identified for review and included expert opinion or hypothetical discussion (n=5), cross-sectional survey research (n=3), and qualitative research (n=1). Three themes were identified: capacity for decision-making is conceptualised as 'all or nothing'; there are no universal principles for including people living with dementia in decision-making in acute care settings; and autonomy is recognised but superseded by beneficence. CONCLUSIONS Contemporary hospital practice is focused on determining capacity for decisions, with an all or nothing attitude to capacity, effectively excluding many people living with dementia from participation in decisions. While there is limited evidence to guide clinicians in this complex and situated process of making clinical decisions, emerging models of supported decision-making require further evaluation in the hospital setting.
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Affiliation(s)
- Jo-Anne Todd
- School of Nursing & Midwifery, Griffith University, Gold Coast, QLD 4215 Australia
| | - Charles Lawson
- Griffith Law School, Griffith University, Gold Coast, QLD 4215 Australia
| | - Laurie Grealish
- School of Nursing & Midwifery, Griffith University, Gold Coast, QLD 4215 Australia; Menzies Health Institute Queensland, Griffith University; Gold Coast Hospital & Health Services.
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12
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Aaltonen MS, Martin-Matthews A, Pulkki JM, Eskola P, Jolanki OH. Experiences of people with memory disorders and their spouse carers on influencing formal care: "They ask my wife questions that they should ask me". DEMENTIA 2021; 20:2307-2322. [PMID: 33595339 PMCID: PMC8564245 DOI: 10.1177/1471301221994300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background People with memory disorders often need care and help from family carers and health and
social care providers. Due to the deterioration of cognitive capacity and language
skills, they may be unable to convey their thoughts and care preferences to other
people. As a result, their agency may become restricted. We investigated the
descriptions provided by people with memory disorders and spousal carers of their
influence on care in encounters with formal care providers. Methods Qualitative thematic analysis was used to identify, analyze, and report themes that
describe encounters with professionals in different social or healthcare environments.
In-depth interview data were gathered from 19 spouse carers and 15 persons with memory
disorders. Findings Three themes out of four describe how people with memory disorders and their spouse
carers influence formal care: Acquiescence, negotiating care decisions, and taking
control. The fourth theme describes lack of influence. People with memory disorders and
their spouse carers have ways to influence care, but spouse carers identified more ways
of doing so. Both either accepted and followed the care guidelines by the formal carers
or took control of the situation and made their own decisions. Spouse carers also sought
to influence care decisions through negotiations with formal carers. When formal carers’
decisions were experienced as inconsistent or the rationale of their actions difficult
to follow, the possibilities to influence care were limited. Conclusions People with memory disorders and their family carers are often in a disadvantaged
position as they lack power over the health and social care decision-making during the
illness, which is often guided by structural factors. To support the agency of people
with memory disorders and to promote shared decision-making, clarification of the
service structure and clearer communication between the different parties involved in
care are required.
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Affiliation(s)
- Mari S Aaltonen
- Faculty of Social Sciences, (Health Sciences), and Gerontology Research Center (GEREC), 7840Tampere University, Finland; Department of Sociology, University of British Columbia, Canada
| | - Anne Martin-Matthews
- Department of Sociology and Office of the Vice-President, Health, University of British Columbia, Canada
| | - Jutta M Pulkki
- Faculty of Social Sciences, (Health Sciences), and Gerontology Research Center (GEREC), 7840Tampere University, Finland
| | - Päivi Eskola
- Faculty of Sport and Health Sciences, Gerontology Research Center (GEREC) and Open University, University of Jyväskylä, Finland
| | - Outi H Jolanki
- Faculty of Social Sciences, Health Sciences, and Gerontology Research Center (GEREC), 7840Tampere University, Finland; Department of Social Sciences and Philosophy, 4168University of Jyväskylä, Finland
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13
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Eriksen S, Bartlett RL, Grov EK, Ibsen TL, Telenius EW, Mork Rokstad AM. The Experience of Lived Time in People with Dementia: A Systematic Meta-Synthesis. Dement Geriatr Cogn Disord 2020; 49:435-455. [PMID: 33176312 PMCID: PMC7949212 DOI: 10.1159/000511225] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 08/27/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION For people with dementia, lived time is important to understand, as the condition affects memory, perceptions of time, and life expectancy. The aim of this study was to locate, interpret, and synthesize the experience of lived time for people with dementia. METHOD This article presents a qualitative systematic meta-synthesis. The theoretical framework of lifeworlds by van Manen provided the context for the study. The Critical Appraisal Skills Programme criteria for qualitative studies were used to appraise the studies. Sixty-one qualitative research studies based on interviews with people with dementia were included in the review. The analysis followed the principles of interpretive synthesis. RESULTS Four categories were revealed: (1) rooted in the past - "I am the same as before"; (2) focussing on the present - "Nobody has tomorrow"; (3) thinking about the future - "What is going to happen to me?"; and (4) changes in the experience of self over time - "I used to…." The latent overall meaning was expressed as "being engaged with the dimensions of time." DISCUSSION/CONCLUSION The experience of lived time is an active and important one, enabling people to manage the dementia journey. Future work involving people with dementia should foreground the experience of lived time.
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Affiliation(s)
- Siren Eriksen
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Lovisenberg Diaconal University College, Oslo, Norway
| | - Ruth Louise Bartlett
- Faculty of Health Studies, VID Specialized University, Oslo, Norway
- School of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Ellen Karine Grov
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Tanja Louise Ibsen
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - Elisabeth Wiken Telenius
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - Anne Marie Mork Rokstad
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway,
- Faculty of Health Sciences and Social Care, Molde University College, Molde, Norway,
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De Sabbata K. Dementia, Treatment Decisions, and the UN Convention on the Rights of Persons With Disabilities. A New Framework for Old Problems. Front Psychiatry 2020; 11:571722. [PMID: 33240127 PMCID: PMC7680726 DOI: 10.3389/fpsyt.2020.571722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 09/22/2020] [Indexed: 11/20/2022] Open
Abstract
The UN Convention on the Rights of Persons with Disabilities has been at the center of considerable debate in the field of mental health. The discussion has caught up in particular after the publication of General Comment No. 1 in which the Committee on the Rights of Persons with Disabilities proposes a particularly radical interpretation of Article 12 of the Convention. Such a document has triggered skeptic and at times hostile reactions especially by psychiatrists, together with some positive comments. In this context, there is sometimes the tendency to focus only on the problematic aspects of the rights and support based model proposed by the CRPD and its Committee, forgetting that also "pre-CRPD" legislations on legal capacity present significant shortcomings. In this contribution I focus on the paradigmatic case of treatment decisions of people living with dementia with the aim to show how a number of provisions emerging from the CRPD and General Comment No. 1 can contribute to overcome the issues characterizing the traditional model of legal capacity and consent to treatment. First, I provide a brief overview of the provisions contained in the CRPD and General Comment No.1, summarizing the debate in this area. Then, I move to the case of treatment decisions of people living with dementia, analysing the main issues posed by the traditional model of capacity still characterizing European legislations. I will show how such problems and the solutions previously advanced by academics and practitioners resound in many ways with those identified by the CRPD and its Committee. In the second part, I analyse one by one the main provisions proposed by the CRPD and the Committee, studying how they can be applied in the area of treatment decisions of people living with dementia. In this context I point out the possible interpretations of the various provisions and their pros and cons, also referring to ongoing initiatives providing an insight on how such norms might work in practice.
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Affiliation(s)
- Kevin De Sabbata
- Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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