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Oher N, Tingberg J, Bengtsson A. The Design of Health Promoting Outdoor Environments for People with Young-Onset Dementia-A Study from a Rehabilitation Garden. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:1047. [PMID: 39200659 PMCID: PMC11353659 DOI: 10.3390/ijerph21081047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 08/03/2024] [Accepted: 08/05/2024] [Indexed: 09/02/2024]
Abstract
Health-promoting outdoor environments designed for people living with dementia (PLwD) has proved to be an effective non-pharmacological intervention for treatment of symptoms and improved well-being. However, for individuals with Young-Onset Dementia (YOD), who have particular symptoms and needs, the content and design of these environments are underexplored. This study aimed to explore the needs of individuals with YOD in a garden setting, to generate design-related knowledge for 'dementia-friendly' outdoor environments, while contributing to the field of Evidence-Based Design (EBD). An 8-week long nature-based program was carried out in Alnarp's rehabilitation garden, a specifically developed garden based on research from e.g., landscape architecture, environmental psychology and medical science. The study used a triangulation of qualitative methods including six participants with YOD and a multidisciplinary team of five staff members. Content analysis was used for all gathered data, including 17 semi-structured interviews with participants with YOD and with staff. Data collection and analysis was performed based on the evidence-based Quality Evaluation Tool (QET). The study led to a target group adapted version of the QET for people with YOD containing 20 developed environmental qualities for designers to pursue in therapeutic gardens, including the additional quality of Calmness. A progression was noted, as a result of perceived positive effects during the intervention, indicating possible change and development of the group's needs and preferences in the outdoors.
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Affiliation(s)
- Nina Oher
- Department of People and Society, Faculty of Landscape Architecture, Horticulture and Crop Production Sciences, Swedish University of Agricultural Sciences (SLU), Alnarp, P.O. Box 190, 234 22 Lomma, Sweden;
| | - Jonna Tingberg
- Memory Clinic, Skåne University Hospital, 205 02 Malmö, Sweden;
| | - Anna Bengtsson
- Department of People and Society, Faculty of Landscape Architecture, Horticulture and Crop Production Sciences, Swedish University of Agricultural Sciences (SLU), Alnarp, P.O. Box 190, 234 22 Lomma, Sweden;
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Giotas D, Dening KH. Incorporating advance care planning in dementia care. Nurs Older People 2024; 36:20-25. [PMID: 38715540 DOI: 10.7748/nop.2024.e1463] [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] [Accepted: 12/06/2023] [Indexed: 07/30/2024]
Abstract
Recent policy focus in dementia care has been on living well with the condition; however, being able to die well with dementia is of equal importance. Advance care planning (ACP) enables people to consider, express and record their wishes and preferences for palliative and end of life care, however there is a low uptake of ACP in people with dementia. Although ACP discussions should be initiated as soon as possible after a diagnosis of dementia, there are other opportunities and transition points in the person's care during which health and social care professionals could promote, engage in and support ACP discussions. This article considers the importance of ACP in dementia care and uses a case study to explore opportunities for initiating and engaging in ACP with people with dementia.
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Affiliation(s)
- Dionysios Giotas
- Guy's and St Thomas' NHS Foundation Trust, London, England (Admiral Nurse, Haringey GP Federation, London, England at the time of writing)
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Cui X, Wang J, Tang X, Ding D, Wu B, Zhao Q, Wang J. Navigating the Journey of Living with Young-Onset Dementia: Experiences of Spousal Caregivers. J Alzheimers Dis 2024; 101:197-209. [PMID: 39213083 PMCID: PMC11380298 DOI: 10.3233/jad-240249] [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: 09/04/2024]
Abstract
Background Young-onset dementia (YOD) refers to dementia occurring before the age of 65, with Alzheimer's disease being the most common form, posing distinct challenges for spousal caregivers. Objective This study aims to investigate the unique experiences of spousal caregivers of persons with YOD in China, where dementia-specific community care services and primary healthcare professionals are relatively lacking, in order to inform the tailored support services development. Methods This qualitative-design study utilized semi-structured interviews with 11 spousal caregivers of persons with YOD dwelling in the community. Traditional content analysis was employed to analyze the interview data. Results Limited dementia-specific healthcare professionals and low public awareness made diagnosing and accepting YOD a prolonged and challenging journey. Spousal caregivers faced skepticism when seeking diagnosis, exacerbating their burden and emotional stress. Disparities in healthcare professionals and insufficient collaboration between institutions worsened the situation. YOD significantly impacted family dynamics and led to changes in emotional communication within the family. The stigma surrounding YOD raised concerns among spousal caregivers about their children's future in marriage and career, emphasizing genetic risks. Conclusions In settings where dementia-specific community care services and primary healthcare professionals are limited and unevenly distributed, integrating support services at both the primary and community levels is crucial for families dealing with YOD in the community. Additionally, raising public awareness about YOD can foster a more understanding and supportive environment, addressing challenges related to stigma faced by affected families, contributing to increased investment in supporting resources, and encouraging individuals to seek help early on.
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Affiliation(s)
- Xiaoyan Cui
- Fudan University School of Nursing, Shanghai, China
| | - Junqiao Wang
- Fudan University School of Nursing, Shanghai, China
| | - Xueting Tang
- Fudan University School of Nursing, Shanghai, China
| | - Ding Ding
- Institute of Neurology, Huashan Hospital, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Huashan Hospital, Fudan University, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Bei Wu
- Rory Meyers College of Nursing, New York University, New York, NY, USA
| | - Qianhua Zhao
- Institute of Neurology, Huashan Hospital, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Huashan Hospital, Fudan University, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Jing Wang
- College of Health and Human Services, University of New Hampshire, Durham, NH, USA
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Borroni B, Libri I, Rota M, Binetti G, Benussi L, Ghidoni R, Cotelli MS, Fostinelli S, Guerini F, Boffelli S, Magni E, Pengo M, Gennuso M, Bianchi M, Cossu B, Palomba V, Crucitti A, Bianchetti A, Logroscino G, Padovani A. Incidence of young-onset dementia in Italy: The Brescia register study. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2024; 16:e12544. [PMID: 38433744 PMCID: PMC10904882 DOI: 10.1002/dad2.12544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 12/22/2023] [Accepted: 01/02/2024] [Indexed: 03/05/2024]
Abstract
INTRODUCTION The goal of the present work was to assess the incidence of dementia with onset before the age of 65 years (i.e., young-onset dementia [YOD]) and define the frequencies of young-onset Alzheimer's disease (AD), frontotemporal lobar degeneration (FTLD), and dementia with Lewy bodies (DLB) in the general population. METHODS The study was conducted from January 1, 2019 to December 31, 2019 in Brescia province (population: 1,268,455). During the study period, all new YOD cases (incident YOD) were counted, and all patients' records reviewed. The incidence was standardized to the Italian general population in 2019. RESULTS A total of 29 YOD patients were diagnosed. The age-sex standardized incidence rate was 4.58 (95% confidence interval, 3.07-6.58) per 100,000 person-years. No difference in incidence rate between YOD due to AD or FTLD (P = 0.83) and between sexes (P = 0.81) was observed. YOD incidence increased with age, reaching its peak after 60 years. DISCUSSION Presenting neurodegenerative YOD phenotypes encompasses both AD and FTLD. Improved knowledge on YOD epidemiology is essential to adequately plan and organize health services.
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Affiliation(s)
- Barbara Borroni
- Department of Clinical and Experimental SciencesUniversity of BresciaBresciaItaly
- Department of Continuity of Care and FrialtyASST Spedali Civili BresciaBresciaItaly
| | - Ilenia Libri
- Department of Clinical and Experimental SciencesUniversity of BresciaBresciaItaly
| | - Matteo Rota
- Department of Molecular and Translational MedicineUniversity of BresciaBresciaItaly
| | - Giuliano Binetti
- Memory ClinicIRCCS Istituto Centro San Giovanni di Dio FatebenefratelliBresciaItaly
| | - Luisa Benussi
- Molecular Markers LaboratoryIRCCS Istituto Centro San Giovanni di Dio FatebenefratelliBresciaItaly
| | - Roberta Ghidoni
- Molecular Markers LaboratoryIRCCS Istituto Centro San Giovanni di Dio FatebenefratelliBresciaItaly
| | | | - Silvia Fostinelli
- Memory ClinicIRCCS Istituto Centro San Giovanni di Dio FatebenefratelliBresciaItaly
| | - Fabio Guerini
- Medicine and Rehabilitative Unit, Sant'Anna InstituteBresciaItaly
| | | | | | - Marta Pengo
- Neurology Unit, “Città di Brescia” HospitalBresciaItaly
| | | | | | | | | | | | | | - Giancarlo Logroscino
- Center for Neurodegenerative Diseases and the Aging BrainDepartment of Clinical Research in NeurologyUniversity of Bari “Aldo Moro”Pia Fondazione Cardinale G. PanicoTricaseLecceItaly
- Department of Basic Medical SciencesNeuroscience and Sense OrgansUniversity of Bari “Aldo Moro”BariItaly
| | - Alessandro Padovani
- Department of Clinical and Experimental SciencesUniversity of BresciaBresciaItaly
- Department of Continuity of Care and FrialtyASST Spedali Civili BresciaBresciaItaly
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Wilson CF, Turnbull S. Connecting, learning, supporting: Caregivers' experiences of a stress and distress biopsychosocial group intervention. DEMENTIA 2024; 23:23-40. [PMID: 37897035 PMCID: PMC10798010 DOI: 10.1177/14713012231207946] [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: 10/29/2023]
Abstract
BACKGROUND Family caregivers are fundamental in supporting people living with dementia to remain at home, however, psychological distress can occur as a result of their caring role. Research into interventions for caregivers of people living with young-onset dementia, including their experience of and the mediating processes of such interventions, remains limited. METHODS An Interpretative Phenomenological Analysis explored caregiver experiences and influence on caregiving of participating in a "Responding to Distress in Dementia" group. Five family caregivers were interviewed with discussions covering the period from first noticing symptoms to the interview session. RESULTS Within the group experience, four superordinate themes were identified: 'connecting to other caregivers', 'learning about caregiving', 'group factors' and 'reduced caregiver distress'. During the post-group period, three superordinate themes were recognised: 'maintaining support', 'applying learning', and 'normalising caregiving'. CONCLUSIONS The study highlighted several interrelated themes involving creating connections amongst caregivers with similar experiences, social learning, and supportive learning through group structure and facilitation. Many of the processes reflected those found in existing dementia caregiver intervention research. Recommendations included facilitating peer support groups and exploring whole-family approaches.
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Affiliation(s)
- Craig F Wilson
- Institute of Health and Wellbeing, University of Glasgow, UK
| | - Sue Turnbull
- Institute of Health and Wellbeing, University of Glasgow, UK
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Fox S. "Give me the knowledge, and I can do what I want with it, it's my right and my choice": Triangulated perspectives on the disclosure of young onset dementia. DEMENTIA 2023; 22:1757-1775. [PMID: 37505214 PMCID: PMC10644682 DOI: 10.1177/14713012231191958] [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: 07/29/2023]
Abstract
INTRODUCTION Receiving a diagnosis of young onset dementia is particularly distressing; the person under 65 years is often in employment, with financial commitments, young children, and an active social life. Some of the stress experienced by younger people experiencing cognitive changes can be reduced by an early and accurate diagnosis, but this is contingent on the timing of disclosure and a process which is sensitive and appropriate to the person. The study aim was to explore experiences of giving and receiving a diagnosis of young onset dementia, by triangulating the perspectives of the key parties involved. METHODS A qualitative design was employed, using semi-structured interviews. Participants (N = 47) included people with young onset dementia (n = 10), family members (n = 12), and health and social care professionals (n = 25). Thematic analysis and triangulation enabled identification of overall themes across different participant groups. RESULTS All participant groups agreed on key aspects of good disclosure practice, with two overarching themes: The optimal conditions for disclosure, and how best to disclose a diagnosis. Positive experiences of disclosure were prefaced on having the appropriate space and time; having a support person present; clearly labelling the diagnosis; providing appropriate information at the right pace. Other findings include recommendations for longer appointment times, offering additional support for young families, and for carers of people with atypical presentations (e.g. frontotemporal dementia). CONCLUSION Many people with young onset dementia had unsatisfactory disclosure experiences. Health and social care professionals should provide a 'pre-disclosure' appointment, elicit the amount of information the person may want at the point of disclosure of the diagnosis, balance truth and hope, provide contact details for follow-up, and overall be mindful of the individual in front of them. While young onset dementia may be a life-altering diagnosis, a disclosure meeting which is sensitively undertaken can increase the person's agency, coping ability, and ultimately empower them to live well with their diagnosis.
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Affiliation(s)
- Siobhán Fox
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland
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Sullivan MP, Camic PM, Harding E, Stott J, Windle G, Brotherhood EV, Grillo A, Crutch SJ. Situating support for people living with rarer forms of dementia. BMC Geriatr 2023; 23:627. [PMID: 37803252 PMCID: PMC10557369 DOI: 10.1186/s12877-023-04268-4] [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: 06/19/2023] [Accepted: 08/31/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND Awareness of a multitude of diseases that can cause neurodegenerative decline and their unique symptom profiles in the dementia care and support sectors remains limited. Obtaining an accurate diagnosis and post-diagnostic care and support is a challenge for many people and their families. As part of a larger study examining multi-component forms of support for people living with rarer dementias, the aim of this present study was to examine how rare dementia was situated within the complex social groupings, their organization and embedded discursive constructions that broadly form dementia care and support delivery. METHODS Adopting a situational analysis approach, we undertook an examination of public documents and organizational websites within the support sector for people living with dementia in Canada, England, and Wales. We also surveyed professionals to further explore the situation at the point of care and support delivery. Consistent with our approach, data collection and analysis occurred concurrently including the development of a series of analytic maps. RESULTS Recognizing the complexities within the situation, our findings provided new insights on the situated structures for support action and the discursive representations that illuminate both the limitations of the current support landscape and possibilities for a more flexible and tailored rare dementia support. Alongside, the predominant universal versus tailored support positionings within our data reinforced the complexity from which a promising new social space for people living with rarer dementias is being cultivated. CONCLUSIONS The social worlds engaged in supportive action with people living with rare dementia are less visible within the shadow of a universally constructed dementia support milieu and appear to be negotiated within this powerful arena. However, their evolving organization and discursive constructions point to an emerging new social space for people living with rarer conditions.
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Affiliation(s)
- Mary Pat Sullivan
- Faculty of Education and Professional Studies, School of Social Work, Nipissing University, North Bay, ON, Canada.
| | - Paul M Camic
- Dementia Research Centre, Queen Square Institute of Neurology, University College London (UCL), London, UK
| | - Emma Harding
- Dementia Research Centre, Queen Square Institute of Neurology, University College London (UCL), London, UK
| | - Joshua Stott
- Department of Clinical, Educational and Health Psychology, University College London (UCL), London, UK
| | - Gill Windle
- Ageing and Dementia @ Bangor, Dementia Services Development Centre (DSDC), School of Medical and Health Sciences, Bangor University, Bangor, UK
| | - Emilie V Brotherhood
- Dementia Research Centre, Queen Square Institute of Neurology, University College London (UCL), London, UK
| | - Adetola Grillo
- Faculty of Education and Professional Studies, School of Social Work, Nipissing University, North Bay, ON, Canada
| | - Sebastian J Crutch
- Dementia Research Centre, Queen Square Institute of Neurology, University College London (UCL), London, UK
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Oyebode JR, La Fontaine J, Stamou V, O'Malley M, Parkes J, Carter J. Establishing and sustaining high-quality services for people with young onset dementia: the perspective of senior service providers and commissioners. Int Psychogeriatr 2023:1-10. [PMID: 37731261 DOI: 10.1017/s1041610223000443] [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] [Indexed: 09/22/2023]
Abstract
OBJECTIVES We aimed to understand the facilitators to developing and sustaining high-quality services for people with young onset dementia (YOD) and their families/supporters. DESIGN This qualitative study used semi-structured interviews with commissioners and service managers, analyzed using inductive thematic analysis. SETTING A purposive sample of providers was selected from diverse areas and contrasting YOD services. PARTICIPANTS Eighteen senior staff from YOD services and two dementia service commissioners took part. MEASUREMENTS For commissioners, key interview topics were experiences of commissioning YOD services, perceived facilitators or barriers, and how future guidance should be structured for ease of use. For service providers, key topics explored experiences of delivering YOD services; what was achievable or challenging; how the service was funded; how it linked with broader provision for YOD in the area; and how guidance should be structured. RESULTS Recorded interviews lasted 30-40 minutes. Seven key facilitators to the development and sustaining of YOD services were identified: having knowledgeable, committed local champions; involvement of people living with YOD and family supporters; initial delivery within existing resources; partnership working within and between sectors; having a reflective, supportive organizational culture; gathering evidence of impact; and having wider support and guidance. CONCLUSIONS Improvements in provision for those with YOD and their families need to be built on understanding of service-level and interpersonal influences as well as on understanding of YOD itself. Our findings highlight a set of facilitators which need to be in place to establish and sustain high-quality YOD services that fit the local context.
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Affiliation(s)
- Jan Rachel Oyebode
- Centre for Applied Dementia Studies, Faculty of Health Studies, University of Bradford, Bradford, UK
| | - Jenny La Fontaine
- Centre for Applied Dementia Studies, Faculty of Health Studies, University of Bradford, Bradford, UK
| | - Vasileios Stamou
- Centre for Applied Dementia Studies, Faculty of Health Studies, University of Bradford, Bradford, UK
| | - Mary O'Malley
- Centre for Applied Mental Health Research, Faculty of Health and Society, University of Northampton, Northampton, UK
| | - Jacqueline Parkes
- Centre for Applied Mental Health Research, Faculty of Health and Society, University of Northampton, Northampton, UK
| | - Janet Carter
- Division of Psychiatry, Faculty of Brain Sciences, Maple House, University College London, London, UK
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Harding E, Rossi-Harries S, Alterkawi S, Waddington C, Grillo A, Wood O, Brotherhood EV, Windle G, Sullivan MP, Camic PM, Stott J, Crutch SJ. 'The oxygen of shared experience': exploring social support processes within peer support groups for carers of people with non-memory-led and inherited dementias. Aging Ment Health 2023; 27:1912-1928. [PMID: 36999880 DOI: 10.1080/13607863.2023.2194848] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 03/18/2023] [Indexed: 04/01/2023]
Abstract
OBJECTIVES To explore support processes and behaviours taking place during online peer support groups for family carers of people living with rare, non-memory-led and inherited dementias (PLWRD). METHODS Twenty-five family carers of PLWRD participated in a series of ongoing online peer support groups on the theme of 'Independence and Identity'. Transcripts from 16 sessions were analysed using qualitative directed content analysis with a coding framework informed by Cutrona & Suhr's (2004) Social Support Behaviour Code (SSBC). RESULTS Most of the social support behaviours outlined in the SSBC were identified within the sessions, along with two novel social support categories - 'Experiential Support' and 'Community Support' - and novel support behaviours including 'Advocacy and Collective Action' and 'Uses Humour'. The SSBC code 'Relationship' appeared to be of central importance. CONCLUSIONS This study sheds light on the unique challenges of the caring context for those affected by non-memory-led and inherited dementias and the significant contributions carers can offer to, and receive from, peers in similar situations. It highlights the importance of services which recognise the value of the informational and emotional expertise of carers of PLWRD and encourages the continued development and delivery of tailored support for these populations.
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Affiliation(s)
- Emma Harding
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Samuel Rossi-Harries
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Shaima Alterkawi
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Claire Waddington
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Adetola Grillo
- School of Social Work, Faculty of Education and Professional Studies, Nipissing University, Nipissing, Ontario, Canada
| | - Olivia Wood
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Emilie V Brotherhood
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Gill Windle
- Dementia Services Development Centre, Bangor University, Bangor, UK
| | - Mary Pat Sullivan
- School of Social Work, Faculty of Education and Professional Studies, Nipissing University, Nipissing, Ontario, Canada
| | - Paul M Camic
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Joshua Stott
- Department of Clinical, Educational, and Health Psychology, UCL Division of Psychology and Language Sciences, UCL, London, UK
| | - Sebastian J Crutch
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
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Harding E, Rossi-Harries S, Gerritzen EV, Zimmerman N, Hoare Z, Proctor D, Brotherhood E, Crutch S, Suárez-González A. "I felt like I had been put on the shelf and forgotten about" - lasting lessons about the impact of COVID-19 on people affected by rarer dementias. BMC Geriatr 2023; 23:392. [PMID: 37370011 DOI: 10.1186/s12877-023-03992-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 04/23/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND The public health measures imposed in many countries to contain the spread of COVID-19 resulted in significant suspensions in the provision of support and care for people with dementia. The negative effects of these measures have been extensively reported. However, little is known about the specific impact on people with young onset, non-memory-led and inherited dementias. This group may have experienced different challenges compared to those with late onset dementia given their non-memory phenotypes and younger age. We explored the impact of the first COVID-19 lockdown on people living with familial Alzheimer's disease, behavioural variant frontotemporal dementia, familial frontotemporal dementia, dementia with Lewy bodies, posterior cortical atrophy and primary progressive aphasia and their carers in the UK and their self-reported strategies for coping. METHODS This was a mixed methods study. An online survey was administered to people with dementia and family carers recruited via Rare Dementia Support. Free-text responses were analysed using framework analysis to identify key issues and themes. RESULTS 184 carers and 24 people with dementia completed the survey. Overall, people with dementia experienced worsening of cognitive symptoms (70%), ability to do things (62%), well-being (57%) and changes to medication (26%) during lockdown. Carers reported a reduction in the support they received (55%) which impacted their own mental health negatively. Qualitative analysis of free-text responses shed light on how the disruption to routines, changes to roles and responsibilities, and widespread disconnection from friends, family and health and social care support varied according to phenotype. These impacts were exacerbated by a more general sense that precious time was being lost, given the progressive nature of dementia. Despite significant challenges, respondents demonstrated resilience and resourcefulness in reporting unexpected positives and strategies for adapting to confinement. CONCLUSIONS This study has highlighted the specific impacts of the COVID-19 restrictions on people with young onset, non-memory-led and inherited dementias, including behavioural variant frontotemporal dementia, primary progressive aphasia and posterior cortical atrophy, and their carers. The specific challenges faced according to diagnosis and the self-reported strategies speak to the importance of - and may inform the development of - tailored support for these underrepresented groups more generally.
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Affiliation(s)
- Emma Harding
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, 8-11 Queen Square, London, WC1N 3BG, UK
| | - Sam Rossi-Harries
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, 8-11 Queen Square, London, WC1N 3BG, UK
| | - Esther Vera Gerritzen
- Institute of Mental Health, Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
| | - Nikki Zimmerman
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, 8-11 Queen Square, London, WC1N 3BG, UK
| | - Zoe Hoare
- NWORTH Clinical Trials Unit, School of Health Sciences, Bangor University, Bangor, UK
| | - Danielle Proctor
- Department of Clinical, Educational, and Health Psychology, UCL Division of Psychology and Language Sciences, UCL, London, UK
| | - Emilie Brotherhood
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, 8-11 Queen Square, London, WC1N 3BG, UK
| | - Sebastian Crutch
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, 8-11 Queen Square, London, WC1N 3BG, UK
| | - Aida Suárez-González
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, 8-11 Queen Square, London, WC1N 3BG, UK.
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Good practice in needs-based post-diagnostic support for people with young onset dementia: findings from the Angela Project. AGEING & SOCIETY 2023. [DOI: 10.1017/s0144686x22001362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Abstract
Evidence on post-diagnostic support for people with young onset dementia is scarce. Previous studies have employed a problem-focused approach; however, evidence on ‘what works’ in real-life practice is essential to develop recommendations for service design and delivery. This study aimed to provide insight into ‘what works’ from the perspectives of people with young onset dementia and their supporters. We gathered free-text responses on positive service experiences via a UK cross-sectional survey. Inductive thematic analysis was used to identify the objectives of positive services and the needs these met. Follow-up interviews enabled in-depth insights from people with diverse diagnoses, ages and social situations. These were analysed using a template drawn from the survey. The 233 survey respondents gave 856 examples of positive support. Analysis of 24 follow-up interviews led to 16 themes clustered under three superordinate themes: ‘maintaining autonomy’, ‘being myself’ and ‘togetherness’. We found that positive services address the disruptions to sense of agency, selfhood and meaningful relationships that are experienced by those with young onset dementia. The study provides an in-depth understanding of the needs met by positive services for younger people with dementia. Our nuanced findings on good practice can inform age-specific guidelines for young onset dementia and indicate how personalisation can work in practice to help people with young onset dementia to maintain identity, autonomy and connections.
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Perin S, Lai R, Diehl-Schmid J, You E, Kurz A, Tensil M, Wenz M, Foertsch B, Lautenschlager NT. Online counselling for family carers of people with young onset dementia: The RHAPSODY-Plus pilot study. Digit Health 2023; 9:20552076231161962. [PMID: 36908377 PMCID: PMC9998420 DOI: 10.1177/20552076231161962] [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: 06/06/2022] [Accepted: 02/17/2023] [Indexed: 03/11/2023] Open
Abstract
Objective Compared to late life dementia, Young Onset Dementia (YOD) has its own distinct challenges, including a lack of specialised and age-appropriate support services. Carers of people with YOD experience higher levels of psychological and physical symptoms, and lower quality of life. This study (RHAPSODY-Plus) assessed the acceptability and feasibility of combining RHAPSODY (Research to Assess Policies and Strategies for Dementia in the Young; a web-based information and skill-building programme for carers of people with YOD) with individually tailored support sessions with health professionals (a social worker and a clinical psychologist) provided via online videoconferencing. Methods Participants (n = 20) were informal carers aged over 18 years, who were caring for a person with YOD (either Alzheimer's disease or frontotemporal dementia type). Participants used the RHAPSODY programme for 4 weeks, then attended 2 support sessions. Participants and the health professionals then attended individual feedback sessions. Feedback was collected via open-ended and Likert-style questions. Results The majority of carers rated the RHAPSODY-Plus programme as good to very good, demonstrating a high level of acceptability. Positive feedback about the programme included being able to receive personal advice additionally to the information provided in RHAPSODY. The healthcare professionals also thought the programme was acceptable and beneficial for access to support. Some limitations in the feasibility of videoconferencing included network and technical issues and the loss of non-verbal communication. Conclusions This online pilot study had a high level of acceptability, demonstrating the potential of an individualised multi-modal intervention for carers of people with YOD which offers opportunities to overcome geographical and service access barriers.
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Affiliation(s)
- Stephanie Perin
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Melbourne, Australia
| | - Rhoda Lai
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Melbourne, Australia
| | - Janine Diehl-Schmid
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany.,kbo-Inn-Salzach-Klinikum, Wasserburg, Germany
| | - Emily You
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Melbourne, Australia
| | - Alexander Kurz
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Maria Tensil
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Michael Wenz
- Schön Clinic Bad Aibling Harthausen, Alzheimer Therapy Centre, Bad Aibling, Germany
| | - Bettina Foertsch
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Nicola T Lautenschlager
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Melbourne, Australia.,NorthWestern Mental Health, Royal Melbourne Hospital, Melbourne, Australia
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13
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Kilty C, Cahill S, Foley T, Fox S. Young onset dementia: implications for employment and finances. DEMENTIA 2023; 22:68-84. [PMID: 36254673 PMCID: PMC9772889 DOI: 10.1177/14713012221132374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND People with young onset dementia face unique challenges. Notably, at time of symptom presentation, many people affected by young onset dementia are still employed with significant financial obligations. The aim of this study was to explore the specific impact that young onset dementia has on continued employment and finances and to identify ways to optimise post-diagnostic approaches in this regard. METHODS Purposive sampling, with a maximum variation technique, was used to recruit a small but diverse range of people with young onset dementia in Ireland. In-depth semi-structured interviews were conducted, and data were analysed using Reflexive Thematic Analysis. In total, 22 interviews were conducted with 10 people with young onset dementia and 12 spouses and children. Two themes were constructed: impact of young onset dementia on (I) employment and (II) finances. FINDINGS Participants' lived accounts showed the devastating effect of a diagnosis of young onset dementia on working life, and the resultant financial, social, and psychological consequences. Participants reported having to leave paid employment early, reported losing contracts and retiring on medical grounds. There were financial implications caused by loss of income, and many additional expenses owing to dementia were incurred. In some families, spouses had to take up employment at the same time as a caring role to mitigate the loss of income, and young children were anxious at the resultant occupational and financial tensions. CONCLUSION People diagnosed with young onset dementia encounter significant challenges associated with employment, and individual and family finances. There is a need for more specific information and guidance from healthcare professionals around employment rights, income support and welfare benefits and the pension status for this group of people. Additionally, healthcare professionals should be cognisant of the additional financial burden people face in young onset dementia when advising on services which incur out-of-pocket costs.
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Affiliation(s)
- Caroline Kilty
- Caroline Kilty, School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, Republic of Ireland.
| | - Suzanne Cahill
- School of Social Work and Social Policy, Trinity College Dublin Centre for Economic and Social Research on Dementia, NUI Galway and Institute of Gerontology, Jonkoping University, Sweden
| | - Tony Foley
- Department of General Practice, 8795University College Cork, Republic of Ireland
| | - Siobhán Fox
- Centre for Gerontology and Rehabilitation, 8795University College Cork, Republic of Ireland
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14
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Novek S, Menec V. Conceptualizing access to community-based supports from the perspectives of people living with young onset dementia, family members and providers. DEMENTIA 2023; 22:180-196. [PMID: 36377262 PMCID: PMC9772890 DOI: 10.1177/14713012221138145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
People living with young onset dementia and their families have significant support needs, but experience difficulties accessing services. This study explored the process of accessing community-based services drawing on semi-structured interviews with people living with dementia, family members and providers in Winnipeg, Canada. Data analysis involved a combination of inductive coding and theoretical analysis using the candidacy framework as a conceptual lens. Forced to navigate services that do not recognize people with young onset dementia as a user group, participants experienced ongoing barriers that generated continuous work and stress for families. Access was constrained by information resources geared towards older adults and restrictive eligibility criteria that constructed people with young onset dementia as "not impaired enough" or "too impaired". At the organizational level, fragmentation and underrepresentation of young onset dementia diminished access. Our findings underscore the need for continuous, coordinated supports alongside broader representation of young onset dementia within research, policy, and practice. We conclude with a discussion of how the candidacy theory could be extended to account for the social and political status of user groups.
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Affiliation(s)
- Sheila Novek
- Sheila Novek, School of Nursing, University of British Columbia.
| | - Verena Menec
- Department of Community Health Sciences, Rady Faculty of Health Sciences, 423134University of Manitoba, Winnipeg, Canada
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15
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Fallahpour M, Nygård L, Asaba E. Communication and engagement as potentiality in everyday life between persons with young onset dementia living in a nursing home and caregivers. Int J Qual Stud Health Well-being 2022; 17:2035305. [PMID: 35133256 PMCID: PMC8925924 DOI: 10.1080/17482631.2022.2035305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives To explore communication and engagement in everyday situations between persons with young-onset dementia (YOD) living in a nursing home (NH) and the caregivers. Methods The study draws on ethnographic methods aligned with participatory design. Three residents with YOD living in a NH and eight staff members were recruited. A narrative approach was used for data collection and analysis. Findings Three narrative vignettes were developed representing everyday situations in which communication and engagement was enacted among residents and caregiver staff: (a) waiting for something to happen, (b) tensions about everyday communication, and (c) negotiating a combined living + working environment. The findings stress a paradoxical tension rooted in the NH as residence and workplace as well as place of calm and place of boredom. The everyday situations are interpreted differently from the perspective of the residents and staff. Conclusion The identified paradox of planned and spontaneous situations influences communication and engagement in everyday life, and the potentiality for active engagement embedded in contexts of units for residents with YOD. The degree to which everyday activities and encounters are redefined and renegotiated is an important part of caregiving practices in NH settings for residents with YOD.
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Affiliation(s)
- Mandana Fallahpour
- Department of Neurobiology, Care Sciences and Society (Nvs), Division of Occupational Therapy, Karolinska Institutet, Stockholm, Sweden
| | - Louise Nygård
- Department of Neurobiology, Care Sciences and Society (Nvs), Division of Occupational Therapy, Karolinska Institutet, Stockholm, Sweden
| | - Eric Asaba
- Department of Neurobiology, Care Sciences and Society (Nvs), Division of Occupational Therapy, Karolinska Institutet, Stockholm, Sweden
- Unit for Research, Education, Development, & Innovation, Stockholms Sjukhem Foundation, Stockholm, Sweden
- Department of Health Sciences, Occupational Science and Occupational Therapy Research Group, Lund University, Lund, Sweden
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16
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Zary N, Healy D, Barry M, Brennan A, Redfern S, Houghton C, Casey D. Key Stakeholders' Experiences and Perceptions of Virtual Reality for Older Adults Living With Dementia: Systematic Review and Thematic Synthesis. JMIR Serious Games 2022; 10:e37228. [PMID: 36563042 PMCID: PMC9823606 DOI: 10.2196/37228] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 06/01/2022] [Accepted: 07/21/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Technology is increasingly being used and evolving in the dementia care landscape. One such technology that has gained traction over the last decade is virtual reality (VR). VR is being applied in many areas of dementia care, including cognitive assessment and training, reminiscence therapy, music therapy, and other recreational VR applications. Despite the plethora of applications, they are often not shaped by the experiences and perceptions of older adults living with dementia. Currently, there is no qualitative evidence synthesis (QES) to explore this area. This review aimed to provide qualitative evidence supporting existing systematic reviews in this area. OBJECTIVE The aim of this QES was to explore key stakeholders' experiences and perceptions of VR for older adults living with dementia. It aimed to explore the barriers and facilitators to VR use and provide recommendations for future design and implementation. METHODS QES was used, which involved a systematic search of 6 databases to identify studies that qualitatively explored key stakeholders' experiences and perceptions of VR for older adults living with dementia. Thematic synthesis was used to integrate the findings of 14 studies (from 15 reports). The Critical Appraisal Skills Programme tool was used to assess the methodological quality of the included studies. The confidence placed in the review findings was assessed using the GRADE-CERQUAL (Confidence in the Evidence from Reviews of Qualitative research). RESULTS A total of 15 reports from 14 studies were included in the review, consisting of a range of levels of VR immersion, stages of dementia, and care contexts. Three analytical themes were generated: stepping into virtuality, a virtual world, and returning to reality. The results indicate the importance of sensitively designing and introducing VR to this population, as older adults living with dementia often have no prior experience of using this technology. VR can be a positive experience for older adults living with dementia and can provide meaningful interactions, positive expressions, and long-term impacts on everyday functioning. However, it should be acknowledged that some negative associations must be accounted for before, during, and after use. CONCLUSIONS This review highlights the positive implications as well as negative associations of VR use. It emphasizes the need for VR design and implementation driven by the needs and views of older adults living with dementia as well as with other key stakeholders. Future research needs to explore the vital role that older adults living with dementia can play in the design process and how they can be empowered to meaningfully design and use this technology.
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Affiliation(s)
| | - David Healy
- School of Psychology, University of Galway, Galway, Ireland
| | - Marguerite Barry
- School of Information and Communication Studies, ADAPT Centre, University College Dublin, Dublin, Ireland
| | - Attracta Brennan
- Engineering and Informatics, University of Galway, Galway, Ireland
| | - Sam Redfern
- Engineering and Informatics, University of Galway, Galway, Ireland
| | | | - Dympna Casey
- School of Nursing and Midwifery, Aras Moyola, Galway, Ireland
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17
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Chirico I, Ottoboni G, Linarello S, Ferriani E, Marrocco E, Chattat R. Family experience of young-onset dementia: the perspectives of spouses and children. Aging Ment Health 2022; 26:2243-2251. [PMID: 34842004 DOI: 10.1080/13607863.2021.2008871] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Although young-onset dementia (YOD) affects the whole family system, this population is still under-represented in literature, and no progress in care provision has been made. Hence, additional evidence is necessary to understand how family and social relationships are affected by YOD and care challenges, as to provide recommendations for clinical practice and service improvement from a family perspective. METHOD Family carers were recruited via one memory clinic and the local Alzheimer's Associations in Italy. Semi-structured interviews explored their experiences with YOD, the impact of the condition on their lives, family and social relationships, and the support and care they received. Transcripts were coded by three researchers and analysed using inductive thematic analysis. RESULTS Thirty-eight interviews were conducted with 26 spouses and 12 adult children. Three themes emerged: 1) Problems around diagnosis, 2) Lack of post-diagnostic support, and 3) Living with YOD as a family. Overall, problems occurred across the dementia pathway. Without appropriate support, it was difficult for families to adjust to living with YOD and to the associated changes in family roles and relationships. CONCLUSIONS Since optimal care depends on good family relationships, better support for families in the adaptation to condition would likely benefit patient care while ensuring social inclusion and health equity for vulnerable groups.
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Affiliation(s)
- Ilaria Chirico
- Department of Psychology, University of Bologna, Bologna, Italy
| | | | - Simona Linarello
- Center for Cognitive Disorders and Dementia, Local Health Care Unit, Bologna, Italy
| | - Elisa Ferriani
- Center for Cognitive Disorders and Dementia, Local Health Care Unit, Bologna, Italy.,Department of Oncology, Local Health Care Unit, Bologna, Italy
| | - Enrica Marrocco
- Center for Cognitive Disorders and Dementia, Local Health Care Unit, Bologna, Italy.,Department of Oncology, Local Health Care Unit, Bologna, Italy
| | - Rabih Chattat
- Department of Psychology, University of Bologna, Bologna, Italy
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18
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Intergenerational family relationships and the impact of behavioural variant frontotemporal dementia (bvFTD): a qualitative longitudinal study. AGEING & SOCIETY 2022. [DOI: 10.1017/s0144686x22001088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Research concerning the reciprocal influence of relationships and dementia largely focuses on dyadic relationships despite evidence that whole families are affected. Furthermore, such research generally considers more common forms of dementia such as Alzheimer's disease. Behavioural variant fronto-temporal dementia (bvFTD) primarily although not exclusively affects people below the age of 65 and is distinctly different in its impact from more common forms of dementia, affecting social cognition and therefore relational functioning. We aimed to develop a detailed understanding of intergenerational family experiences of bvFTD over time. We adopted a social constructivist and pluralist approach, using Narrative Thematic Analysis and Grounded Theory. We interviewed seven families in their own homes, including the person with bvFTD, at up to three time-points every six to nine months from 2012 to 2014, resulting in 46 interviews with 19 family members. Three super-ordinate themes were identified: Theme 1: We before bvFTD: cohesive and connected – disconnected and distant; Theme 2: Challenges experienced by us; and Theme 3: Relational outcomes: a changing we – an entrenched we. Results emphasise bvFTD brought early and significant disruption to family relationships. The interplay of prior relational functioning, involving the nature of the relationship for family members, the specific impact of bvFTD on these relationships and family member's understanding of bvFTD was critical to how each family fared over the duration of the research, and the relational outcomes they experienced. These findings suggest health-care practice could enhance its support for families living with bvFTD, through the development of tailored, family-oriented approaches to assessment and practice. Such approaches are necessary to understand how families work together and identify interventions that address the family-specific challenges bvFTD brings. The provision of tailored, relational-focused and specialised information concerning the experience of living with bvFTD is needed to flexibly address families' needs and expectations.
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19
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How long does it take to diagnose young-onset dementia? A comparison with late-onset dementia. Neurol Sci 2022; 43:4729-4734. [DOI: 10.1007/s10072-022-06056-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 04/02/2022] [Indexed: 10/18/2022]
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20
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Abstract
OBJECTIVES While early diagnosis of younger-onset dementia (YOD) is crucial in terms of accessing appropriate services and future planning, diagnostic delays are common. This study aims to identify predictors of delay to diagnosis in a large sample of people with YOD and to investigate the impact of a specialist YOD service on this time to diagnosis. DESIGN A retrospective cross-sectional study. SETTING The inpatient unit of a tertiary neuropsychiatry service in metropolitan Victoria, Australia. PARTICIPANTS People diagnosed with a YOD. MEASUREMENTS AND METHODS We investigated the following predictors using general linear modeling: demographics including sex and location, age at onset, dementia type, cognition, psychiatric diagnosis, and number of services consulted with prior to diagnosis. RESULTS A total of 242 inpatients were included. The mean time to diagnosis was 3.4 years. Significant predictors of delay included younger age at onset, dementia type other than Alzheimer's disease (AD) and behavioral-variant frontotemporal dementia (bvFTD), and increased number of services consulted. These predictors individually led to an increased diagnostic delay of approximately 19 days, 5 months, and 6 months, respectively. A specialized YOD service reduced time to diagnosis by 12 months. CONCLUSION We found that younger age at onset, having a dementia which was not the most commonly occurring AD or bvFTD, and increasing number of services were significant predictors of diagnostic delay. A novel result was that a specialist YOD service may decrease diagnostic delay, highlighting the importance of such as service in reducing time to diagnosis as well as providing post-diagnostic support.
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21
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Bellass S, Canvin K, McLintock K, Wright N, Farragher T, Foy R, Sheard L. Quality indicators and performance measures for prison healthcare: a scoping review. HEALTH & JUSTICE 2022; 10:13. [PMID: 35257254 PMCID: PMC8902782 DOI: 10.1186/s40352-022-00175-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 02/20/2022] [Indexed: 06/10/2023]
Abstract
BACKGROUND Internationally, people in prison should receive a standard of healthcare provision equivalent to people living in the community. Yet efforts to assess the quality of healthcare through the use of quality indicators or performance measures have been much more widely reported in the community than in the prison setting. This review aims to provide an overview of research undertaken to develop quality indicators suitable for prison healthcare. METHODS An international scoping review of articles published in English was conducted between 2004 and 2021. Searches of six electronic databases (MEDLINE, CINAHL, Scopus, Embase, PsycInfo and Criminal Justice Abstracts) were supplemented with journal searches, author searches and forwards and backwards citation tracking. RESULTS Twelve articles were included in the review, all of which were from the United States. Quality indicator selection processes varied in rigour, and there was no evidence of patient involvement in consultation activities. Selected indicators predominantly measured healthcare processes rather than health outcomes or healthcare structure. Difficulties identified in developing performance measures for the prison setting included resource constraints, data system functionality, and the comparability of the prison population to the non-incarcerated population. CONCLUSIONS Selecting performance measures for healthcare that are evidence-based, relevant to the population and feasible requires rigorous and transparent processes. Balanced sets of indicators for prison healthcare need to reflect prison population trends, be operable within data systems and be aligned with equivalence principles. More effort needs to be made to meaningfully engage people with lived experience in stakeholder consultations on prison healthcare quality. Monitoring healthcare structure, processes and outcomes in prison settings will provide evidence to improve care quality with the aim of reducing health inequalities experienced by people living in prison.
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Affiliation(s)
- Sue Bellass
- Leeds Institute for Health Sciences, University of Leeds, Leeds, UK.
| | - Krysia Canvin
- Leeds Institute for Health Sciences, University of Leeds, Leeds, UK
| | - Kate McLintock
- Leeds Institute for Health Sciences, University of Leeds, Leeds, UK
| | - Nat Wright
- Spectrum Community Health CIC, Wakefield, UK
| | - Tracey Farragher
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, UK
| | - Robbie Foy
- Leeds Institute for Health Sciences, University of Leeds, Leeds, UK
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22
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Loi SM, Walterfang M, Kelso W, Bevilacqua J, Mocellin R, Velakoulis D. A description of the components of a specialist younger-onset dementia service: a potential model for a dementia-specific service for younger people. Australas Psychiatry 2022; 30:37-40. [PMID: 33626305 DOI: 10.1177/1039856221992643] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This narrative paper describes the influences behind the development of, and key components of a specialist younger-onset dementia service located in metropolitan Victoria, Australia. CONCLUSION The Melbourne Young-Onset Dementia Service was established in 2013 and provides diagnosis and ongoing care for people with younger-onset dementia and their families, through collaboration with other medical units, allied health and community services. It is potentially a model for other younger-onset dementia services nationally and internationally.
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Affiliation(s)
- Samantha M Loi
- Neuropsychiatry, NorthWestern Mental Health, Royal Melbourne Hospital, Parkville, Australia.,Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Royal Melbourne Hospital, Parkville, Australia
| | - Mark Walterfang
- Neuropsychiatry, NorthWestern Mental Health, Royal Melbourne Hospital, Parkville, Australia.,Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Royal Melbourne Hospital, Grattan Street, Parkville, Australia.,Florey Institute of Neuroscience and Mental Health, Parkville, Australia
| | - Wendy Kelso
- Neuropsychiatry, NorthWestern Mental Health, Royal Melbourne Hospital, Parkville, Australia.,Department of Psychology, Monash University, Clayton, Australia
| | | | | | - Dennis Velakoulis
- Neuropsychiatry, NorthWestern Mental Health, Royal Melbourne Hospital, Parkville, Australia.,Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Royal Melbourne Hospital, Grattan Street, Parkville, Australia
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23
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Stamou V, La Fontaine J, O'Malley M, Jones B, Parkes J, Carter J, Oyebode JR. Helpful post-diagnostic services for young onset dementia: Findings and recommendations from the Angela project. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:142-153. [PMID: 33951252 DOI: 10.1111/hsc.13383] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Revised: 03/04/2021] [Accepted: 03/15/2021] [Indexed: 06/12/2023]
Abstract
There is a significant lack of evidence regarding optimum models for service provision in young onset dementia (YOD). Our study aim was to gather detailed information about services experienced as helpful by those with YOD and family carers. The objective was to identify the core features of these services to inform service design, delivery and improvements. A qualitative approach based on appreciative inquiry was used, posing open-ended questions about services experienced as helpful, as part of a national UK survey of people with YOD and carers. We used inductive thematic analysis to analyse the free-text responses. The resulting template was used as a basis for analysis of in-depth follow-up interviews, conducted to acquire greater in-depth understanding. Two hundred and thirty-three survey respondents provided 856 examples of helpful support. Twenty-four follow-up interviews were conducted (two with dyads, so 26 participants in total: 8 with people with YOD, 14 with carers, 2 with dyads). Twelve themes capturing the features of helpful services were clustered into three super-ordinate themes. 'Person-centredness' reflects micro levels of person-professional interaction (positive attitude, flexibility, collaborative, user-friendly materials, and in-person). 'Functional consistency' captures the meso level, demonstrating that services were helpful when organised consistently with needs (age-appropriate, holistic, responsive, and accessible). 'Organisational coherence', at the macro level, emphasises the need for service integration, specialist services and service continuity. Key conclusions are that the needs for flexibility and a collaborative stance may be particularly important for those under 65 years with dementia, who have full lives and are used to being in control; to be age-appropriate, helpful services need to provide activities and opportunities suitable for active middle-aged people; and to be holistic, services need to provide for needs associated with rare dementias and be family-centred. Specialist services need to be commissioned and arrangements need to be stable over time to enable continuity.
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Affiliation(s)
- Vasileios Stamou
- Faculty of Health Studies, Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Jenny La Fontaine
- Faculty of Health Studies, Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Mary O'Malley
- Faculty of Health, Education and Society, University of Northampton, Northampton, UK
| | - Bridget Jones
- Department of Economics, Surrey Health Economics Centre, University of Surrey, Guildford, UK
| | - Jacqueline Parkes
- Faculty of Health, Education and Society, University of Northampton, Northampton, UK
| | - Janet Carter
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Jan R Oyebode
- Faculty of Health Studies, Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
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24
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Ruiz-Adame M. A Systematic Review of the Indirect and Social Costs in Early and Young Onset Dementias. J Alzheimers Dis 2021; 85:21-29. [PMID: 34806610 DOI: 10.3233/jad-215204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The World Health Organization has estimated that worldwide around 50 million people have dementia. The World Alzheimer Report estimated that between 2 and 10% of all cases of dementia begin before the age of 65. Early and young onset dementias (EYOD) provoke more working, social, family, and economic consequences than late onset dementias. All general studies about costs of dementias show that most of them are indirect or social costs. Despite that, very few studies have been performed in EYOD. OBJECTIVE To do a systematic review of literature about indirect or social costs in EYOD to know the state of knowledge and to discover gaps that should be filled. METHODS A systematic review was performed in the main database: Scopus, PsychInfo, Web of Science (Web of Science Core Collection, Medline and SciELO), and CINAHL. Additionally, we looked for reviews in Cochrane and in the International Prospective Register Of Systematic Reviews (PROSPERO). RESULTS Most of the studies are about costs of dementias in general, but they do no differentiate costs for the case of EYOD. Many studies highlight the increased costs for EYOD but very little included evidence of that. 135 papers were selected. Finally, only two were studies providing data. EYOD reduce the odds to get or maintain a job. Most of the care is provided by informal caregivers. The costs in EYOD are 39.26% higher among EYOD than in late onset. CONCLUSION There is a lack of studies about social and indirect costs in EYOD. More evidence is needed.
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25
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van de Veen D, Bakker C, Peetoom K, Pijnenburg Y, Papma JM, de Vugt M, Koopmans R. An Integrative Literature Review on the Nomenclature and Definition of Dementia at a Young Age. J Alzheimers Dis 2021; 83:1891-1916. [PMID: 34487041 PMCID: PMC8609678 DOI: 10.3233/jad-210458] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background: There has been growing interest in young people living with dementia. Future research requires consensus on the terminology and operational definition of this group. Objective: The purpose of this integrative review was to explore and include all operational definitions used to define dementia at a young age. Methods: On August 14, 2020, the PubMed, Embase, Cinahl, and PsycInfo databases were searched for empirical and theoretical literature using Google. Various terms to describe and define ‘dementia’ and ‘at a young age’ were used to collect literature concerning terminology; age-related aspects, including cut-off ages and criteria; and etiologies of dementia at a young age. Results: The search yielded 6,891 empirical and 4,660 theoretical publications, resulting in the inclusion of 89 publications, including 36 publications containing an explicit discussion and 53 publications as confirmation. ‘Young-onset dementia’ was the most commonly used term of seven identified terms, in the last two decades. The age of 65 years at symptom onset was used most frequently when considering a total of six upper age limits and four criteria to define a cut-off age. Eight lower age limits and an option for subdivision based on age were included. We identified 251 different etiologies and 27 categories of etiologies. Conclusion: Despite relative consensus on the term young-onset dementia and an age at symptom onset being used as a cut-off criterion, much is still unclear concerning possible etiologies of dementia at a young age. In the current study, controversies were detected for discussion in an international consensus study.
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Affiliation(s)
- Dennis van de Veen
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands.,Radboudumc Alzheimer Center, Nijmegen, the Netherlands.,Florence, Mariahoeve, Center for Specialized Care in Young-Onset Dementia, The Hague, the Netherlands
| | - Christian Bakker
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands.,Radboudumc Alzheimer Center, Nijmegen, the Netherlands.,Groenhuysen, Center for Specialized Geriatric Care, Roosendaal, the Netherlands
| | - Kirsten Peetoom
- Alzheimer Center Limburg, Maastricht University, Maastricht, the Netherlands
| | - Yolande Pijnenburg
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Janne M Papma
- Department of Neurology and Alzheimer Center, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands
| | | | - Marjolein de Vugt
- Department of Neurology and Alzheimer Center, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Raymond Koopmans
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands.,Radboudumc Alzheimer Center, Nijmegen, the Netherlands.,Joachim en Anna, Center for Specialized Geriatric Care, Nijmegen, the Netherlands
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Nwadiugwu M. Early-onset dementia: key issues using a relationship-centred care approach. Postgrad Med J 2021; 97:598-604. [PMID: 32883770 PMCID: PMC8408578 DOI: 10.1136/postgradmedj-2020-138517] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/29/2020] [Indexed: 12/02/2022]
Abstract
People with early-onset dementia have a potential risk of being marginalised with respect to care and social support as a result of the blame and stigma associated with their condition, and because they have reduced access to treatment options and postdiagnostic care. The limited use of community services and the resulting psychological implications are two key issues facing the group and their caregivers. Early diagnosis, behavioural therapies such as talking therapy, meaningful Montessori activities and friendly community services tailored to meet the needs of people with early-onset dementia are relationship-centred care approaches that could be implemented in practice, using the 'Senses Framework' to promote an enriched supportive environment of care with zero tolerance for marginalisation and discriminatory tendencies. Support for caregivers is invaluable in controlling behavioural changes in people with early-onset dementia. A combined approach involving pharmacological and behavioural interventions could be used in severe mood and behavioural changes.
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Affiliation(s)
- Martin Nwadiugwu
- Health and Sport, University of Stirling, Stirling, UK
- Biomedical Informatics, University of Nebraska Omaha, Omaha, Nebraska, USA
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27
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Dixit D, Spreadbury J, Orlando R, Hayward E, Kipps C. Quality of Life Assessments in Individuals With Young-Onset Dementia and Their Caregivers. J Geriatr Psychiatry Neurol 2021; 34:426-433. [PMID: 32643511 PMCID: PMC8326890 DOI: 10.1177/0891988720933348] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Quality of life (QoL) has seldom been investigated or explicitly measured in young-onset dementia (YoD). The aims of this study were (1) to investigate and compare QoL self- and proxy reports in a sample of YoD patients and caregivers using different conceptual assessments of QoL and (2) to examine the relationship between caregiver QoL and both burden and mental health. METHODS There were 52 participants (26 YoD patient-caregiver dyads). The design was cross-sectional and part of a larger longitudinal prospective cohort study of YoD patients and caregivers. Primary measures included generic QoL (World Health Organization Quality of Life-short version [WHOQOL-BREF]), dementia-specific QoL (Quality of Life in Alzheimer's Disease Scale [QoL-AD]), health-related QoL (EQ5D), and a single-item QoL measure. Secondary measures included caregiver burden (Zarit Burden Index), mental health (Hospital Anxiety and Depression Scale), and dementia severity (Clinical Dementia Rating). RESULTS Patient QoL self-reports were higher than caregiver proxy reports on the QoL-AD (P = .001). Patient QoL self-reports for the WHOQOL-BREF (P < .01) and single-item QoL (P < .05) measure were significantly higher than caregiver self-reports. Dementia severity had no relationship with QoL self-reports. Caregiver burden, anxiety, and depression were negatively correlated with QoL when measured using a generic and single-item measure, but not with the health-related measure. DISCUSSION Patients and caregivers show a disparity in QoL reports, with patients tending to report higher QoL. Caregiver burden, anxiety, and depression should be areas targeted for interventions when supporting caregivers.
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Affiliation(s)
- Divyansh Dixit
- Faculty of Medicine, University of Southampton, United Kingdom,Divyansh Dixit, Faculty of Medicine, University of Southampton, South Academic Block, Tremona Road, Southampton SO16 6YD, United Kingdom.
| | - John Spreadbury
- Faculty of Medicine, University of Southampton, United Kingdom,NIHR Applied Research Collaboration Wessex, Southampton, United Kingdom
| | | | - Elaine Hayward
- Wessex Neurological Centre, University Hospital Southampton, Southampton, United Kingdom
| | - Christopher Kipps
- Faculty of Medicine, University of Southampton, United Kingdom,NIHR Applied Research Collaboration Wessex, Southampton, United Kingdom,Wessex Neurological Centre, University Hospital Southampton, Southampton, United Kingdom
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28
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Mayrhofer AM, Greenwood N, Smeeton N, Almack K, Buckingham L, Shora S, Goodman C. Understanding the financial impact of a diagnosis of young onset dementia on individuals and families in the United Kingdom: Results of an online survey. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:664-671. [PMID: 33745216 DOI: 10.1111/hsc.13334] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/07/2021] [Accepted: 02/09/2021] [Indexed: 06/12/2023]
Abstract
Although literature on postdiagnostic support for people affected by young onset dementia acknowledges financial concerns, this topic has remained underresearched. The aim of this study was to explore the financial impact of a diagnosis of young onset dementia on individuals and families. An online survey, comprising binary yes/no, multiple-response and open-ended questions, was codesigned with people living with young onset dementia. The survey was promoted via networks and online platforms. Data were collected from August to October 2019. Survey respondents across the United Kingdom (n = 55) who had received a diagnosis of young onset dementia were aged between 45 and 64, were at different stages of dementia and had been diagnosed with thirteen different types of dementia. Of the 55 respondents, 71% (n = 39) had received assistance from family members when completing the survey. The main financial impact of a diagnosis of young onset dementia resulted from premature loss of income and reduced and often deferred pension entitlements. In some cases, care-costs became unaffordable. Lack of clarity of processes and procedures around needs assessments, carers' assessments and financial assessments by different organisations resulted in some families having to ask for legal advice and, in some cases, involved lengthy appeal processes. Future research needs to involve Adult Social Care and Third Sector organisations to help codesign and test financial management interventions to support people affected by this progressive health condition.
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Affiliation(s)
- Andrea M Mayrhofer
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK
| | - Nan Greenwood
- Faculty of Health, Social Care and Education, St George's University of London and Kingston University, London, UK
| | - Nigel Smeeton
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK
| | - Kathryn Almack
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK
| | | | - Shaheen Shora
- Hertfordshire Partnership University NHS Foundation Trust, Hatfield, UK
| | - Claire Goodman
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK
- CRIPACC, Faculty of Health and Human Sciences, University of Hertfordshire, Hatfield, UK
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Ottoboni G, Stamou V, Chirico I, De Riso L, Allione L, Johannessen A, Chattat R. Needs-appropriate services for people with young onset dementia: The perspectives of healthcare professionals. DEMENTIA 2021; 20:2725-2745. [PMID: 33896232 DOI: 10.1177/14713012211009340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Young onset dementia has become a growing challenge in national healthcare systems. Concerns about the situation have already been expressed; however, they mostly report the views of services end-users. Aimed at finding out useful further improvement, interviews documenting the working experiences of professionals addressing healthcare services to people with young onset dementia (YOD) were analysed qualitatively. The interviews resulted in four themes and twelve categories. The themes regarded services' complexity and responsiveness, the levels of education and knowledge on YOD, the impact that serving people with YOD reflects on staff working experience and quality of life, and a series of proposals aimed at improving services by giving people with YOD and families the provision of care they deserve. Although some of the themes recapped the ones reported in the previous literature, the mixture of internally and externally driven instances represented in the themes depict the complexity of care delivery in the services. Findings are discussed in the light of a pragmatical framework capable of suggesting what changes services should implement to be timely responsive.
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Affiliation(s)
- Giovanni Ottoboni
- Department of Psychology; "Giorgio Prodi" Center for Cancer Research, Alma Mater Studiorum, 9296University of Bologna, Bologna, Italy
| | - Vasileios Stamou
- Department of Psychology, Faculty of Health, Psychology & Social Care, Manchester Metropolitan University, Manchester, UK
| | - Ilaria Chirico
- Department of Psychology, 9296University of Bologna, Bologna, Italy
| | - Laura De Riso
- Department of Psychology, 9296University of Bologna, Bologna, Italy
| | - Luisa Allione
- Department of Psychology, 9296University of Bologna, Bologna, Italy
| | - Aud Johannessen
- Faculty of Health and Social Sciences, Department of Nursing and Health Sciences, University of South-Eastern Norway USN, Norway/ Vestfold Hospital Trust, National Advisory Unit on Ageing and HealthNational Advisory Unit on Ageing and Health, Norway
| | - Rabih Chattat
- Department of Psychology, 9296University of Bologna, Bologna, Italy
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30
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Booth J. Specialist services for people with young-onset dementia (YOD) are associated with better postdiagnostic care quality and satisfaction. Evid Based Nurs 2021; 25:66. [PMID: 33785537 DOI: 10.1136/ebnurs-2020-103361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Jo Booth
- Research Centre for Health (ReaCH), Glasgow Caledonian University, Glasgow, Glasgow, UK
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31
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Sociodemographic and Clinical Characteristics of 1350 Patients With Young Onset Dementia. Alzheimer Dis Assoc Disord 2021; 35:200-207. [DOI: 10.1097/wad.0000000000000435] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 12/15/2020] [Indexed: 11/26/2022]
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32
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Egdell V, Cook M, Stavert J, Ritchie L, Tolson D, Danson M. Dementia in the workplace: are employers supporting employees living with dementia? Aging Ment Health 2021; 25:134-141. [PMID: 31549517 DOI: 10.1080/13607863.2019.1667299] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES As working lives extend and there is better recognition of early-onset dementias, employers need to consider dementia as a workplace concern. With suitable support, people living with dementia can continue employment - although, this is not appropriate for all. The requirement for employers to support employees living with dementia has human rights and legal foundations. This article considers whether employers consider dementia as a workplace concern; and the policies and/or practices available to support employees living with dementia. Thus, it develops understanding of whether employers are meeting their human rights/legislative obligations. METHOD A sequential mixed-methods approach was employed, with data collection undertaken in Scotland (United Kingdom). An online survey was sent to employers across Scotland, with 331 participating. Thirty employer interviews were conducted, with the survey results informing the interview approach. RESULTS The survey and interview data were analyzed separately and then combined and presented thematically. The themes identified were (1) Dementia as a workplace concern, (2) Support for employees living with dementia and (3) Employer policy development and awareness raising. The findings demonstrate dementia awareness, but this knowledge is not applied to employment situations. There was little evidence suggesting that the rights of employees living with dementia are consistently upheld. CONCLUSION This research sends out strong messages about the rights and legal position of person living with dementia which cannot be ignored. The continuing potential of employees living with dementia and their legal rights are not consistently recognized. This highlights the need for robust training interventions for employers.
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Affiliation(s)
- Valerie Egdell
- Newcastle Business School, Northumbria University, Newcastle upon Tyne, UK
| | - Mandy Cook
- Centre for International Research on Care, Labour and Equalities, University of Sheffield, Sheffield, UK
| | - Jill Stavert
- Centre for Mental Health and Capacity Law, Edinburgh Napier University, Edinburgh, UK
| | - Louise Ritchie
- Alzheimer Scotland Centre for Policy and Practice, University of the West of Scotland, Lanarkshire, UK
| | - Debbie Tolson
- Alzheimer Scotland Centre for Policy and Practice, University of the West of Scotland, Lanarkshire, UK
| | - Michael Danson
- Business Management, Heriot-Watt University, Edinburgh, UK
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Spreadbury JH, Kipps CM. Clinical nurse specialist's role in young-onset dementia care. Br J Community Nurs 2020; 25:604-609. [PMID: 33275505 DOI: 10.12968/bjcn.2020.25.12.604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Post-diagnostic care in young-onset dementia (YoD) varies, from something that is occasionally structured, to improvised, to frequently non-existent depending on geographic region. In a few regions in England, a nurse designated to helping families may exist. This study aimed to describe this seldom-observed nursing role and its content. It used an investigative qualitative case study design based on the analysis of two YoD clinical nurse specialists (CNSs) describing the work they did in providing post-diagnostic care to YoD service users. The CNSs address various areas affected by mid-life dementia, including patients' mental health, caregiver stress and families' psycho-social problems. They use various approaches in delivering care, including making home visits, acting as a personal contact for service users and liaising with other health and social care services. Desirable attributes of a CNS service include service users having access to the same CNS throughout their care, receiving timely care and experiencing longer-term support and reassurance. In the post-diagnostic period, service user needs are often more psycho-social than medical, and the CNS role can complement and add value to clinical appointments. The role allows service users to be managed in the community, to receive information, guidance and advice and can prevent and de-escalate problems.
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Affiliation(s)
- John H Spreadbury
- Senior Research Fellow, Faculty of Medicine, University of Southampton; National Institute for Health Research (NIHR), Applied Research Collaboration (ARC), Wessex
| | - Christopher M Kipps
- Consultant Neurologist and Hon Senior Clinical Lecturer, University of Southampton and University Hospital Southampton NHS Foundation Trust; National Institute for Health Research (NIHR), Applied Research Collaboration (ARC), Wessex
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34
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Pu L, Bakker C, Appelhof B, Zwijsen SA, Teerenstra S, Smalbrugge M, Verhey FRJ, de Vugt ME, Zuidema SU, Koopmans RTCM. The Course of Quality of Life and Its Predictors in Nursing Home Residents With Young-Onset Dementia. J Am Med Dir Assoc 2020; 22:1456-1464.e1. [PMID: 33221165 DOI: 10.1016/j.jamda.2020.09.040] [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: 07/10/2020] [Revised: 09/24/2020] [Accepted: 09/28/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To explore the course of quality of life (QoL) and possible resident-related predictors associated with this course in institutionalized people with young-onset dementia (YOD). DESIGN An observational longitudinal study. SETTING AND PARTICIPANTS A total of 278 residents with YOD were recruited from 13 YOD special care units in the Netherlands. METHODS Secondary analyses were conducted with longitudinal data from the Behavior and Evolution in Young-ONset Dementia (BEYOND)-II study. QoL was assessed with proxy ratings, using the Quality of Life in Dementia (QUALIDEM) questionnaire at 4 assessment points over 18 months. Predictors included age, gender, dementia subtype, length of stay, dementia severity, neuropsychiatric symptoms, and psychotropic drug use at baseline. Multilevel modeling was used to adjust for the correlation of measurements within residents and clustering of residents within nursing homes. RESULTS The total QUALIDEM score (range: 0-111) decreased over 18 months with a small change of 0.65 (95% confidence interval -1.27, -0.04) points per 6 months. An increase in several domains of QoL regarding care relationship, positive self-image, and feeling at home was seen over time, whereas a decline was observed in the subscales positive affect, social relations, and having something to do. Residents with higher levels of QoL and more advanced dementia at baseline showed a more progressive decline in QoL over time. Sensitivity analyses indicated a more progressive decline in QoL for residents who died during the follow-up. CONCLUSION AND IMPLICATIONS This study shows that although overall QoL in nursing home residents with YOD was relatively stable over 18 months, there were multidirectional changes in the QoL subscales that could be clinically relevant. Higher levels of QoL and more advanced stages of dementia at baseline predicted a more progressive decline in QoL over time. More longitudinal studies are needed to verify factors influencing QoL in YOD.
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Affiliation(s)
- Lihui Pu
- Department of Primary and Community Care, Medical Center, Radboud University Nijmegen, Nijmegen, the Netherlands; Menzies Health Institute Queensland & School of Nursing and Midwifery, Griffith University, Queensland, Australia
| | - Christian Bakker
- Department of Primary and Community Care, Medical Center, Radboud University Nijmegen, Nijmegen, the Netherlands; Radboudumc Alzheimer Center, Nijmegen, the Netherlands; Groenhuysen, Center for Specialized Geriatric Care, Roosendaal, the Netherlands.
| | - Britt Appelhof
- Department of Primary and Community Care, Medical Center, Radboud University Nijmegen, Nijmegen, the Netherlands; Radboudumc Alzheimer Center, Nijmegen, the Netherlands; Archipel, Landrijt, Knowledge Center for Specialized Care, Eindhoven, the Netherlands
| | - Sandra A Zwijsen
- Department of General Practice and Elderly Care Medicine/EMGO + Institute for Health and Care Research, Amsterdam UMC, Amsterdam, the Netherlands
| | - Steven Teerenstra
- Section Biostatistics, Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Martin Smalbrugge
- Department of General Practice and Elderly Care Medicine/EMGO + Institute for Health and Care Research, Amsterdam UMC, Amsterdam, the Netherlands
| | - Frans R J Verhey
- Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Marjolein E de Vugt
- Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Sytse U Zuidema
- Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Raymond T C M Koopmans
- Department of Primary and Community Care, Medical Center, Radboud University Nijmegen, Nijmegen, the Netherlands; Radboudumc Alzheimer Center, Nijmegen, the Netherlands; De Waalboog "Joachim en Anna," Center for Specialized Geriatric Care, Nijmegen, the Netherlands
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35
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O'Malley M, Parkes J, Campbell J, Stamou V, LaFontaine J, Oyebode JR, Carter J. Receiving a diagnosis of young onset dementia: Evidence-based statements to inform best practice. DEMENTIA 2020; 20:1745-1771. [PMID: 33124442 PMCID: PMC8216318 DOI: 10.1177/1471301220969269] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Introduction Better understanding of patient experience is an important driver for service improvements and can act as a lever for system change. In the United Kingdom, the patient experience is now a central issue for the National Health Service Commissioning Board, clinical commissioning groups and the providers they commission from. Traditionally, dementia care in the United Kingdom has focused predominantly on the individual experience of those with late onset dementia, while the voice of those with young onset dementia has been, comparatively, unheard. This study aims to improve the understanding of the personal experience of younger people undergoing investigation for dementia. Methods A modified Delphi approach was undertaken with 18 younger people with dementia and 18 supporters of people with young onset dementia. Questions were informed by a scoping review of the literature (O’Malley, M., Carter, J., Stamou, V., Lafontaine, J., & Parkes, J. (2019a). Receiving a diagnosis of young onset dementia: A scoping review of lived experiences. Ageing & Mental Health, 0(0), 1-12). Summary individual statements were refined over two rounds to a final list of 29 key statements. Results Twenty-seven of these statements were rated as absolutely essential or very important and included (1) for the general practitioner to identify dementia in younger people, (2) clinicians should be compassionate, empathic and respectful during the assessment and particularly sensitive when providing information about a diagnosis, and (3) remembering that receiving the diagnosis is a lot to absorb for a person with dementia and their supporter. Statistical analyses found no difference in the scoring patterns between younger people with dementia and supporters, suggesting similar shared experiences during the diagnostic process. Conclusion Understanding the uniquely personal experience of young people going through the process of diagnosis for dementia is essential to provide person-centred, needs-led, and cost-effective services. Patient’s values and experiences should be used to support and guide clinical decision-making.
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Affiliation(s)
| | - Jacqueline Parkes
- UoN Dementia Research & Innovation Centre, Faculty of Health, Education and Society, 6087University of Northampton, Northampton, UK
| | - Jackie Campbell
- Faculty of Health, Education and Society, 6087University of Northampton, Northampton, UK
| | | | | | - Jan R Oyebode
- Centre for Applied Dementia Studies, Faculty of Health Studies, 1905University of Bradford, Bradford, UK
| | - Janet Carter
- Faculty of Brain Sciences, Division of Psychiatry, Maple House, 4919University College London, London, UK
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Abstract
Whilst the support requirements of people diagnosed with young onset dementia are well-documented, less is known about what needs to be in place to provide age-appropriate care. To understand priorities for service planning and commissioning and to inform the design of a future study of community-based service delivery models, we held two rounds of discussions with four groups of people affected by young onset dementia (n = 31) and interviewed memory services (n = 3) and non-profit service providers (n = 7) in two sites in England. Discussions confirmed published evidence on support requirements, but also reframed priorities for support and suggested new approaches to dementia care at the community level. This paper argues that involving people with young onset dementia in the assessment of research findings in terms of what is important to them, and inviting suggestions for solutions, provides a way for co-designing services that address the challenges of accessing support for people affected by young onset dementia.
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Affiliation(s)
- Andrea M Mayrhofer
- Andrea M Mayrhofer, Centre for Research in
Public Health and Community Care, University of Hertfordshire, College Lane,
Hatfield AL10 9AB, UK.
| | - Elspeth Mathie
- Centre for Research in Public Health and
Community Care, University of Hertfordshire, Hatfield, UK
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37
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Giebel C, Eastham C, Cannon J, Wilson J, Wilson J, Pearson A. Evaluating a young-onset dementia service from two sides of the coin: staff and service user perspectives. BMC Health Serv Res 2020; 20:187. [PMID: 32143694 PMCID: PMC7060597 DOI: 10.1186/s12913-020-5027-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 02/24/2020] [Indexed: 12/11/2022] Open
Abstract
Background People with young-onset dementia (YOD) can often struggle getting the right treatment. This is because of their frequently different characteristics and needs compared to people with late-onset dementia. The aim of this project was to assess a memory service for its adaptation to the needs and wishes of people with YOD and their carers. Methods This project evaluated a memory service in the North West of England by performing two focus groups with clinical staff and six semi-structured interviews with people with YOD and carers. The focus groups took place on site and lasted one hour each. People with YOD and their carers were identified via the memory clinics caseload and via the local Alzheimer’s Society charity organisation. Both focus groups and interviews were audio-recorded and transcribed, and data were analysed using thematic analysis. The public (a person living with YOD and his carer) were involved from the design stages of the project through to the analysis and dissemination. Results Eleven members of staff with different clinical backgrounds participated in the focus groups and six interviews were held with people with YOD and their carers. Both indicated that whilst the diagnostic process is relatively well conducted at the service, the post-diagnostic service has many gaps. These include limited post-diagnostic support by the service, better enabling peer support, as well as providing meaningful activities, as some activities provided might be more suitable to older adults with dementia. Conclusions Post-diagnostic services and support for people with YOD and their carers need to be improved. The next step will be to implement the findings from this service evaluation in practice and improve service satisfaction and relevance to people with YOD.
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Affiliation(s)
- Clarissa Giebel
- Institute of Population Health Sciences, University of Liverpool, 1st floor B Block Waterhouse Building, Liverpool L69 3GL, England, UK. .,NIHR ARC NWC, Liverpool, UK.
| | - Cassie Eastham
- NIHR ARC NWC, Liverpool, UK.,North West Boroughs NHS Foundation Trust, Warrington, UK
| | | | | | | | - Anna Pearson
- North West Boroughs NHS Foundation Trust, Warrington, UK
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38
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van Duinen‐van den IJssel JC, Bakker C, Smalbrugge M, Zwijsen SA, Adang E, Appelhof B, Zuidema SU, de Vugt ME, Verhey FR, Koopmans RT. Cost-consequence analysis of an intervention for the management of neuropsychiatric symptoms in young-onset dementia: Results from the BEYOND-II study. Int J Geriatr Psychiatry 2020; 35:131-137. [PMID: 31657080 PMCID: PMC6916543 DOI: 10.1002/gps.5229] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 09/24/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To evaluate the cost-consequences of an intervention for the management of neuropsychiatric symptoms in nursing home residents with young-onset dementia. METHODS A stepped wedge design was used. The intervention consisted of an educational program and a multidisciplinary care program and was implemented in 13 nursing homes from September 2015 to March 2017. Costs' outcomes included the time investment of the elderly care physician and health care psychologists regarding the management of neuropsychiatric symptoms, residents' psychotropic drug use, nursing staff absenteeism, and costs of the educational program. Composite cost measure contained the sum of costs of staff absenteeism, costs on psychotropic drugs, and costs of the educational program. Costs of time investment were investigated by comparing means. Costs of psychotropic drug use were analyzed with mixed models at resident level and as part of the composite cost measure on unit level. Staff absenteeism was also analyzed at unit level. RESULTS Compared with care as usual, the mean costs of time invested decreased with €36.79 for the elderly care physician but increased with €46.05 for the health care psychologist in the intervention condition. Mixed model analysis showed no effect of the intervention compared with care as usual on the costs of psychotropic drug use, staff absenteeism, and the composite cost measure. The costs of the educational program were on average €174.13 per resident. CONCLUSION The intervention did not result in increased costs compared with care as usual. Other aspects, such as the lack of a structured working method, should be taken into account when considering implementation of the intervention.
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Affiliation(s)
- Jeannette C.L. van Duinen‐van den IJssel
- Department of Primary and Community CareRadboud University Medical Center, Radboud Institute for Health SciencesNijmegenThe Netherlands,Radboud Alzheimer CenterRadboud University Medical CenterNijmegenThe Netherlands
| | - Christian Bakker
- Department of Primary and Community CareRadboud University Medical Center, Radboud Institute for Health SciencesNijmegenThe Netherlands,Radboud Alzheimer CenterRadboud University Medical CenterNijmegenThe Netherlands,Groenhuysen, Center for Geriatric CareRoosendaalThe Netherlands
| | - Martin Smalbrugge
- Department of General Practice and Elderly Care Medicine/Amsterdam Public Health Research InstituteAmsterdam UMCAmsterdamThe Netherlands
| | - Sandra A. Zwijsen
- Department of General Practice and Elderly Care Medicine/Amsterdam Public Health Research InstituteAmsterdam UMCAmsterdamThe Netherlands
| | - Eddy Adang
- Department for Health EvidenceRadboud University Medical Center, Radboud Institute for Health SciencesNijmegenThe Netherlands
| | - Britt Appelhof
- Department of Primary and Community CareRadboud University Medical Center, Radboud Institute for Health SciencesNijmegenThe Netherlands,Radboud Alzheimer CenterRadboud University Medical CenterNijmegenThe Netherlands,Archipel Care Group, Landrijt, Center for Specialized CareEindhovenThe Netherlands
| | - Sytse U. Zuidema
- Department of General Practice and Elderly Care MedicineUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
| | - Marjolein E. de Vugt
- School for Mental Health and Neuroscience, Alzheimer Center LimburgMaastricht University Medical CenterMaastrichtThe Netherlands
| | - Frans R.J. Verhey
- School for Mental Health and Neuroscience, Alzheimer Center LimburgMaastricht University Medical CenterMaastrichtThe Netherlands
| | - Raymond T.C.M. Koopmans
- Department of Primary and Community CareRadboud University Medical Center, Radboud Institute for Health SciencesNijmegenThe Netherlands,Radboud Alzheimer CenterRadboud University Medical CenterNijmegenThe Netherlands,De Waalboog, “Joachim en Anna”Center for Specialized Geriatric CareNijmegenthe Netherlands
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Oliver K, O'Malley M, Parkes J, Stamou V, La Fontaine J, Oyebode J, Carter J. Living with young onset dementia and actively shaping dementia research – The Angela Project. DEMENTIA 2019; 19:41-48. [DOI: 10.1177/1471301219876414] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Keith Oliver
- Kent & Medway PT NHS Dementia Service User Envoy, UK; 3 Nations Dementia Working Group, London, UK
| | | | - Jacqueline Parkes
- Faculty of Health and Society, University of Northampton, Northampton, UK
| | | | | | - Jan Oyebode
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Janet Carter
- Division of Psychiatry, University College London, London, UK
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Survival and life-expectancy in a young-onset dementia cohort with six years of follow-up: the NeedYD-study. Int Psychogeriatr 2019; 31:1781-1789. [PMID: 30915930 DOI: 10.1017/s1041610219000152] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The aim of this study was to investigate survival time and life-expectancy in people with young-onset dementia (YOD) and to examine the relationship with age, sex, dementia subtype and comorbidity. DESIGN, SETTING AND PARTICIPANTS Survival was examined in 198 participants in the Needs in Young-onset Dementia study, including participants with Alzheimer's dementia (AD), vascular dementia (VaD) and frontotemporal dementia (FTD). MEASURES The primary outcomes were survival time after symptom onset and after date of diagnosis. Cox proportional hazards models were used to explore the relationship between survival and age, sex, dementia subtype and comorbidity. Additionally, the impact on remaining life expectancy was explored. RESULTS During the six-year follow-up, 77 of the participants died (38.9%), 78 participants survived (39.4%) and 43 were lost to follow-up (21.7%). The mean survival time after symptom onset and diagnosis was 209 months (95% CI 185-233) and 120 months (95% CI 110-130) respectively. Participants with AD had a statistically significant shorter survival compared with VaD participants, both regarding survival after symptom onset (p = 0.047) as well as regarding survival after diagnosis (p = 0.049). Younger age at symptom onset or at diagnosis was associated with longer survival times. The remaining life expectancy, after diagnosis, was reduced with 51% for males and 59% for females compared to the life expectancy of the general population in the same age groups. CONCLUSION/IMPLICATIONS It is important to consider the dementia subtype when persons with YOD and their families are informed about the prognosis of survival. Our study suggests longer survival times compared to other studies on YOD, and survival is prolonged compared to studies on LOD. Younger age at symptom onset or at diagnosis was positively related to survival but diagnosis at younger ages, nevertheless, still diminishes life expectancy dramatically.
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Kilty C, Naughton C, de Roiste A. Constraints and ethical tensions in the area of young-onset dementia. ACTA ACUST UNITED AC 2019; 28:1380-1386. [PMID: 31778332 DOI: 10.12968/bjon.2019.28.21.1380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND young-onset dementia (under age 65) varies in many respects to typical aged dementia. Health professionals are centrally involved in supporting individuals and families to cope with the unique challenges that young-onset dementia (YOD) brings. AIMS this study aimed to explore professionals' perceptions of the key challenges faced by people living with YOD and their families, and how they provide support to this group. METHODS qualitative interviews were conducted with nine health professionals from a range of health and social care contexts. Data were analysed using interpretative phenomenological analysis. FINDINGS interviewees reported significant challenges in trying to enact support for people with YOD, and families. Particular challenges relate to delays in accessing timely diagnosis, and difficulty in accessing relevant, age-appropriate supports. Interviewees experienced ethical tensions working in this area; interviewees were keen to enact support for the person following diagnosis, but felt constrained by service options that were not relevant or readily accessible to the person, and in some instances, traditional dementia services added to, rather than lessened the stress experienced by those involved. CONCLUSION dementia and health services should be cognisant of the unique challenges of YOD, and models of service provision should aim to respond accordingly. Nurses and other health professionals should be afforded the necessary structures to support people living with YOD. This relates to dedicated YOD models of care, specifically timely diagnosis, post-diagnosis support and community services that enhance personhood and resilience.
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Affiliation(s)
- Caroline Kilty
- Lecturer, School of Nursing & Midwifery, University College Cork, Cork, Ireland
| | - Corina Naughton
- Professor of Clinical Nursing in Older Person Healthcare, School of Nursing & Midwifery, University College Cork, Cork, Ireland
| | - Aine de Roiste
- Senior Lecturer, Department of Applied Social Sciences, Cork Institute of Technology, Cork, Ireland
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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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Kilty C, Boland P, Goodwin J, de Róiste Á. Caring for People With Young Onset Dementia: An Interpretative Phenomenological Analysis of Family Caregivers' Experiences. J Psychosoc Nurs Ment Health Serv 2019; 57:37-44. [PMID: 31437284 DOI: 10.3928/02793695-20190821-02] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 06/19/2019] [Indexed: 11/20/2022]
Abstract
People with young onset dementia (YOD) experience many unique challenges. Similarly, family caregivers experience changing personal, familial, and societal roles. However, YOD is under recognized and under resourced with a lack of dedicated models of care. The current study explored family members' experience of caregiving for persons with YOD to identify barriers and opportunities to accessing support. Qualitative interviews were conducted with six family caregivers, using interpretative phenomenological analysis. Findings show that caregivers experience significant uncertainty within their role, difficulty accessing timely diagnosis, and face unclear care pathways and age-related restrictions to accessing support. These findings also reflect elements of ambiguous loss and anticipatory grief: caregivers experienced sudden changes to relationships and family structure, along with the anticipation of a changed future. Optimum models of care should target timely diagnosis and clear post-diagnosis pathways and services that are flexible, relevant, and accessible. Services should offer psychosocial support for family members as they adjust to their new role as caregivers. [Journal of Psychosocial Nursing and Mental Health Services, 57(11), 37-44.].
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van Duinen-van den IJssel JC, Bakker C, Smalbrugge M, Zwijsen SA, Appelhof B, Teerenstra S, Zuidema SU, de Vugt ME, Verhey FR, Koopmans RT. Effects on staff outcomes from an intervention for management of neuropsychiatric symptoms in residents of young-onset dementia care units: A cluster randomised controlled trial. Int J Nurs Stud 2019; 96:35-43. [DOI: 10.1016/j.ijnurstu.2019.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 03/04/2019] [Accepted: 03/08/2019] [Indexed: 11/15/2022]
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O'Malley M, Parkes J, Stamou V, LaFontaine J, Oyebode J, Carter J. Young-onset dementia: scoping review of key pointers to diagnostic accuracy. BJPsych Open 2019; 5:e48. [PMID: 31530311 PMCID: PMC6582217 DOI: 10.1192/bjo.2019.36] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Routine psychiatric assessments tailored to older patients are often insufficient to identify the complexity of presentation in younger patients with dementia. Significant overlap between psychiatric disorders and neurodegenerative disease means that high rates of prior incorrect psychiatric diagnosis are common. Long delays to diagnosis, misdiagnosis and lack of knowledge from professionals are key concerns. No specific practice guidelines exist for diagnosis of young-onset dementia (YOD). AIMS The review evaluates the current evidence about best practice in diagnosis to guide thorough assessment of the complex presentations of YOD with a view to upskilling professionals in the field. METHOD A comprehensive search of the literature adopting a scoping review methodology was conducted regarding essential elements of diagnosis in YOD, over and above those in current diagnostic criteria for disease subtypes. This methodology was chosen because research in this area is sparse and not amenable to a traditional systematic review. RESULTS The quality of evidence identified is variable with the majority provided from expert opinion and evidence is lacking on some topics. Evidence appears weighted towards diagnosis in frontotemporal dementia and its subtypes and young-onset Alzheimer's disease. CONCLUSIONS The literature demonstrates that a clinically rigorous and systematic approach is necessary in order to avoid mis- or underdiagnosis for younger people. The advent of new disease-modifying treatments necessitates clinicians in the field to improve knowledge of new imaging techniques and genetics, with the goal of improving training and practice, and highlights the need for quality indicators and alignment of diagnostic procedures across clinical settings. DECLARATION OF INTEREST None.
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Affiliation(s)
- Mary O'Malley
- Research Assistant, Faculty of Health and Society, University of Northampton, UK
| | - Jacqueline Parkes
- Professor, Faculty of Health and Society, University of Northampton, UK
| | - Vasileios Stamou
- Research Assistant, Centre for Applied Dementia Studies, University of Bradford, UK
| | - Jenny LaFontaine
- Research Fellow, Centre for Applied Dementia Studies, University of Bradford, UK
| | - Jan Oyebode
- Centre for Applied Dementia Studies, University of Bradford, UK
| | - Janet Carter
- Assistant Professor, Division of Psychiatry, University College London, UK
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Werner P, Shpigelman CN, Raviv Turgeman L. Family caregivers' and professionals' stigmatic experiences with persons with early-onset dementia: a qualitative study. Scand J Caring Sci 2019; 34:52-61. [PMID: 31058357 DOI: 10.1111/scs.12704] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 03/31/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Recently, research has focused on understanding the needs of persons with early-onset dementia and their family caregivers who often experience stigmatic beliefs. However, to date, research has not provided a thorough and deep understanding of the stigma formation process and its implications for this population. Thus, the aim of the present study was to explore the stigma formation process as experienced by family members as informal caregivers of persons with early-onset dementia, and professionals as formal caregivers who are involved in the development, management and provision of services. METHOD We conducted three focus groups with 16 participants, including spouses of a person with early-onset dementia and professionals. The focus groups' transcripts were analysed following a thematic analysis procedure. RESULTS Results indicated that both family members and professionals encounter stigmatic experiences because of their association with younger persons with dementia. Lack of knowledge emerged as the main antecedent and emotional burden as the main consequence of stigma. CONCLUSION Stigmatic experiences emerged as a pervasive and complex phenomenon among formal and informal caregivers of persons with early-onset dementia, suggesting the need to developing a comprehensive and integrated approach to reduce them at the individual, professional and societal levels.
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Affiliation(s)
- Perla Werner
- Department of Community Mental Health, University of Haifa, Haifa, Israel
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Harbishettar V, Reddy Mukku S, S. Gorthi NS, Sivakumar P, Varghese M. Clinical profile of early-onset dementia from a geriatric clinic in South India. JOURNAL OF GERIATRIC MENTAL HEALTH 2019. [DOI: 10.4103/jgmh.jgmh_16_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Kobiske KR, Bekhet AK, Garnier-Villarreal M, Frenn M. Predeath Grief, Resourcefulness, and Perceived Stress Among Caregivers of Partners With Young-Onset Dementia. West J Nurs Res 2018; 41:973-989. [DOI: 10.1177/0193945918806689] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
More than 200,000 Americans are currently diagnosed with young-onset dementia (YOD). YOD is dementia diagnosed prior to the age of 65. Most persons of YOD are cared for by their partners. Using the theoretical framework of Resilience Theory, this cross-sectional, correlational study examined the moderating effects of personal and social resourcefulness on the relationship between predeath grief and perceived stress among 104 YOD caregiving partners (life partners/spouses) using an online survey platform. Results indicated a large positive correlation between predeath grief and caregiver perceived stress ( r = .65; p < .001). Together predeath grief, personal resourcefulness and social resourcefulness explained 51.5% of the variance in perceived stress. Personal resourcefulness did not moderate the relationship. Social resourcefulness did positively moderate this relationship between predeath grief and perceived stress. These findings allow for a better understanding of the caregiving experience for a partner with YOD and creates opportunities for future research studies.
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