Ethical care in dementia

Social networks, social capital and end-of-life care for people with dementia: a realist review

OBJECTIVES

(1) To develop an understanding of how social capital may be conceptualised within the context of end-of-life care and how it can influence outcomes for people with dementia and their families with specific reference to the context and mechanisms that explain observed outcomes. (2) To produce guidance for healthcare systems and researchers to better structure and design a public health approach to end-of-life care for people with dementia.

DESIGN

A realist review.

DATA SOURCES

MEDLINE, EMBASE, CINAHL and grey literature.

ANALYSIS

We conceptualised social capital as a complex intervention and, in order to understand how change is generated, used realist evaluation methods to create different configurations of context, mechanism and outcomes. We conducted an iterative search focusing on social capital, social networks and end-of-life care in dementia. All study designs and outcomes were screened and analysed to elicit explanations for a range of outcomes identified. Explanations were consolidated into an overarching programme theory that drew on substantive theory from the social sciences and a public health approach to palliative care.

RESULTS

We identified 118 articles from 16 countries ranging from 1992 to 2018. A total of 40 context-mechanism-outcome configurations help explain how social capital may influence end-of-life care for people with dementia. Such influence was identified within five key areas. These included: (1) socially orientating a person with dementia following diagnosis; (2) transitions in the physical environment of care; (3) how the caregiving experience is viewed by those directly involved with it; (4) transition of a person with dementia into the fourth age; (5) the decision making processes underpinning such processes.

CONCLUSION

This review contributes to the dispassionate understanding of how complex systems such as community and social capital might be viewed as a tool to improve end-of-life care for people with dementia.

PROSPERO REGISTRATION NUMBER

CRD42018084524.

Alzheimer's patients' spouses critiques of the support services

Introduction. Caregiving families of patients with dementia are often reluctant to use support services. The aim of this study was to describe their subjective critiques of these services. Material and Methods. A cross-sectional questionnaire was sent to a random sample (N = 1943) of Alzheimer's patients' spouses in Finland with an open-ended question: “What kind of problems have you faced with the services?” Their responses were analyzed with thematic content analysis. Results. Of the responders identifying themselves as caregivers (N = 1386), 728 (mean age 77.8, 65.1% females) responded. Opinions could be divided into two categories: (1) problems with the service application process (N = 296); (2) critiques of the services offered (N = 270) including either problems with community care support services or institutional care. 74 indicated that they had no need for services, and 15 praised the services they had received. Conclusions. From the caregiver's perspective, the service system is complicated, bureaucratic and works organization centredly.

[Perception, attitudes and needs of Primary Care professionals as regards the patient with dementia]

OBJECTIVE

To find out the perception, attitudes and needs expressed by primary care professionals in the Girona (Spain) health area as regards the diagnosis and monitoring of patients with cognitive disorders.

DESIGN

Cross sectional study conducted in 26 primary healthcare areas (ABS) in Girona.

SETTING

Primary healthcare areas (ABS) in Girona.

PARTICIPANTS

Physicians and primary nursing care (PNC). MAIN MEASURAMENTS: Self-administered questionnaire by the professionals in the centres. In the context of regular meetings of the teams.

RESULTS

A total 218 practitioners from 19 ABS (73% of total) responded to the questionnaire (108 physicians and 110 primary nursing care-PNC-). Almost all (98.6%) of participants thought they needed training in dementia, but 49.1% of physicians and 74.5% of PNC mentioned never having any specific training or not in the last 5 years. A total of 88.7% of doctors do not make a diagnosis of dementia on a regular basis, and only in 25.5% of cases do they make one in the mild stages of dementia. The main barriers reported by physicians in the diagnosis of dementia were the lack of confidence in diagnosis (32.6%) and lack of consultation time (31.4%). The great majority (87%) of physicians mentioned difficulties in monitoring and control of these patients.

CONCLUSIONS

This study provides useful information for those involved in the care of dementia. It identifies priority training issues, and barriers and difficulties in the diagnosis, treatment and monitoring of these patients in the field of primary care.