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Kim D, Hong Y, Chang SO. Ways of interdisciplinary approaches to advocating for nursing home residents with dementia. J Adv Nurs 2024. [PMID: 38771071 DOI: 10.1111/jan.16251] [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] [Received: 01/04/2024] [Revised: 04/04/2024] [Accepted: 05/10/2024] [Indexed: 05/22/2024]
Abstract
AIM To explore how nursing home staff advocate for residents with dementia. DESIGN Phenomenographic qualitative research. METHODS Twenty nursing home staff from four disciplines (six nurses, four physical therapists, five social workers and five care workers) were purposively recruited from three different nursing homes. Data were collected through semi-structured interviews conducted from February 2023 to March 2023, and the analysis followed the sequential steps of phenomenographic analysis. RESULTS The analysis identified five categories of description: focusing on what happened, finding the gaps in perspectives, how to bridge for finding a common perspective, how to tailor care such that each resident receives equitable care and how to establish interdisciplinary sharing for a consistent advocative pattern. Their structural relationship was also identified as an outcome space. CONCLUSION The cyclical advocacy structure illustrated that nursing home staff engage in an ongoing process of advocacy during conflict situations as part of interdisciplinary care, emphasizing continuity of care rather than separate occurrences of care. IMPLICATIONS FOR THE PROFESSION This study revealed that, in advocating for residents with dementia, nursing home staff adopted an approach that fosters consistent care and proactive prevention, achieved through the formation of shared knowledge applicable uniformly across similar situations. IMPACT This study contributes significantly to the continuing education or training of interdisciplinary staff in nursing homes. The revelations of the study hold significance not only for the practical application but also for the theoretical advancement of concepts related to safeguarding the dignity, human rights and personhood of residents with dementia, with the ultimate goal of enhancing their quality of life within nursing homes. REPORTING METHOD Reporting complied with the COREQ criteria for qualitative research. PATIENT OR PUBLIC CONTRIBUTION Nursing home directors have contributed to the validation of data analysis and interpretation.
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Affiliation(s)
- Dayeong Kim
- College of Nursing and L-HOPE Program for Community-Based Total Learning Health Systems, Korea University, Seoul, Republic of Korea
| | - Youjung Hong
- College of Nursing and L-HOPE Program for Community-Based Total Learning Health Systems, Korea University, Seoul, Republic of Korea
| | - Sung Ok Chang
- College of Nursing and L-HOPE Program for Community-Based Total Learning Health Systems, Korea University, Seoul, Republic of Korea
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2
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Taylor JO, Child CE, Sharma RK, Asirot MG, Miller LM, Turner AM. Supportive care decision-making processes of persons with dementia and their caregivers. DEMENTIA 2023; 22:1695-1717. [PMID: 37656956 PMCID: PMC10688994 DOI: 10.1177/14713012231193139] [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] [Indexed: 09/03/2023]
Abstract
Little is known about the decision-making processes around seeking more supportive care for dementia. Persons with dementia are often left out of decision-making regarding seeking more supportive care as their dementia progresses. This paper provides a description of findings from the Decision-making in Alzheimer's Research project (DMAR) investigating the process of decision-making about transitions to more supportive care. We conducted 61 qualitative interviews with two stakeholder groups: 24 persons with dementia, and 37 informal caregivers to explore supportive care decisions and associated decision-making factors from the perspectives of persons with dementia and their caregivers. We identified four main decisions that persons with dementia and their informal caregivers played a role in: (1) sharing household responsibilities; (2) limiting routine daily activities; (3) bringing in formal support; and (4) moving to a care facility. Based on our findings we developed a schematized roadmap of decision-making that we used to guide the discussion of our findings. Four crosscutting themes emerged from our analysis: unknowns and uncertainties, maintaining life as you know it, there's no place like home and resource constraints. These results will be incorporated into the development of instruments whose goal is to identify preferences of persons with dementia and their caregivers, in order to include persons with dementia in care decisions even as their dementia progresses.
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Affiliation(s)
- Jean O Taylor
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, USA
| | - Claire E Child
- Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, WA, USA
| | - Rashmi K Sharma
- Division of General Internal Medicine, School of Medicine, University of Washington, Seattle, WA, USA
| | - Mary Grace Asirot
- Department of Neurology, School of Medicine, University of Washington, Seattle, WA, USA
| | | | - Anne M Turner
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, USA
- Department of Biomedical Informatics and Medical Education, School of Medicine, University of Washington, Seattle, WA, USA
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3
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Khemai C, Meijers JM, Bolt SR, Pieters S, Janssen DJA, Schols JMGA. I want to be seen as myself: needs and perspectives of persons with dementia concerning collaboration and a possible future move to the nursing home in palliative dementia care. Aging Ment Health 2023; 27:2410-2419. [PMID: 37354050 DOI: 10.1080/13607863.2023.2226079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 05/11/2023] [Indexed: 06/26/2023]
Abstract
Introduction: Interprofessional collaboration (IPC) within and during movements between care settings is crucial for optimal palliative dementia care. The objective of this study was to explore the experiences of persons with dementia regarding collaboration with and between healthcare professionals (HCPs) and their perceptions of a possible future move to the nursing home (NH) in palliative dementia care. Method: We conducted a cross-sectional qualitative study and performed semi-structured interviews with a purposive sample of persons with dementia living at home (N = 18). Data analysis involved content analysis. Results: Our study demonstrated that even though most persons with dementia find it difficult to perceive the collaboration amongst HCPs, they could describe their perceived continuity of care (Theme 1. My perception of collaboration among HCPs). Their core needs in collaboration with HCPs were receiving information, support from informal caregivers, personal attention and tailored care (Theme 2. My needs in IPC). Regarding a possible future move to the NH, persons with dementia cope with their current decline, future decline and a possible future move to the NH (Theme 3. My coping strategies for a possible future move to the NH). They also prefer to choose the NH, and continue social life and activities in their future NH (Theme 4. My preferences when a NH becomes my possible future home). Conclusion: Persons with dementia are collaborative partners who could express their needs and preferences, if they are willing and able to communicate, in the collaboration with HCPs and a possible future move to the NH.
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Affiliation(s)
- Chandni Khemai
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Judith M Meijers
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
- Zuyderland Care, Zuyderland Medical Centre, Sittard-Geleen, the Netherlands
| | - Sascha R Bolt
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Sabine Pieters
- Zuyd University of Applied Sciences, Heerlen, the Netherlands
| | - Daisy J A Janssen
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
- Department of Research and Education, CIRO, Horn, The Netherlands
| | - Jos M G A Schols
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
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Chan OF, Chui CHK, Wong GHY, Lum TYS. Threats to personhood from within the family? A study of family caregivers of people with dementia in the Chinese context. DEMENTIA 2023; 22:1677-1694. [PMID: 37534460 DOI: 10.1177/14713012231193144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Dementia care creates ethical and legal dilemmas due to the struggle to balance the quality of care and personhood. Disagreement and conflict in caregiving relationships are common. However, limited attention has been given to particular stressful circumstances, such as care practice and decision disagreements. Moreover, the cultural context of personhood has been overlooked. This study drew on Hong Kong family caregivers' reports of their cargiving practice and disagreements with care recipients about care-related decisions and their implications for personhood to identify person-centered family care support needs. RESEARCH DESIGN AND METHODS We conducted 18 semi-structured interviews with family caregivers of people with dementia in Hong Kong, China. Participants were asked to share their family dementia caregiving experience and practice, specifically regarding decisions and practices that elicited disagreement. We used thematic analysis to analyze data generated from interviews. RESULTS Six caregiver practices were identified: exchange for mutual agreement, a foot-in-the-door approach, acceptance of requests/behaviors contrary to the caregivers' views, infantilization, treachery, and exclusion and imposition. DISCUSSION AND IMPLICATIONS These findings highlight the importance of providing support and guidelines for person-centered care to promote personhood in the family caregiving context in dementia care.
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Affiliation(s)
- On-Fung Chan
- Department of Social Work and Social Administration, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR, China
| | - Cheryl Hiu-Kwan Chui
- Department of Social Work and Social Administration, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR, China
| | - Gloria Hoi-Yan Wong
- Department of Social Work and Social Administration, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR, China
| | - Terry Yat-Sang Lum
- Department of Social Work and Social Administration, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR, China
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5
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Monnet F, Pivodic L, Dupont C, Dröes RM, Van den Block L. Information on advance care planning on websites of dementia associations in Europe: A content analysis. Aging Ment Health 2023; 27:1821-1831. [PMID: 36420632 DOI: 10.1080/13607863.2022.2146051] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 11/05/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To gain insight into the advance care planning (ACP) content provided on dementia associations' websites in Europe. METHODS We conducted a content analysis of dementia associations' websites in Europe regarding ACP information, using deductive and inductive approaches and a reference framework derived from two ACP definitions. RESULTS We included 26 dementia associations' websites from 20 countries and one European association, covering 12 languages. Ten websites did not mention ACP. The information on the remaining 16 varied in terms of themes addressed and amount of information. Four explicitly define ACP. Several websites made multiple references to legal frameworks (n = 10, 705 excerpts), choosing legal representatives (n = 12, 274 excerpts), and care and treatment preferences (n = 14, 89 excerpts); while themes such as communication with family (n = 9, 67 excerpts) and professionals (n = 9, 49 excerpts) or identifying personal values (n = 9, 73 excerpts) were mentioned on fewer websites or addressed in fewer excerpts. CONCLUSION ACP content is non-existent in 10 out of 26 dementia associations' websites. On those that have ACP content, legal and medical themes were prominent. It would be beneficial to include more comprehensive ACP information stressing the importance of communication with families and professionals, in line with current ACP conceptualisations framing ACP as an iterative communication process, rather than a documentation-focused exercise.
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Affiliation(s)
- Fanny Monnet
- End-of-Life Care Research Group, Vrije Universiteit (VUB) & Ghent University, Brussels, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Lara Pivodic
- End-of-Life Care Research Group, Vrije Universiteit (VUB) & Ghent University, Brussels, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Charlèss Dupont
- End-of-Life Care Research Group, Vrije Universiteit (VUB) & Ghent University, Brussels, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Rose-Marie Dröes
- Department of Psychiatry, Amsterdam University Medical Centres, location VUmc/Amsterdam Public Health Research institute, Amsterdam, The Netherlands
| | - Lieve Van den Block
- End-of-Life Care Research Group, Vrije Universiteit (VUB) & Ghent University, Brussels, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
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6
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Nilsson E, Olaison A. "I See What You Mean"-A Case Study of the Interactional Foundation of Building a Working Alliance in Care Decisions Involving an Older Couple Living with Cognitive Decline. Healthcare (Basel) 2023; 11:2124. [PMID: 37570364 PMCID: PMC10418874 DOI: 10.3390/healthcare11152124] [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] [Received: 05/29/2023] [Revised: 07/06/2023] [Accepted: 07/12/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Social workers have a key role in needs assessment meetings with families dealing with dementia, providing information, support, and advocacy, while also assessing needs and making decisions about care services for several parties. These contacts are especially important during the introduction of home care services, where often the person has previously relied on informal support from relatives. The needs assessment process entails the involvement of all present parties, with the aim to reach a mutual agreement, a working alliance, regarding which services to apply for. PURPOSE The aim of this case study is to explore how the participants, by means of different conversational practices, jointly create a working alliance between the different parties in one family. The study provides insights into the process of co-constructing a working alliance in the needs assessment process for elder care services. METHODS This article addresses the process by which social workers build a working alliance in a multi-party conversation with a family living with cognitive decline; a meeting that lasted 50 min. In this case study, we benefit from an inductive and detailed conversation analytic methodology. The theoretical framework of working alliances in institutional interaction has informed the analysis. RESULTS The findings illustrate how the social worker in this case study involves all parties in the decision regarding care services and explores the use of the conversational practices of mitigations, positive framing, adding information, and positioning, as a "we" achieve mutual agreement toward the end of several sequences. CONCLUSIONS Drawing on the results of this case study, we argue that multi-party interaction involving relatives enables diversity in role-taking, where the professional, for instance, can pursue a more empathic role. Also, our results indicate that minimal agreement to a proposal is sufficient in a multi-party interaction involving clients with cognitive decline.
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Affiliation(s)
- Elin Nilsson
- Division of Social Work, Department of Culture and Society, Linköping University, SE-601 74 Norrköping, Sweden;
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Anantapong K, Bruun A, Walford A, Smith CH, Manthorpe J, Sampson EL, Davies N. Co-design development of a decision guide on eating and drinking for people with severe dementia during acute hospital admissions. Health Expect 2023; 26:613-629. [PMID: 36647692 PMCID: PMC10010093 DOI: 10.1111/hex.13672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/27/2022] [Accepted: 11/05/2022] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Using co-design processes, we aimed to develop an evidence-based decision guide for family carers and hospital professionals to support decision-making about eating and drinking for hospital patients with severe dementia. METHODS Following a systematic review, we interviewed people with mild dementia, family carers and hospital professionals in England. We then held co-design workshops with family carers and hospital professionals. In parallel with the workshops, we used a matrix to synthesize data from all studies and to develop a decision guide prototype. The prototype was iteratively refined through further co-design workshops and discussions among researchers and Patient and Public Involvement (PPI) representatives. We conducted user testing for final feedback and to finalize the decision guide. RESULTS Most participants acknowledged the limited benefits of tube feeding and would not use or want it for someone with severe dementia. However, they found decision-making processes and communication about nutrition and hydration were emotionally demanding and poorly supported in acute hospitals. The co-design groups developed the aims of the decision guide to support conversations and shared decision-making processes in acute hospitals, and help people reach evidence-based decisions. It was designed to clarify decision-making stages, provide information and elicit the values/preferences of everyone involved. It encouraged person-centred care, best-interests decision-making and multidisciplinary team working. From user testing, family carers and hospital professionals thought the decision guide could help initiate conversations and inform decisions. The final decision guide was disseminated and is being used in clinical practice in England. CONCLUSION We used rigorous and transparent processes to co-design the decision guide with everyone involved. The decision guide may facilitate conversations about nutrition and hydration and help people reach shared decisions that meet the needs and preferences of people with severe dementia. Future evaluation is required to test its real-world impacts. PATIENT OR PUBLIC CONTRIBUTION People with mild dementia, family carers and hospital professionals contributed to the design of the decision guide through the interviews and co-design workshops. PPI members helped design study procedures and materials and prepare this manuscript.
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Affiliation(s)
- Kanthee Anantapong
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK.,Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Andrea Bruun
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK.,Faculty of Health, Science, Social Care and Education, Kingston University, London, UK
| | - Anne Walford
- Family Carer, Patient and Public Involvement Panel, London, UK
| | - Christina H Smith
- Language and Cognition, Division of Psychology and Language Sciences, University College London, London, UK
| | - Jill Manthorpe
- NIHR Policy Research Unit in Health & Social Care Workforce, King's College London, London, UK.,NIHR Applied Research Collaboration (ARC) South London, London, UK
| | - Elizabeth L Sampson
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK.,Department of Psychological Medicine, Royal London Hospital, East London NHS Foundation Trust, London, UK
| | - Nathan Davies
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK.,Research Department of Primary Care and Population Health, Centre for Ageing Population Studies, University College London, London, UK
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Anantapong K, Sampson EL, Davies N. A shared decision-making model about care for people with severe dementia: A qualitative study based on nutrition and hydration decisions in acute hospitals. Int J Geriatr Psychiatry 2023; 38:e5884. [PMID: 36750227 PMCID: PMC10108087 DOI: 10.1002/gps.5884] [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: 10/18/2022] [Accepted: 01/24/2023] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To understand the decision-making processes regarding eating and drinking for hospital patients with severe dementia and use this data to modify a decision-making model about care for people with severe dementia. METHODS From January to May 2021, qualitative semi-structured interviews were conducted with 29 family carers and hospital staff in England who cared for people with severe dementia during hospital admissions. Interviews were transcribed verbatim and analysed using codebook thematic analysis. RESULTS We demonstrated a modified decision-making model consisting of six stages of the decision-making process: (i) identify a decision to be made; (ii) exchange information and recognise emotions; (iii) clarify values and preferences of all involved; (iv) consider feasibility of each choice; (v) share preferred choice and make a final decision; and (vi) deliver the decision, monitor outcomes and renegotiation. From this study, decision-making needed to be shared among all people involved and address holistic needs and personal values of people with dementia and family carers. However, hospital staff often made assumptions about the persons' ability to eat and drink without adequate consultation with family carers. The process was impacted by ward culture, professional practice, and legal framework, which might overlook cultural and personal beliefs of the persons and families. Treatment escalation plans could help inform stepwise treatments, create realistic expectations, and guide future decisions. CONCLUSIONS Our decision-making model provides clear stages of decision-making processes and can be used to guide clinical practice and policy around care decisions for eating and drinking, which is often poorly supported.
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Affiliation(s)
- Kanthee Anantapong
- Marie Curie Palliative Care Research DepartmentUCL Division of PsychiatryUniversity College LondonLondonUK
- Department of PsychiatryFaculty of MedicinePrince of Songkla UniversityHat YaiThailand
| | - Elizabeth L. Sampson
- Marie Curie Palliative Care Research DepartmentUCL Division of PsychiatryUniversity College LondonLondonUK
- Department of Psychological MedicineRoyal London HospitalEast London NHS Foundation TrustLondonUK
| | - Nathan Davies
- Marie Curie Palliative Care Research DepartmentUCL Division of PsychiatryUniversity College LondonLondonUK
- Centre for Ageing Population StudiesResearch Department of Primary Care and Population HealthUniversity College LondonLondonUK
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Sabatini S, Martyr A, Gamble LD, Collins R, Matthews FE, Morris RG, Rusted JM, Pentecost C, Quinn C, Clare L. Longitudinal Predictors of Informant-Rated Involvement of People with Dementia in Everyday Decision-Making: Findings from the IDEAL Program. J Appl Gerontol 2023; 42:290-301. [PMID: 36193737 PMCID: PMC9841822 DOI: 10.1177/07334648221128558] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The extent to which people with dementia are involved in everyday decision-making is unclear. We explored informant-rated involvement of people with dementia in everyday decision-making over 2 years and whether functional, behavioral, and psychological factors related to the person with dementia and the caregiver explain variability in involvement of people with dementia in everyday decision-making. We used IDEAL data for 1182 people with dementia and their caregivers. Baseline mean score on the decision-making involvement scale was 31/45; it minimally declined over time. People with dementia who were female, single, and/or whose caregiver was younger had greater involvement in everyday decision-making than those without these characteristics. Better cognition, fewer functional difficulties, fewer neuropsychiatric symptoms, less caregiver stress, and better informant-rated relationship quality were associated with higher involvement in everyday decision-making. Cognitive and functional rehabilitation, and educational resources for caregivers, could prolong involvement of people with dementia in everyday decision-making.
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Affiliation(s)
- Serena Sabatini
- Faculty of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland
| | - Anthony Martyr
- Centre for Research in Ageing and Cognitive Health, Faculty of Health and Life Sciences, University of Exeter Medical School, Exeter, UK
| | - Laura D. Gamble
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | - Rachel Collins
- Centre for Research in Ageing and Cognitive Health, Faculty of Health and Life Sciences, University of Exeter Medical School, Exeter, UK
| | - Fiona E. Matthews
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | - Robin G. Morris
- Department of Psychology, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | | | - Claire Pentecost
- Centre for Research in Ageing and Cognitive Health, Faculty of Health and Life Sciences, University of Exeter Medical School, Exeter, UK
| | - Catherine Quinn
- Centre for Applied Dementia Studies, Bradford University, Bradford, UK,Wolfson Centre for Applied Health Research, Bradford, UK
| | - Linda Clare
- Centre for Research in Ageing and Cognitive Health, Faculty of Health and Life Sciences, University of Exeter Medical School, Exeter, UK,Linda Clare, Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter EX1 2LU, UK.
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Stelma-Roorda HN, Eichelsheim VI. Decision-making by and for adults with impaired capacity: The potential of the Dutch levenstestament. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2023; 86:101844. [PMID: 36442390 DOI: 10.1016/j.ijlp.2022.101844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 06/16/2023]
Abstract
Anticipatory decision-making instruments - continuing powers of attorney and advance directives - are increasingly seen as a promising way forward to enhance the autonomy of adults with impaired capacity by making the adult's voice an influential component of future decisions. However, little is known about the experiences with these instruments in practice. This article presents the findings of an interview study looking at the expectations and experiences of both adults and attorneys with a Dutch anticipatory decision-making instrument, the so-called levenstestament. In order to realise its full potential, anticipatory decision-making instruments, such as the levenstestament, should be embedded in robust, timely and ongoing conversations between adults and attorneys about the adult's (changing) wishes and preferences and the role of the attorney.
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Affiliation(s)
- H N Stelma-Roorda
- Faculty of Law, Vrije Universiteit Amsterdam, De Boelelaan 1105, HV 1081, Amsterdam.
| | - V I Eichelsheim
- Netherlands Institute for the Study of Crime and Law Enforcement, PO Box 71304, BH 1008, Amsterdam.
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11
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Anantapong K, Davies N, Sampson EL. Communication between the multidisciplinary team and families regarding nutrition and hydration for people with severe dementia in acute hospitals: a qualitative study. Age Ageing 2022; 51:6834151. [PMID: 36434801 PMCID: PMC9701106 DOI: 10.1093/ageing/afac230] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND When a person with severe dementia is in hospital and has eating and drinking difficulties, communication between the multidisciplinary team and families can be challenging and lead to suboptimal care. OBJECTIVE To gain in-depth understanding about the experiences, views and needs of family carers and hospital staff, regarding communication and conversations about nutrition and hydration, for hospital patients with severe dementia. DESIGN Qualitative semi-structured interview study. SETTING Acute hospital in England. METHODS From January to May 2021, semi-structured interviews were conducted with 29 family carers and hospital staff. Interviews were transcribed verbatim and analysed using reflexive thematic methods. RESULTS Four overarching themes were developed: (i) prerequisites to initiating communication about eating and drinking; (ii) communication aiming to develop agreed care plans; (iii) difficulty discussing palliative and end-of-life care; and (iv) needs of information and plans about future eating and drinking difficulties. Families tended to wait for hospital staff to initiate discussions but usually experienced frustration with delays and repeated conversations with different staff. Some staff felt unprepared to manage these conversations and found it challenging to work across the multidisciplinary team. During discharge processes, key information and care plans about eating and drinking were not regularly passed on to people involved to avoid unnecessary readmissions. CONCLUSIONS In acute hospitals, family carers and hospital staff can have disjointed communications and conversations about nutrition and hydration for persons with severe dementia. Timely reassurance, ongoing discussions and clear information sharing will support communication between those involved.
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Affiliation(s)
| | - Nathan Davies
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK,Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Elizabeth L Sampson
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK,Department of Psychological Medicine, Royal London Hospital, East London NHS Foundation Trust, London, UK
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12
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Östlund L, Ernsth Bravell M, Johansson L. Working in a gray area—Healthcare staff experiences of receiving consent when caring for persons with dementia. DEMENTIA 2022; 22:144-160. [DOI: 10.1177/14713012221137472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Every person has the right to autonomy, and to be involved in decisions about their care. When persons with dementia have difficulties in expressing what they want, their autonomy is challenged. Staff should strive to involve the person in care decisions, to obtain consent and to avoid the use of coercion and restraints. However, care without consent exists and coercion and restraints are being used. In order to improve care, further knowledge is warranted. Aims The purpose of this study was to explore staff’s experiences of obtaining consent when caring for persons with dementia. Methods In total 14 focus group interviews were conducted with staff with experience of dementia care who work in either home care or residential care in Sweden. An inductive qualitative content analysis was used to analyze the collected data. Results Three categories were generated describing staff experiences of consent in dementia care: the person as the decision-maker, the staff as the decision-makers, and the viability of the consent. Overall, staff found it difficult to know if they really had consent from the individual. Even if the person verbally gave consent, it was challenging to know if the person really understood what they had consented to. Common to all three categories was the significance of the relationship between the person with dementia and staff: getting to know the person, recognizing the person’s response in terms of their facial expressions and body language as well as being able to explain and justify specific actions to the person. Conclusion Staff need better conditions in dementia care, including training and time to reflect on how to obtain consent. A person-centered approach can be one way to develop care and ensure that persons with dementia are allowed autonomy and to share in making decisions.
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Affiliation(s)
- Lena Östlund
- School of Health and Welfare, Ageing Research Network, Institute of Gerontology, Jönköping University,Jönköping,Sweden
| | - Marie Ernsth Bravell
- School of Health and Welfare, Ageing Research Network, Institute of Gerontology, Jönköping University,Jönköping,Sweden
| | - Linda Johansson
- School of Health and Welfare, Ageing Research Network, Institute of Gerontology, Jönköping University,Jönköping,Sweden
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Bavelaar L, McCann A, Cornally N, Hartigan I, Kaasalainen S, Vankova H, Di Giulio P, Volicer L, Arcand M, van der Steen JT, Brazil K. Guidance for family about comfort care in dementia: a comparison of an educational booklet adopted in six jurisdictions over a 15 year timespan. Palliat Care 2022; 21:76. [PMID: 35578219 PMCID: PMC9112535 DOI: 10.1186/s12904-022-00962-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 04/28/2022] [Indexed: 11/07/2022] Open
Abstract
Background To support family caregivers of people with dementia in end-of-life decision making, a family booklet on comfort care has been adapted and adopted by several European jurisdictions since the original publication in Canada in 2005. Methods We analyzed and compared the adaptations to the family booklets used in Canada, the Czech Republic, Italy, the Netherlands, the UK and Ireland that were made up to 2021. Qualitative content analysis was used to create a typology of changes to the original booklet. Interviews with the teams that adapted the booklets contributed to methodological triangulation. Further, using an established framework, we assessed whether the contents of the booklets addressed all domains relevant to optimal palliative dementia care. Results The booklets differed in the types of treatment addressed, in particular tube feeding, euthanasia, and spiritual care. There was also variability in the extent to which medical details were provided, an emphasis on previously expressed wishes in medical decision making, addressing of treatment dilemmas at the end of life, the tone of the messages (indirect or explicit) and the discussion of prognosis (as more or less positive), and the involvement of various healthcare professionals and family caregivers in care. All booklets addressed all domains of palliative dementia care. Conclusions We identified core elements in providing information on end-of-life care to family caregivers of people with dementia as related to optimal palliative care in dementia. Additionally, local adaptations and updates are required to account for socio-cultural, clinical, and legal differences which may also change over time. These results may inform development of educational and advance care planning materials for different contexts. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-022-00962-z.
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Voice your values, a tailored advance care planning intervention in persons living with mild dementia: A pilot study. Palliat Support Care 2022; 21:445-453. [PMID: 35481452 DOI: 10.1017/s1478951522000475] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND In the early stage of dementia, persons living with dementia (PLwD) can identify their values and wishes for future care with a high degree of accuracy and reliability. However, there is a paucity of research to guide best practices on how best to incorporate advance care planning (ACP) in older adults diagnosed with mild dementia and therefore only a minority of these individuals participate in any ACP discussions. We developed an intervention called Voice Your Values (VYV) that healthcare professionals can implement to identify and document the values of PLwD and their trusted individuals such as friends or family. PURPOSE This single-group pre-test and post-test design aimed to determine the feasibility, acceptability, and preliminary efficacy of the VYV intervention. METHODS A convenience sample of 21 dyads of PLwD and their trusted individuals were recruited from five outpatient geriatric clinics. The tailored VYV intervention was delivered to the dyads over two sessions using videoconferencing. RESULTS In terms of feasibility, the recruitment rate was lower (52%) than the expected 60%; the retention rate was high at 94%, and the intervention fidelity was high based on the audit of 20% of the sessions. In terms of preliminary efficacy, PLwD demonstrated improvement in ACP engagement (p = <0.01); trusted individuals showed improvements in decision-making confidence (p = 0.01) and psychological distress (p = 0.02); whereas a minimal change was noted in their dementia knowledge (p = 0.22). CONCLUSION Most of the feasibility parameters were met. A larger sample along with a control group, as well as a longitudinal study, are requisite to rigorously evaluate the efficacy of the promising VYV intervention. There is emerging evidence that people living with mild dementia can effectively participate in identifying and expressing their values and wishes for future care.
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Hynes C, Hodges VJ, Wyld L, Mitchell C. Cancer treatment decisions for people living with dementia: Experiences of family carers, a qualitative interview study. Health Expect 2022; 25:1131-1139. [PMID: 35297137 PMCID: PMC9122422 DOI: 10.1111/hex.13466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 02/20/2022] [Accepted: 02/21/2022] [Indexed: 11/28/2022] Open
Abstract
Background As the UK population ages, the prevalence of both dementia and cancer will increase. Family carers of people with dementia who are subsequently diagnosed with cancer are often involved in treatment decisions about cancer. These decisions are uniquely challenging. Objectives To explore the experience of carers involved in cancer treatment decisions for people with dementia. Design A cross‐sectional qualitative interview study with inductive thematic analysis. Setting and Participants Sixteen carers of people with dementia were identified via Primary Care Research Networks and the Join Dementia Research database. Results Three main themes were derived: ‘already at breaking point’, which describes the extreme strain that carers were already under when the cancer diagnosis was made; ‘maintaining the status quo’, which describes how despite the gravity of a cancer diagnosis, avoiding further dementia‐related deterioration was of prime importance; and ‘LPA’, which explores the benefits and frustrations of the use of lasting powers of attorney. Discussion Current services are ill‐equipped to deal with people who have a combination of dementia and cancer. Proxy decisions about cancer care are made in the context of carer stress and exhaustion, which is exacerbated by shortcomings in service provision. Conclusions As the prevalence of comorbid cancer and dementia rises, there is an urgent need to improve services that support carers with proxy health care decision‐making. Patient or Public Contribution The study design was codeveloped with a local dementia‐specific patient and public involvement (PPI) group. A project‐specific PPI group was formed with support from the Alzheimer's Society Research Partnership scheme to provide further bespoke input.
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Affiliation(s)
- Catherine Hynes
- Academic Unit of Primary Medical Care, University of Sheffield, Sheffield, UK
| | - Victoria J Hodges
- Academic Unit of Primary Medical Care, University of Sheffield, Sheffield, UK
| | - Lynda Wyld
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Caroline Mitchell
- Academic Unit of Primary Medical Care, University of Sheffield, Sheffield, UK
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Francis N, Hanna P. Informal carer experiences of UK dementia services-A systematic review. J Psychiatr Ment Health Nurs 2022; 29:116-129. [PMID: 33047451 DOI: 10.1111/jpm.12698] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 09/07/2020] [Accepted: 09/27/2020] [Indexed: 12/21/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Dementia affects an increasing number of people and a person with dementia requires significant levels of care. Dementia care is often delivered by family members. Caring for someone with dementia places significant demand on the carer and support for the carer is often needed. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Research has been conducted into caregivers' experiences of caring for someone with dementia, but a synthesis of findings for studies from the UK is needed to collate the research evidence and provide an account of the common trends within the existing research. This paper adds to existing knowledge by highlighting the key difficulties experienced by carers of a person with dementia in their caring role and their experiences with support services across the existing research evidence. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Improvements to the process of dementia assessment and the process of receiving a dementia diagnosis are needed. Information and support needs to be more accessible for the carer of a person with dementia Cultural differences need to be acknowledged in the support and information offered to carers of a person with dementia. ABSTRACT: Aim To understand the experiences of informal carers' of individuals with dementia in the UK when engaging with services for support in their caring role. Methods Following the PRISMA guidelines, a qualitative systematic literature review was carried out. Six Internet databases were searched. Results were screened, and eligible studies were appraised using Critical Appraisal Skills Programme (CASP, 2019) and data synthesized using Evan & Pearson (2001) and Evans (2002). Results The search returned 231 records, 11 were selected for critical appraisal and data synthesis. Four main themes (information for carers, process of diagnosing dementia, difficulties accessing support and cultural differences of experiences of services) were extracted. Discussion Carers experience services as providing inadequate support for the Person with Dementia (PwD) and themselves for support relating to dementia. Difficulties in receiving information and support were experienced from before diagnosis to end-of-life (EoL) care. Additionally, cultural differences were found in carers' experiences. Implications for practice The provision of and access to dementia support should be improved; more information for carers about dementia and dementia services is needed; cultural differences need to be appreciated in the support and information offered.
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Affiliation(s)
- Nick Francis
- School of Psychology, University of Surrey, Guildford, UK
| | - Paul Hanna
- School of Psychology, University of Surrey, Guildford, UK
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17
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Aker N, West E, Davies N, Moore KJ, Sampson EL, Nair P, Kupeli N. Challenges faced during the COVID-19 pandemic by family carers of people living with dementia towards the end of life. BMC Health Serv Res 2021; 21:996. [PMID: 34548067 PMCID: PMC8454696 DOI: 10.1186/s12913-021-07019-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 08/31/2021] [Indexed: 01/10/2023] Open
Abstract
Background People living with dementia account for a large proportion of deaths due to COVID-19. Family carers are faced with making significant and emotive decisions during the pandemic, including decisions about end of life. We aimed to explore the challenges faced by family carers of people living with dementia during the first wave of the COVID-19 pandemic in England, as reported by charity telephone support line staff, who were able to objectively discuss a range of different experiences of many different carers who call the helpline. In particular, we focussed on key concerns and areas of decision making at the end of life. Methods We conducted a qualitative study using semi-structured interviews with eight telephone support line staff from two UK based charities who support carers of people living with dementia and those at the end of life. Interviews were conducted in the first wave of the pandemic in England in May–June 2020. Results An overarching theme of uncertainty and reactivity during a crisis was identified, and within this, five main themes were identified: concerns about care transitions, uncertainty in engaging support and help, pandemic-motivated care planning, maintaining the wellbeing of the person living with dementia, and trust, loss of agency and confusion. Conclusions Family carers may be reluctant to seek support because of fear of what may happen to their relative, which may include hospitalisation and becoming ill with COVID-19, care home placement, or not being able to be with a relative at the end of life. In some cases, a lack of trust has developed, and instead carers are seeking support from alternative services they trust such as nationally known charities.This study was used to inform the development of a decision aid to support family carers making decisions about care for their relative with dementia during the pandemic, who the lack the capacity to make their own decisions.
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Affiliation(s)
- Narin Aker
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Emily West
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Nathan Davies
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, UK.,Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Kirsten J Moore
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.,National Ageing Research Institute, Parkville, Victoria, Australia
| | - Elizabeth L Sampson
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.,Barnet, Enfield and Haringey Mental Health Liaison Service, North Middlesex University Hospital NHS Trust, London, UK
| | - Pushpa Nair
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Nuriye Kupeli
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
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18
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Anantapong K, Barrado-Martín Y, Nair P, Rait G, Smith CH, Moore KJ, Manthorpe J, Sampson EL, Davies N. How do people living with dementia perceive eating and drinking difficulties? A qualitative study. Age Ageing 2021; 50:1820-1828. [PMID: 34120181 PMCID: PMC8522686 DOI: 10.1093/ageing/afab108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Indexed: 11/20/2022] Open
Abstract
Background Eating and drinking problems are common among people living with later-stage
dementia, yet few studies have explored their perspectives. Objective This study aimed to explore how people living with mild dementia understand
possible future eating and drinking problems and their perspectives on
assistance. Design Qualitative study using semi-structured interviews. Setting Community. Methods We conducted semi-structured interviews with 19 people living with mild
dementia. Interviews were transcribed verbatim and analysed
thematically. Results Five themes were identified: (i) awareness of eating and drinking problems;
(ii) food and drink representing an individual’s identity and agency;
(iii) delegating later decisions about eating and drinking to family carers;
(iv) acceptability of eating and drinking options; and (v) eating and
drinking towards the end of life. For people living with mild dementia,
possible later eating and drinking problems could feel irrelevant and action
may be postponed until they occur. Fears of being a burden to family and of
being treated like a child may explain reluctance to discuss such future
problems. People living with mild dementia might wish to preserve their
agency and maintain good quality of life, rather than be kept alive at later
stages by artificial nutrition and hydration. Conclusion For people with mild dementia, eating and drinking problems may seem
unrelated to them and so get left undiscussed. Negative connotations
regarding eating and drinking problems may hinder the discussion. The
optimal time to discuss possible future problems with eating and drinking
with people with mild dementia may need an individual approach.
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Affiliation(s)
- Kanthee Anantapong
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Yolanda Barrado-Martín
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Pushpa Nair
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Greta Rait
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Christina H Smith
- Language and Cognition, Division of Psychology and Language Sciences, University College London, London, UK
| | - Kirsten J Moore
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
- National Ageing Research Institute, Parkville, Victoria, Australia
| | - Jill Manthorpe
- NIHR Policy Research Unit in Health & Social Care Workforce and NIHR Applied Research Collaborative (ARC) South London, King's College London, London, UK
| | - Elizabeth L Sampson
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
- Barnet Enfield and Haringey Mental Health Trust Liaison Team, North Middlesex University Hospital, Sterling Way, London, UK
| | - Nathan Davies
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, UK
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19
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Teh WL, Roystonn K, Vaingankar JA, Goh CMJ, Zhang Y, Chong SA, Verma S, Tay B, Subramaniam M. Caregivers' hopes, expectations and concerns surrounding the employment and future of young people with mental health conditions. Int J Soc Psychiatry 2021; 67:432-440. [PMID: 33012238 PMCID: PMC8290979 DOI: 10.1177/0020764020960763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Informal caregivers are often placed in a better position to understand and advocate for the vocational needs of young persons with mental health conditions. However, their opinions are largely ignored in the planning of vocational outcomes. This qualitative study had two broad aims: to explore (1) the perceptions of caregivers of young adults with mental health conditions on issues of paid employment and (2) their views and expectations of employment support services. METHODS A total of 30 semi-structured interviews were conducted. Caregivers were 45 years old on average, the majority were women (73%) and were of Chinese ethnicity (53%). Most participants (60%) were parents of the young persons with psychotic disorders (57%), or affective and mood disorders, such as depression or anxiety disorders (43%). RESULTS Thematic analyses of data revealed three superordinate themes: (1) caregiving roles, (2) caregivers' expectations and hopes, and (3) barriers to employmentof young persons with mental health conditions. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Caregivers strongly believed that employment support services should prioritise and advocate for recovery while securing employment. Local mental health employment support services should incorporate the views and expectations of caregivers of young persons with mental health conditions to foster better coordination between stakeholders, and enhance support for successful employment, reintegration into the community, and ultimately recovery for these individuals.
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Affiliation(s)
- Wen Lin Teh
- Research Division, Institute of Mental Health, Singapore
| | | | | | | | - YunJue Zhang
- Research Division, Institute of Mental Health, Singapore
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore
| | - Swapna Verma
- Department of Psychosis, Institute of Mental Health, Singapore
| | - Benjamin Tay
- National Council of Social Service, Ulu Pandan Community Building, Singapore
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20
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Strickland K, Bail K, Cope S, Turner M, Moss C. Supported decision-making to assist older persons experiencing elder abuse: An integrative review. Collegian 2021. [DOI: 10.1016/j.colegn.2020.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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21
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Bonds Johnson K, Epps FR, Song M, Lyons KS, Driessnack M. Using poetry as data to explore daily and formal care decision making within African American dementia dyads. Geriatr Nurs 2021; 42:919-925. [PMID: 34098446 PMCID: PMC8335738 DOI: 10.1016/j.gerinurse.2021.05.001] [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: 03/04/2021] [Revised: 05/02/2021] [Accepted: 05/04/2021] [Indexed: 11/29/2022]
Abstract
There is limited research exploring how daily and formal care decision making occurs within African American dementia dyads as well as how these dyads navigate decision making across the dementia trajectory. Through semi-structured interviews, five African American dementia dyads shared their decision-making processes. We used a multimethod approach to the analysis of data, including qualitative and quantitative content analysis and the creation of I Poems. This novel use of I Poems provided a uniquely personal account of the lived experiences of the African American persons living with dementia, while other analyses revealed that within dyads, daily care decision making was led by African American persons living with dementia, whereas formal care decision making varied between dyads. There was intra-dyad congruence regarding who the final decision maker was in daily and formal care. Clinicians and researchers may be able to tailor interventions based on the dyad's involvement in these decision-making processes.
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Affiliation(s)
- Kalisha Bonds Johnson
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Rd, Atlanta, GA 30322, United States.
| | - Fayron R Epps
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Rd, Atlanta, GA 30322, United States
| | - MinKyoung Song
- School of Nursing, Oregon Health & Science University, Portland, OR, United States
| | - Karen S Lyons
- Connell School of Nursing, Boston College, Chestnut Hill, MA, United States
| | - Martha Driessnack
- School of Nursing, Oregon Health & Science University, Portland, OR, United States
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22
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Li X, Keady J, Ward R. Neighbourhoods and dementia: An updated realist review of the qualitative literature to inform contemporary practice and policy understanding. DEMENTIA 2021; 20:2957-2981. [PMID: 34098765 DOI: 10.1177/14713012211023649] [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] [Indexed: 12/16/2022]
Abstract
This realist review of the literature provided a contemporary understanding of neighbourhoods and dementia and described how people living with dementia and their neighbourhood interacted via ongoing place-making and remaking processes. Drawing on 44 articles, neighbourhoods were revealed to have fluid and dynamic qualities where people with dementia used their strength and resources to connect to significant people and places. The review also indicated that the person with dementia-neighbourhood relationship was underpinned by four themes: 'home', 'social interactions', 'activities' and 'transportation'. Further research is encouraged to use innovative, participatory methods to explore the neighbourhood-dementia nexus in depth whilst paying close attention to social inclusion and diversity.
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Affiliation(s)
- Xia Li
- 13985National Institute for Health and Care Excellence, Manchester, UK
| | - John Keady
- University of Manchester, Manchester, UK
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23
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Bonds K, Whitlatch CJ, Song M, Lyons KS. Factors influencing quality of life in African-American dementia dyads. Aging Ment Health 2021; 25:703-710. [PMID: 31920090 PMCID: PMC7347433 DOI: 10.1080/13607863.2020.1711865] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 12/26/2019] [Indexed: 10/25/2022]
Abstract
Objective: Both caregivers and the older adults they care for can experience declines in quality of life (QOL) over the course of the dementia trajectory. Little research has examined QOL in African-American caregivers and even less in African-American persons with dementia (PWDs), making it difficult to identify associated factors.Method: Guided by the Negro Family as a Social System framework, a secondary data analysis was used to examine the influence of family structure, instrumental and expressive role functions on QOL in a sample of 62 African-American dementia dyads (i.e. African-American PWDs and their African-American caregivers). Dyadic data were analyzed using multilevel modeling to control for the interdependent nature of the data.Results: On average, African-American PWDs reported significantly worse QOL than African-American caregivers. Within African-American dementia dyads, QOL covaried. African-American PWDs experienced significantly worse QOL when their caregiver was a non-spouse and they themselves perceived less involvement in decision-making. In addition, African-American caregivers experienced significantly worse QOL when they reported greater dyadic strain with the African-American PWD and were non-spouses of African-American PWDs.Conclusion: Findings suggest understanding the interpersonal characteristics (e.g., dyadic relationship, family structure and role functions) of dyads may hold promise for improving their QOL.
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Affiliation(s)
- Kalisha Bonds
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - Carol J Whitlatch
- Center for Research and Education, Benjamin Rose Institute on Aging, Cleveland, OH, USA
| | - MinKyoung Song
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - Karen S Lyons
- Connell School of Nursing, Boston College, Chestnut Hill, MA, USA
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24
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Wehrmann H, Michalowsky B, Lepper S, Mohr W, Raedke A, Hoffmann W. Priorities and Preferences of People Living with Dementia or Cognitive Impairment - A Systematic Review. Patient Prefer Adherence 2021; 15:2793-2807. [PMID: 34934309 PMCID: PMC8684431 DOI: 10.2147/ppa.s333923] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/01/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Knowledge about the priorities and preferences of people living with dementia (PwD) might help to individualize treatment, care, and support, which could improve patient-related outcomes. This study aimed to summarize preferences of PwD or people with mild cognitive impairment (MCI), considering all relevant aspects of health care and everyday life. METHODS We conducted a systematic literature review and included studies about patient preferences published in English between January 1, 1990 and October 28, 2019. The inclusion criteria were that preferences were elicited directly by PwD or patients with MCI. We used the International Consortium for Health Outcomes Management value set for dementia to categorize the preferences into the following topics: a) clinical status, b) symptoms, functioning, and quality of life, and c) sustainability of care. RESULTS Of 578 initially identified studies, 45 met the inclusion criteria. Patients preferred to be informed about the diagnosis as early as possible, especially for anticipatory care planning. They ranked caregiver quality of life as their highest priority. They preferred not to be a burden to others more than their caregivers' mood, their own functional status, or their own distressing behaviors. Furthermore, PwD are eager to participate in medical decisions, especially in those about creating an everyday life routine. PwD preferred their own quality of life, self-efficacy, and emotional well-being. Institutionalized PwD preferred individualized and person-centered care. According to the sustainability of care, PwD preferred to maintain close bonds with their family at the end of their life and wanted to be treated with empathy. CONCLUSION This systematic review provides essential insights into cognitively impaired patients' preferences, which are rarely considered in treatment, care, and support services. Further studies should evaluate whether considering preferences in treatment and care or daily living can improve patient-reported outcomes.
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Affiliation(s)
- Hannah Wehrmann
- Translational Health Care Research, German Center for Neurodegenerative Diseases (DZNE) Site Rostock/Greifswald, Greifswald, Germany
| | - Bernhard Michalowsky
- Translational Health Care Research, German Center for Neurodegenerative Diseases (DZNE) Site Rostock/Greifswald, Greifswald, Germany
- Correspondence: Bernhard Michalowsky Tel +49 3834 86 75 07 Email
| | - Simon Lepper
- Translational Health Care Research, German Center for Neurodegenerative Diseases (DZNE) Site Rostock/Greifswald, Greifswald, Germany
| | - Wiebke Mohr
- Translational Health Care Research, German Center for Neurodegenerative Diseases (DZNE) Site Rostock/Greifswald, Greifswald, Germany
| | - Anika Raedke
- Translational Health Care Research, German Center for Neurodegenerative Diseases (DZNE) Site Rostock/Greifswald, Greifswald, Germany
| | - Wolfgang Hoffmann
- Translational Health Care Research, German Center for Neurodegenerative Diseases (DZNE) Site Rostock/Greifswald, Greifswald, Germany
- Epidemiology of Health Care and Community Health, Institute for Community Medicine & University Medicine Greifswald (UMG), Greifswald, Germany
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25
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Cresp SJ, Lee SF, Moss C. A framework for nurses working in partnership with substitute decision-makers for people living with advanced dementia: A discursive paper. J Clin Nurs 2020; 31:1864-1873. [PMID: 33348467 DOI: 10.1111/jocn.15618] [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: 07/29/2020] [Revised: 12/07/2020] [Accepted: 12/17/2020] [Indexed: 11/28/2022]
Abstract
AIM To describe and discuss clinical strategies for nurses working in partnership with substitute decision-makers for people living with advanced dementia. BACKGROUND By providing person-centred care to patients living with advanced dementia, nurses are positioned to work in partnership with substitute decision-makers who make healthcare decisions related to advanced care. Because the experience of being substitute decision-makers is complex and stressful, nurses need skillsets for working in partnership with substitute decision-makers. DESIGN In this discursive paper, an innovative framework for working in partnership with substitute decision-makers is proposed. METHOD Evidence-based findings from a systematic review provided five domain foci for the partnership framework. In each domain, two clinical strategies were discursively proposed. Clinical strategies were hypothesised from research findings and insights from the authors' nursing experiences. Then, topical literature was searched, and findings were used to support the discursively argued strategies. DISCUSSION To deal with complexities and reduce stress for substitute decision-makers, an innovative Nurse-Substitute Decision-Maker Partnership Framework for use in the context of advanced dementia is proposed and discussed. The partnership framework consists of five domains: Building trust, Exploring emotions, Translating quality of life, Encouraging proactivity and Negotiating families. Within these domains, ten strategies to support the practices of clinical nurses to work in partnership with substitute decision-makers are discussed. RELEVANCE TO CLINICAL PRACTICE In the framework, the ten clinical nursing strategies are designed to provide targeted care to substitute decision-makers in areas that are known to cause complexity and stress to them. The Nurse-Substitute Decision-Maker Partnership Framework has been designed to improve nurse-substitute decision-maker partnerships and reduce the stress experienced by substitute decision-makers as they work through the complexities associated with advanced dementia.
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Affiliation(s)
- Sarah Jane Cresp
- Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic., Australia
| | - Susan Fiona Lee
- Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic., Australia
| | - Cheryle Moss
- Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic., Australia
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De Poli C, Oyebode JR, Binns C, Glover R, Airoldi M. Effectiveness-implementation hybrid type 2 study evaluating an intervention to support 'information work' in dementia care: an implementation study protocol. BMJ Open 2020; 10:e038397. [PMID: 33293389 PMCID: PMC7725094 DOI: 10.1136/bmjopen-2020-038397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Patients with long-term conditions consistently report a lack of information around services and support available to them. This unmet need for information is significant among people with dementia and family carers. A quality improvement intervention is being carried out to tackle this issue as part of a co-creation initiative in the North East of England (UK). The intervention consists of the dissemination (via the local Community Mental Health Services for Older People) of a leaflet about services available to people with dementia and their family carers in the study site. This protocol is reported in accordance with the Standards for Reporting Implementation Studies. METHODS AND ANALYSIS This effectiveness-implementation hybrid type 2 study aims at understanding (1) the unfolding and outcomes of the implementation strategy, (2) the outcomes of the intervention (for people with dementia and family carers, staff implementing the intervention and local service providers) and (3) the contribution of co-creation to the design and implementation of the intervention and its outcomes. The prospective theory of change of the intervention articulated by local stakeholders is used as a reference framework against which to assess the implementation and outcomes of the intervention. Evaluation data will be collected through in-depth interviews with people with dementia and family carers receiving the intervention, staff implementing the intervention and managers from local service providers. Referral data from local service providers will be collected to triangulate the interview data. A focus group with key stakeholders will support the sense-making of findings. The realist configuration of mechanism-context-outcome, operationalised using an information behaviour model, will inform data analysis and interpretation. ETHICS AND DISSEMINATION Ethical and research governance approvals have been obtained from the West Midlands-South Birmingham Research Ethics Committee. The results of the study will be submitted for publication in peer-reviewed journals and disseminated through conferences.
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Affiliation(s)
- Chiara De Poli
- Department of Social Policy and Department of Management, London School of Economics and Political Science, London, UK
| | - Jan R Oyebode
- School of Dementia Studies, University of Bradford, Bradford, West Yorkshire, UK
| | | | - Richard Glover
- NHS North of England Commissioning Support Unit, Durham, UK
| | - Mara Airoldi
- Blavatnik School of Government, University of Oxford, Oxford, UK
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Wiloth S, Kramer B, Kiefer A, Wittek M, Böttner S, Fraas C, Kruse A. [The method of "town hall talks": a study protocol]. Z Gerontol Geriatr 2020; 54:775-780. [PMID: 32997232 DOI: 10.1007/s00391-020-01788-1] [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: 04/18/2020] [Accepted: 09/03/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND AIM Society is responsible for strengthening "caregiver-sensitive" communities based on the principle of social services to the public and are thus oriented towards the appreciation of caring relatives (CR) of people with dementia (PwD), their capability for self-care and participation. This requires methods to emphasize the social value of informal care and to re-evaluate existing support services. The article aims to present the method of "town hall talks". METHOD In 20 communities throughout Germany a public town hall talk in which CR, actors in the community (AC) and the citizens enter into a dialogue, was conducted. In three moderated discussion groups the question of communal responsibility for the provision of resources was addressed. These resources should encourage the CR ability of self-care as well as strategies for their support. In order to make a statement regarding the success of the project planning, three pilot town hall talks were evaluated. PREVIOUS RESULTS The recruitment of the population sample and the organization of the town hall talks in particular are administratively and logistically challenging. The project can only be successful through networking and intensive cooperation between scientists and the communities. In terms of content and logistics, the project planning of the pilot town hall talks was successful. The method received excellent ratings from the majority of the CR and AC. CONCLUSION Regarding the creation of caregiver-sensitive communities the town hall talks promise great potential. The specific benefit of the method for the CR and the community will be examined.
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Affiliation(s)
- Stefanie Wiloth
- Institut für Gerontologie, Ruprecht-Karls-Universität Heidelberg, Bergheimer Straße 20, 69115, Heidelberg, Deutschland.
| | - Birgit Kramer
- Institut für Gerontologie, Ruprecht-Karls-Universität Heidelberg, Bergheimer Straße 20, 69115, Heidelberg, Deutschland
| | - Anna Kiefer
- Institut für Gerontologie, Ruprecht-Karls-Universität Heidelberg, Bergheimer Straße 20, 69115, Heidelberg, Deutschland
| | - Maren Wittek
- Institut für Gerontologie, Ruprecht-Karls-Universität Heidelberg, Bergheimer Straße 20, 69115, Heidelberg, Deutschland
| | - Stephanie Böttner
- Institut für Gerontologie, Ruprecht-Karls-Universität Heidelberg, Bergheimer Straße 20, 69115, Heidelberg, Deutschland
| | - Claudia Fraas
- Institut für Gerontologie, Ruprecht-Karls-Universität Heidelberg, Bergheimer Straße 20, 69115, Heidelberg, Deutschland
| | - Andreas Kruse
- Institut für Gerontologie, Ruprecht-Karls-Universität Heidelberg, Bergheimer Straße 20, 69115, Heidelberg, Deutschland
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Kermel-Schiffman I, Werner P. Beliefs of Israeli Family Caregivers of People with Dementia toward Advance Care Planning. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2020; 16:250-265. [PMID: 32251608 DOI: 10.1080/15524256.2020.1745729] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Family caregivers of people with dementia often must make crucial medical decisions for them that may increase the burden of care experienced. Although undertaking Advance Care Planning (ACP) might reduce their decision-making burden, completion rates remain very low. The present study aimed to explore the common beliefs of family caregivers of people with dementia about undertaking ACP for themselves. A qualitative study was conducted, using a semi-structured questionnaire based on the Theory of Planned Behavior. Face-to-face interviews were conducted with a convenience sample of 20 family caregivers of people with dementia in Israel. The behavioral beliefs expressed by the participants referred to the dual benefits of ACP, for the person who will not be able to make medical decisions at the end of life and for themselves. Participants mentioned that family members and friends were the main persons with whom they would consult in making decisions regarding ACP. Personal characteristics and instrumental factors were mentioned as enablers and barriers to undertaking ACP. Findings from the study provide an important basis for expanding research and for developing interventions that can encourage undertaking ACP.
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Affiliation(s)
| | - Perla Werner
- Department of Community Mental Health, University of Haifa, Haifa, Israel
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Read ST, Toye C, Wynaden D. A qualitative exploration of family carer's understandings of people with dementia's expectations for the future. DEMENTIA 2020; 20:1284-1299. [PMID: 32551874 DOI: 10.1177/1471301220929543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND There is little evidence that outlines how family carers understand the person with dementia's perspective, values and anticipated future needs. Whilst people with dementia should be consulted about their own quality of life and care values, carers - otherwise known as care partners - require such understandings to ensure that the support the person receives into the future upholds their quality of life and is consistent with what they desire. AIM This research aimed to explore and describe family carers' experience of supporting the person with dementia to maintain their quality of life by understanding how carers developed an awareness and understanding of the person with dementia's expectations for the future and what they believed was important for the person to whom they provided care. METHOD Using an application of the grounded theory method, data were collected from 21 carers during semi structured interviews and analysed using constant comparative analysis. FINDINGS Four categories emerged from the data: Knowing the person, Process of decision making, Maintaining normalcy and quality of life and Out of their control. DISCUSSION This study provides insights into how carers developed awareness of the expectations of people with dementia. Findings also illuminate carers' perspectives of the changing nature of decision making during the dementia trajectory. CONCLUSION Understanding the perspective of the person living with dementia is essential to facilitate advocacy and support that is 'person centred' now and into the future. Assisting carers to incorporate this perspective into caring has the potential to be better facilitated by health professionals and merits further investigation.
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Affiliation(s)
- Sheridan T Read
- School of Nursing, Midwifery and Paramedicine, Curtin University, Australia
| | - Christine Toye
- School of Nursing, Midwifery and Paramedicine, Curtin University, Australia
| | - Dianne Wynaden
- School of Nursing, Midwifery and Paramedicine, Curtin University, Australia
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Bhatt J, Walton H, Stoner CR, Scior K, Charlesworth G. The nature of decision-making in people living with dementia: a systematic review. Aging Ment Health 2020; 24:363-373. [PMID: 30521371 DOI: 10.1080/13607863.2018.1544212] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: The objectives of this systematic review were to: 1) understand how people living with dementia are involved in making decisions; 2) explore the different decisional styles and domains of decision-making that people living with dementia experience and 3) identify what influences the level of decisional involvement of people living with dementia.Methods: A systematic review of literature identified studies from Medline, PsycINFO, HAPI and CINAHL databases. Search terms related to decision-making and dementia. Qualitative and quantitative research designs were included. Appraisal of included studies was done using quality ratings. All studies focused on how decision-making took place. Extracted findings were synthesised narratively with concept mapping, conceptualisation and an exploration of connections between studies to develop an overall model of decision-making involvementResults: Fifteen studies fully met the eligibility criteria (thirteen qualitative and two quantitative). All studies had moderate (n = 10) to high (n = 5) quality ratings. Participants were predominantly people living with dementia (n = 13), Parkinson's disease and stroke. The model of decision-making encompasses four decisional styles (managed autonomy, mutual, reductive and delegated) determined by different degrees of involvement from the person living with dementia and their supporter. The decisional style implemented was influenced by the presence or absence of background (the Freedom of Choice framework) and contextual factors (risk, relationships and resources).Conclusion: Decision-making in dementia is complex and influenced by many factors beyond cognitive impairment alone. This review indicates that decision-making in dementia takes place through decisional styles, determined by unique levels of involvement from people living with dementia and their carers.
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Affiliation(s)
- Jem Bhatt
- Research Department of Clinical, Educational and Health Psychology, Faculty of Brain Sciences, University College London, London, UK
| | - Holly Walton
- Research Department of Clinical, Educational and Health Psychology, Faculty of Brain Sciences, University College London, London, UK
| | - Charlotte R Stoner
- Research Department of Clinical, Educational and Health Psychology, Faculty of Brain Sciences, University College London, London, UK
| | - Katrina Scior
- Research Department of Clinical, Educational and Health Psychology, Faculty of Brain Sciences, University College London, London, UK
| | - Georgina Charlesworth
- Research Department of Clinical, Educational and Health Psychology, Faculty of Brain Sciences, University College London, London, UK
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Miller LM, Whitlatch CJ, Lee CS, Caserta MS. Care Values in Dementia: Patterns of Perception and Incongruence Among Family Care Dyads. THE GERONTOLOGIST 2020; 59:509-518. [PMID: 29546327 DOI: 10.1093/geront/gny008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Persons with dementia (PWDs) often place greater importance on their care values (i.e., maintaining autonomy and social relations, choosing caregivers, avoiding being a burden) than family caregivers (CGs) perceive, which can detract from dementia care planning (e.g., care arrangements or surrogate decisions). Notable variability has been found across family care dyads (PWD and CG) in their perceptions of care values, suggesting that there may be multiple patterns of perception. The purpose of this study was to characterize distinct patterns of perception of care values in family care dyads. DESIGN AND METHODS Using cross-sectional data from 228 community-dwelling family care dyads, we quantified dyads' average perceptions and incongruence in perceptions of the importance of everyday care values using multilevel modeling. These scores were then used in a latent class analysis to identify distinct patterns of perception, with the dyad as the unit of analysis. RESULTS Two distinct patterns of care value perception were identified. 25% of dyads were labeled as "CG underestimating" due to lower average estimations of the importance of PWDs' care values, and a significant amount of dyadic incongruence. Underestimating dyads were characterized by a confirmed diagnosis of dementia, lower cognitive function, and younger age in PWDs, and higher relationship strain in the dyad. IMPLICATIONS Care dyads that fall into an underestimating pattern may be at greater risk for inadequate dementia care planning. Interventions to improve care planning in this higher-risk group may include care values identification with the PWD, strategies for alleviating relationship strain, early-stage planning, and disease education.
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Affiliation(s)
| | - Carol J Whitlatch
- Center for Research and Education, Benjamin Rose Institute on Aging, Cleveland, Ohio
| | - Christopher S Lee
- William F. Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts
| | - Michael S Caserta
- College of Nursing and Center on Aging, The University of Utah, Salt Lake City
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Sinclair C, Gersbach K, Hogan M, Blake M, Bucks R, Auret K, Clayton J, Stewart C, Field S, Radoslovich H, Agar M, Martini A, Gresham M, Williams K, Kurrle S. "A Real Bucket of Worms": Views of People Living with Dementia and Family Members on Supported Decision-Making. JOURNAL OF BIOETHICAL INQUIRY 2019; 16:587-608. [PMID: 31832863 PMCID: PMC6937221 DOI: 10.1007/s11673-019-09945-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 10/09/2019] [Indexed: 06/10/2023]
Abstract
Supported decision-making has been promoted at a policy level and within international human rights treaties as a way of ensuring that people with disabilities enjoy the right to legal capacity on an equal basis with others. However, little is known about the practical issues associated with implementing supported decision-making, particularly in the context of dementia. This study aimed to understand the experiences of people with dementia and their family members with respect to decision-making and their views on supported decision-making. Thirty-six interviews (twenty-one dyadic and fifteen individual) were undertaken with fifty-seven participants (twenty-five people living with dementia and thirty-two family members) across three states in Australia. Interpretative Phenomenological Analysis (IPA) was used as the methodological approach, with relational autonomy as a theoretical perspective. We identified two overarching themes relating to participants' experiences with decision-making: "the person in relationship over time" and "maintaining involvement." Participant views on the practical issues associated with supported decision-making are addressed under the themes of "facilitating decision-making," "supported decision-making arrangements," "constraints on decision-making," and "safeguarding decision-making." While participants endorsed the principles of supported decision-making as part of their overarching strategy of "maintaining involvement" in decision-making, they recognized that progressive cognitive impairment meant that there was an inevitable transition toward greater involvement of, and reliance upon, others in decision-making. Social and contextual "constraints on decision-making" also impacted on the ability of people with dementia to maintain involvement. These themes inform our proposal for a "spectrum approach" to decision-making involvement among people living with dementia, along with recommendations for policy and practice to assist in the implementation of supported decision-making within this population.
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Affiliation(s)
- Craig Sinclair
- Rural Clinical School of Western Australia, University of Western Australia Albany Centre, 31 Stirling Terrace, Albany, Western Australia, 6330, Australia.
| | - Kate Gersbach
- Brightwater Group, 3/355 Scarborough Beach Road, Osborne Park, Western Australia, 6017, Australia
| | - Michelle Hogan
- Helping Hand Aged Care, 34 Molesworth Street, North Adelaide, South Australia, 5006, Australia
| | - Meredith Blake
- UWA Law School, University of Western Australia, 35 Stirling Highway, Crawley, Western Australia, 6009, Australia
| | - Romola Bucks
- School of Psychological Science, University of Western Australia, 35 Stirling Highway, Crawley, Western Australia, 6009, Australia
| | - Kirsten Auret
- Rural Clinical School of Western Australia, University of Western Australia Albany Centre, 31 Stirling Terrace, Albany, Western Australia, 6330, Australia
| | - Josephine Clayton
- HammondCare Centre for Learning & Research in Palliative Care and Northern Clinical, School, Greenwich Hospital, University of Sydney, Sydney, New South Wales, 2065, Australia
| | - Cameron Stewart
- University of Sydney Law School, University of Sydney, Sydney, New South Wales, 2006, Australia
| | - Sue Field
- UWA Law School, University of Western Australia, Hackett Drive, Crawley, Western Australia, 6009, Australia
| | - Helen Radoslovich
- Helping Hand Aged Care, 34 Molesworth Street, North Adelaide, South Australia, 5006, Australia
| | - Meera Agar
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, (IMPACCT), University of Technology Sydney, 235 Jones Street, Ultimo, New South Wales, 2007, Australia
| | - Angelita Martini
- Brightwater Group, 3/355 Scarborough Beach Road, Osborne Park, Western Australia, 6017, Australia
| | - Meredith Gresham
- HammondCare Dementia Centre, 97 River Road, Greenwich, New South Wales, 2065, Australia
| | - Kathy Williams
- Dementia Australia Consumer Dementia Network, National Office, 42 MacQuarie Street, Barton, Canberra, Australian Capital Territory, 2600, Australia
| | - Sue Kurrle
- Northern Clinical School, University of Sydney, Sydney, New South Wales, 2006, Australia
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Van Rickstal R, De Vleminck A, Aldridge MD, Morrison SR, Koopmans RT, van der Steen JT, Engelborghs S, Van den Block L. Limited engagement in, yet clear preferences for advance care planning in young-onset dementia: An exploratory interview-study with family caregivers. Palliat Med 2019; 33:1166-1175. [PMID: 31342861 DOI: 10.1177/0269216319864777] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The significance of advance care planning in dementia is widely acknowledged. Despite the suggestion that younger people with dementia and their family might have distinct needs and preferences in this area, studies on advance care planning in young-onset dementia are absent. AIM We aim to explore (1) whether family caregivers had already engaged in advance care planning with patients and/ or professionals and the accompanying reasons and (2) family caregivers' preferences for how to ideally engage in the process with patients, family and professionals. DESIGN A qualitative study was conducted: we analysed semi-structured interviews (n = 15) through the method of constant comparative analysis. SETTING/PARTICIPANTS We included Flemish family caregivers of persons with young-onset dementia. RESULTS Plans for the future typically concerned non-medical affairs. Participants' limited engagement in advance care planning was clarified through several reasons: not considering it useful, hindering patient behaviour, adopting a day-to-day attitude, caregivers emotionally protecting themselves and uncertainty about patients' cognitive competence. However, endorsement for advance care planning showed from respondents' preferences that it should be initiated timely, by a third party, and emphasize patients' remaining capacities. Finally, the need for information and high-quality care emerged. CONCLUSION A gap of knowledge, of information and in care intertwiningly hinder advance care planning. In young-onset dementia, engaging in advance care planning is not an option equally accessible as not doing so. Policy makers, institutions and professionals could reflect on their responsibility in providing these patients and caregivers an actual choice to engage in advance care planning or not.
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Affiliation(s)
- Romy Van Rickstal
- Department of Family Medicine and Chronic Care, End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | - Aline De Vleminck
- Department of Family Medicine and Chronic Care, End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | - Melissa D Aldridge
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,James J. Peters Veterans Affairs Medical Center, New York, NY, USA
| | - Sean R Morrison
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,James J. Peters Veterans Affairs Medical Center, New York, NY, USA
| | - Raymond T Koopmans
- Department of Primary and Community Care, Radboud Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands.,Joachim and Anna, Centre for Specialized Geriatric Care, Nijmegen, The Netherlands
| | - Jenny T van der Steen
- Department of Primary and Community Care, Radboud Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Sebastiaan Engelborghs
- Institute Born-Bunge, University of Antwerp, Antwerp, Belgium.,Department of Neurology, UZ Brussel, Brussels, Belgium and Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Lieve Van den Block
- Department of Family Medicine and Chronic Care, End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
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Yates L, Csipke E, Moniz-Cook E, Leung P, Walton H, Charlesworth G, Spector A, Hogervorst E, Mountain G, Orrell M. The development of the Promoting Independence in Dementia (PRIDE) intervention to enhance independence in dementia. Clin Interv Aging 2019; 14:1615-1630. [PMID: 31571842 PMCID: PMC6748161 DOI: 10.2147/cia.s214367] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 07/07/2019] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Support after a diagnosis of dementia may facilitate better adjustment and ongoing management of symptoms. The aim of the Promoting Independence in Dementia (PRIDE) study was to develop a postdiagnostic social intervention to help people live as well and as independently as possible. The intervention facilitates engagement in evidence-based stimulating cognitive, physical and social activities. METHODS Theories to promote adjustment to a dementia diagnosis, including theories of social learning and self-efficacy, were reviewed alongside self-management and the selective optimization model, to form the basis of the intervention. Analyses of two longitudinal databases of older adults, and qualitative analyses of interviews of older people, people with dementia, and their carers about their experiences of dementia, informed the content and focus of the intervention. Consensus expert review involving stakeholders was conducted to synthesize key components. Participants were sourced from the British NHS, voluntary services, and patient and public involvement groups. A tailored manual-based intervention was developed with the aim for this to be delivered by an intervention provider. RESULTS Evidence-based stimulating cognitive, physical, and social activities that have been shown to benefit people were key components of the proposed PRIDE intervention. Thirty-two participants including people with dementia (n=4), carers (n=11), dementia advisers (n=14), and older people (n=3) provided feedback on the drafts of the intervention and manual. Seven topics for activities were included (eg, "making decisions" and "getting your message across"). The manual outlines delivery of the intervention over three sessions where personalized profiles and plans for up to three activities are developed, implemented, and reviewed. CONCLUSION A manualized intervention was constructed based on robust methodology and found to be acceptable to participants. Consultations with stakeholders played a key role in shaping the manualized PRIDE intervention and its delivery. Unlike most social interventions for dementia, the target audience for our intervention is the people with dementia themselves.
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Affiliation(s)
- Lauren Yates
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Emese Csipke
- Division of Psychiatry, University College London, London, UK
| | - Esme Moniz-Cook
- Department of Psychological Health and Well-Being, Faculty of Health Sciences, School of Health and Social Work, University of Hull, Hull, UK
| | - Phuong Leung
- Division of Psychiatry, University College London, London, UK
| | - Holly Walton
- Department of Applied Health Research, University College London, London, UK
| | - Georgina Charlesworth
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Aimee Spector
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Eef Hogervorst
- National Centre for Sports and Exercise Medicine, Loughborough University, Loughborough, UK
| | - Gail Mountain
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Martin Orrell
- Institute of Mental Health, University of Nottingham, Nottingham, UK
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Pritchard-Jones L. Exploring the potential and the pitfalls of the United Nations Convention on the Rights of Persons with Disabilities and General Comment no. 1 for people with dementia. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2019; 66:101467. [PMID: 31706380 DOI: 10.1016/j.ijlp.2019.101467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 05/15/2019] [Indexed: 06/10/2023]
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Kerpershoek L, Wolfs C, Verhey F, Jelley H, Woods B, Bieber A, Bartoszek G, Stephan A, Selbaek G, Eriksen S, Sjölund B, Hopper L, Irving K, Marques MJ, Gonçalves‐Pereira M, Portolani D, Zanetti O, Vugt M. Optimizing access to and use of formal dementia care: Qualitative findings from the European Actifcare study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:e814-e823. [PMID: 31293018 PMCID: PMC6851600 DOI: 10.1111/hsc.12804] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 05/27/2019] [Accepted: 06/04/2019] [Indexed: 06/09/2023]
Abstract
This paper reports on qualitative data from the Actifcare study investigating experiences, attitudes, barriers and facilitators concerning access to and use of formal care. A total of 85 semi-structured in-depth interviews were conducted in eight European countries. Results were analysed with a deductive content analysis, first within country and then integrated in a cross-national analysis. Overall, analysis of the in-depth interviews revealed two major themes with five subcategories. The results can be summarised in an optimal pathway for access to dementia care. This pathway includes fixed factors such as disease-related factors and system-related factors. In addition there are personal factors that are subject to change such as attitudes towards care. An important finding consisted of the necessity of having sufficient information about the disease and available care and having a key contact person to guide you through the process of finding suitable care while monitoring your needs. In addition, it is important to involve your social network as they can take on care-giving tasks. It is helpful to have a diagnosis (in most countries). Concerning decision-making, the person closest to the person with dementia is in the majority of cases the one who makes the ultimate decision to access and use services and he/she should therefore be supported in this process. These results provide insight into the factors that influence the pathway to formal care use and help professionals to enhance access to formal dementia care by focusing on factors that can be modified.
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Affiliation(s)
| | - Claire Wolfs
- Alzheimer Centre LimburgMaastricht UniversityMaastrichtNetherlands
| | - Frans Verhey
- Alzheimer Centre LimburgMaastricht UniversityMaastrichtNetherlands
| | | | | | - Anja Bieber
- Martin‐Luther University Halle‐WittenbergHalleGermany
| | | | | | - Geir Selbaek
- Norwegian National Advisory Unit on Ageing and HealthVestfold HospitalTonsbergNorway
- Centre for Old Age Psychiatry ResearchInnlandet Hospital TrustOttestadNorway
- Faculty of MedicineUniversity of OsloOsloNorway
| | - Siren Eriksen
- Norwegian National Advisory Unit on Ageing and HealthVestfold HospitalTonsbergNorway
| | - Britt‐Marie Sjölund
- Aging Research Center (ARC), Department of Neurobiology, Care Sciences and Society (NVS)Karolinska Institutet and Stockholm UniversityStockholmSweden
- Faculty of Health and Occupational Studies, Department of Health and Caring SciencesUniversity of GävleGävleSweden
| | - Louise Hopper
- School of Nursing and Human SciencesDublin City UniversityDublinIreland
| | - Kate Irving
- School of Nursing and Human SciencesDublin City UniversityDublinIreland
| | - Maria J. Marques
- CEDOC, Nova Medical School, Faculdade de Ciências MédicasUniversidade Nova de LisboaLisbonPortugal
| | - Manuel Gonçalves‐Pereira
- CEDOC, Nova Medical School, Faculdade de Ciências MédicasUniversidade Nova de LisboaLisbonPortugal
| | - Daniel Portolani
- IRCCS Istituto Centro San Giovanni di Dio FatebenefratelliBresciaItaly
| | - Orazio Zanetti
- IRCCS Istituto Centro San Giovanni di Dio FatebenefratelliBresciaItaly
| | - Marjolein Vugt
- Alzheimer Centre LimburgMaastricht UniversityMaastrichtNetherlands
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Development of a self-management support program for caregivers of relatives with dementia in Shanghai. Geriatr Nurs 2019; 41:98-104. [PMID: 31402185 DOI: 10.1016/j.gerinurse.2019.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 07/17/2019] [Accepted: 07/17/2019] [Indexed: 11/20/2022]
Abstract
The purposes of this study were to develop a caregiver-education booklet and to elicit intervention strategies for a self-management support program for caregivers of relatives with dementia in Shanghai. Two focus groups with 32 eligible caregivers were conducted to clarify the knowledge and information about the scope and main points of, as well as the barriers to and support for caregiver self-management. Content analysis revealed that the main challenges caregivers faced were a lack of reliable and accessible information about dementia care, frustrations related to communication with the care recipient, disturbances in daily routines, and unfamiliarity with and/or difficulty in balancing the caregiver's own health needs. Access to individualized and reliable instruction and/or group support were the major types of support the participants expected for their self-management. Based on the findings and relevant literature, an illustrated caregiver-education booklet was developed and the intervention strategies were also discussed for the program.
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Acceptability of Robots to Assist the Elderly by Future Designers: A Case of Guangdong Ocean University Industrial Design Students. SUSTAINABILITY 2019. [DOI: 10.3390/su11154139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The development of robot technology provides many possibilities for the life support of the elderly. This study explored the acceptability of robots to assist the elderly from the perspective of future designers. A quantitative questionnaire (58 copies) and a qualitative one-to-one interview (10 people) were conducted to explore the attitude of future designers towards the use of robots to assist the elderly. One-sample Wilcoxon signed-rank test statistic was used to analyze the data of the questionnaire. The results show that the mean and median of 11 of the 12 dimensions of the acceptability questionnaire are greater than 3 (3 represents uncertain and neutral attitude), and 10 have statistical significance (p < 0.05). Also, the interview results show the positive attitude of future designers. The research shows that future designers hold a positive and open attitude towards the use of robots to assist the elderly. The research findings can help people understand the attitude of future designers and provide some reference for subsequent robot design and development.
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Sinclair C, Bajic-Smith J, Gresham M, Blake M, Bucks RS, Field S, Clayton JM, Radoslovich H, Agar M, Kurrle S. Professionals' views and experiences in supporting decision-making involvement for people living with dementia. DEMENTIA 2019; 20:84-105. [PMID: 31349752 DOI: 10.1177/1471301219864849] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The provision of supported decision-making for people living with disabilities is an emerging area of practice and rights-based law reform, and is required under international law. OBJECTIVES This qualitative study aimed to understand how Australian health and legal professionals conceptualised their professional roles in the practice of providing decision-making support for people living with dementia. METHODS The methods were informed by grounded theory principles. In-depth, semi-structured interviews were conducted with 28 health and legal professionals involved in providing care or services for people with dementia. Interviews explored how professionals described their practice of providing support for decision-making and how they conceptualised their roles. The analysis was underpinned by the theoretical perspective of symbolic interactionism. RESULTS Participants described providing support across a range of decision domains, some of which were specific to their professional role. Four key themes were identified: 'establishing a basis for decision-making', 'the supportive toolbox', 'managing professional boundaries' and 'individualist advocacy versus relational practice'. Participants identified a range of generic and specialised techniques they used to provide support for people with dementia. These techniques were applied subject to resource limitations and perceived professional obligations and boundaries. A continuum of professional practice, ranging from 'individualist advocacy' to 'relational practice' describes the approaches adopted by different professionals. DISCUSSION Professionals conceptualised their role in providing support for decision-making through the lens of their own profession. Differences in positioning on the continuum of 'individualist advocacy' through to 'relational practice' had practical implications for capacity assessment, engaging with persons with impaired decision-making capacity, and the inclusion of supporters and family members in decision-making processes. Further progress in implementing supported decision-making (including through law and policy reform) will require an understanding of these inter-professional differences in perceived roles relating to the practice of providing decision-making support.
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Affiliation(s)
- Craig Sinclair
- Rural Clinical School of Western Australia, University of Western Australia, Australia; Centre of Excellence in Population Ageing Research, University of New South Wales, Australia
| | | | | | - Meredith Blake
- UWA Law School, University of Western Australia, Australia
| | - Romola S Bucks
- School of Psychological Science, University of Western Australia, Australia
| | - Sue Field
- UWA Law School, University of Western Australia, Australia
| | - Josephine M Clayton
- HammondCare, Australia; Sydney Medical School, University of Sydney, Australia
| | | | - Meera Agar
- Faculty of Health, University of Technology Sydney, Australia
| | - Susan Kurrle
- Faculty of Medicine and Health, University of Sydney, Australia
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Abstract
UNLABELLED ABSTRACTObjectives:Dementia often limits the agency of the person to such an extent that there is need for external support in making daily life decisions. This support is usually provided by family members who are sometimes legally empowered to engage in decision-making on behalf of the person for whom they care. However, such family carers receive little or no information on how to best provide support when there is a lack of capacity. This may have an impact on the agency of the person with dementia. This review explores the experience of agency in people living with dementia. DESIGN A systematic search was conducted on IBSS, MedLine, PsychINFO, EMBASE, and CINAHL. Two independent researchers screened the studies and conducted the quality appraisal. We used meta-ethnography for data analysis. As part of the synthesis, we identified behavioral mechanisms underlying the process of decision-making and looked at how the support of carers comes into play in making deliberate choices. RESULTS The meta-ethnography involved 20 studies. Three levels of third-order constructs were identified, each describing a decision-making pathway and reflecting the degree of autonomy of the person with dementia: autonomous decision-making, shared decision-making, and pseudo decision-making. Findings highlight those inter-relational processes that promote or negatively impact on the agency of people with dementia. CONCLUSIONS Our review will provide health and social care personnel with an understanding of the role of the carer in the decision-making process, and therefore which mechanisms need to be promoted or discouraged through training.
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Harrison Dening K, Sampson EL, De Vries K. Advance care planning in dementia: recommendations for healthcare professionals. Palliat Care 2019; 12:1178224219826579. [PMID: 30833812 PMCID: PMC6393818 DOI: 10.1177/1178224219826579] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 01/04/2019] [Indexed: 11/17/2022] Open
Abstract
The process of advance care planning in dementia is far from straightforward; as dementia progresses, the ability to consider future thoughts and actions becomes compromised, thus affecting decision-making abilities. Family carers find themselves increasingly in a position where they need to inform, or directly make, decisions on behalf of the person with dementia. This article discusses the context and importance of a palliative care approach and recommends rationales and strategies for healthcare professionals to support families affected by dementia to better plan for their future care.
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Affiliation(s)
- Karen Harrison Dening
- Research & Publications, Dementia UK, London, UK; School of Nursing and Midwifery, De Montfort University, Leicester, UK
| | - Elizabeth L Sampson
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Kay De Vries
- School of Nursing and Midwifery, De Montfort University, Leicester, UK
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CE: Original Research: New Acute Symptoms in Older Adults with Cognitive Impairment: What Should Family Caregivers Do? Am J Nurs 2019; 119:22-29. [PMID: 30741762 DOI: 10.1097/01.naj.0000554006.31272.d1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
: Background: When older adults with cognitive impairment develop new physical or behavioral symptoms, their family caregivers face a difficult decision: whether and when to seek professional medical care. Most family caregivers lack formal training in assessment and may have difficulty making such decisions. The Veterans Health Administration's home-based primary care (HBPC) program, which is widely available, offers community-dwelling frail veterans and their family caregivers guidance, with the goal of reducing hospitalization and institutionalization in long-term care facilities. OBJECTIVE This study sought to assess the frequency with which family caregivers of cognitively impaired older adults sought prehospital guidance from health care professionals when that resource was available to them, and to describe the characteristics of such events. METHODS This study used a retrospective chart review of patients who were enrolled in the Orlando Veterans Affairs Medical Center HBPC program for at least one month between October 1, 2013, and September 30, 2014; had a diagnosis indicative of cognitive impairment (Alzheimer's disease, vascular dementia, or mild cognitive impairment); had a dedicated family caregiver; and were not enrolled in hospice care. Data were collected from data collection templates and nurses' narrative notes. Univariate descriptive analyses were conducted regarding the type of staff contacted by family caregivers, the presenting diagnoses, the guidance offered by staff, and the number of unplanned acute care encounters. RESULTS Among the 215 patients studied, there were 254 unplanned acute care encounters (including ED visits followed by discharge to home and ED visits resulting in hospital admission). Family caregivers sought guidance from a health care professional 22% of the time before such an encounter. The presenting clinical issues were most often new problems (43%) that included falls, feeding tube problems, fever, new pain, rash or other skin problems, and unexplained edema. Overall, 25% of all unplanned acute care encounters were for reasons considered potentially avoidable. About half of the patients who were subsequently hospitalized had symptoms of delirium, indicating that their illness had significantly advanced before presentation. CONCLUSIONS It's important for health care professionals to ensure that family caregivers of cognitively impaired older adults can access professional guidance readily when facing decisions about a loved one's care, especially when there is an acute onset of new symptoms. Teaching caregivers how to recognize such symptoms early in order to prevent exacerbations of chronic illness and subsequent hospitalization should be a high priority. Our findings underscore the need to do so, so that caregivers can best use the resources that HBPC programs have (or ought to have) in place, in particular 24/7 guidance and decision assistance.
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Abstract
INTRODUCTION AND OBJECTIVE Palliative care can be of great help to people with dementia during their old ages. The aim of this study was to assess the use of palliative care in patients with dementia. METHODS Search was conducted in PubMed, ScienceDirect, Google Scholar, and Scopus databases. A step-by-step approach was used to identify relevant studies, and related studies of were demarcated and other studies were excluded. This study has used empirical studies, review studies, and guidelines for health organizations in different countries. RESULTS A total of 65 sources were used, of which 24 were completely related to the subject of the study. In related studies, the use of various ways and means of palliative care to improve quality of life, reduce pain, and prevent falling in people with dementia is discussed. DISCUSSION AND CONCLUSION Palliative care can help people with dementia to improve their quality of life; however, more research is needed on the application and proper management of palliative care in patients with dementia.
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Affiliation(s)
- Masoumeh Pandpazir
- Department of Medical Librarianship and Information, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mozhdeh Tajari
- Department of Critical Care Nursing, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Kristiansen ED, Rasmussen G, Andersen EM. Practices for making residents’ wishes fit institutional constraints: a case of manipulation in dementia care. LOGOP PHONIATR VOCO 2019; 44:7-13. [DOI: 10.1080/14015439.2019.1554851] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Gitte Rasmussen
- Department of Language and Communication, The University of Southern Denmark, Odense, Denmark
| | - Elisabeth Muth Andersen
- Department of Language and Communication, The University of Southern Denmark, Odense, Denmark
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Caregivers' Experience of Decision-Making regarding Diagnostic Assessment following Cognitive Screening of Older Adults. J Aging Res 2019; 2018:8352816. [PMID: 30631599 PMCID: PMC6304837 DOI: 10.1155/2018/8352816] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 09/21/2018] [Accepted: 11/04/2018] [Indexed: 11/21/2022] Open
Abstract
Targeted screening for dementia among older adults in primary healthcare has potential benefits such as better clinical outcomes and the opportunity to access services. Cognitive screening can be followed up by further diagnostic assessment to determine a diagnosis of dementia. Unfortunately, the rates of accepting further diagnostic assessment following cognitive screening are low. The objective of this study was to explore the caregivers' decision-making process regarding uptake of diagnostic assessment following positive screening results. A qualitative design was employed, and interpretative phenomenological analysis was used to analyze the data. Three major themes in caregiver decision-making were identified: gathering information, protecting the patient, and balancing obligation and convenience in caregiving. These findings suggest that the decision-making process involved effort to process information through observations of the patient and that caregivers emphasized quality of life.
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Larsen LS, Blix BH, Hamran T. Family caregivers' involvement in decision-making processes regarding admission of persons with dementia to nursing homes. DEMENTIA 2018; 19:2038-2055. [PMID: 30470152 DOI: 10.1177/1471301218814641] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The current Western health policy of ageing in place relies on a triad collaboration among patients, healthcare service providers and family caregivers. Such collaborations presuppose involvement in a vague juridical landscape. This article explores family caregivers' experiences with involvement in and influence on nursing home decision-making processes for persons with dementia. The data consist of 12 in-depth interviews with family caregivers. Using positioning theory, we demonstrate how family caregivers strive to balance their assumed duty to care for the person with their needs to care for themselves. Their involvement (or non-involvement) in the complex decision-making process is demonstrated through the following seven positions: (1) self-condemning determiner, (2) dominant, (3) proponent, (4) saluting, (5) pending, (6) prisoner, and (7) stooge. Furthermore, we discuss why expedient positions are more available for some individuals and the consequences of family caregivers' various positions on the healthcare policy aims of collaboration and equal healthcare services.
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Affiliation(s)
- Lill Sverresdatter Larsen
- Faculty of Health Sciences, Department of Health and Care Sciences and Centre for Care Research North, UiT The Arctic University of Norway, Tromso, Norway
| | - Bodil Hansen Blix
- Faculty of Health Sciences, Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromso, Norway
| | - Torunn Hamran
- Faculty of Health Sciences, Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromso, Norway
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Abstract
UNLABELLED ABSTRACTObjectives:Recent research has demonstrated the challenges to self-identity associated with dementia, and the importance of maintaining involvement in decision-making while adjusting to changes in role and lifestyle. This study aimed to understand the lived experiences of couples living with dementia, with respect to healthcare, lifestyle, and "everyday" decision-making. DESIGN Semi-structured qualitative interviews using Interpretative Phenomenological Analysis as the methodological approach. SETTING Community and residential care settings in Australia. PARTICIPANTS Twenty eight participants who self-identified as being in a close and continuing relationship (N = 13 people with dementia, N = 15 spouse partners). Nine couples were interviewed together. RESULTS Participants described a spectrum of decision-making approaches (independent, joint, supported, and substituted), with these approaches often intertwining in everyday life. Couples' approaches to decision-making were influenced by "decisional," "individual," "relational," and "external" factors. The overarching themes of "knowing and being known," "maintaining and re-defining couplehood" and "relational decision-making," are used to interpret these experiences. The spousal relationship provided an important context for decision-making, with couples expressing a history and ongoing preference for joint decision-making, as an integral part of their experience of couplehood. However, the progressive impairments associated with dementia presented challenges to maintaining joint decision-making and mutuality in the relationship. CONCLUSIONS This study illustrates relational perspectives on decision-making in couples with dementia. Post-diagnostic support, education resources, proactive dyadic interventions, and assistance for spouse care partners may facilitate more productive attempts at joint decision-making by couples living with dementia.
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Cresp SJ, Lee SF, Moss C. Substitute decision makers' experiences of making decisions at end of life for older persons with dementia: A systematic review and qualitative meta-synthesis. DEMENTIA 2018; 19:1532-1559. [PMID: 30253658 DOI: 10.1177/1471301218802127] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Substitute decision makers are important for people with advanced dementia, particularly at the end of life. Substitute decision makers report issues in providing support, and physical and psychological consequences from the role. However, there is no synthesised evidence about how substitute decision makers are affected by and experience making decisions for older persons diagnosed with dementia at end of life. Methodology: A protocol for a qualitative systematic review was developed. Seven articles met both inclusion and research quality criteria following a comprehensive search for published and unpublished studies (January 2007-2017, English language). Meta-synthesis was achieved through meta-aggregation of the results from included studies. RESULTS Meta-aggregation of 20 themes into eight categories resulted in five synthesised findings. The findings were: 'trust'; 'guilt, mistrust and confusion'; 'translating quality of life'; 'negotiating families'; and 'uncertainty and reactivity'. Trust in healthcare personnel positively affected substitute decision makers and supported their adaptability. Substitute decision makers experienced guilt, mistrust, and confusion as they encountered increased complexity in care and health interventions as social needs changed. Substitute decision makers experienced complexities and struggles as they interpreted quality of life and negotiated end of life treatment decisions. Substitute decision makers experienced practical needs to negotiate family as they fulfilled their support roles. Ambiguity in advance care plans, limited knowledge of dementia, end of life uncertainties, and communication issues reduced substitute decision makers' proactivity. Implications: Being a substitute decision maker for people with advanced dementia at end of life is stressful. Health professionals need to be cognizant of substitute decision makers experiences and needs, and identify mechanisms to achieve support and education. The findings generate need for further investigation of interventions to meet the needs of substitute decision makers.
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Affiliation(s)
- Sarah Jane Cresp
- Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
| | - Susan Fiona Lee
- Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
| | - Cheryle Moss
- Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
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Resnik L, Acluche F, Borgia M. The DEKA hand: A multifunction prosthetic terminal device-patterns of grip usage at home. Prosthet Orthot Int 2018; 42:446-454. [PMID: 28914583 DOI: 10.1177/0309364617728117] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Research is needed to understand how upper limb prosthesis users take advantage of multiple grip options. OBJECTIVES To quantify usage of DEKA hand grip patterns during home use and compare patterns of usage at home to test sessions. STUDY DESIGN Observational study design. METHODS Data were collected from 21 subjects. Engineering data on grip were downloaded at various intervals. Proportion of time in each grip was calculated for the first 4 weeks of home use, later months, and test sessions (testing use) and compared statistically across intervals. Exploratory analyses compared grip proportion by DEKA Arm level and prior prosthesis use. RESULTS Three most commonly used grips during home use were power, pinch open, and lateral pinch. There were no significant differences between grip use during the first month and later months. Power grip was used 55% of the time at home and 23% of the time in testing use. Pinch closed, lateral, and chuck grip were used less at home than in tests. Comparisons were by configuration level and prosthetic use and no significant differences were found. CONCLUSION Patterns of DEKA hand grip usage differed between home and test environments, suggesting that users relied on fewer grip patterns at home. Clinical relevance These findings have implications for prosthetic training with multi-articulating terminal devices.
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Affiliation(s)
- Linda Resnik
- Providence VA Medical Center, Providence, RI, USA
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Miller LM, Lee CS, Whitlatch CJ, Lyons KS. Involvement of Hospitalized Persons With Dementia in Everyday Decisions: A Dyadic Study. THE GERONTOLOGIST 2018; 58:644-653. [PMID: 28379352 PMCID: PMC6044333 DOI: 10.1093/geront/gnw265] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Indexed: 11/14/2022] Open
Abstract
Background and Objectives To examine the involvement of persons with dementia (PWDs) in everyday decision making from the perspectives of hospitalized PWDs and their family caregivers, and to identify determinants thereof. Research Design and Methods Using multilevel modeling, we examined cross-sectional data collected prospectively from 42 family care dyads regarding the care values of the PWD. Results Both members of the dyad rated the PWD, on average, as being "somewhat involved". There was a significant amount of variability around the average perceptions of PWD involvement in decision making for both PWDs (χ2 = 351.02, p < .001) and family caregivers (χ2 = 327.01, p < .001). Both PWDs and family caregivers were significantly more likely to perceive greater PWD involvement in decision making when the family caregiver reported the PWD as valuing autonomy. Additionally, PWDs were significantly more likely to report greater involvement when they had greater cognitive function. Finally, family caregivers perceived significantly greater involvement of the patient in decision making when they reported less strain in the relationship. Together, autonomy, relationship strain, cognitive function, and care-related strain accounted for 38% and 46% of the variability in PWDs' and family caregivers' perceptions, respectively, of the PWD's decision-making involvement. Discussion and Implications Although research indicates that decision-making abilities decline with advancing dementia, these results imply that working with families to support PWDs in their value of autonomy and mitigate strain in the dyad's relationship may help prolong PWDs' decision-making involvement.
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Affiliation(s)
| | | | - Carol J Whitlatch
- Benjamin Rose Institute on Aging/Center for Research and Education, Cleveland, OH
| | - Karen S Lyons
- School of Nursing, Oregon Health and Science University, Portland
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